Can Bacteria Cause Cancer?: Alternative Medicine Confronts Big Science 9780814744833

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Can Bacteri a Caus e Cancer ?

Can Bacteri a Cause Cancer ?

Alternative Medicine Confronts Big Science

David J . Hes s

NEW Y O R K U N I V E R S I T Y PRES S New York and London

NEW YOR K UNIVERSIT Y PRES S New York and Londo n © 199 7 by New Yor k Universit y All rights reserve d Library of Congress Cataloging-in-Publicatio n Dat a Hess, David J. Can bacteria caus e cancer? : alternative medicin e confront s bi g science / Davi d J. Hess. p. cm . Includes bibliographical reference s an d index . ISBN 0-8147- 3 561-4 (clothbound).—ISB N 0-8147-3562- 2 (paperbound) 1. Carcinogenesis . 2 . Cocarcinogenesis . 3 . Bacteria l diseases. 4. Cancer—Alternativ e treatment . I . Title . RC268.5.H47 199 7 616.99^071—dc2i 97-491 0 CIP New Yor k University Pres s books ar e printed o n acid-fre e paper , and their binding materials ar e chosen fo r strengt h an d durability . Manufactured i n the United State s of America 10 9 8 7 6 5 4 3 2 1

Contents

Acknowledgments vi i Introductio 2 Ger

ni

m Warfare: Th e Cas e for Bacteria a s Carcinogen 7

3 Cultur 4 Bu

i

e an d Power in Cance r Research 4 t I s It Goo d Science ? 10

5 Polic

y Cures: Forging a New Cance r Agenda 15

6 Appendix

: The Ne w Scienc e Studie s 17

Notes 18 Bibliography 20 Index 23 About the Author 23

9 5 6 4 9 1 1 4

Acknowledgments

For comments , bibliographi c references , and/o r researc h help , I thank Jeann e Becke r an d th e Memoria l Sloan-Ketterin g Cance r Center , Gerald Domingue , Willia m Fry , Patrici a Huntley , Clinto n Miller , Hele n Coley Naut s an d th e Cance r Researc h Institute , Geronim o Rubio , To m Rosenbaum an d th e Rockefelle r Archives , an d Jaym e Treiger . I wis h als o to than k Gretche n Koerpe l fo r he r patienc e a s a spous e an d he r referenc e help a s a librarian . Stev e Fulle r provide d helpfu l comment s o n th e manu script a s a whole , an d edito r Eri c Zinne r provide d ver y helpfu l advic e o n structuring an d positionin g th e book . Give n th e controversia l natur e o f th e topics covered , i t shoul d b e emphasize d tha t th e opinion s expresse d i n thi s book ar e m y ow n an d d o no t necessaril y reflec t thos e o f th e peopl e w h o have bee n kin d enoug h t o hel p me .

Caveat T h e informatio n presente d her e doe s no t constitut e medica l advic e fo r individuals; the y ar e advise d t o see k th e guidanc e o f competen t physicians .

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1 Introduction

T h e carcinoge n i s th e ger m o f ou r time . Mos t o f th e worl d s population live s i n a se a o f carcinogens : cigarett e smoke , pollution , pesti cides, asbestos , radiation , radon , exces s sunlight , foo d additives , hazardou s waste, poo r nutrition , hormones , viruse s . . . th e lis t continue s t o grow . Because ther e i s s o muc h complexit y an d uncertaint y regardin g th e ris k factors an d treatment , cance r i s mor e tha n a disease . I t i s a politica l an d social problem . Cance r i s a sympto m o f a globa l civilizatio n tha t i s ou t o f balance wit h it s biolog y an d ecology . I t i s a medica l crisi s tha t affect s millions o f individual s an d thei r families , bu t i t i s als o a politica l an d scientific crisis . Rates o f cance r incidenc e i n th e Unite d State s hav e rise n consistentl y a t about i percen t pe r year . I n th e lat e 1950 s on e i n fou r person s wa s likel y t o contract cance r an d on e i n fiv e woul d di e fro m th e disease , bu t b y th e 1990s th e incidenc e ha d climbe d t o ove r on e i n thre e wit h ove r on e i n fou r mortalities. Shockingly , curren t estimate s indicat e tha t i n th e Unite d State s 45 percent o f males an d 3 9 percent o f females wil l be diagnose d wit h cance r in thei r lifetimes . Ove r on e an d a quarte r millio n American s ar e diagnose d with cance r eac h year , an d ove r a hal f millio n di e fro m th e diseas e eac h year. I t i s possibl e tha t b y th e secon d o r thir d decad e o f th e twenty-firs t century hal f o f al l American s wil l b e diagnose d wit h cance r a t som e poin t during thei r lifetimes. 1 O f th e million s o f American s w h o hav e cance r a t an y on e time , man y have turne d t o alternativ e cance r therapie s t o complemen t thei r conven tional treatments , t o replac e officiall y recommende d therapies , o r t o us e a s a las t resor t w h e n thei r doctor s hav e give n the m u p a s terminal . W h e n th e hundreds o f thousand s o f cance r patient s w h o choos e alternativ e therapie s are recognize d no t a s a singl e p h e n o m e n o n bu t a s a subgrou p o f th e millions o f othe r American s w h o us e alternativ e therapie s fo r othe r disease s and conditions , th e dimension s o f a grassroot s healt h car e revolutio n b e come visible . Thi s se a chang e i s spurre d b y competitio n amon g health maintenance organizations , whic h ar e drive n b y marke t force s t o fun d a n

1

2 Introduction

increasing variet y o f alternativ e therapies . Likewise , constituen t demand s for bette r acces s t o alternativ e therapie s hav e le d t o legislativ e reform s i n many state s an d a t th e federa l level. 2 This rapidl y changin g situatio n ha s give n ris e t o a widesprea d nee d for evaluation : legislators , insurers , health-car e professionals , an d abov e al l patients nee d mor e informatio n abou t whic h alternativ e therapie s wor k an d which one s d o not . Clearly , on e wa y t o answe r thi s questio n i s throug h massive publi c fundin g o f randomized , controlle d trial s o f specifi c alterna tive therapie s tha t patient s ar e no w using . Constituen t demand s fo r thi s typ e of evaluatio n wil l gro w a s th e us e o f alternativ e therapie s grows . However , in additio n t o testin g specifi c therapies , th e broade r theoretica l framework s also nee d t o b e evaluated . Ther e i s growin g publi c dissatisfactio n wit h cancer researc h an d it s annua l expenditure s o f billion s o f taxpaye r dollars . T h e emphasi s o n basi c researc h an d o n toxi c chemotherap y ha s le d t o fe w real succes s storie s fo r conventiona l cance r treatment . Advance s hav e cen tered o n th e earl y childhoo d cancer s an d som e o f the les s commo n cancers ; however, th e advance s associate d wit h chemotherap y occurre d decade s ag o and the y probabl y canno t b e extende d t o th e mor e c o m m o n cancer s (Mos s 1995). Overal l five-yea r surviva l rate s o f abou t 5 0 percen t increase d onl y marginally fro m 197 4 t o 1987 , an d eve n thos e margina l gain s ma y b e du e largely t o earlie r diagnosis. 3 Give n thi s disma l pictur e fo r cance r treatment , advocates o f alternativ e therapie s ofte n see k mor e tha n testin g o f specifi c therapies. The y see k a reevaluatio n o f curren t researc h program s an d the y demand fundin g fo r alternativ e ones . This boo k contribute s t o th e evaluatio n issu e b y providin g a framewor k for examinin g no t a specifi c therap y bu t a broade r alternativ e researc h program i n whic h therapie s ar e embedded . T h e term s "researc h program " and "researc h tradition, " whic h hav e bee n use d i n specifi c way s i n th e philosophy o f science , wil l b e use d her e loosel y t o refe r t o a n intercon nected networ k o f empirica l studies , researc h practices , application s (e.g. , therapies), an d guidin g theories. 4 T h e fundamenta l questio n fo r thi s boo k is, "Wha t i s th e bes t wa y t o evaluat e alternativ e medica l researc h program s in orde r t o improv e th e one s tha t ar e currentl y i n place? " T o develo p a n answer fo r thi s leve l o f th e evaluatio n problem , I focu s o n on e alternativ e research traditio n fo r cancer : wor k guide d b y th e unorthodo x theor y tha t bacteria pla y a n overlooke d rol e i n th e etiolog y o f cancer . By assessin g on e alternativ e theor y o f cancer, I provide a general metho d for analyzin g th e politic s an d possibilitie s o f alternativ e researc h programs . A ke y assumptio n i s tha t i n orde r fo r a criticis m o f existin g researc h

Introduction \

3

programs t o b e useful , i t shoul d asses s th e feasibilit y o f a n alternative . I t does n o goo d merel y t o criticiz e th e failure s o f existin g researc h programs ; the mor e difficul t an d necessar y tas k i s t o evaluat e alternative s tha t ma y contribute t o reconstructin g th e existin g programs . Fo r th e comple x fiel d of cance r research , on e possibilit y amon g man y i s researc h o n th e rol e o f bacteria i n tumo r genesi s an d promotion . Medical researcher s hav e alread y change d thei r thinkin g o n on e majo r chronic disease , th e gastri c ulcer , whic h i s no w recognize d t o hav e a largel y bacterial etiology . The y hav e als o show n a n increasin g interes t i n th e rol e of bacteri a i n arthritis . Viruse s ar e no w widel y recognize d a s th e agent s o f a numbe r o f cancers , rar e one s fo r human s an d mor e c o m m o n one s for animals . However , th e standar d explanation s fo r report s o f bacteria l colonization o f huma n cance r tissue s ar e tha t bacteri a represen t eithe r a n artifact (contamination ) o r a n opportunistic , secondar y infectio n tha t play s little o r n o rol e i n tumo r genesi s and/o r progression . Thes e explanation s face a numbe r o f anomalou s finding s tha t wil l b e describe d an d evaluated . In effect , tw o theorie s wil l b e compared : th e theor y tha t bacteri a ma y pla y an unrecognize d rol e i n tumo r genesi s an d promotion , an d th e nul l theor y that bacteri a foun d i n cance r tissue s ar e merel y opportunistic , secondar y infections tha t hav e little impac t o n th e multistag e proces s o f carcinogenesis . T h e compariso n o f theorie s shoul d no t b e don e naively . T h e muc h heralded "wa r o n c a n c e r " — w h i c h Presiden t Nixo n declare d w h e n th e Cold Wa r wa s movin g towar d detente—ha s lef t behin d a battlefield blood ied wit h th e bodie s o f advocate s o f alternativ e therapie s w h o hav e bee n victims o f intellectual suppression . T h e histor y o f research o n th e bacterial etiology theor y i s n o exception . I n som e case s th e suppressio n ma y appea r to b e legitimate , becaus e som e o f th e researc h wa s s o poorl y describe d o r executed tha t mos t peopl e wit h som e college-leve l scienc e backgroun d would probabl y rejec t i t a s ba d science . However , durin g th e decade s following Worl d Wa r I I a large amoun t o f legitimat e scientifi c researc h ha s appeared i n standard , peer-reviewe d journals . Thes e publication s revea l some evidenc e tha t bacteri a d o pla y a role i n tumo r genesi s o r progression . Yet, th e significanc e an d importanc e o f tha t rol e remain , i n m y opinion , unanswered. Ther e ar e som e report s o f ser a an d vaccine s base d o n bacteria l cultures tha t sho w strikin g success . Thes e therapie s pos e relativel y lo w ris k to th e patien t an d relativel y lo w cos t fo r societ y t o develo p an d produc e them. Consequently , th e bacteri a an d cance r researc h progra m appear s t o be on e exampl e o f th e man y alternativ e cance r researc h program s tha t warrants legislativ e mandat e fro m Congress , approva l fo r testin g b y th e

4I

Introduction

FDA, fundin g fro m publi c agencies , attentio n fro m cance r researchers , an d evaluation b y open-minde d clinicians . Lik e othe r alternativ e cance r researc h programs, th e bacteria l progra m ma y tur n ou t t o b e a dea d end . However , additional evaluatio n ca n b e obtaine d a t relativel y littl e cos t t o a citizenr y that i s alread y payin g tw o billio n dollar s pe r yea r fo r cance r researc h an d much mor e fo r toxi c treatments . More generally , th e cance r researc h agend a need s t o b e rethough t i n light o f th e stalle d progres s i n cance r treatmen t an d th e ga p betwee n research a t th e leve l o f molecula r biolog y an d usefu l ne w therapies . T h e public need s t o reevaluat e existin g cance r researc h fundin g wit h th e pros pect o f divertin g a substantia l percentag e towar d project s o f relativel y lo w cost tha t demonstrat e reasonabl e preliminar y scientifi c evidenc e an d a possibly hig h benefi t t o patients . Suc h a strateg y ha s alread y bee n adapted , wit h some success , i n th e are a o f specifi c immunotherapies . I n th e conclusion , I will advocat e extendin g th e researc h an d testin g o f immunotherapie s t o those base d o n th e bacteria l etiolog y theory . Mor e generally , I will argu e i n favor o f extended fundin g fo r evaluatio n o f those alternativ e cance r theorie s and therapie s tha t pas s wha t I wil l describ e a s a credibl e biologica l mecha nism test , provide d tha t the y ca n muste r som e clinica l evidenc e fo r efficac y and safety . Because anyon e w h o dare s t o questio n th e standar d wisdo m o f cance r research ma y fac e sever e an d deliberat e distortio n throug h attack s b y a well funded networ k o f debunkers , i t i s wort h pausin g fo r a momen t t o under score th e specifi c claim s mad e i n thi s book. I as k four basi c question s i n thi s book: wha t i s th e histor y o f thi s fiel d o f research , wha t ar e th e reason s fo r its rejection , ho w soun d i s th e research , an d wha t polic y change s woul d make i t easie r fo r a mor e measure d consideratio n o f alternativ e researc h programs. M y claim s ar e ver y specific , an d the y correspon d t o th e chapte r organization o f the book : i. Ther e i s a histor y o f researc h o n bacteri a a s etiologica l agent s i n cancer, an d thi s researc h traditio n ha s no t bee n merel y forgotte n o r disregarded, bu t activel y suppressed . Thi s propositio n i s demonstrate d in chapte r two , whic h review s th e relevan t historica l record . 2. T h e explanatio n fo r th e suppressio n need s t o tak e int o accoun t factor s beyond thos e o f evidence . Chapte r thre e demonstrate s tha t financia l and professiona l interest s a s wel l a s mor e genera l cultura l factor s ar e necessary t o explai n th e histor y o f suppression .

Introduction \

5

3. W h e n on e review s th e evidenc e i n suppor t o f th e bacteria l etiolog y theory agains t today s bes t availabl e scientifi c knowledge , i t appear s that bacteria l infection s ma y pla y som e contributin g rol e i n th e genesis o r promotio n o f som e huma n cancers . Furthermore , th e occasional efficac y o f bacteria l vaccines— a clinica l findin g tha t ha s long bee n recognize d i n cance r research—ma y b e du e partl y t o thei r effect o n bacteria l infections , no t merel y becaus e the y provid e genera l stimulation t o th e immun e system . However , th e fourt h chapte r als o considers counterevidenc e an d counterarguments , an d som e o f th e earlier claims—fo r example , tha t ther e i s a single "cance r microbe " — are rejecte d a s probably erroneous . 4. Severa l othe r alternativ e cance r therapie s sho w som e preliminar y evidence i n suppor t o f claim s o f safet y an d efficacy , an d the y hav e a credible possibl e biologica l mechanism . Thos e therapie s shoul d b e provided wit h additiona l publi c fundin g fo r evaluation . T h e fift h chapter argue s tha t i n th e Unite d State s (an d perhaps othe r countries) , the funding , evaluation , an d regulator y apparatu s fo r cance r researc h needs t o b e reforme d substantiall y s o tha t reasonabl e alternativ e thera pies ar e evaluate d promptl y an d fairly . It i s likely tha t som e reader s wil l misunderstan d th e poin t o f th e boo k a s an argumen t tha t bacteri a caus e cancer . T h e scientific-medica l argumen t that I mak e i s muc h narrower . I n orde r fo r th e questio n pose d i n th e titl e of thi s boo k t o mak e sense , i t i s necessar y t o vie w th e rol e o f bacteri a a s contributing agents t o cance r causality , perhap s eve n a s promoters rathe r tha n initiators. I n othe r words , a mor e scientifi c wa y o f askin g th e questio n would be : "I n huma n bodie s tha t ar e immunologicall y compromise d b y poor diet , exposur e t o carcinogens , an d othe r ris k factors , ca n th e emer gence o f laten t bacteria l infection s contribut e t o tumo r genesi s a n d / o r promotion?" I argu e tha t bacteria l infection s ma y pla y a n overlooke d rol e in th e etiolog y o f cancer , an d understandin g tha t rol e coul d b e importan t for developin g mor e effectiv e therapies . T h e cas e o f th e bacteria l theor y i s merel y on e amon g severa l ver y promising approache s tha t warran t extensiv e publi c fundin g fo r furthe r investigation a s adjunctiv e treatment s o r i n som e case s replacement s fo r conventional therapies . T h e othe r alternativ e therapie s includ e som e o f th e dietary, herbal , metabolic , an d immunologica l approaches . I t i s very possibl e that th e bacteria l theor y i s no t eve n th e mos t promisin g o f th e man y

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Introduction

alternative researc h program s i n cance r research . Rather , th e cas e stud y o f the bacteria l theor y provide s a method fo r a holistic analysis—sociological / anthropological, biomedical , an d policy-oriented—o f theorie s an d thei r affiliated researc h program s i n th e alternativ e medicin e field . This cas e stud y als o provide s a n empirica l exampl e o f a n alternativ e typ e of analysi s fo r thos e involve d i n th e interdisciplinar y fiel d o f scienc e an d technology studies—th e philosophy , sociology , history , anthropology , cul tural studies , an d polic y analysi s o f scienc e an d technology . Fo r thos e w h o are intereste d i n th e science-studie s theor y tha t inform s m y analysis , th e key argument s ar e develope d i n th e appendix . I advocat e movin g beyon d the assumption s o f th e neutra l observe r i n scienc e studie s t o th e scientifi c evaluation o f researc h program s a s policy choices , an d o f publi c institution s as candidate s fo r reform . Thus , th e voice s sounde d her e ar e no t merel y those o f descriptiv e scienc e an d socia l science , bu t tha t o f a citize n w h o i s concerned wit h polic y reform s o f great publi c concern .

2 Germ Warfar e The Case for Bacteria as Carcinogen

If anyon e wer e t o clai m toda y tha t ther e i s a causa l relationshi p between bacteri a an d cancer , mos t cance r researcher s woul d quickl y dismis s the idea . Suc h skepticis m i s th e produc t o f a histor y i n whic h som e researchers claime d tha t bacteri a and/o r viruse s wer e th e sol e etiologica l agents o f cancer . Agains t suc h unicausa l theorie s fo r a disease—o r variet y of diseases—a s comple x a s cancer, skepticis m wa s warranted . However , th e skepticism ma y hav e overcompensate d fo r th e mor e extrem e claims . A review o f th e histor y o f claim s o f bacteri a a s carcinogeni c agent s ma y lea d to a n intermediat e positio n betwee n extrem e skepticism—ther e i s n o relationship betwee n bacteri a an d cancer—an d extrem e advocacy—cance r is a n infectiou s diseas e lik e tuberculosis , cause d b y a single bacteria l species . T h e firs t ste p i n thi s exercis e i s t o demonstrat e tha t som e o f th e advocate s of a bacterial theor y o f cance r ha d a less tha n fai r hearing . O n e o f th e classi c expression s o f extrem e skepticis m wa s th e firs t editio n of Jame s Ewing s Neoplastic Diseases (1919) . I n tha t boo k th e influentia l director o f what wa s the n know n a s the Memoria l Hospita l (no w Memoria l Sloan-Kettering Cance r Center ) pronounce d hi s diagnosis : " T h e parasiti c theory . . . appeale d t o th e ancients , wa s tacitl y accepte d throughou t th e Middle Ages , wa s definitel y argue d b y moder n observers , an d reache d th e height o f its popularity a s a scientific theor y abou t 1895 , but durin g th e las t fifteen year s i t ha s rapidl y los t ground , an d toda y fe w competen t observer s consider i t a s a possibl e explanatio n o f th e unknow n elemen t i n blasto matosis" (1919 : 114) . Ewing s positio n o n microbe s wa s a n extrem e one . H e rejecte d a contemporar y stud y o f a bacteriu m tha t brough t abou t tumorlike growth s i n plant s (Agrobacterium tumefaciens), and h e als o rejecte d the wor k o f Rockefelle r Institut e researche r Peyto n R o u s o n chicke n sarcoma viruse s (117 , 121) . A t most , h e argued , studie s o f th e microbia l origin o f cance r sugges t tha t a microorganis m "ma y hav e a specia l capacit y to excit e inflammator y processe s whic h ten d t o g o o n t o tumo r growth ,

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but the y offe r n o suppor t t o th e theor y o f a specifi c cance r parasit e livin g in symbiosi s wit h th e cancer-cel l an d constantl y stimulatin g it s growth " (125). Although Ewin g reporte d tha t interes t i n th e microbia l theor y o f cance r had bee n dyin g ou t afte r th e mid-1890s , vira l oncologist s toda y vie w th e first decad e o f the twentiet h centur y a s the originar y momen t o f their field . As Ewin g s comments suggest , recognitio n fo r thei r fiel d wa s slow . I t gre w gradually ove r th e decade s a s studie s mounte d t o sho w evidenc e fo r vira l etiology i n a numbe r o f cancers . R o u s wa s no t honore d wit h th e Nobe l Prize unti l 1966 ; a s a field , tumo r virolog y di d no t becom e a n importan t part o f mainstream cance r researc h unti l th e 1960s , w h en successe s wit h th e polio vaccin e sparke d a renewe d interes t i n viruse s an d cancer . Neverthe less, althoug h virolog y i s no w a n accepte d par t o f cance r research , viruse s today remai n relegate d t o th e rare r huma n cancers , suc h a s cervical an d ski n carcinomas, Kaposi' s sarcoma , an d som e kind s o f leukemias , lymphomas , and live r cancers . Another o f Ewing s mistakes involve s Agrobacterium tumefaciens. T he bac terium i s no w recognize d a s producin g tumorlik e growth s i n plants . Fur thermore, microorganism s toda y ar e know n t o b e involve d i n carcinogene sis throug h mechanism s othe r tha n inflammation , a s i n th e cas e o f th e fungal carcinoge n aflatoxin . However , thes e example s ar e regarde d a s rela tively limite d causa l linkage s betwee n cance r an d nonvira l microorganisms . Thus, i n genera l term s Ewin g s view o f th e importanc e o f microorgan isms t o th e understandin g o f cance r remain s th e consensus , especiall y fo r bacteria an d fungi . T h e consensu s toda y i s that bacteri a isolate d fro m cance r tissues represen t secondar y infection s tha t hav e littl e i f an y rol e i n th e promotion o f tumo r growth . Bacteri a ar e opportunistic , no t etiological , agents. W h e re the y ar e recognize d toda y a s playing a role i n th e etiolog y o f human cancer , suc h a s th e cas e o f th e ulce r bacteriu m Helicobacter pylori, i t is assume d t o b e throug h chroni c tissu e irritatio n tha t ma y se t th e stag e fo r tumor genesis . Likewise , althoug h ther e i s a traditio n o f immunotherapie s that us e bacteri a an d bacteria l product s t o stimulat e th e immun e syste m t o attack cance r cells , th e efficac y o f thes e therapie s i s believe d t o res t o n general immun e syste m stimulatio n rathe r tha n a specifi c attac k o n pur ported oncobacteria . Leadin g tumo r immunologist s suc h a s Steve n R o s e n berg therefor e ar e suspiciou s o f th e apparentl y "blun t an d empirica l ap proach" o f bacteria l vaccine s suc h a s th e tuberculosi s vaccin e BCG , whic h has sometime s bee n use d i n th e treatmen t o f cancer . I n hi s words , "[T]h e immune syste m i s highl y specific ; a respons e t o on e stimulus , th e BCG ,

Germ Warfare \ 9 should no t stimulat e a respons e t o anothe r stimulus , cancer " (Rosenber g and Barr y 1992 : 59) . W h e n use d fo r cancer , th e ol d bacteria l vaccine s suc h as B C G ar e considere d nonspecifi c becaus e the y wor k b y stimulatin g th e immune syste m i n general . I n contrast , specifi c immunotherapie s suc h a s interleukin-2 ar e considere d superio r becaus e the y attac k cance r cell s through recognitio n o f specifi c immunologica l markers . Unfortunately , th e new, specifi c immunotherapie s suffe r fro m problem s o f toxicit y an d onl y moderate efficacy . Bacterial vaccine s hav e sometime s bee n associate d wit h th e theor y tha t bacteria, an d sometime s fungi , ar e etiologica l agent s i n cancer . Thi s theor y was supporte d b y a ric h alternativ e researc h traditio n tha t involve d a t leas t fifty scientist s an d clinician s i n a numbe r o f countries . Popula r durin g th e nineteenth century , th e theor y receive d continue d suppor t durin g th e twentieth centur y a s a minorit y tradition . Althoug h th e qualit y o f th e research i s very uneven , som e o f the bes t o f the researc h ha s been publishe d in recognized , peer-reviewe d scientifi c journals . Thi s alternativ e researc h tradition present s severa l anomalie s i n th e receive d wisdo m o n bacteri a an d cancer. B y n o mean s d o th e anomalie s requir e adoptin g a unicausal bacteria l theory o f cancer , a s some o f th e researcher s wanted . However , a broadene d cancer researc h progra m tha t addresse s som e o f th e anomalie s an d som e o f the experiment s o f th e bacteria l researc h progra m coul d provid e ne w an d crucial insight s int o th e etiolog y an d treatmen t o f cancer . This chapte r wil l demonstrat e tha t man y o f th e researcher s suffere d instances o f intellectual suppression , particularl y w h e n the y develope d clini cal applications . T o accomplis h a complet e analysis , i t i s necessar y t o sepa rate th e "is " an d "ought " questions . First , th e demonstratio n tha t ther e was a systematic patter n o f suppression need s t o b e answere d befor e th e questio n of whethe r suc h suppressio n should hav e occurred . Som e reader s ma y willingly gran t th e argumen t tha t suc h theorie s wer e suppressed , bu t the y may the n argue , "S o what ? T h e theorie s wer e s o craz y tha t an y reasonabl e person wit h a scientifi c backgroun d woul d als o hav e advocate d thei r mar ginalization. Scientist s an d doctor s wer e merel y doin g thei r job, whic h i s t o protect th e publi c fro m quacks. " T o som e exten t I wil l agre e wit h th e argument, bu t certainl y no t i n suc h a baldly state d an d oversimplifie d form . Among th e case s tha t I wil l discus s ther e i s a rang e o f credibilit y an d scientific rigor , fro m Cole y a t on e extrem e t o Loren z an d Rif e a t another . Some o f th e advocate s o f bacteria l approache s t o cance r invite d thei r ow n demise wit h reckles s claims , illega l practic e o f medicine , overl y secretiv e behavior, an d shee r arrogance . However , other s suc h a s Cole y an d Alexan -

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der-Jackson wer e carefu l researcher s w h o di d no t ge t a fai r hearin g fro m their peers . T h e sortin g ou t o f th e whea t fro m th e chaf f i s a tas k tha t I wil l defer unti l th e fourt h chapter , afte r I hav e firs t demonstrate d a patter n o f suppression an d the n provide d a n explanatio n o f why i t occurred .

Coley T h e choic e t o begi n wit h th e America n surgeo n an d cance r researche r William B . Cole y ma y b e controversia l becaus e th e connectio n h e dre w between bacteri a an d cance r wa s primaril y therapeutic . However , Cole y supported a microbia l theor y o f th e etiolog y o f cancer , an d hi s therap y i s certainly consisten t wit h th e theory . I n a report o n a conferenc e i n 192 6 i n which bacteria l theorie s wer e heavil y criticized , Cole y wrote , "T o thos e o f us w ho believ e tha t cance r i s of infectious natur e an d du e t o som e microbi c organism o r grou p o f closel y allie d microorganisms , th e discover y o f suc h cause o r cause s offer s th e onl y rea l hop e o f solvin g thi s greates t o f medica l problems" (1926 : 225) . I n othe r publication s a s well a s personal correspon dence, Cole y defende d th e microbia l theor y a s a contende r worth y o f serious researc h attentio n (1925 , 1928 , 1931) . Another reaso n t o begi n wit h Cole y i s that h e ha s becom e recognize d a s a founde r an d precurso r o f contemporar y cance r immunotherapies . A n example o f Cole y s new statu s i n th e histor y o f cance r researc h i s a chapte r by th e prominen t cance r researcher s Herber t Oettge n an d Lloy d Ol d o n the histor y o f immunotherap y i n The Biologic Therapy of Cancer, wher e Coley i s grante d th e statu s o f a foundin g figur e (1991 : 97) . H e wa s a Harvard-educated surgeo n bor n i n 186 2 whos e firs t patien t wa s a nineteen year-old woma n wit h bon e cancer . Afte r h e amputate d he r arm , a standar d treatment fo r th e day , sh e die d o f widespread metastase s o f th e bon e cance r (sarcoma). Accordin g t o hi s daughter , Hele n Cole y Nauts , D.Sc , hon. , This experienc e saddene d Cole y an d mad e hi m recogniz e tha t h e di d no t know enoug h abou t cancer , an d s o he wen t t o th e recor d roo m o f the Ne w York Hospita l where h e ha d interne d fo r tw o years, and studie d al l the case s of sarcom a treate d i n th e precedin g fiftee n years . H e foun d a patien t wh o had recovere d fro m a n advance d cas e o f sarcom a afte r developin g erysipela s in th e woun d followin g a fourth incomplet e surgica l removal. Erysipelas i s a form o f Streptococcus pyogenes affectin g th e skin , causin g hig h fever . Cole y succeeded i n tracin g th e patien t i n 189 1 an d foun d h e wa s aliv e an d well ,

Germ Warfare | n having ha d n o furthe r recurrences , seve n year s afte r hi s recovery . I n 1891 , Coley began inoculating erysipelas cultures in cancer patients and soon foun d it wise to use killed culture s since it was difficult t o actuall y produce erysipe las o r i f on e di d t o contro l it . Stre p alon e wa s no t effectiv e s o h e adde d another organism , Bacillus prodigiousus (no w know n a s Serratia marcescens) . This mixtur e wa s sterilize d eithe r b y hea t o r filtratio n an d wa s calle d th e Coley toxins . Th e firs t cas e treate d i n January 189 3 was a nineteen-year-ol d boy wit h a n inoperabl e sarcom a involvin g th e abdomina l wal l an d bladder , who wa s incontinent an d bedridden . Thi s larg e tumo r regresse d completel y under fou r month s o f injection s an d th e patien t remaine d wel l unti l deat h from a heart attac k seventee n year s later. Durin g 1891-9 2 Cole y studie d th e literature (Germa n an d French ) an d foun d tha t a number o f German physi cians beginning with Fehleise n in 188 2 had actually tried to inoculate erysip elas into inoperable cance r patients. 1 The result s o f Cole y s vaccine s wer e mixe d bu t promising , an d the y wer e possibly bette r tha n overal l five-yea r surviva l rate s toda y fo r simila r cancer s at comparabl e stages . Hi s daughte r Hele n Cole y Naut s subsequentl y ab stracted an d analyze d 89 4 toxin-treate d case s an d foun d tha t 4 5 percen t o f the inoperabl e case s survive d five years , a s di d 5 1 percen t o f th e operabl e cases (Naut s 1975 , 1976 , 1980) . Science studie s analys t lian a Low y argue s tha t ther e wa s " a shar p declin e in th e applicatio n o f Cole y s toxin s fro m th e 1910 s o n " (1993 : 340) . Sh e argues tha t Cole y himsel f attribute d th e declin e t o th e amoun t o f tim e an d supervision tha t th e metho d required . Naut s dispute s th e exten t o f th e decline; sh e point s t o th e larg e numbe r o f publications b y Cole y an d othe r surgeons, th e amoun t o f recognition tha t Cole y receive d durin g hi s lifetim e (especially a t hi s retiremen t i n 1931) , an d th e fac t tha t man y doctor s an d cancer researcher s wer e experimentin g wit h hi s toxins . A s Naut s point s out, th e Cole y toxin s wer e bein g use d b y th e Memoria l Hospita l an d th e Mayo Clinic , b y Henr i Matagn e o f Brussels , an d b y a numbe r o f othe r doctors i n th e Unite d States . Patient s wer e als o bein g referre d t o Cole y from Franc e an d England . Furthermore , hi s toxins wer e prepare d i n Europ e by th e Liste r Institut e i n Londo n fro m 189 4 t o 1943 , an d b y th e Germa n pharmaceutical compan y Sudmedic a fro m 191 4 t o Decembe r 1981 . Naut s points ou t tha t th e Germa n preparation , Vaccineurin , wa s widel y use d i n Europe, an d it s us e include d disease s suc h a s neuralgi a an d arthriti s a s wel l as cancer. 2 Thus , th e questio n i s no t wh y Coley' s toxin s fel l int o decline , but wh y the y faile d t o tak e of f an d t o becom e th e prevailin g therap y o f choice fo r sarcoma s an d perhap s othe r cancers .

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Lowy give s fiv e mai n reasons , o f whic h th e firs t tw o wer e originall y suggested b y Cole y an d Nauts . Accordin g t o Nauts : Coley himself believed that the method require d considerabl e time and effor t on th e par t o f the oncologist . Naut s foun d tha t th e result s depende d largel y on th e potenc y o f th e preparatio n use d an d ho w i t wa s administered—i.e. , the site, dosage, frequency, an d especially the duration o f treatment. Th e bes t results occurre d whe n marke d febril e reaction s (i02°-i04 ° F ) wer e elicite d and treatmen t wa s continue d fo r thre e t o fou r months . Eighty-fiv e percen t of th e osteogeni c sarcom a case s receivin g toxin s fo r thre e t o fou r month s survived fiv e t o fift y years . Th e surviva l rat e fo r surger y alon e in tha t perio d was te n t o twelv e percen t (Naut s 1975 : re f 315) . Wha t bot h fathe r an d daughter sugges t is that the therapy was not difficul t t o use if the product was potent an d correctl y administered . However , clinician s foun d i t difficul t t o get consisten t result s becaus e the y wer e no t awar e tha t the y wer e ofte n using weake r commercia l product s an d couldn' t achiev e th e correc t febril e reactions.3 Nauts add s tha t th e commercia l version s o f th e Cole y toxin s manufacture d by Parke , Davis , an d Co . wer e weake r tha n thos e mad e b y Cole y s bacteri ologists, an d likewis e th e Liste r Institut e product s wer e probabl y ver y wea k and ineffective. 4 T h e lac k o f uniformity , togethe r wit h th e tim e an d effor t required, wer e deterrent s t o widesprea d us e o f th e method . According t o Low y a thir d facto r tha t contribute d t o Cole y s toxins ' failure t o becom e widel y accepte d wa s th e empirica l natur e o f th e therapy . In othe r words , th e therap y di d no t appea l t o othe r medica l researcher s because ther e wa s n o explanatio n o f wh y i t worked . Thi s i s a potentiall y important facto r becaus e i t coul d hav e contribute d t o blockin g Cole y s ability t o buil d a powerfu l network . Low y note s tha t ther e wa s n o break through i n th e understandin g o f mechanism s unti l th e 1930 s an d 1940s. 5 However, th e evidenc e provide d b y Naut s tha t man y clinician s seeme d willing t o tr y th e therap y notwithstandin g it s empirica l natur e suggest s tha t this reaso n wa s relativel y unimportant . Regarding th e questio n o f mechanisms, Naut s ha s subsequentl y outline d a numbe r o f mean s b y whic h th e therap y migh t work . Perhap s th e mos t obvious mechanis m wa s tha t th e feve r generate d fro m th e infectio n wa s high enoug h t o kil l cance r cell s bu t no t hig h enoug h t o caus e permanen t damage t o norma l cells . T h e fac t tha t cance r cell s di e a t a temperatur e o f 105—I07°F, o r slightl y belo w norma l cells , ha s bee n a t th e basi s o f hyper thermia therapy , whic h ha s gaine d increasin g acceptanc e a s a n adjuvan t

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1

3

therapy i n recen t years . Hyperthermi a therap y wa s efficaciou s enoug h tha t in 197 7 th e America n Cance r Societ y remove d i t fro m it s Unprove n Methods list , an d i n 198 4 th e Foo d an d D r u g Administratio n approve d i t (Walters 1993 : 241) . However , Cole y recognize d tha t hyperthermi a coul d not b e th e onl y mechanis m (1931 : 615-16) . Nauts outline d a numbe r o f othe r specifi c mechanisms , includin g in creased lymphocyte s an d th e bacteria l sequesterin g o f iro n o r nutrient s indispensable fo r tumo r growt h (1980 : 15-19) . Anothe r lin e o f researc h involves th e triggerin g o f cytokines , o r chemical s tha t regulat e cellula r growth an d function . I n 197 1 a tea m o f researcher s a t Sloan-Ketterin g Institute le d b y Lloy d J . Old , currentl y medica l directo r o f th e Cance r Research Institut e an d th e Ludwi g Institut e fo r Cance r Research , discov ered tumo r necrosi s facto r o r " T N F " (Ol d 1988 : 60) . Interes t i n T N F ha s played a majo r rol e i n subsequen t researc h o n immunotherapies , an d i t ha s also bee n partl y responsibl e fo r a revive d interes t i n Cole y s toxin s durin g the 1990s . Old' s researc h an d tha t o f immunologis t Charle s O . Starne s o f Amgen sugges t tha t Cole y s toxin s stimulat e a cascad e o f cytokines—in cluding TNF , interferon , an d interleukins—tha t induc e a n immun e re sponse t o cancer. 6 Accordin g t o Nauts , i f th e cytokine s ar e administere d separately, the y ca n b e extremel y toxic , i n contras t wit h th e Cole y toxins , which ar e wel l tolerated . Lowy provide s tw o additiona l reasons , which sh e deem s mos t important , for th e declin e o f interes t i n th e Cole y toxins : th e Memoria l Hospita l director, James Ewing , oppose d th e treatment , an d i n th e 1920 s radiother apy displace d Cole y s therap y a s a treatmen t fo r inoperabl e cancers . Thus , when Ewin g tolle d th e deat h knel l o f th e microbia l theor y o f cance r i n hi s book Neoplastic Diseases, h e wa s perhap s underplayin g hi s ow n rol e a s a n active participant , rathe r tha n a mer e chronicler , o f th e chang e underwa y In on e o f th e ironi c twist s o f medica l history , Cole y wa s th e perso n w h o brought radiotherap y t o Memoria l Hospital , a s Nauts describes : Coley establishe d th e first X-ra y machine in Memorial Hospita l in 190 1 paid for b y tw o o f hi s wealthie r patients , a s Memorial Hospita l di d no t wis h t o spend mone y o n suc h a n unprove n an d unexplore d approach . H e wa s determined tha t ever y ne w ide a deserve d evaluation . Late r o n X-ray s an d radium helpe d t o eclips e th e Cole y toxins , especiall y whe n Ewin g becam e Medical Directo r a t Memorial Hospita l [i n 1913] . Ewing the n becam e ver y enthusiastic abou t radiu m an d rule d tha t ever y war d cas e o f bon e sarcom a must receiv e radiu m prio r t o an y othe r treatment . Thi s continue d fo r te n

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years an d no t on e singl e cas e survived . Coley' s privat e case s receive d th e Coley toxin s t o preven t metastase s afte r surgery . I f the toxin s wer e give n fo r at least 3- 4 months , 85 % survived.7 Coley retire d i n 193 1 but h e di d no t pas s into obscurity . H e wa s honore d with a huge banque t o f ove r tw o hundre d colleagues , friends , an d famil y a t the Waldor f Astori a Hotel . Th e speaker s include d hi s "ol d adversar y Jame s Ewing." 8 I n 193 5 Cole y wa s name d a n honorar y fello w o f th e Roya l College o f Surgeon s i n London , an d obituarie s writte n a t hi s deat h i n 193 6 honored hi m a s a pionee r an d leade r i n cance r researc h a s wel l a s i n othe r areas o f medicine. 9 Bradley L . Coley , w h o succeede d hi s fathe r i n 193 1 a s th e hea d o f th e Bone Tumo r Servic e a t Memorial , an d hi s associat e N o r m a n Higinbotha m continued t o us e th e Cole y toxin s fo r severa l type s o f bon e sarcoma . A s Nauts writes : B.L. Cole y an d Higinbotha m serve d i n th e Arm y fro m 194 2 t o 1946 . Upon thei r return chemotherap y soo n became a priority. Corneliu s Rhoads , Medical Directo r o f Memorial Hospital , wrot e Parke , Davis , an d Compan y in 195 0 that the y n o longe r neede d t o prepar e th e Cole y toxin s a s they ha d been mad e i n Sloa n Ketterin g sinc e 1946 . (Parke , Davis , an d Compan y ha d prepared th e toxin s sinc e 1899) . Fo r a time Rhoad s ha d th e toxin s mad e a t Sloan-Kettering Institut e an d eigh t reticulu m cel l sarcomas were successfull y treated wit h thi s product, combine d wit h X-ra y therap y i n som e cases . Th e limb wa s save d i n al l thes e patients ; on e wa s a Mayo clini c cas e (Mille r an d Nicholson 1971) . Without warnin g Coley , Higinbotham , th e May o Clinic , or anyon e else , i n Octobe r 199 5 Rhoad s arbitraril y stoppe d th e productio n of the toxin s a t Sloa n Kettering whil e severa l patients wer e unde r treatment . Rhoads ha d becom e enthusiasti c abou t chemotherap y an d wante d t o dro p the toxin s altogether. At that time severa l patients were receiving them an d it was a cruel blow. 10 Rhoads als o ha d intervene d i n 1941 , w h en h e wrot e t o John D . Rockefel ler, Jr., an d urge d hi m no t t o fun d th e researc h o f Hele n Cole y Naut s o n the Cole y toxins. 11 By 194 0 Naut s ha d begu n assemblin g an d correlatin g al l th e historie s o f the toxin-treate d case s b y Cole y an d othe r surgeon s i n th e Unite d State s and abroad . I n doin g s o sh e analyze d th e factor s tha t affec t succes s an d failure: th e preparatio n used ; th e site , dosage , frequency , an d duratio n o f injections; th e amoun t o f fever produced ; an d th e stag e o f the diseas e w h e n the toxin s wer e begun . Betwee n 195 3 an d 198 4 sh e edite d o r wrot e

Germ Warfare | 1 5 eighteen monographs , som e o f whic h wer e publishe d i n medica l journal s such a s Acta Medica Scandinavica and som e b y th e Cance r Researc h Institut e (e.g., Naut s 1975 , 1980) . Sh e als o presente d paper s i n th e Unite d State s an d in severa l foreig n countries . Wit h hel p fro m Olive r R . Grac e sh e founde d the N e w Yor k Cance r Researc h Institut e i n 1953 . T h e Institut e publishe d monographs o n Coley' s work , provide d postdoctora l fellowships , an d funded som e experimenta l an d clinica l research . Clinical studie s durin g th e 1950 s an d earl y 1960 s demonstrate d th e efficacy o f th e Cole y toxins. 12 However , i n 196 3 th e FD A rule d tha t th e Coley toxin s ha d t o pas s throug h th e complet e ne w drug-approva l proce dure, an d i n 196 5 th e America n Cance r Societ y pu t th e vaccin e o n it s lis t of unprove n therapies . Althoug h th e AC S i s a private , nongovernmenta l organization, it s decisio n t o lis t therapie s a s unprove n ha s historicall y cor responded wit h lac k o f funding fo r research , officia l governmen t disapprova l of a therapy , an d prosecutio n o f doctor s w h o us e th e unapprove d therapy . Given th e implication s o f th e FD A an d AC S ruling s fo r futur e testing , i t i s not surprisin g tha t Naut s strengthene d alliance s with mor e orthodo x cance r immunologists. Sh e note s tha t sh e wa s ver y fortunat e w h e n i n 196 9 th e head o f immunolog y a t th e Memoria l Hospital , Lloy d J . Old , becam e Medical Directo r o f th e N e w Yor k Cance r Researc h Institute . I n 197 1 h e reorganized th e Scientifi c Advisor y Counci l t o includ e th e world' s leadin g cancer immunologists , an d i n 197 3 th e nam e o f th e institut e wa s change d to th e Cance r Researc h Institute . Naut s adds , "I n 197 5 a t th e urgen t suggestion o f th e member s o f th e Counci l an d o f Memoria l Sloan-Ketter ing Cance r Center , th e America n Cance r Societ y remove d th e Cole y toxins fro m th e lis t o f unprove n cance r therapies." 1 3 Sinc e tha t tim e th e organization tha t sh e founde d ha s bee n a majo r supporte r o f postdoctora l fellowships i n cance r immunolog y (ove r fiv e hundre d i n twenty-fiv e years) . However, unti l recentl y ther e ha s bee n relativel y littl e clinica l researc h on th e Cole y toxins . Accordin g t o Lowy , a single clinica l tria l too k plac e a t Memorial Sloan-Ketterin g Cance r Cente r i n 197 6 (Kempi n e t al . 1981 , 1983). Low y writes , "I n thi s tria l som e improvemen t o f surviva l an d dis ease-free interval s [was ] observe d i n lymphom a patient s treate d wit h MBV , but th e long-ter m effect s o f thi s treatmen t wer e judge d statisticall y insig nificant, an d th e tria l wa s abandoned " (1993 : 345) . Naut s explain s th e problem wit h th e trial : They gav e a singl e injectio n o f MB V (Mixe d Bacteria l Vaccine , th e nam e then use d fo r Coley' s toxins ) combine d wit h a considerabl e amoun t o f

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chemotherapy. Initiall y th e surviva l rate was better bu t a t the en d o f three years the survival rates were no better for those getting toxins than those on chemotherapy alone. The single injection was totally inadequate. (No patient treated by Coley was ever given a single injection). 14 More favorabl e evaluation s o f th e Cole y toxin s appeare d durin g th e 1990s, whe n som e clinica l trial s o f th e vaccin e appeare d i n th e peer reviewed literature . As immunotherapies hav e grow n i n importance durin g the 1980 s an d 1990s , i t appear s tha t interes t i n th e Cole y toxin s ha s als o revived. However , Naut s note d tha t a t th e sam e tim e ther e ha s bee n th e new developmen t o f black-market manufactur e o f the Cole y toxins , that is, without FD A permission o r th e supervisio n o f the Cance r Researc h Insti tute. Thes e black-market version s o f the Cole y toxin s are being used in th e United State s and other countries. 15 The histor y o f th e Cole y toxin s represent s a relativel y mil d cas e o f intellectual suppressio n compare d t o th e fate s o f som e o f th e othe r advo cates o f alternativ e cance r therapie s discusse d i n thi s chapter. 16 Cole y wa s allowed t o practice hi s therapy, bu t i t als o lost ou t t o radiotherap y an d later chemotherapy, bot h o f whic h ha d mor e powerfu l supporter s withi n th e cancer research community . Th e FD A and ACS rulings appeared t o seal the fate o f the therap y i n th e 1960s , but th e effort s o f Helen Cole y Naut s an d her supporters , togethe r wit h th e increase d interes t i n immunotherapies , have le d t o a comeback . Thus , th e Cole y cas e i s interestin g becaus e i t shows tha t a so-calle d unproven , unconventional , o r alternativ e cance r treatment ca n b e rescued . However , th e pric e tha t ha s bee n pai d i s t o classify it as an historical antecedent o f specific immunotherapies , whic h ar e presumed t o b e mor e promisin g an d mor e worth y o f researc h attentio n today.

Glover Coley s interest i n the infectious theor y o f cancer led him to investigate th e controversial claim s o f Canadia n physicia n Thoma s J . Glover . Glove r i s perhaps th e mos t mysteriou s o f th e researcher s wh o supporte d th e infec tious theor y o f cance r durin g th e firs t hal f o f th e twentiet h century . A highly secretiv e man , h e becam e consume d wit h th e belie f tha t h e ha d discovered th e cur e fo r cance r an d tha t h e woul d becom e ric h an d famou s for th e discovery . Thi s belie f reache d suc h a leve l o f obsessio n tha t h e refused t o shar e hi s knowledg e wit h othe r researchers , an d h e cu t of f tie s

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with anyon e wh o migh t becom e a competito r fo r priority . Ultimatel y Glover did more har m tha n goo d t o th e infectiou s theory . It i s no w know n tha t th e rea l researc h brai n behin d Glove r wa s To m Deaken, a laborator y assistan t wh o ha d acquire d a grea t dea l o f practica l knowledge abou t scienc e ove r th e decades . Influence d b y th e idea s o n cancer-causing microorganisms o f Eugene Doyen o f Paris and James Young of Edinburgh, Deake n began secre t experiment s o n hi s own. Eventually h e developed a medium upo n whic h h e wa s able to cultur e regularl y what h e believed wa s a cancer microbe . B y 191 0 h e believe d h e coul d successfull y inoculate laborator y animal s an d produc e cance r wit h metastase s i n mic e and dogs. Drawing o n his research o n a serum for ho g cholera (researc h fo r which h e di d receive some credit), Deaken develope d a serum for cance r as well a s cancer vaccines , an d b y 1917—1 8 he ha d successfull y used the m o n his experimenta l animals . (O f course , term s lik e "successfully " wer e mor e loosely define d i n thos e days. ) Th e seru m wa s draw n fro m horse s tha t ha d been inoculate d wit h th e suppose d cance r organis m (Boesc h i960 : 234— 41).

Notwithstanding hi s apparent success, Deaken coul d not interest doctor s in hi s work , largel y du e t o hi s lac k o f forma l educatio n an d credentials . The firs t docto r wh o di d pa y attentio n t o hi m wa s Glover . Glove r an d hi s business partne r soo n dre w u p a n agreemen t wit h Deake n t o for m a corporation t o marke t hi s products . Glove r the n returne d t o Toronto , where h e ha d earne d hi s medica l degree , t o ope n a cance r clini c tha t used th e seru m provide d b y Deaken . B y Octobe r 192 0 Glove r wa s unde r investigation fro m Canada' s deput y ministe r o f health, an d th e departmen t subsequently ordere d hi m t o mak e a complet e presentatio n befor e th e Toronto Academ y o f Medicin e withi n thre e weeks . Th e committe e ap pointed b y th e academ y turne d i n a negative repor t i n January, 1921 , and Glover lef t Canad a i n orde r t o pursu e hi s researc h an d fortun e i n Ne w York (Boesc h i960 : 240-44). The Canadia n committe e claime d tha t Glove r ha d bee n ver y secretiv e about hi s work. H e refuse d t o allo w the member s t o visit his laboratory, t o examine hi s cultures , o r t o witnes s an y experimenta l demonstration s o f his cultures o r seru m treatment s (Boesc h i960 : 205) . It i s likely tha t hi s reaso n for bein g s o secretiv e wa s tha t h e believe d h e ha d th e cur e fo r cance r an d that h e wa s going t o get rich , an d h e di d no t wan t anyon e t o stea l it fro m him. However , hi s strateg y o f secrec y produce d oppositio n no t onl y i n Canada bu t als o i n th e Unite d States . I n 192 1 th e Journal of the American Medical Association began publishing notices warning its members abou t th e

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advertisements tha t Glove r wa s circulatin g fo r hi s cance r serum . Franci s Wood o f Columbi a University , a prominent cance r researcher , wrot e tha t he purchase d seru m fro m Glove r an d injecte d i t int o whit e rat s wit h transplanted carcinoma s an d sarcomas , an d he conclude d tha t ther e wa s n o beneficial effect. 17 Coley was among the few peopl e wh o spen t substantia l effor t t o investi gate Glover' s claim s fairly , bu t eve n h e ultimatel y becam e ver y frustrate d and disillusione d wit h th e Canadia n doctor . Cole y firs t becam e awar e o f Glover an d hi s seru m i n 1920 , when h e receive d a letter fro m a Canadia n former patient. 18 I n 192 3 Archibal d Dougla s o f th e Memoria l Hospita l wrote to Cole y about a report h e had made on Glover , and Douglas offere d to mak e th e facilitie s availabl e a t th e hospita l i f Cole y an d hi s colleague s were t o conclud e tha t ther e wa s anythin g o f value. 19 However , Glove r cancelled a visit from Cole y an d associates , an d later Glove r postponed th e trial a t Memoria l indefinitely , claimin g tha t h e di d no t hav e enoug h se rum. 20 Meanwhile , Charle s May o o f the May o Clini c wrot e t o Cole y an d suggested tha t a committee investigat e Glover' s claims . Mayo seeme d t o b e genuinely intereste d i n th e research , an d h e wante d Edwar d Roseno w t o look a t it, but he was busy with othe r research. 21 Rosenow wa s an eminen t bacteriologist wh o a s early as 1914 had published o n pleomorphism (bacte rial for m changes ) withi n th e streptococcus-pneumococcu s group . R o senow had long been interested in the theory that chroni c disease s emerge d from foca l infection s suc h a s encyste d wound s o r infecte d roo t canal s (Rosenow 1914 ; Hughes 1994) . Coley apparently continue d to investigate Glover' s claims by undertakin g independent researc h at the Hospital for Ruptured an d Crippled. Notwith standing hi s attempt s t o wi n fo r Glove r a fair hearin g i n th e wide r cance r research community , i n 193 1 Glove r becam e concerne d tha t Cole y s re search fellow, a physician named Richard Berg, believed that he had isolated a microorganis m fro m malignan t tissu e tha t wa s differen t fro m Glover' s organism.22 Glove r then wrote t o Cole y and claimed that he, not Berg, ha d isolated th e organis m fro m th e malignan t tissue , an d tha t Ber g ha d con firmed Glover' s findings wit h a culture sent from hi s laboratory. Glove r also claimed tha t Cole y wa s callin g th e organism s th e "Ber g organism. " Cole y wrote bac k to explai n tha t non e o f the charge s was true an d that he wa s in no way interested in taking credit from Glover. 23 Coley became increasingl y frustrated wit h Glover' s lack of cooperation, especiall y his failure t o provide Coley an d Ber g wit h animal s tha t ha d bee n inoculate d wit h th e organis m that Ber g an d Cole y ha d isolate d fro m thei r chicke n tumors. 24 Thos e

Germ Warfare | 1 9 animals wer e house d a t Glover' s laborator y du e t o th e lac k o f facilitie s for extensiv e anima l experimentatio n a t th e Hospita l fo r Rupture d an d Crippled. Coley ha d man y friend s i n England, includin g th e prominen t pathologis t Sir Charle s Ballance . H e ha d persuade d Ballanc e t o attemp t t o replicat e th e results tha t h e an d Ber g ha d obtained , an d Charle s May o continue d t o express interes t i n th e project . However , Glover s lac k o f cooperatio n pu t Coley i n a difficul t position . Finally , h e wrot e t o Ballanc e an d May o letter s that explaine d th e problem s an d frustration s h e ha d experience d wit h Glover. Hi s lette r t o May o state d tha t eve n i f Glove r wer e t o provid e hi m with a culture , Cole y woul d no t us e i t becaus e h e woul d no t b e sur e tha t Glover ha d provide d hi m wit h thei r ow n organism . A s a resul t h e decide d to sen d t o th e Britis h virologis t Willia m Gy e fo r mor e o f th e "origina l dried virus, " an d t o repea t th e experiment s b y producin g tumor s i n th e fowl an d attemptin g t o cultur e th e organis m again . Cole y adde d tha t Peyto n R o u s ha d urge d hi m t o dissociat e hi s wor k fro m Glover' s laboratory . Although Cole y believe d tha t al l th e year s o f workin g alon e ha d mad e Glover especiall y suspicious , Cole y nonetheles s wrot e tha t h e stil l believe d that Glove r ha d foun d a n organis m o f "grea t etiologica l significance. " 2 5 Apparently Cole y persevere d wit h hi s pla n t o star t over . I n 193 5 h e brought culture s t o Gye , bu t a yea r late r Gy e wrot e bac k a negativ e letter . H e believe d tha t th e organism s wer e contaminant s becaus e h e faile d t o produce cance r wit h the m an d becaus e the y gre w easil y o n a simpl e aga r medium. 2 6 However , a s th e Britis h cance r researche r Willia m Crofto n noted, Gy e wa s convince d o f th e virus-onl y versio n o f th e infectiou s theory, an d hi s min d wa s close d t o othe r interpretation s (Crofto n 1936 : 108). I n hi s letter t o Coley , Gy e reiterate d hi s commitmen t t o th e infectiou s theory o f cancer , bu t fo r viruse s only . T h e availabl e correspondenc e end s with thi s letter , an d Cole y die d o n Apri l 16 , 1936 . Naut s wrot e t o me , " T h e awfu l anxiet y an d disappointment s whic h Glover' s behavio r gav e Coley ove r a ten-yea r perio d contribute d t o hi s duodena l ulcer , hemor rhages, an d ultimatel y shortene d hi s life. " 27 Another docto r w h o spen t som e tim e researchin g Glover' s claim s wa s Michael Scott , a surgeon fro m Butte , Montana . Scot t becam e intereste d i n Glover afte r h e ha d use d th e ne w X-ra y technolog y carelessl y an d devel oped cance r i n hi s hand . Hi s frien d Rev . Charle s Moulinier , S.J. , th e president o f th e Catholi c Hospita l Association , tol d Scot t abou t Glover , s o in October , 1921 , Scot t travele d t o N e w Yor k t o mee t wit h him . Glove r told Scot t tha t h e ha d don e al l th e researc h tha t i n fact , a s Scot t late r

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learned, Deake n ha d done . Scot t becam e enthusiasti c abou t Glover s re search, an d h e mad e additiona l trip s t o N e w York . I n th e meantime , h e had hi s affecte d finge r remove d surgicall y b y a colleagu e i n Portland , an d he use d th e Glove r seru m a s adjunctive treatmen t (Boesc h i960 : 202-11) . O n retur n visits , Scot t followe d Glove r a s they passe d laborator y animal s through th e stage s o f Koch' s postulates . Koch' s postulate s stipulat e th e conditions tha t ar e necessar y an d sufficien t fo r establishin g a causal relation ship betwee n a microbe an d disease . Briefly , thos e postulate s ar e a s follows : the organis m shoul d b e presen t i n th e disease d animal s an d absen t fro m healthy ones ; th e organis m shoul d b e grow n i n pur e cultures ; the n i t shoul d be reinoculate d int o health y animal s an d produc e th e diseas e symptoms ; and finall y upo n re-isolatio n i n pur e cultur e th e sam e organis m shoul d b e found. Glover remaine d secretiv e abou t th e formul a fo r th e cultur e mediu m and th e metho d fo r producin g th e serum . Scot t wante d t o mak e th e research public , bu t Glove r insiste d o n keepin g i t secre t unti l h e ha d teste d the seru m further . Scot t continue d t o follo w th e researc h progres s fro m a distance, an d h e sen t Glove r increasingl y larg e sum s o f mone y t o suppor t his research . I n th e middl e o f 1922 , Scot t treate d hi s firs t cance r patien t with th e serum . T h e woma n ha d originall y undergon e a mastectom y fo r breast cancer , bu t th e cance r returne d an d sh e wa s facin g inoperabl e metas tases. Accordin g t o Scott , afte r si x months o f treatmen t wit h th e serum , sh e was fre e o f cancer. Sh e live d unti l 1959 , whe n sh e die d fro m injurie s du e t o a fall . Scot t continue d t o trea t patients , an d b y 192 3 h e ha d develope d a network o f doctor s i n th e Midwes t an d o n th e Wes t Coas t w h o wer e testing th e serum . I n 192 4 h e too k a leav e fro m hi s medica l practic e an d moved t o N e w York . Scot t als o bega n workin g o n publication s o f hi s results wit h th e seru m (Boesc h i960 : 211-30). 2 8 Scott continue d t o pres s Glove r t o publis h hi s research results , but Glove r refused. T h e tensio n le d t o a confrontatio n i n 1926 , w h e n Glove r becam e furious an d accuse d Scot t o f "attemptin g t o muscl e i n fo r a shar e o f th e riches tha t wer e sur e t o c o m e " (Boesc h i960 : 233) . A fe w day s afte r th e split, Deake n visite d Scot t an d tol d hi m th e trut h abou t hi s relationshi p t o Glover. 29 Shortl y afte r th e fallin g out , Scot t move d t o Milwaukee , wher e he continue d hi s researc h wit h th e hel p o f Fathe r Moulinier , w h o tappe d the wealth y Cudah y famil y t o provid e Scot t wit h a laborator y an d assis tance. Deake n joined Scot t i n Milwaukee . Father Moulinie r the n gav e Scot t to p billin g i n th e meetin g o f th e Catholic Hospita l Associatio n i n June 1926 . Naively , Scot t visite d th e A M A

Germ Warfare | 2 1 headquarters i n Chicag o an d informe d Morri s Fishbein , th e edito r o f th e Journal of the American Medical Association fro m 192 4 t o 1949 , o f hi s forth coming announcement . Scot t mad e thi s courtes y cal l i n orde r t o giv e th e A M A th e firs t chanc e t o mak e th e publi c announcemen t abou t th e cur e fo r cancer. H e mus t hav e bee n unawar e o f Fishbei n s reputation. Today , h e i s a legendary figur e i n alternativ e medica l circles ; hi s epi c battle s wit h cance r herbalist Harr y Hoxse y ar e wel l known , an d h e ha s bee n nickname d i n alternative medica l circle s th e "medica l Mussolini " (Beal e 1939) . Fishbei n told Scot t the y wer e "to o bus y fo r anythin g lik e that, " bu t h e immediatel y began organizin g a countercampaign. Eventually , Fathe r Moulinie r receive d orders fro m hi s superior s t o withdra w Scott' s pape r fro m th e program . Unable t o disobe y churc h orders , th e Jesuit pries t figure d ou t a way aroun d the orders : h e close d th e meetin g earl y o n th e las t day , hel d a shor t recess , then allowe d Scot t t o spea k unofficially . However , wor d wa s passe d aroun d the audienc e tha t Moulinie r wa s ou t o f hi s mind , Deake n an d Scot t wer e crackpots, an d th e whol e busines s wa s a farce . Shortly afte r th e meeting , Fathe r Moulinie r wa s release d fro m hi s posi tion a s hea d o f th e Catholi c Hospita l Association . Deake n an d Scot t re turned t o N e w York . Scot t ha d becom e nearl y penniles s afte r havin g spen t his fortun e o n cance r research . Moulinie r an d Deake n die d withi n a fe w years, th e latte r believin g tha t hi s il l healt h wa s fro m th e cance r microb e that h e ha d picke d u p i n hi s laborator y work . Scot t continue d t o trave l w h e n possibl e an d t o giv e lecture s o n cance r researc h a t Catholi c universi ties (Boesc h i960 : 230—69) . Befor e hi s deat h i n 1967 , a dentis t i n Butte , R o b e r t Netterberg , becam e intereste d i n Scott' s researc h an d manage d t o get a pharmaceutica l compan y t o attemp t t o isolat e th e microbes , bu t th e efforts wer e withou t succes s (Netterber g an d Taylo r 1981 : 9-11) . Glover an d colleague s bega n publishin g thei r result s i n th e Canada Lancet and Practitioner in th e mi d 1920s , probabl y unde r som e pressur e fro m Scot t and fro m Glover' s busines s partne r an d funde r J . J . Murdock . Glove r claimed t o hav e isolate d a highly pleomorphic , o r form-changing , microor ganism tha t h e believe d wa s th e etiologica l agen t i n cance r a s indicate d b y his fulfillmen t o f Koch' s postulate s (Glove r 1926) . H e explicitl y linke d hi s research t o relate d project s o f som e o f hi s contemporarie s b y claimin g tha t his organis m wa s th e sam e a s that o f cancer researcher s James Youn g (1925a , 1925b), John N u z u m (1921 , 1925) , and C . R a t h (1925) . Glove r als o claime d that h e coul d cultur e thi s pleomorphi c organis m fro m th e R o u s sarcom a virus, an d thu s tha t th e filterabl e phas e o f hi s huma n cance r organis m wa s the sam e a s the avia n virus .

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Glover's wor k wa s distinguishe d fro m som e o f hi s colleague s i n tha t h e claimed t o hav e isolated a complete microbia l cycl e for th e cance r organism . Although microbiologist s hav e lon g agree d tha t a t leas t som e specie s o f bacteria ca n chang e for m i n respons e t o environmenta l changes , th e rang e of th e possibl e change s an d numbe r o f specie s tha t exhibi t pleomorphis m i s controversial. Glover' s positio n wa s locate d a t a n extrem e en d o f th e spec trum o f opinio n i n tw o ways . H e believe d tha t th e organis m coul d pas s through a t least a dozen phase s tha t include d (i n order ) cocci , bacilli , spores , an amorphou s substanc e (toda y sometime s calle d th e L-phase) , hyphae , spore sacs , an d a filterable phase . Th e latte r wa s a ter m tha t wa s use d a t th e time fo r "viruses, " whic h wer e distinguishe d fro m bacteri a becaus e the y were abl e t o pas s throug h a filte r tha t exclude d bacteria . (A t th e tim e viruses wer e ofte n calle d "filterabl e viruses, " an d thei r statu s a s chemica l agents o r lif e form s wa s contested . Man y als o believe d tha t viruse s wer e merely on e stag e o f a bacterial cycle. ) I n additio n t o th e extrem e pleomor phism tha t Glove r attribute d t o th e organism , h e believe d tha t th e phase s were organize d i n a lif e cycle , thu s makin g hi m a "cyclogenist " (Glove r 1930: n o ) . Glover's 192 6 publication i n th e Canada Lancet and Practitioner, whic h wa s heralded b y a favorabl e editorial , presente d a revie w o f fift y patients . Mos t of them ha d achieve d remarkabl e remissions , ofte n fro m heav y tumo r load s and fo r mor e tha n a year. I t i s clear from th e repor t tha t a number o f doctor s throughout N o r t h Americ a wer e eithe r testin g th e seru m o r sendin g Glove r patients, an d h e therefor e ha d a fairly well-develope d networ k o f supporter s that wen t wel l beyon d th e networ k assemble d b y Scott . In 192 9 Dr . Georg e W . McCoy , th e directo r o f what wa s the n calle d th e Hygienic Laborator y o f th e Unite d State s Publi c Healt h Service , visite d Glover's la b a t th e Murdoc k Foundatio n i n N e w Yor k Cit y an d invite d hi m to repea t th e wor k unde r supervision . Th e tea m include d Georg e Clark , a pathologist i n Scranto n w h o late r becam e a ke y lin k betwee n th e Glove r network an d th e post—Worl d Wa r I I networ k o f Virgini a Livingsto n an d Europeans suc h a s Fran z Gerlach . T h e wor k i n wha t becam e th e Nationa l Institute o f Healt h bega n i n December , 1929 , an d ende d i n 1938 . I n 193 3 M c C o y gav e th e go-ahea d fo r th e firs t repor t o f th e Glove r team' s research , which demonstrate d th e experimenta l productio n o f a malignan t adenom a with metastase s i n a guinea pig . A s Glove r recounts , Notwithstanding th e fact tha t the announcemen t i n the Public Health Reports, dated Marc h 31 , 193 3 [Glove r an d Engl e 1933] , was rendere d les s hars h b y

Germ Warfare | 2 3 the descriptio n o f onl y on e case , i t ha d th e effec t o f originatin g a wav e of advers e criticis m fro m wha t appeare d t o b e a n oppositio n organize d against th e acceptanc e o f th e microbi c o r viru s doctrin e o f th e etiolog y o f malignant disease . Thi s criticism , whil e aime d chiefl y a t th e work , wa s als o directed agains t thos e wh o sanctione d th e wor k i n th e Institut e an d per mitted th e appearanc e o f the abov e mentioned publication . Thes e influence s not onl y impede d th e progres s o f th e wor k i n th e Nationa l Institut e o f Health bu t derange d an d delaye d th e publicatio n o f a manuscrip t tha t de tailed the successfu l repetition , a t the Institute , o f the production o f metastasizing tumor s i n othe r group s o f experimenta l animals . (Glove r an d Whit e 1940)

McCoy supporte d additiona l publicatio n o f thei r work , bu t ther e wer e delays. I n 193 7 M c C oy wa s replaced b y Dr . R . H . Thompson , w h o becam e director o f th e newl y forme d Nationa l Institut e o f Health . (Th e " s " wa s not adde d unti l 194 8 w h e n th e Nationa l Hear t Institut e wa s created , according t o Stricklan d 1972 : 53. ) Thompso n appointe d a specia l commit tee t o revie w th e planne d publication , an d afte r som e delay s th e committe e recommended publicatio n o f th e materia l a s thre e separat e studies . A t firs t the Surgeo n Genera l approve d th e recommendation , bu t the n h e adde d a member o f the Nationa l Advisor y Cance r Counci l t o mee t wit h th e specia l conimittee an d t o revie w publicatio n o f th e firs t pape r again . Afte r variou s negotiations an d interferences , on e o f th e minorit y member s (presumabl y from th e Nationa l Advisor y Cance r Council ) suggeste d th e wor k shoul d b e repeated b y a membe r o f th e staf f o f th e Institut e befor e publication , an d the Surgeo n Genera l approve d th e suggestio n (Glove r an d Engl e 1938) . Glover wa s extremel y frustrate d becaus e fro m th e beginnin g h e ha d bee n supervised b y McCoy , an d M c C o y ha d eve n sai d tha t h e believe d th e quality o f research wa s equivalen t t o tha t o f his ow n laboratory . Becaus e th e new proposa l o f supervisio n woul d caus e a t leas t a n additiona l two-yea r delay, Glove r opte d t o retur n t o th e Murdoc k Foundatio n i n N e w Yor k and t o publis h hi s wor k independently . For Glove r th e laborator y studie s o n guine a pig s wer e onl y a n experi mental portio n o f a tota l researc h pictur e tha t include d hi s clinica l work , which h e regarde d a s more important . However , hi s reques t t o th e Surgeo n General i n March , 1938 , t o sen d a medical office r t o hi s clinic s an d observ e the result s o f th e treatmen t wa s no t acte d upon . M c C o y di d spen d severa l days a t th e clinic s an d tol d Glove r tha t h e wa s "greatl y impressed , especiall y with thos e case s tha t wer e clinicall y fre e o f th e diseas e ove r a lon g perio d of time " (Glove r an d Whit e 1940) . Glover s 194 0 repor t include s dozen s o f

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cases of long-term surviva l (ove r five years, sometimes ove r fifteen years ) in patients diagnose d with cancer . Glovers account of his experience in Washington suggests political inter vention fro m cance r researcher s wh o oppose d th e infectiou s theory . How ever, h e helpe d t o creat e th e condition s o f hi s ow n defeat . Hi s secretiv e behavior mean t tha t h e los t ke y allie s suc h a s Scott an d Coley , wh o coul d have helpe d shif t opinio n i n cance r researc h circles . Th e Glove r cas e i s therefore complicate d becaus e h e an d Scot t appea r t o hav e been victim s o f organized effort s t o suppres s thei r research , bu t Glove r himsel f als o sup pressed recognitio n o f the work o f his assistant Tom Deaken an d h e wa s so concerned wit h priorit y tha t h e lie d t o Cole y abou t Berg' s independen t culturing o f the organism . Glover' s controversia l researc h an d clinica l practice soo n heade d t o th e dustbi n o f medica l history . B y th e 1960 s th e American Cance r Society' s Unproven Methods of Cancer Treatment included a short descriptio n o f negative aspect s of Glover and his serum.

Rife and Kendall Contemporary t o Glover but on the West Coast, the Rife networ k involve d an odd coalitio n o f experienced medica l researchers and an uncredentialed , independent invento r name d Roya l Raymon d Rife . Lik e Glover , Rif e claimed t o b e abl e t o cultur e pleomorphi c organism s fro m th e tissu e o f cancer patient s an d t o provid e a nontoxic , successfu l cance r therapy . Ac cording t o journalist Barr y Lyne s (1987) , wh o worke d wit h Rife' s forme r partner John Cran e t o researc h th e biography , Rif e wa s bor n i n Nebrask a in 1888 , serve d i n th e Nav y durin g Worl d Wa r I , an d wa s assigne d t o investigate foreig n laboratorie s fo r th e U.S . government . I t i s possible tha t he cam e acros s simila r wor k b y th e researche r George s Lakhovsk y o r tha t Rife me t directl y wit h Nikol a Tesla. 30 Afte r th e wa r Rif e worke d a s a handyman an d chauffeu r fo r th e roller-bearin g magnat e Henr y Timken , and he spent his productive adult research years in Sa n Diego. In hi s 195 3 repor t Rif e claime d tha t afte r 192 0 h e buil t severa l high powered microscope s tha t worke d a t magnification s o f i7,ooo X o r higher , that is , a t level s wa y beyon d 2,ooo X t o 3,ooo X associate d wit h standar d light an d darkfiel d microscopes . H e claime d t o achiev e thi s hig h leve l o f magnification withou t sacrificin g a grea t dea l o f resolutio n becaus e h e polarized ligh t b y passin g i t throug h rotatin g quart z prisms . Rathe r tha n stain samples , h e used a variable monochromati c bea m o f ligh t whic h h e

Germ Warfare | 2 5 "tuned t o coordinat e wit h th e chemica l constituent s o f th e particle , virus , or microorganism " (Rif e an d Cran e 1953) . By 193 1 Rif e ha d attracte d th e interes t o f Arthu r Kendall , th e Directo r of Medica l Researc h a t Northwester n Medica l School . Kendal l brough t with hi m hi s protein-base d " K - m e d i u m " tha t allowe d hi m an d Rif e t o culture filter-passin g bacteria l organisms . B y th e en d o f 193 1 Kendal l an d Rife publishe d o n th e typhoi d bacteri a i n th e filterable state , which Kendal l claimed the y ha d bee n abl e t o se e wit h th e Rif e microscop e (Kendal l an d Rife 1931 ; Kendal l 1931) . The y als o announce d thei r finding s befor e a meeting o f severa l prominen t doctor s an d researcher s i n Lo s Angeles , and Rif e wa s soo n demonstratin g th e microscop e befor e th e loca l medi cal an d researc h communit y (Lyne s 1987 : 43-45) . I n 193 2 Kendal l pre sented hi s result s befor e th e meetin g o f th e Associatio n o f America n Physicians, an d i n tha t yea r h e als o publishe d th e article s i n Science and th e Journal of the American Medical Association. Kendal l wa s a n activ e participan t in a scientific controvers y tha t i s sometimes calle d th e "filtrationist " contro versy; i n th e 1920 s an d 1930 s bacteriologist s debate d claim s tha t bacteri a could pas s throug h a filterabl e stage . Althoug h Kendal l faile d t o interes t many o f th e leadin g bacteriologist s i n hi s research , on e importan t excep tion wa s Edward Roseno w o f the May o Clinic . I n 193 2 R o s e n o w me t wit h Rife an d Kendal l a t Northwestern , an d h e subsequentl y confirme d i n prin t their observation s o f filter-passin g organism s (Roseno w 1932 ; Lyne s 1987 : 46). Kendall an d Roseno w ma y hav e bee n mor e intereste d i n Rif e s researc h because o f it s implication s fo r th e theor y tha t bacteri a ca n ente r int o a viruslike "filterable " state , bu t Rif e use d hi s microscop e t o follo w microor ganisms throug h wha t h e interprete d a s thei r pleomorphi c cycles . H e soo n arrived a t a n extrem e versio n o f th e pleomorphi c theory :

We have classified th e entire category of pathogenic bacteria into ten individ ual groups . An y organis m withi n it s grou p ca n b e readil y change d t o an y other organism within th e ten groups depending upon th e media with whic h it i s fe d an d grown . Fo r example , wit h a pur e cultur e o f bacillu s coli , b y altering the media as little as two parts per million by volume, we can chang e that microorganis m i n 3 6 hour s t o a Bacillus typhosis showin g ever y know n laboratory tes t eve n t o th e Wida l retraction . Furthe r controlle d alternation s of th e medi a wil l en d u p wit h th e viru s o f poliomyelitis o r tuberculosi s o r cancer a s desired, an d then , i f you please , alte r th e medi a agai n an d chang e the microorganism back t o a bacillus coli. (Rif e an d Cran e 1953 : 3)

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By 193 2 Rif e believe d h e ha d identifie d viruse s fo r cancer , typhoid , polio, an d herpes . I n tha t yea r h e culture d bacteri a fro m a breast mas s tha t contained a ten-millimete r bloc k o f tumo r tha t ha d bee n independentl y confirmed fro m anothe r laboratory. After incubatin g the test tube for a day, he foun d i t t o b e teemin g wit h th e cance r "virus. " Rif e repeate d th e method an d claime d t o get identica l results . H e als o conclude d fro m hi s experiments tha t therma l deat h wa s achieve d a t 107. 6° F , the cance r mi crobe wa s sporogenou s an d anaerobic , an d th e viru s wa s no t destroye d b y X-rays (a t least th e kin d an d dosag e tha t h e used) . He believe d instea d tha t the dea d tissu e lef t b y th e X-ray s forme d a "natura l parasiti c feast " (Rif e and Cran e 1953 : 11). In accordance with Koch's postulates, Rife reinjecte d hi s viruses into rats and late r foun d a t th e poin t o f injectio n a mas s tha t microscopi c analysi s revealed t o be malignant . H e repeate d thi s procedure successfull y ove r on e hundred time s (a n olde r metho d sometime s use d a s a type o f control), an d he claime d tha t i n othe r analyse s h e ha d isolate d th e cance r viru s fro m a wide variet y o f huma n tumors . However , h e di d no t thin k othe r labora tories would be able to replicate his procedure because conventiona l micro scopes lacked th e combinatio n o f high magnificatio n an d appropriat e ligh t frequency tha t wer e require d t o se e th e viruses . On e solutio n t o thi s problem wa s Rife s finding tha t b y altering th e mediu m i n a slightly acidi c direction, th e virus transformed int o something larger that would no longe r pass through his filters. At the next stage, the organism reached a monococcoid for m tha t h e als o foun d i n th e monocyte s o f th e bloo d o f ove r 9 0 percent o f patients diagnosed with cancer . This form coul d be seen throug h a standar d microscop e whe n staine d wit h silve r nitrat e an d gentia n violet . When cance r researche r an d medica l docto r O . Camero n Grune r fro m McGill University cam e to visit, they found tha t they could take the fungu s that Grune r ha d isolate d fro m hi s cance r samples , pu t i t throug h th e K medium an d filter, an d arrive at Rife s virus; likewise, when the y put Rife s virus on Gruner' s pH-basic asparagu s medium, it transformed int o Grune r s "Cryptomyces" pleomorphi c fungu s (Lyne s 1987 : 71; Gruner 1942) . Thi s observation becam e th e basi s o f a lastin g friendshi p betwee n th e tw o researchers. In the 1930 s Rife als o developed an electronic frequency instrumen t tha t could creat e th e appropriat e frequenc y t o kil l th e viru s (Rif e an d Cran e 1953: 1) . Afte r successfull y destroyin g th e viru s i n ove r fou r hundre d experimental animal s b y usin g th e "morta l oscillator y rate " o f hi s elec tronic-frequency machine , Rife bega n t o experimen t wit h huma n cancers .

Germ Warfare | 2 7

He claime d tha t whe n h e used th e machin e o n a patient—today used b y attaching electrocardiograp h plug s t o th e patient—th e machin e woul d destroy o r rende r harmles s th e organism s withou t causin g an y damag e t o the patient . Under th e supervisio n o f medica l docto r Milban k Johnson , a specia l medical researc h tea m wa s se t u p a t th e Universit y o f Souther n Californi a to tes t th e Rif e machin e o n humans . Johnso n obtaine d fund s fro m th e Hooper Foundatio n fo r Medica l Researc h a t th e Universit y o f Californi a at San Francisco t o carr y ou t clinica l trials (Lyne s 1987 : 55). They use d th e machine fo r three-minute s duratio n a t three-da y interval s i n orde r t o giv e the lymphati c syste m tim e t o absor b an d cas t of f th e devitalize d dea d particles o f th e cance r virus . Rif e an d Cran e write , "Sixtee n case s wer e treated a t th e clini c fo r man y type s o f malignancy . Afte r thre e months , fourteen o f these so-calle d hopeless case s were signe d of f as clinically cure d by the staff of five medical doctors and Dr. Alvin G. Ford, M.D., pathologist for th e group " (1953 : 11) . Unfortunately , ther e ar e n o detail s o n th e definition fo r "clinicall y cured"; it probably means substantial tumor regression. By 193 7 Johnson ha d opene d hi s third clinic , an d ther e wa s widesprea d interest i n th e Rif e "frequenc y instrument, " especiall y in Californi a (Lyne s 1987: 71). Johnson an d colleagues were finding tha t the y coul d successfull y treat a numbe r o f degenerativ e diseases , includin g cataracts . Rif e als o formed th e compan y "Bea m Ray" t o begin manufacturin g th e instrument . However, Johnso n an d th e specia l committe e decide d t o hol d bac k o n making a publi c announcemen t regardin g th e efficac y o f th e frequenc y instrument, becaus e the y wishe d firs t t o documen t th e etiolog y o f cancer , given th e controversia l natur e o f their claim s (Lyne s 1987 : 83). Meanwhil e Gruner, whos e dea n ha d denie d hi m a leav e t o stud y wit h Rife , visite d Washington, D.C. , t o examin e th e wor k o f Glover , whos e oncogeni c microorganism Grune r believe d t o b e th e sam e a s th e Rif e viru s an d Gruner fungus . Grune r wrot e t o Johnson tha t th e Departmen t o f Publi c Health i n Washingto n ha d undergon e a chang e o f managemen t an d i t appeared tha t the y woul d shu t dow n th e Glove r research . H e als o wrot e that h e doubte d tha t th e distributio n o f th e machin e woul d mak e a bi g difference, becaus e mos t cance r researcher s di d no t examin e livin g tissue s and were not trained to culture microorganisms from cance r samples (Lyne s 1987: 93-94)The shutdow n o f th e clinic s an d Rif e researc h bega n whe n a patien t they had treated returned t o Chicago, and Morris Fishbein found ou t abou t

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the Rif e machine . Accordin g t o Lynes , Fishbei n a t firs t trie d t o bu y in , an d w h e n tha t failed , h e persuade d a disgruntle d partne r o f Bea m Ra y t o su e the compan y i n 193 9 (Lyne s 1987 : 89) . Beam Ra y eventuall y w o n th e suit , and afte r th e tria l th e judge offere d t o represen t th e defendant s i n a lawsui t against th e A M A (97) . However , th e tria l serve d it s purpose. Rif e ende d u p an alcoholic , hi s partner s wer e lef t nearl y bankrupt , an d i n th e meantim e any doctor s w h o use d th e frequenc y emitter s wer e threatene d wit h los s o f license. Immediatel y prio r t o th e tria l th e "onl y othe r qualit y 'electroni c medicine researc h lab ' wa s mysteriousl y destroye d b y fire " (99) . T h e clinic s were al l close d down , an d i n 194 2 Johnso n sen t hi s machin e t o Gruner , w h o decide d no t t o us e i t ou t o f fea r o f retribution . I n 194 4 Johnson die d under mysteriou s conditions , which , accordin g t o Lynes , federa l inspector s later rule d a s death b y poisonin g (97) . Allies o f Rif e claime d tha t i t wa s impossibl e t o publis h anythin g o n th e topic i n medica l journals . However , i n 194 4 Dr . R a y m o n d Seide l becam e interested i n th e Rif e machine , an d h e an d Elizabet h Winte r publishe d a clever essa y title d " T h e N e w Microscopes " i n th e Journal of the Franklin Institute, a scientifi c rathe r tha n a medica l journal. T h e articl e too k advan tage o f the interes t i n th e ne w electron-microscop y technolog y t o cove r th e Rife microscop e alon g wit h th e othe r technology . Seide l als o describe d i n an annua l Smithsonia n repor t h o w th e frequenc y emitte r coul d kil l th e cancer virus . Lyne s writes , "Followin g th e publication , Seide l soo n becam e aware tha t h e wa s bein g followed . T h e n a bulle t crashe d throug h hi s ca r windshield whil e h e wa s driving " (1987 : 98) . Kendall wa s sai d t o hav e bee n paid $200,00 0 t o remai n silen t (102) . Finally , a ne w technicia n stol e th e quartz prism s fro m Rif e s microscope , renderin g i t impossibl e t o operate . Rife close d th e la b i n 1947. 31 After Rif e becam e a recoverin g alcoholic , h e entere d int o partnershi p with enginee r Joh n Cran e t o begi n manufacturin g th e frequenc y emitter s again. B y i96 0 the y ha d lease d ou t ninet y machine s t o doctor s acros s th e country fo r testing . I n tha t yea r Cran e s offic e wa s raided , an d equipmen t and record s wer e confiscated . Cran e wa s place d o n tria l fo r whic h th e foreman o f th e j u ry wa s a n A M A doctor , an d h e wa s denie d acces s t o hi s own confiscate d records . Cran e wa s foun d guilt y an d sentence d t o te n year s in jail, an d h e serve d a term o f thre e years . Othe r doctor s wer e tol d t o sto p using th e machine , an d Rif e wen t int o hidin g i n Mexico . Rife die d i n 1971 . T he FD A continue s th e ba n o n th e Rif e machin e fo r medical use . Rif e generator s an d copycat s ar e apparentl y availabl e fo r thos e

Germ Warfare | 2 9

plugged int o th e appropriat e networks ; however , eve n withi n th e alterna tive cancer-therapy movement , som e have cautioned agains t the use of Rife machines because the y are untested an d they may be poorly calibrated . I t is possible tha t th e imprope r us e o f som e bioelectri c therapie s ma y lea d t o cancer-cell proliferation rathe r tha n remission .

A Women's Network Following Worl d Wa r I I ne w network s o f researcher s an d clinician s de fended theorie s relate d t o bacteri a an d cancer . On e grou p o f researcher s centered o n th e controversia l Krebioze n therapy , whic h lik e th e Glove r serum wa s develope d b y injectin g a microorganism int o horses . However , the microb e wa s Actinomyces bovis an d th e researc h wa s not positione d a s a contribution t o the study of a specific, pleomorphic , cancer-causin g organ ism.32 Anothe r network , whic h obtaine d muc h mor e scientifi c credibilit y and whic h pursue d th e infectiou s theory , centere d o n Virgini a "Living ston." Her last name is in quotatio n mark s because it was as pleomorphic a s the bacteri a sh e studied : sh e i s know n i n th e literatur e a s Wuerthele , Wuerthele-Caspe, an d Livingston-Wheeler . Wuerthel e i s the nam e o f he r father, wh o wa s a membe r o f th e America n Colleg e o f Physicians . He r other las t names reflec t he r abilit y t o outliv e mor e tha n on e husban d an d her decisio n t o chang e her name with eac h marriage. Although th e chang ing names make it difficult t o follow he r work in the medical literature, sh e became known a s a leader in the continuatio n an d development o f research on nonviral microbes in the etiolog y o f cancer. Livingston graduate d fro m Bellevu e Medica l Colleg e o f Ne w Yor k University i n 193 6 as one o f four wome n doctor s i n he r class. 33 Soon afte r graduating sh e me t th e commissione r o f hospital s an d complaine d tha t a woman ha d neve r bee n appointe d a s a residen t o r chie f inter n a t a Ne w York hospital . Te n day s late r sh e receive d a n appointmen t a s th e firs t woman residen t i n Ne w Yor k City , wher e sh e worke d i n th e infectious disease sectio n o f a hospital priso n war d fo r venereall y infecte d prostitutes . Although th e jo b wa s no t wha t sh e ha d ha d i n mind , sh e accepte d it , "thinking tha t I woul d a t least clea r th e wa y fo r futur e wome n residents. " She adds , "M y preconceive d notion s o f th e prostitut e underwen t rapi d reevaluation, an d I develope d grea t compassio n fo r thes e women , ofte n diseased and discarded by society" (Livingsto n 1984 : 56).

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During Worl d Wa r I I sh e worke d a s an industria l physicia n a t Wester n Electric, and when sh e and her husband adopte d a baby, she took a job a s a school docto r i n Newark . There , a school nurs e wit h a skin diseas e aske d Livingston t o examin e her . Althoug h th e nurse s docto r ha d diagnose d Renaud s syndrome, Livingsto n foun d sign s o f scleroderma , a progressiv e hardening o f the ski n tha t involve s bod y organ s an d ca n b e fatal . Sh e ha d seen case s o f leprosy an d tuberculosi s o n he r round s a s a resident i n Ne w York, and she decided to stain tissue samples from th e nurse with the Ziehl Neelsen stain , whic h wa s use d t o identif y th e bacteri a o f lepros y an d tuberculosis. Leprosy an d tuberculosi s bacteri a ar e know n a s mycobacteri a becaus e they exhibi t som e characteristic s simila r t o fungi. The y ar e als o know n a s acid-fast becaus e the y stai n re d an d d o no t los e thei r colo r afte r bein g washed with alcohol . The metho d wa s discovered by Robert Koc h in 188 2 and was used to identify th e tubercle bacillus, and acid-fastness i s used today as a classificatio n criterio n fo r th e mycobacteri a (Atla s 1988 : 284) . Whe n Livingston analyze d th e staine d samples , sh e foun d "a n acid-fas t microor ganism tha t wa s neithe r th e lepr a bacillu s no r th e tubercl e bacillus " (1984 : 7). Sh e reasoned tha t i t was a new sclerobacillu s an d treate d th e nurs e wit h medications fo r leprosy . Th e nurse , an d late r othe r patient s wit h sclero derma, improved . He r curiosit y aroused , Livingsto n se t u p a laborator y in he r basemen t an d studie d th e microorganism , whic h sh e foun d wa s pleomorphic bu t neithe r th e lepr a no r th e tubercl e bacillus . Sh e publishe d her wor k o n scleroderma , an d similar , confirmin g observation s wer e mad e subsequently bot h i n Europ e a t th e Brussel s Pasteu r Institut e an d i n th e United State s (Livingston, Brodkin, an d Mermod 1947 ; Cantwell and Kelso 1971).

Livingston the n foun d tha t whe n sh e inoculate d animal s wit h thi s mi crobe, man y develope d cancer . Sh e bega n seekin g tumo r sample s fro m colleagues in the area, and she found microbe s that appeared to be the same as the scleroderm a microbes . Concerne d tha t sh e might have contaminate d samples, sh e obtaine d tissu e sample s an d bloo d directl y fro m operatin g rooms an d continue d t o fin d th e sam e microb e i n he r slides . Whe n th e microbes wer e culture d an d injected int o mice , man y develope d cance r o r a collage n diseas e suc h a s scleroderm a o r lupu s erythematosi s (Livingsto n and Allen 1948) . During thes e year s Livingsto n bega n a partnershi p wit h Dr . Eleano r Alexander-Jackson, wh o wa s workin g o n th e questio n o f variation i n th e

Germ Warfare | 3 1 tubercle bacillu s a t th e laborator y o f Dr. Wilso n Smilli e o f Cornel l Univer sity. W h en Smilli e foun d ou t tha t the y wer e workin g o n a possible bacteria l origin o f scleroderm a an d othe r collage n diseases , h e though t o f kickin g them bot h out : However, on e o f hi s physician s challenge d u s wit h fort y bloo d samples , o f which som e ha d bee n take n fro m patient s wit h collage n diseases . W e soo n brought hi m a 100 % accurate selectio n o f the twenty-tw o sample s tha t wer e infected. (Livingsto n 1984 : 58) After Livingsto n an d Alexander-Jackso n me t th e challeng e successfully , Dr . Smillie s oppositio n softened . However , w h e n Livingsto n bega n t o sugges t that cance r ha d th e sam e etiology , Alexander-Jackso n becam e concerne d about th e futur e o f he r wor k o n th e tubercl e an d lepr a bacillu s a t th e lab , and Livingsto n decide d t o sta y away . T h e presiden t o f the Newar k Presbyteria n Hospita l the n offere d Living ston spac e fo r a laborator y i n a n ol d nurses ' residence , provide d tha t sh e had a university affiliation . Althoug h ther e wer e n o medica l school s i n N e w Jersey du e t o th e stat e s antivivisection laws , sh e receive d a n affiliatio n wit h the Burea u o f Biological Researc h o f Rutgers University . Sh e bega n settin g up th e laborator y an d receive d hel p fro m a numbe r o f foundation s an d laboratories, includin g th e America n Cance r Societ y an d som e pharmaceu tical companies . Sh e the n assemble d a tea m tha t include d Alexander Jackson a s her first appointment . O n e o f thei r first activitie s wa s t o obtai n anima l tumo r sample s infecte d with th e majo r tumo r viruses , suc h a s th e Rous , Walker , Sprage-Dawley , Shope, an d Sarcoma-18 0 (Livingsto n 1984 : 61) . Believing tha t a t least som e viruses wer e filterable stage s o f bacteria l cycles , sh e an d he r colleague s attempted t o develo p bacteria l culture s fro m th e vira l sample s an d believe d that the y coul d d o s o successfully . I n accordanc e wit h Koch' s postulates , Livingston an d colleague s produce d disease s i n animal s from thei r bacteria l cultures take n from viru s samples . The y use d guine a pigs , whic h sh e state d produced cance r spontaneousl y i n onl y on e o f a hal f millio n animals , bu t which produce d cance r i n a quarte r o f he r samples . The y als o use d geneti cally inbre d mic e tha t wer e know n t o produc e a predictable percentag e o f tumors. T h e disease s range d from tumor s t o tuberculosislik e lesion s t o collagen diseases . Tissu e sample s reveale d smal l cocc i insid e cells , whic h they believe d wer e th e intracellula r cance r pathogen . I n th e cours e o f thes e experiments the y foun d tha t th e diseas e coul d pas s fro m anima l drinkin g

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water tha t wa s contaminate d wit h fece s fro m disease d animals . Livingsto n and colleague s the n reisolate d th e bacteri a fro m th e disease d animal s (Liv ingston e t al. 1950). Livingston believe d tha t thei r researc h prove d tha t th e Rou s sarcom a virus an d perhaps othe r cance r viruse s wer e par t o f the cycl e o f an as-yet undiscovered microbe . Sh e later classifie d th e pleomorphic , cancer-causin g microorganism a s par t o f th e actinomycetale s orde r o f bacteria , an d sh e christened th e organis m Progenitoraceae cryptocides. Th e nam e "Progenitor " reflects he r belie f that th e organis m i s primitive an d archaic , an d th e ter m "cryptocides" indicates its capacity to be a "hidden killer. " They argue d tha t supportin g evidenc e cam e fro m th e researc h o f Fran cisco Duran-Reynals. H e cam e fro m th e Pasteu r Institut e i n 192 6 to wor k on oncoviruse s a t th e Rockefelle r Institute , an d afte r spendin g som e tim e at Yale University wen t o n t o organiz e a Rockefeller-like institut e i n Spai n (Corner 1964 : 223—24). In th e 1940 s Duran-Reynals worke d o n th e Rou s virus an d showe d tha t i t coul d b e transmitte d t o a numbe r o f othe r avia n species. I n a review essa y published i n 1950 , h e argue d i n favo r o f a mor e extended vie w o f vira l variatio n t o explai n th e variou s pattern s o f vira l transmission. H e believed that a number o f non-neoplastic ordinar y viruse s could caus e tissu e destructio n simila r t o o r equivalen t t o neoplasms . I n general, h e though t tha t a key variabl e i n th e patter n o f diseas e variatio n was th e ag e o f the host : "Infectio n o f the ol d an d generall y mor e resistan t host ma y manifes t itsel f preferentially b y cel l proliferatio n rathe r tha n cel l destruction" (Duran-Reynal s 1950) . Livingston extende d thi s position by arguing that the Rous virus did no t behave like other viruses: A true viru s has been define d a s a submicroscopic infectiou s uni t tha t lives only i n th e presenc e o f livin g cell s an d canno t exis t eve n momentaril y outside of them. But Rous's "tumor agents" could be dried, stored on a shelf at room temperatur e fo r years , and when mixe d with salin e coul d the n be reactivated t o initiat e fres h tumors . (1984 : 65 ; see als o Alexander-Jackso n 1966)

In th e 1950 s sh e visite d Peyto n Rou s an d wa s warmly received . Whe n she tol d hi m abou t growin g th e Rou s viru s i n artificia l medi a outsid e th e living cell , "h e sai d tha t h e di d no t thin k thi s wa s unlikel y o r impossible " (Livingston 1984 : 79). Rous had also argued that 95 percent o f the chicken s in Ne w Yor k Cit y wer e infected , an d h e mad e th e transmissibilit y o f chicken cance r th e subjec t o f hi s Nobe l Priz e lectur e i n 196 6 (Livingsto n

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1984: 115) . Thus, h e seeme d t o believ e tha t th e chicke n viru s coul d cros s species int o humans . Livingsto n carrie d o n hi s campaig n b y cautionin g patients an d reader s abou t th e possibilitie s o f gettin g cance r fro m eatin g undercooked chicken , a s in stir-fried chicke n dishes . Slowly Livingston' s networ k o f allie s an d fello w researcher s grew . I n about 195 0 sh e go t i n touc h wit h Elis e L'Esperance , a docto r who m Livingston had first heard about in medical school when a professor dispar agingly referred t o a woman pathologist at Cornell University who believe d Hodgkin's diseas e wa s cause d b y avia n tuberculosi s bacteria . I n 193 1 L'Esperance ha d publishe d he r repor t o n Hodgkin' s disease , i n whic h sh e argued that Hodgkin's sample s contained large multinucleated Reed-Stern berg cell s that were simila r to th e gian t cell s of tuberculosis. A niece o f the president o f the Ne w Yor k Centra l Railroad , L'Esperanc e ha d bee n activ e in th e Ne w Yor k Women' s Infirmar y fo r years . When he r mothe r die d o f cancer, L'Esperanc e use d th e famil y mone y t o foun d th e Kat e Depe w Strong Memorial Cance r Detectio n Clini c i n he r memory . Th e clini c was the first of its kind t o be founded i n the world . When Livingsto n visited L'Esperance s clinic, she met Georg e Papanico laou, th e invento r o f th e Pa p smear . A s sh e notes , "Unti l L'Esperanc e demonstrated the usefulness o f the Pap smear at her cancer detection clinics, Dr. Papanicolaou' s wor k wa s no t accepted " (1972 : 51) . When Livingsto n told L'Esperanc e abou t he r wor k wit h acid-fas t organism s simila r t o th e ones L'Esperance ha d found, th e latter said she had als o isolated th e organ isms from th e gland s o f the Hodgkin' s patients , culture d them , an d repro duced the lesions in guinea pigs after injecting th e animals with the culture d organisms. Sh e the n showe d th e anima l tissue s t o Jame s Ewing , an d h e confirmed tha t the y wer e Hodgkin' s disease . However , "Whe n sh e tol d him that they were from experimentally inoculated guine a pigs, he said that of course the y were no t Hodgkin' s disease , that i t was impossible t o repro duce th e diseas e from cultures " (1972 : 52) . Disgusted, L'Esperanc e never theless continue d he r wor k unti l a technician becam e il l and coul d no t b e replaced. Sh e then switche d t o work in prevention an d early detection . By 195 0 Livingston ha d als o found suppor t from Iren e Diller , th e edito r of Growth and a cytologist a t the Institut e fo r Cance r Research i n Philadel phia, an d fro m he r husban d Willia m Diller , a professor o f parasitolog y a t the Universit y o f Pennsylvania. Dille r attempte d t o organiz e a symposiu m at th e Ne w Yor k Academ y o f Sciences , bu t thi s meetin g wa s blocke d b y the Memoria l Hospita l Directo r Corneliu s PJioads . H e accuse d Dille r o f commercializing her work an d therefore o f not being qualified t o sponsor a

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symposium (a n ironi c clai m give n Rhoad s s relationship wit h th e chemo therapy industry). All she had don e wa s accept severa l ultraviolet sterilizin g lights, wit h n o string s attached , fro m a private compan y (Livingsto n 1984 : 73—74). Thi s even t marke d th e beginnin g o f th e suppressio n tha t th e Livingston networ k woul d fac e a lifetime battling . I n November, 1951 , the New York Academy of Sciences hosted a conference o n viruses as causative agents i n cance r tha t Rhoad s organize d (Mine r 1952) . The conferenc e di d not conside r an y o f th e researc h o n bacteri a an d cancer , an d Rhoad s s introductory comment s demonstrate d tha t h e wa s als o skeptica l o f vira l research as well. Blocking th e planne d Ne w Yor k Academ y o f Science s symposiu m wa s only th e firs t o f th e run-in s betwee n Livingston' s networ k an d Rhoads . When Alexander-Jackso n wa s diagnose d wit h breas t cance r i n 1951 , sh e underwent a radical mastectomy a t Memorial Sloan-Kettering . Whil e the y were waiting , Rhoad s calle d Livingsto n int o hi s offic e an d aske d i f the y could tr y ou t a new surgica l techniqu e tha t involve d splittin g th e sternu m to remov e gland s aroun d th e hear t an d grea t vessels . "Sh e woul d b e per forming a great servic e i n permittin g u s t o d o this, " Livingston state s tha t Rhoads sai d t o her , "a s i t woul d b e a n experimen t t o se e ho w i t woul d affect a patien t an d t o determin e th e lengt h o f tim e sh e migh t survive " (1984: 75) . Livingston wa s shocke d an d tol d him , "No t o n you r life ! Tha t is a crue l an d disfigurin g operation " (75) . When Alexander-Jackso n cam e through th e surger y an d Livingsto n tol d he r wha t ha d happened , sh e wa s indignant. Sh e resolve d no t t o submi t t o an y cobal t treatment s o r t o an y more surgery , an d the y resolve d t o us e die t an d th e vaccine s the y wer e developing. In 195 3 Livingston and colleagues exhibite d thei r work a t the New York American Medical Association. The exhibit apparently created quite a sensation becaus e a televisio n hooku p allowe d visitor s t o watc h th e purporte d cancer microbes. "The publicity would have been great," Livingston writes, "but again the formidable Dr. Rhoads forbade the New York AMA publicity people to interview us. He also threatened to withhold further new s releases from th e press if they reporte d o n ou r findings " (1984 : 79). She claim s tha t although ther e wer e crowd s waitin g t o get int o thei r booth , th e pres s was intimidated and did not mention the exhibit at all in their reports. Stymied i n th e Unite d States , Livingsto n bega n preparation s fo r th e Sixth International Congres s of Microbiology i n Rome. Prio r t o the meet ing sh e me t wit h Georg e Clark , th e pathologis t fro m Scranto n wh o ha d worked o n Glover s organis m an d ha d als o produce d tumor s b y injectin g

Germ Warfare | 3 5 them int o animals . Clar k explaine d t o Livingsto n tha t Glove r ha d bee n abl e to produc e antibodie s i n shee p an d horse s tha t wer e beneficia l t o human s with cancer . The y trie d t o replicat e th e experimen t bu t ende d u p infectin g the shee p rathe r tha n vaccinatin g them . However , the y trie d agai n wit h a chicken farme r w h o wa s losin g abou t a quarte r o f hi s chicken s t o fow l leukosis, an d thi s tim e the y use d dea d culture s t o produc e antibodie s i n rabbits. The y experimente d wit h si x dyin g chickens . T h e tw o unvaccinate d ones die d an d th e fou r tha t receive d th e vaccin e returne d t o healt h (Living ston 1972 : 43) . At abou t thi s tim e the y raise d fund s t o brin g Dr . Fran z Gerlach , a highl y respected microbiologis t fro m th e Universit y o f Vienna , fo r a celebratio n in hi s honor . Gerlac h worke d o n cance r an d mycoplasma , a type o f bacteri a that lac k a cell wall an d ar e ofte n confuse d wit h cell-wal l deficien t form s o f other bacteria . Afte r 195 8 Gerlac h worke d a t th e Bavaria n clini c o f Jose f Issels, w ho ha d pioneered th e "whole-body " therap y progra m tha t include d diet, exercise , vaccines , an d othe r nonspecifi c intervention s develope d t o bolster th e immun e system . Whil e Gerlac h wa s visitin g Livingsto n an d colleagues, the y obtaine d sample s o f Agrobacterium tumefaciens fro m th e Bronx Botanica l Gardens . The y the n use d th e culture d bacteri a t o perfor m experiments wit h mic e (Livingsto n 1984 : 82) . In thei r travel s t o Europe , Livingsto n an d colleague s ha d th e opportunit y to mee t wit h Emm y Klieneberger-Nobel , w h o worke d o n th e L-form s o f bacteria a t th e Liste r Institute , an d wit h Ernes t Brieger , w h o worke d o n filterable form s o f th e tubercl e bacillu s a t Cambridg e University . The y als o stopped t o mee t wit h Wilhel m vo n Brehme r an d t o lear n abou t hi s dark field techniques , tha t is , microscopes i n whic h ligh t i s not directl y transmit ted throug h th e specime n int o th e objectiv e lens . However , report s o f Livingstons wor k appeare d i n th e America n press , an d a spokesperso n for th e N e w Yor k Academ y o f Medicin e discounte d thei r claims . W h e n Livingston an d colleague s returned , the y wer e i n th e middl e o f controvers y (1984: 86-87) . In 195 1 th e Presbyteria n Hospita l o f Newar k an d Memoria l Sloan Kettering Cance r Cente r i n N e w Yor k ha d eac h bee n awarde d $750,00 0 i n a gran t fro m th e Black-Stevenso n Cance r Foundation . Livingsto n an d colleagues ha d bee n expectin g t o begi n wor k unde r thei r ne w gran t w h e n they returne d fro m Europe . However , th e stor y wa s t o tur n ou t differently : As Mr. Hardin , on e o f th e director s o f th e Blac k grant , la y dyin g o f cance r in th e Memorial Center , h e ha d been prevaile d upo n t o sig n a codicil to th e

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bequest statin g tha t w e a t th e Presbyteria n Hospita l coul d no t expen d ou r share o f the gran t without th e permission o f Dr. Rhoads' s Memorial Center . As it turne d out , th e onl y acquisition s tha t Dr . Rhoad s woul d gran t u s were a ne w win g t o b e adde d t o th e hospita l an d th e installatio n o f a high-voltage cobalt machine. Th e sister s Black were betrayed as were Dr. Alexander-Jackso n and myself , wh o ha d labore d s o long an d diligentl y t o establis h a top-fligh t research laborator y devote d t o th e biological approac h t o th e treatmen t o f cancer, an d not to radiation . I t wa s ou r wor k tha t brough t th e $750,00 0 gif t to Presbyteria n i n th e firs t place , ye t i t wa s th e machin e thi s gif t purchase d that destroye d all that we had accomplished . At th e time o f the announcemen t o f the Black grant , w e were elated . W e could forese e establishin g preventiv e clinic s acros s th e natio n tha t woul d screen patient s an d immuniz e the m whe n the y wer e bacteriologicall y posi tive, clinic s tha t woul d promot e bette r lif e habits , bette r nutrition , safe r an d cleaner surroundings , industria l an d environmenta l contro l o f carcinogens , earlier detection o f precancerous lesions, and genetic counseling . It was a great drea m while it lasted. (Livingsto n 1984 : 88) T h e situatio n continue d t o crumble . Thei r sponso r a t Rutger s wante d to clos e dow n th e laboratory . H e offere d t o kee p Livingsto n a s a n associat e professor wit h a salary , bu t ther e wa s n o roo m fo r Alexander-Jackson . I n addition, Livingsto n report s tha t th e Interna l Revenu e Servic e bega n t o investigate he r husban d o n th e sourc e o f fund s use d fo r th e Europea n trip . She claim s tha t sh e wa s tol d confidentiall y tha t "someon e hig h u p i n N e w Yor k i n cancer " ha d spurre d th e investigatio n (Livingsto n 1972 : 69). Althoug h th e clai m ma y soun d paranoid , othe r alternative-medica l researchers hav e experience d simila r suppressio n (Carte r 1993) . Livingston an d he r husban d move d t o Souther n California , hi m t o b e closer t o busines s opportunitie s i n Mexic o an d he r t o b e close r t o he r family, whic h ha d move d t o Lo s Angeles . A fe w year s late r he r husban d returned t o N e w York , an d shortl y thereafte r h e died . Sh e continue d t o work i n a Californi a clini c unde r ver y stressfu l conditions , an d i n 195 7 sh e married a doctor ther e name d A . M . Livingston . I n 195 8 she , he r husband , the Dillers , an d Alexander-Jackso n attende d th e Firs t Internationa l C o n gress fo r th e Microbiolog y o f Cance r an d Leukemi a i n Antwerp . Ther e they wer e abl e t o tal k wit h Gerlac h an d vo n Brehme r a s wel l a s othe r leading Europea n researcher s i n th e field . Thes e include d Ernes t Villequez , director o f the Centra l Blood Ban k o f France an d Professo r o f Experimenta l Medicine a t th e Universit y o f Dijon ; Nell o Mori , directo r o f th e Institut o Microbiological Bell a Vist a i n Naples ; an d Clar a Fonti , presiden t o f th e

Germ Warfare | 3 7 Centro Internazional e Oncologica l d i Viggi o i n Milan . The y foun d man y similarities o f ideas , an d i n som e case s som e surprises . Fo r example , Font i had inoculate d th e ski n o n he r ches t betwee n he r breast s wit h bacteri a (no t cancer cells ) culture d fro m huma n cancers , an d thi s ha d produce d a growt h of basal cel l epitheliom a (Font i 1958 ; Livingston 1972 : 90) . Livingston wa s slowe d b y a heart attac k i n 1962 , an d Alexander-Jackso n subsequently los t he r j ob a t Columbia , perhap s du e t o "high-leve l pressure " (Livingston 1972 : 103) . I n 196 8 th e Livingsto n "vaccine " appeare d o n th e ACS lis t o f "unprove n methods " (America n Cance r Societ y 1968) . Ther e were, however , change s o f fortun e i n th e othe r directio n a s well . I n th e 1960s th e wor k o f Britis h microbiologis t Kennet h Bisse t wa s becomin g recognized i n majo r journals. 3 4 H e claime d tha t mycoplasm a coul d brea k down int o viruslik e particle s an d tha t the y an d bacteria l L-form s migh t pla y a role i n malignan t diseases . Thus, h e helpe d pav e th e wa y fo r th e increasin g recognition o f cell-wal l deficien t bacteri a a s "stealt h pathogens, " t o us e th e phrase o f microbiologis t Lid a Mattma n (1993) . A t abou t thi s tim e th e Livingston grou p als o w o n a victory when , nearl y twent y year s afte r Dille r had firs t attempte d t o organiz e th e symposiu m a t th e N e w Yor k Academ y of Sciences , the y finall y gaine d approva l t o presen t thei r result s befor e th e academy. Livingsto n note d tha t sh e ha d ove r five-hundre d request s fo r reprints base d o n th e conference . Nevertheless , discussan t Phylli s Pease , w h o worke d i n Bisse t s laboratory a t th e Universit y o f Birmingham , c o m mented tha t the y face d a n uphil l battle : "A s lon g a s i t i s necessar y t o war n research worker s tha t the y ma y no t mentio n endospore s i n thei r culture s o r suggest tha t a n apparen t mycoplasm a ca n b e th e L-for m o f a bacterium, fo r fear o f ridicul e o r rejection , w e ar e no t likel y t o advanc e furthe r i n [a ] lin e of researc h wher e thes e phenomen a mus t b e looke d i n th e fac e an d prove d true o r fals e o n th e evidence " (Peas e 1970 : 783-84) . An importan t additio n a t th e 196 9 meetin g o f th e Academ y wa s Flor ence Seibert , a senio r microbiologis t an d biochemis t w h o wa s bes t know n for havin g develope d th e P P D (purifie d protei n derivative ) ski n tes t fo r tuberculosis. Sh e ha d studie d th e biochemica l compositio n o f extract s fro m rat sarcom a tumors , an d sh e becam e intereste d i n th e microbiolog y o f cancer i n th e 1950 s w h e n he r frien d an d colleagu e Iren e Dille r showe d he r slides o f acid-fas t bacteri a fro m he r ow n tumo r isolates . Afte r a hiatu s o f several year s followin g he r retiremen t i n Florid a i n 1958 , Seiber t opene d a laboratory an d becam e activel y involve d i n researc h o n bacteri a an d cancer . Although sh e manage d t o produc e a serie s o f article s o n th e topic , sh e di d so i n th e fac e o f funding problems . A s sh e recounts ,

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I soo n found , lik e mos t o f th e othe r worker s o n thi s subjec t ha d alread y found, tha t th e coffer s o f the wealthy organization s supporte d by funds give n from th e heart s o f the cryin g victims for help , o r by the funds supplie d fro m our taxes , wer e empt y whe n thi s phas e o f th e wor k wa s requested . I t wa s hard t o understand , i n vie w o f th e previou s hel p I ha d ha d whe n I wa s working o n th e sam e subjec t bu t i n th e popula r strea m o f thought . Th e challenge, however, became greate r with ever y rebuff, a s I remembered som e of the history of science. Finally support did come from loca l bleeding hearts. (1968: 136 )

She eventuall y di d fin d funding , bu t al l fro m loca l organization s an d indi viduals. T h e wor k becam e slightl y les s controversial , an d receive d mor e recogni tion fro m mainstrea m researchers , w h e n i n 197 2 Livingsto n foun d tha t he r cancer microb e produce d protein s simila r i n structur e t o huma n choriogo nadotropin (hCG) . Thi s growt h h o r m o n e i s implicate d i n som e cancers , and i t ma y hav e a genera l importanc e a s a tumo r marke r (Acevedo , Tong , and Hartsoc k 1995) . Severa l othe r laboratorie s subsequentl y confirme d th e finding, an d thei r wor k i n th e lat e 1970 s an d int o th e 1980 s brough t th e research int o th e er a o f molecular biolog y an d contemporar y immunology . T h e othe r majo r developmen t durin g th e 1970 s wa s th e growt h o f th e Livingston Foundatio n Medica l Center , a clini c whic h Livingsto n an d he r husband opene d i n Sa n Dieg o i n 1969 . I n additio n t o usin g vaccines , the y emphasized a die t hig h i n abscisi c aci d tha t share d som e ke y feature s wit h the Gerso n diet . Fo r th e nex t twent y year s Livingsto n continue d he r research an d treatmen t o f cance r patients , an d sh e battle d t o protec t th e us e of he r vaccine . Ironically , a s sh e pointe d ou t i n a tal k give n i n 1989 , sh e received officia l approva l fo r us e o f the vaccin e o n far m animal s fo r Marek s disease bu t no t fo r us e o n humans . Sh e als o fough t t o ge t Medicar e insurance coverag e fo r he r treatments , and , althoug h sh e wo n th e battl e technically, th e lega l cost s draine d he r resource s (Livingsto n 1989) . In February , 1990 , th e Californi a Departmen t o f Healt h Service s issue d a cease-and-desis t orde r fo r he r clini c t o sto p administerin g an d prescribin g the autogenou s vaccine . Coincidentally , i n th e March/Apri l issu e o f th e American Cance r Societ y s journal CA —A Journal for Clinicians, th e Liv ingston therap y wa s describe d unde r th e headin g o f "Unprove n Method s of Cance r Treatments. " Th e notic e state d tha t "Livingsto n ha s apparentl y mistaken severa l differen t type s o f bacteria , bot h rar e an d common , fo r a unique microbe " (America n Cance r Societ y 1990) . Althoug h thi s clai m was probabl y tru e a s fa r a s i t went , i t ignore d a muc h mor e complicate d

Germ Warfare | 3 9 research pictur e a s wel l a s th e apparen t successe s wit h anima l an d huma n vaccines. T h e repor t als o suggeste d tha t the y ha d contacte d a spokesperso n for th e stat e healt h department , w h o "agre[ed ] tha t th e clini c 'i s probabl y in violation ' o f the 195 9 Californi a Cance r Act " (America n Cance r Societ y 1990: 107) . Accordin g t o th e curren t directo r o f th e clinic , wit h w h o m I spoke i n 1995 , ther e wer e apparentl y n o complaint s fro m patient s tha t le d to th e stat e healt h department s decision , an d th e orde r seeme d ver y od d t o members o f th e clini c give n th e fac t tha t autogenou s vaccine s ar e standar d practice amon g allergists . Virgini a Livingsto n die d o f hear t failur e a fe w months later , i n June, 1990 .

Enderlein, Von Brehmer, Issels, and the Nazis T h e analysi s s o fa r ha s focuse d o n N o r t h America , whic h ha s bee n wher e the bul k o f the researc h advance s wer e mad e durin g th e decade s afte r Worl d War II . However , i n orde r no t t o mak e overl y hast y generalization s fro m the N o r t h America n experience , i t i s helpfu l t o understan d th e histor y o f research o n bacteri a a s etiologica l agent s o f cance r tha t too k plac e i n othe r countries. Durin g thi s tim e period , th e othe r worl d cente r o f biomedica l research wa s Europe . Unti l th e Nazi s cam e t o power , German y ha d th e most advance d scientifi c researc h communit y i n th e world , an d Franc e als o had a long-standin g microbiologica l researc h tradition . I n Britai n som e researchers advocate d th e bacteria l etiolog y t h e o r y — s u c h a s William R u s sell, James Young , an d Willia m Crofton—an d a s in th e Unite d State s the y were attacke d o r ignored . T h e discussio n her e wil l b e limite d t o German y and France , whic h provid e a stronge r comparativ e perspectiv e tha n th e British cas e bot h i n term s o f institutional pattern s an d i n term s o f th e type s of bacterial theory. 35 Germany provide d th e mode l fo r scientifi c medicin e i n th e Unite d States, includin g educationa l experiment s suc h a s thos e a t th e Johns H o p kins Medica l School , an d i t als o provide d som e o f th e mos t advance d research o n pleomorphi c microbiology . Probabl y th e mos t influentia l Ger man researche r o n pleomorphis m wa s Gunthe r Enderlein , w h o bega n a s a student o f the botanis t Wilhel m Pfeffe r an d starte d wor k a t th e Agricultura l University i n Berlin . Officiall y a zoologist , durin g Worl d Wa r I h e worke d as a serologist an d docto r i n th e arm y du e t o th e shortag e o f physicians. Hi s theories o f a pleomorphi c bacteriu m o r fungu s emerge d fro m thi s experi ence, an d i n 191 6 h e bega n submittin g report s base d o n hi s studie s o f

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typhus. Tha t researc h becam e th e basi s fo r hi s 192 5 boo k Bakterien Cydogenie. Enderlei n wa s therefor e endorsin g a cyclogeni c theor y o f bacteria l pleomorphism a t abou t th e sam e tim e a s Glove r was . W h a t distinguishe d Enderlein's wor k wa s hi s focu s o n blood-born e microorganisms . I n genera l the continenta l researcher s tende d t o emphasiz e a n endogenou s blood borne microb e rathe r tha n a latent intracellula r tissu e pathogen . As earl y a s 190 1 th e Germa n researche r Ott o Schmid t ha d foun d m i crobes i n th e bloo d o f cance r patient s (Enb y 1990) . Blood-borne pathogen s are recognize d cause s o f disease s i n microbiolog y today . Fo r example , Lid a Mattman writes , "Disease d lymp h glands , especiall y i f i n th e abdomina l cavity, fee d diptheroid s an d othe r pleomorphi c organism s int o th e blood stream. Bloo d culture s ma y giv e a diagnosti c clu e i n thos e conditions " (1993: 312 , citin g Fleishe r 1952) . Thus , wha t make s Enderlein' s theor y controversial i s no t th e ide a tha t bacteria , viruses , o r fung i ca n appea r i n the bloo d o f sic k people , bu t tha t the y ar e par t o f a microbial cycl e eve n i n healthy people . Enderlein's basi c argumen t wa s tha t th e blood , lik e th e digestiv e tract , has a native flora, an d th e blood-base d microorganism s pla y a n essentia l rol e in th e lif e process . However , w h e n th e body' s interna l environmen t change s and th e bloo d p H changes—du e t o poo r nutritio n o r exposur e t o environ mental stressors—th e blood-base d microbe s transfor m int o highe r stage s (up t o th e leve l o f fungi ) an d caus e disease . Enderlei n calle d hi s highl y pleomorphic microorganis m Mucor racemosus fresen, an d h e believe d i t ha s a life cycl e o f fourteen phases . A t it s lowest stage , th e microorganis m exist s a s a "protit, " a living, nonmoving , apathogenic , protei n particl e abou t th e siz e of .0 1 micron an d simila r t o wha t toda y woul d b e calle d prion s (Enb y 1990 : 28). T h e secon d stag e take s th e for m o f tin y protei n ball s compose d o f a number o f protits. A t th e tent h stag e th e organis m reache s a "multinuclear " form tha t break s of f from th e oute r membran e o f red blood cell s to becom e independent "bacteria. " B y th e thirteent h phas e th e organis m ha s reache d a funga l form , an d i n th e fourteent h phas e i t produce s spores . I f thi s microorganism exists , i t woul d b e quit e differen t fro m ordinar y fung i o r even th e mycobacterium , whic h constitut e a bridg e grou p betwee n th e bacteria an d fungi , becaus e know n fung i an d bacteri a d o no t sho w suc h a range o f pleomorphism . Enderlein di d no t wor k alon e o r i n secret ; rather , h e foun d significan t support fo r hi s ideas . Durin g th e 1930 s h e becam e directo r o f productio n control o f th e pharmaceutica l compan y Sanum . Thei r firs t produc t wa s Utilin, a n antituberculosi s dru g develope d b y th e docto r Friedric h Fried -

Germ Warfare | 4 1 mann an d derive d fro m microorganism s foun d i n th e bloo d o f a se a turtle . (It i s no w use d fo r AID S patients. ) Friedmann' s treatment s ha d alread y received internationa l recognition , an d prio r t o Worl d Wa r I h e ha d lec tured befor e th e U.S . Senat e an d publishe d a documen t wit h th e U.S . Government Printin g Offic e (Friedman n 1913) . During th e 1930s , anothe r German doctor , Wilhel m vo n Brehmer , extende d Enderlein s wor k b y developing a relate d theor y o f cance r base d o n hi s observation s o f th e fungus Mucor racemosus in th e blood . The claim s o f Enderlei n an d othe r German s w h o studie d pleomorphi c blood-borne microorganism s wer e heterodo x enough , bu t accordin g t o th e Swedish docto r an d Enderlei n biographe r Eri k Enby , w h e n th e Nazi s cam e to powe r i n 193 3 Enderlein s idea s cam e int o conflic t wit h th e Naz i doctrine o f purit y o f blood . Enderlei n suffere d sever e criticis m fro m th e Nazi doctors , an d hi s fello w researcher s Friedman n (wh o wa s Jewish) an d von Brehme r wer e openl y persecuted . Prio r t o th e Naz i ris e t o power , vo n Brehmer ha d sue d Hitle r fo r defamatio n o f character , an d h e wa s a n outspoken criti c o f th e leader . W h e n late r presse d t o joi n th e Naz i party , he resigne d hi s position . Enb y write s tha t vo n Brehme r onl y survive d th e Nazi year s du e t o hi s reputatio n a s a scientis t an d hi s connection s wit h people hig h u p i n th e powe r structure . Regardin g Friedmann , Enb y writes : [T]he biological treatmen t wa s viewed by Nazi doctor s a s direct competitio n for th e chemotherap y industry . Director s o f numerous Germa n tuberculosi s sanatoriums als o harshl y criticize d th e Utili n vaccine , whic h pose d a n eco nomic threa t t o thei r clinics . . . . Under suc h sever e pressure, Dr. Friedman n fled t o Monaco i n 1937 . (Enby 1990 : 8) After th e war , th e endogenou s bloo d microb e theor y remaine d unpopular , particularly amon g th e forme r Naz i doctor s w h o continue d t o practic e an d influence Germa n medicine . However , Enderlei n an d colleague s continue d to d o thei r research , an d version s o f thei r biologica l product s continue d t o be manufactured . Former Naz i doctor s wer e als o partl y responsibl e fo r th e suppressio n that th e Germa n docto r Josef Issel s suffere d durin g th e decade s afte r Worl d War II . I n 195 1 Issel s founde d th e firs t hospita l i n German y tha t pioneere d a multimethod , nontoxi c treatmen t o f cancer . H e advocate d a multicausa l theory o f th e etiolog y o f cance r tha t include d heredity , lifestyle , exposur e to carcinogens , an d microorganism s (Issel s 1975) . H e als o employe d Fran z Gerlach, th e Austria n scientis t w h o maintaine d tie s with Livingsto n an d th e network o f N o r t h America n researchers . Gerlac h (1948 ) researche d an d

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published o n th e microbia l theor y o f cancer , an d h e helpe d produc e vac cines that Issels used as part o f his multimethod therapy . Although Gerlach s research an d vaccine s wer e probabl y no t th e mai n caus e o f the lega l problems tha t Issel s encountered , the y contribute d t o hi s controversia l statu s i n the Germa n medica l community . In the 1960 s Issels fought an d won a long legal battle against false charge s of manslaughte r an d frau d tha t hi s biographe r Gordo n Thoma s (1975 ) argues were brought about by the German Cance r Society and the Bavarian Medical Association. Issels s license was never revoked, and after th e hospital closed in 197 3 he continue d t o treat patients o n a n outpatient basis until his retirement i n 1987 . From 198 1 to 198 7 he serve d a s an exper t membe r o f the Germa n federal governmen t commissio n i n the fight agains t cancer. H e retired t o Florida , wher e ther e i s a clinic tha t use s some Issels-base d meth ods, bu t withi n th e confine s o f American law , t o trea t patient s o f chroni c diseases. I n 199 6 h e accepte d a n affiliatio n wit h th e Gerso n Researc h Organization, an d thi s ne w relationshi p promise s t o brin g hi s insight s t o the clinica l practic e o f th e affiliate d Centr o Hospitalari o Internaciona l Pacifico, SA , i n Tijuana . I spok e wit h Issel s briefl y a t th e meetin g o f th e Cancer Contro l Societ y i n 1996 , and h e reiterate d hi s belief in th e impor tance of mycoplasma as contributing agent s in cance r pathology.

French Mandarins In Franc e researc h o n th e possibl e etiologica l rol e o f bacteri a i n cance r dated bac k t o th e lat e nineteent h century . Probabl y th e mos t well-know n early wor k i s tha t o f Eugen e Doyen , a prominent Frenc h surgeo n a t th e Hospital o f Paris. A t th e tur n o f the centur y Doye n defende d hi s researc h on th e microbia l theor y an d th e efficac y o f a seru m befor e a committe e drawn fro m th e Pasteu r Institut e an d th e Societ e d e Chirurgie . Althoug h the committee turned in a positive report o n his work on the organism tha t he name d Micrococcus neqformans, researcher s i n Britai n criticize d Doyen s work severel y an d ultimatel y i t wa s rejecte d (Boesc h i960) . Severa l othe r French researcher s supporte d th e bacteria l theory , includin g Gustav e Rap pin (1939) , th e directo r o f th e Pasteu r Institut e o f Nantes , wh o fo r mor e than a half centur y studie d "th e presenc e o f granular form s o f a microbial nature in cancerou s cells " (Villequez 1969 : 26). This sectio n wil l focu s o n mor e recen t example s o f Frenc h researc h guided b y th e genera l microbia l theor y o f cancer : th e wor k o f Ernes t

Germ Warfare \ 4 3 Villequez an d Gasto n Naessens . T h e Dijon-base d professo r an d medica l researcher Ernes t Villeque z ha s alread y bee n mentione d a s integrate d int o the post—Worl d Wa r I I internationa l researc h network . Hi s wor k i s particu larly interestin g fro m a social-scienc e perspectiv e becaus e h e lef t behin d a record o f th e intellectua l suppressio n tha t h e faced . I n hi s boo k Human Cancer: The Forbidden Study, publishe d i n th e wak e o f th e event s o f 1968 , Villequez no t onl y defende d hi s researc h bu t als o analyze d an d condemne d the cance r researc h communit y i n hi s country . Unlik e simila r critique s o f cancer researc h i n th e Unite d States , whic h generall y hav e focuse d o n corruption b y economi c interests , Villeque z focuse d hi s critiqu e o n th e centralized natur e o f th e Frenc h researc h syste m an d th e stiflin g conservat ivism o f the "mandarins." 3 6 According t o Villequez , th e en d o f the nineteent h centur y wa s a "perio d of great hope s place d o n th e possibl e proo f o f a microbial origi n o f cancer " (1969: 25). He argue s tha t medica l consensu s shifte d awa y from th e bacteria l etiology becaus e th e numerou s late-nineteenth-centur y studie s ha d foun d diverse microorganism s (bacilli , cocci , o r microscopi c fungi) . A s h e c o m ments, "Thes e disparat e an d contradictor y observation s suggeste d tha t th e results wer e th e produc t o f accidenta l contaminations " (35) . T h e renewe d acceptance o f bacterial pleomorphis m afte r th e tur n o f th e centur y mad e i t easier t o reconcil e thes e divers e observation s wit h a theor y o f microbia l etiology, bu t b y the n man y cance r researcher s ha d close d th e doo r t o th e theory. Furthermore , afte r Japanes e scientist s demonstrate d th e rol e o f chemicals a s cancer-causin g agent s i n 1916 , opinio n shifte d eve n furthe r away fro m microbia l research , wit h th e exceptio n o f th e occasiona l studie s on viruse s (26) . Anothe r facto r tha t Villeque z argue s "contribute d t o th e systematic demis e o f th e infectiou s theory " wa s th e creatio n o f the researc h institutes a t th e beginnin g o f th e centur y (35) . I n th e institutes , " T h e training o f th e leader s o f oncolog y di d no t involv e laborator y studie s i n infectious pathology , whic h mean t tha t withou t a doubt the y were deflecte d from enterin g int o a strang e terrai n tha t the y foun d difficul t t o exploit " (35). T h e resultin g climat e o f opinio n i n Franc e was , accordin g t o Villequez , the "dogma " o f th e bacteria l sterilit y o f th e bloo d an d o f tumor s amon g French cance r researchers . "Thi s perfec t academi c an d professiona l igno rance leads t o a prohibition (t o avoi d losing time ) o f studies an d publication s contrary t o th e orthodo x teaching " (1969 : 39) . Villeque z add s tha t o n repeated occasion s hematologist s gav e hi s presentation s a ston y reception . "My presentation s wer e merel y morphological ; i n othe r word s the y wer e

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limited simpl y t o visibl e thing s tha t hadn' t bee n see n before , bu t i t appeare d so fantasti c t o the m tha t I migh t a s well hav e bee n describin g th e detail s o f the flora o f anothe r planet " (40) . Editor s o f journals als o refuse d t o publis h his wor k ove r a perio d o f thre e decades , an d conference s tha t h e an d colleagues hel d o n th e microbiolog y o f cance r i n 1958 , 1959 , an d i96 0 i n Belgium an d Franc e resulte d i n a situatio n i n whic h "non e o f th e invite d medical figure s attende d th e assemblies " (15) . As a result, thei r effort s wer e abandoned (123) . French medica l opinio n als o hardene d a s a resul t o f tw o ver y visibl e events: th e Loren z an d Naessen s trials . F . W . Loren z wa s th e secretar y o f von Brehme r w h o becam e hi s student. W h e n th e tow n wher e the y worked , Badkreuznach, fel l unde r Frenc h occupatio n a t th e en d o f th e war , Loren z moved t o Paris , too k wit h hi m som e bacteria l sample s fro m vo n Brehme r s laboratory, an d use d thos e sample s t o mak e a cance r vaccine . A s Villeque z writes, "Vo n Brehme r prosecute d Loren z throug h th e cour t o f th e Sein e not onl y ou t o f ange r . . . bu t als o becaus e h e hope d tha t th e tria l woul d involve Frenc h scientifi c interes t an d therefor e awake n interes t i n hi s work " (1969: 46) . I n August , 1948 , a committe e o f expert s wa s designated , an d i n 1951 the y mad e publi c thei r negativ e conclusions : 1 ) tha t Siphonospora polymorpha (vo n Brehmer' s nam e fo r th e cancer-causin g microorganism ) was produce d b y a "metho d o f coloratio n tha t i s persona l t o th e researc h and tha t produce s th e appearanc e o f littl e motil e particles" ; 2 ) tha t "i f Siphonosopora polymorpha existed , i t woul d hav e bee n hug e i n th e elec tron microscop e tha t wa s used" ; 3 ) "th e culture s o f Siphonospora polymorpha are merel y c o m m o n air-born e germs " (47) . A pres s releas e fro m th e Minis try o f Healt h informe d th e publi c tha t th e affai r wa s close d (48) . M.-E . Richier-Chevrel (1951) , a medica l studen t i n Paris , defende d a thesi s o n Lorenz an d o n th e nee d fo r toughe r law s i n Franc e t o comba t charlatanis m (49). Becaus e Loren z wa s neithe r a medica l docto r no r a scientist , bu t h e claimed th e titl e o f medica l docto r w h e n h e cam e t o Paris , h e wa s clearl y engaged i n fraudulen t activit y (50) . However , vo n Brehme r als o becam e associated wit h th e charlatanism , particularl y i n pres s account s o f th e "phantom bacteria " (50) . I n repl y t o criticism s o f hi s work , vo n Brehme r wrote a lette r t o th e edito r o f Ce Matin i n 1952 , bu t th e lette r wen t unpublished an d hi s wor k rapidl y passe d int o obscurit y afte r hi s deat h i n 1958 (45 , 50) . Villequez contend s tha t ther e wer e technica l error s i n th e wor k o f bot h the exper t committe e an d th e thesis . I n December , 1951 , he me t wit h on e of th e expert s an d explaine d th e technique s use d t o cultur e pleomorphi c

Germ Warfare | 4 5 bacteria, an d h e conclude d tha t th e studie s wer e conducte d i n a manne r that wa s neithe r rigorou s enoug h t o avoi d contaminatio n no r methodologi cally appropriat e fo r th e stud y o f pleomorphic bacteri a (1969 : 48) . Regard ing th e thesi s h e pointe d ou t som e technica l error s tha t th e studen t made . These include d th e failur e t o maintai n rigorousl y steril e procedure s w h e n drawing bloo d an d als o th e failur e t o maintai n rigorousl y anaerobi c condi tions i n th e bacteria l culture s (52) . Furthermore , h e note d tha t eve n i f th e germs wer e no t du e t o contamination , th e fac t tha t the y wer e c o m m o n germs di d no t mea n tha t the y ha d n o rol e i n th e cance r process . T h e nex t question h e aske d woul d tur n ou t t o b e centra l fo r th e surviva l o f th e bacterial etiolog y theory . "Why, " h e asked , "can' t a c o m m o n germ , i n certain specie s o f it s grou p an d unde r certai n conditions , becom e a n agen t of carcinogenesis ? Cance r researc h suggest s tha t on e accept s th e postulat e of th e interventio n o f diffus e parasite s tha t exis t i n th e organis m i n a laten t state" (52) . Althoug h thi s argumen t ma y see m lik e a n auxiliar y hypothesi s maneuver, i t wil l prov e centra l i n th e subsequen t molecula r biolog y studie s of bacteria fro m cance r samples . In th e generatio n subsequen t t o Villequez , Gasto n Naessen s i s probabl y the best-know n Frenc h researche r t o suppor t th e theor y tha t a pleomorphi c microorganism play s a role i n th e etiolog y o f cancer. Naessen s gre w u p nea r Lille, a norther n cit y tha t i s know n i n th e histor y o f microbiolog y a s th e place wher e Antoin e Becham p taught . Becham p wa s a n advocat e o f a n extreme for m o f bacteria l pleomorphism , an d althoug h Naessen s di d no t become awar e o f Bechamp' s wor k unti l late r i n life , h e probabl y wa s exposed t o tha t lin e o f thinkin g i n hi s colleg e studie s i n scienc e a t th e University o f Lille . Durin g th e Naz i occupation , Naessen s continue d hi s college educatio n i n souther n Franc e amon g displace d professor s fro m Lille . Born int o a famil y o f bankers , h e ha d th e luxur y t o pursu e hi s inventions . Having worke d i n a laborator y fo r bloo d analysis , h e becam e intereste d i n blood parasitology , an d h e invente d a darkfield microscop e tha t use d prism s and laser-beam s t o obtai n hig h level s o f magnification . Althoug h th e tech nology i s differen t fro m tha t o f th e Rif e microscope , Naessen s als o claime d to achiev e hig h level s o f magnificatio n an d resolution . T h e highe r level s o f magnification an d th e darkfiel d technolog y allowe d hi m t o observ e th e smaller, viruslik e phas e o f wha t h e claim s i s a sixteen-stage , pleomorphi c microbial bloo d cycle . Like Villeque z an d th e Germans , h e sa w th e microb e as par t o f th e natura l flor a o f th e bloo d tha t probabl y pla y a n essentia l role i n growt h an d reproduction , perhap s b y producin g necessar y growt h hormones. Naessen s believe s tha t w h e n th e immun e syste m i s compro -

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mised an d "bloo d inhibitors " ar e no t present , th e microb e ca n g o int o extended, funguslik e phases . W h e n I interviewe d hi m a t hi s h o m e i n Quebec, h e explaine d tha t h e think s o f th e "somatid " cycl e a s primaril y diagnostic o f chroni c o r advance d diseases , bu t h e als o believe s tha t i n th e advanced stage s o f th e somati d cycl e exces s growt h hormone s ar e release d that ma y contribut e t o cancer . Although Naessen s toda y i s awar e o f th e entir e researc h traditio n out lined i n thi s chapter , accordin g t o Villeque z h e wa s a novic e w h e n i n i96 0 he attende d th e Internationa l Congres s o f Microbiologists an d Clinician s o f Cancer an d Leukemia , fo r whic h Villeque z wa s th e keynot e speake r (Vil lequez 1969 : 53 , 104) . H e apparentl y disagree d wit h Naessen s o n som e aspects o f hi s research ; fo r example , Villeque z argue d tha t th e microphoto graphs mad e b y Naessen s involve d misinterpretation s o f funga l filament s (58). Nevertheless , Villeque z testifie d i n favo r o f th e bacteria l theor y o f cancer a t Naessen s s trial i n th e earl y 1960 s (58) . Naessens wa s trie d fo r hi s us e o f Anablast, a n anticance r seru m that , lik e the Glove r an d Doye n sera , wa s develope d fro m a hors e injecte d wit h bacteria culture d fro m th e bloo d o f cance r patient s (Villeque z 1969 : 53). 37 Years late r patient s w h o attribute d thei r cur e t o Anablas t cam e t o hi s defense. However , Naessen s wa s no t a doctor , no r di d h e repor t hi s result s in a medical journal. H e therefor e occupie d a position a s an outside r t o th e medical establishmen t an d wa s particularl y vulnerabl e t o suppression . T h e result o f th e tria l fo r illega l exercis e o f medicin e an d pharmac y wa s tha t Naessens wa s fined , hi s laborator y wa s closed , an d muc h o f hi s equipmen t (but no t hi s microscope ) wa s confiscated . To pursu e hi s wor k withou t interference , Naessen s move d t o Corsica . However, wor d sprea d o f hi s whereabout s an d soo n h e wa s invade d b y hundreds o f patients. T h e Frenc h medica l authoritie s bega n a n investigatio n that le d t o anothe r tria l i n 1965 . Meanwhile , h e ha d relocate d t o Quebec , where h e develope d anothe r anticance r drug , 714-X , th e on e tha t i s no w best know n i n th e alternativ e cance r therapie s movemen t toda y an d t o some exten t i n th e AID S movement . T h e dru g affixe s nitroge n atom s t o camphor molecules . Naessen s reason s tha t becaus e cance r cell s ar e nitroge n traps an d becaus e campho r i s attracted t o cance r cells , th e dru g provide s th e cancer cell s wit h th e necessar y nitroge n tha t woul d b e robbe d fro m health y cells. I n th e process , th e immun e syste m i s abl e t o recove r t o th e poin t where i t ca n the n destro y th e cance r cells . T h e toxicit y o f campho r ma y also b e a contributin g factor . In 1985 , th e Quebe c Medica l Corporatio n prodde d th e governmen t

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into indictin g Naessens, and he went t o tria l in 1989 . The charge s include d murder, an d th e potentia l sentenc e wa s life imprisonment . H e ha d treate d a terminall y il l patien t wh o ha d aske d hi m t o trea t her , bu t accordin g t o Naessens he r cance r wa s to o advance d an d ther e wa s not enoug h tim e fo r his treatment t o work. (Th e trial is described in detail in The Persecution and Trial of Gaston Naessens, by journalist/writer Christophe r Bird.) In a surprise event for alternativ e cance r therapies, Naessens won th e trial. The prosecu tion brough t i n male , scientifi c expert s wh o questione d Naessen s s theor y of a pleomorphic microbia l cycl e in the human blood. Th e defens e focuse d on th e therap y rathe r tha n th e theory , an d it brought a s witnesses men an d women fro m al l walk s o f life , includin g som e leader s o f Quebe c society . Many o f th e witnesse s fo r th e defens e state d tha t the y owe d thei r lif e t o Naessens, an d th e jur y swun g i n thei r favor . Althoug h Naessen s i s no w very carefu l no t t o prescrib e o r administe r 714-X , th e Canadia n govern ment allows the drug to be administered under special permission. Request s for th e dru g hav e been hig h durin g th e 1990s , and Naessen s s laboratory i s apparently busy with it s ongoing work o f blood analysis.

Concluding Comments By examinin g th e mos t well-know n case s i n severa l countries , i t i s no w possible t o dra w som e conclusion s abou t th e histor y o f suppressio n o f bacterial theorie s an d therapie s fo r cancer . First , th e detail s o f th e case s suggest tha t th e experienc e o f th e researcher s an d clinician s wa s b y n o means uniform . I n Bria n Martin' s terms , ther e i s a slidin g scal e o f event s between intellectua l suppressio n an d repression , tha t is , betwee n margin alizing techniques an d the us e of extralegal violence (Marti n e t al. 1986 :2 — 3). In general, researchers tended to experience milder problems of suppression suc h a s overcoming gatekeepin g hurdle s o r loss o f academic positions . In contrast , thos e wh o wen t o n t o produc e an d us e clinica l products face d legal challenges and, i n some cases , extralegal repression. I n Nazi Germany , where th e lega l syste m becam e subverte d t o a dictatorship , th e attack s o n the unorthodo x clinician s di d no t nee d t o remai n withi n th e lega l system , but i n th e Unite d State s ther e wer e als o instance s o f apparentl y extralega l repression, suc h a s in th e Rif e case . I n othe r words , ther e wa s a rang e o f responses t o th e bacteria l etiolog y theor y i n it s divers e variants : th e initia l enthusiasm tha t greete d th e Glove r serum , th e gatekeepin g an d cognitiv e cronyism tha t was Villequezs majo r complaint , th e bureaucratic roadblock s

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that Glove r experienced , th e diversio n o f funding tha t Livingsto n experi enced, lega l proceeding s tha t i n som e case s represente d a legitimat e stat e interest i n preventin g th e illega l practic e o f medicin e (a s i n th e Loren z case), more obviously rigged legal prosecution in which interested segment s of the societ y subverte d th e principl e o f equal justice (a s in th e Rif e case) , and case s of extralegal repression, suc h as the claim s of violent repressio n i n the Rife case . For thos e familia r wit h th e histor y o f alternative medicine , th e rang e o f suppression an d repressio n tha t I a m describin g wil l com e a s n o surprise . The contemporar y conflict s hav e thei r parallel s i n th e struggle s betwee n the allopath s an d empirick s i n th e nineteent h centur y (Coulte r 1987) . I n the twentiet h century , th e conflict s continue d i n th e for m o f professional ized, state-sanctione d medica l societie s versu s a wide variet y o f alternativ e medical practitioners . I n som e cases , suc h a s osteopathy , th e resolutio n o f the conflic t ha s been throug h incorporation , wherea s i n other s i t ha s bee n through lega l recognitio n o f a paralle l practice , a s i n chiropracti c (Bae r 1987, 1989) . Th e proble m tha t no w emerge s i s t o develo p a sophisticate d explanation o f why th e nonvira l microbia l theorie s an d therapie s o f cance r met wit h suc h hostility , rathe r tha n bein g simpl y ignored , enthusiasticall y accepted, o r cu t dow n t o siz e an d incorporate d a s occurre d wit h vira l oncology.

3 Culture an d Powe r i n Cancer Researc h

Reconstructing Interest Theory W h a t i s a goo d explanatio n o f th e patter n o f suppressio n tha t occurre d fo r those scientist s an d clinician s w h o advocate d th e microbia l approac h t o cancer? Withi n alternativ e medica l circle s toda y th e standar d explanatio n i s that th e emergin g cance r establishmen t wa s corrupte d b y financia l interests . This approac h i s applied generall y t o explai n a wide rang e o f suppression o f alternative cance r therapies , an d i t ha s a stron g rhetorica l appeal . B y point ing t o th e financia l interest s tha t shap e th e cance r establishment , critic s o f the medical-pharmaceutica l comple x pain t alternativ e medicin e advocate s as th e rational , heroi c underdog s i n th e struggl e fo r truth , justice , an d th e very America n valu e o f medica l freedom . I n contrast , member s o f th e cancer establishmen t becom e a t bes t cog s i n a machiner y the y d o no t eve n understand an d a t wors t par t o f a more-or-les s consciou s conspirac y o f powerful, materia l interests . A s I hav e show n i n previou s research , pinnin g material interes t motive s o n one s opponent s ca n b e a sourc e o f grea t rhetorical powe r i n publi c debate s (Hes s 1993) . T h e powe r i s s o grea t tha t both side s ten d t o tr y thi s strategy . Thus , rhetoric s o f money-grubbin g doctors ge t paire d of f agains t thos e o f money-grubbin g quacks , an d expla nations o f wh y th e suppressio n occurre d becom e mer e caricature s o f goo d social science . Where doe s on e loo k fo r a n alternativ e explanator y framewor k tha t doe s not jettiso n th e basi c insigh t tha t materia l interest s wer e involved ? I n th e interdisciplinary scienc e an d technolog y studie s (STS ) literature , interes t theory wa s a popular approac h fo r th e socia l studie s o f scientifi c controver sies durin g th e lat e 1970s . However , th e theor y fel l ou t o f favor i n th e earl y 1980s afte r a serie s o f ver y shar p criticisms. 1 T h e intellectua l justificatio n for th e abandonmen t o f interes t theor y i s tha t i t tend s t o flatte n scientist s into unidimensiona l beings ; i n othe r words , scientist s ar e portraye d a s

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"interest dopes." Although th e criticism s of interest theory pointed to som e serious problem s tha t neede d t o b e addressed , th e propose d alternativ e viewed interest s a s somethin g tha t scientist s produce d b y makin g other s "interested" i n thei r wor k (e.g. , Callo n an d La w 1982 ; Latou r 1988) . Unfortunately, thi s alternativ e tend s t o inver t th e pictur e b y turnin g inter ested socia l group s int o scientis t dopes . Th e alternativ e therefor e lose s th e original insigh t tha t powerfu l professiona l an d financia l group s ca n pla y a n active rol e i n restrictin g whic h knowledge s mak e i t ont o th e playin g field s of consensus science . Th e histor y o f alternative cance r theorie s an d thera pies represent s a goo d reaso n fo r revisitin g interes t theory , becaus e i t i s difficult t o writ e tha t histor y withou t referrin g t o th e activ e rol e tha t interests pla y i n th e suppressio n o f som e researcher s an d therapies . T o my mind, th e solutio n t o th e proble m wit h interes t theor y i s no t t o dismis s economic an d professiona l interest s a s shaping variable s i n th e explanatio n of scientifi c controversies , bu t t o fin d a bette r wa y o f thinkin g abou t interests. Thus, I advocate neither th e widespread an d almost unquestioned us e of interests explanations that appears sometimes in the alternative cancer literature no r th e opposit e extrem e o f much o f science-and-technology studies , which afte r th e earl y 1980 s tende d t o dro p interes t theory . Thi s chapte r therefore ha s a doubl e import : expandin g th e sociocultura l understandin g of the politics of cancer research, and showing how the cultur e concep t ca n make interest s explanation s mor e sophisticated . M y goa l i s t o explai n th e suppression o f th e microbia l theories , bu t no t b y reducin g th e medica l profession t o a sociological puppet . Rather , I will show ho w scientists , th e medical profession , industria l groups , an d s o o n defin e thei r interest s i n diverse intellectual, professional, gender , national , an d scientific cultures .

The Culture of Orthodox Cancer Research A sophisticate d us e o f interest theor y woul d b e directe d towar d explainin g not individua l historica l case s o f intellectua l suppression , bu t instea d th e fact tha t a n entire researc h traditio n became s o heterodox tha t it s advocate s faced sever e suppression . I n othe r words , th e large r proble m i s t o explai n the historica l emergenc e o f th e genera l contour s o f a cance r researc h culture. I n the United States , this culture congeale d aroun d key people an d institutions, suc h a s James Ewin g an d Corneliu s Rhoad s o f wha t i s toda y called th e Memoria l Sloan-Ketterin g Cance r Center , Franci s Woo d o f

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Columbia, Morri s Fishbei n o f th e AMA , an d Howar d Kell y o f John s Hopkins. B y th e 1930 s an d 1940 s th e consensu s becam e institutionalize d through organizations such as the National Cance r Institut e and the American Cance r Society . Ralp h Mos s (1989) , who develop s a sophisticated us e of interest theory, describe s this confluence o f people and institutions a s the "the cance r industry" : th e America n Cance r Society , th e Nationa l Cance r Institute, th e majo r cance r hospitals , pharmaceutica l companies , an d th e medical profession . At it s inceptio n i n th e 1930 s an d 1940s , th e Nationa l Cance r Institut e began directin g researc h awa y fro m th e infectiou s theor y i n genera l an d bacterial researc h i n particular . Accordin g t o ST S analyst s Kennet h Stude r and Dary l Chubin , whe n th e NC I wa s forme d th e surgeo n genera l ap pointed a committee t o outlin e th e typ e o f research tha t th e ne w institut e would b e doing . Th e committe e resolve d tha t mammalia n cance r wa s no t infectious an d tha t viruse s were amon g th e etiologica l agent s tha t coul d b e disregarded. A s Stude r an d Chubi n comment , th e NC I founder s "kne w what the y di d no t like—viruses—an d thi s n o doub t influenced , throug h funding o f researc h a t majo r universities , th e energ y expende d o n th e discovery o f new oncogeni c viruses" (1980 : 25). Studer an d Chubi n sugges t tha t th e foundin g o f th e NC I wa s a n im portant facto r i n th e "grea t slowdown " o f viru s researc h tha t occurre d during thi s perio d (1980 : 21) . Thi s vie w i s echoe d i n a commen t fro m Ludwik Gross , a leading tumor virologist : "I n th e 1930 s and 1940 s a young scientist applyin g fo r a grant t o carr y ou t a research projec t i n th e fiel d o f tumor-inducing viruses was faced with considerable difficulties i n obtainin g a plac e t o wor k o r sufficien t fund s t o carr y ou t hi s studies " (1983 : 1086) . Likewise, medica l historia n James Patterso n add s that th e six-membe r Na tional Advisory Cance r Counci l o f the NCI—th e grou p tha t gav e Glove r so much trouble with his publication plans—included majo r cance r insiders such a s James Ewing, who pushed researc h toward major centers , includin g Memorial Hospita l (1987 : 131—35) . Patterso n note s tha t tumo r virologis t Peyton Rou s complaine d abou t th e in-grou p tha t dominate d th e NCI , and, "observing the interest in the NCI o f drug companies and of manufacturers o f X-ray machines , h e note d tha t 'th e gun s o f the powerfu l labora tories ru n b y th e electri c an d engineerin g companie s a t onc e bega n t o say, "Boom ! Boom! ' " " (1987 : 130) . Th e counci l als o include d Woo d o f Columbia, wh o worke d t o discredi t Glove r an d wrote o f bacterial theorie s that they had "alway s been th e darlin g of crackpots an d dabblers" (98). Another organizatio n tha t becam e a n integra l par t o f th e cance r estab -

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lishment was the American Cance r Societ y (1966 , 1990) . Although Living ston originall y receive d som e suppor t fro m th e organization , he r therap y ended u p o n it s list o f unconventional cance r therapies , a s did man y othe r alternative therapies . Th e AC S i s merely a private organizatio n an d i t ha s no officia l mandat e from th e U.S. government o r the American people, bu t still it s position s hav e ha d a grea t impac t o n th e federa l government . A s Moss (1989) documented, therapie s that end up on its list of unconventional therapies usuall y canno t get approva l from th e Foo d an d Drug Administra tion an d instead suffe r FD A suppression. Furthermore , th e researc h priori ties o f the ACS hav e an impact o n th e muc h large r funding flow s fro m th e NCI, s o muc h s o tha t th e AC S ha s sometime s bee n calle d th e "tai l tha t wags th e dog. " Economist s James Bennet t an d Thoma s DiLorenz o (1994 ) demonstrated tha t th e AC S an d othe r larg e healt h charitie s ten d t o fun d within th e network s associate d wit h thei r boards ; i n th e cas e o f th e AC S the board includes many members from th e major cance r research organiza tions. Th e in-grou p natur e o f th e fundin g proces s an d pee r revie w fo r cancer research makes it difficult fo r outsider s to break into th e system . To summarize , b y th e middl e decade s o f th e twentiet h centur y i n th e United State s a cancer research community emerge d within the larger arena of th e medica l professio n an d biomedica l researc h science . Thi s cance r research communit y congeale d unde r th e leadershi p o f a fairl y close-kni t "cancer establishment " tha t b y th e 1950 s an d 1960 s include d th e majo r research hospitals , th e NCI , an d th e ACS , wit h suppor t from th e FDA . The establishmen t cance r communit y maintaine d tha t cance r wa s no t a n infectious disease , a t leas t fo r th e vas t majorit y o f human cancers . Rather , cancer aros e fro m a variet y o f othe r factors , o f whic h th e firs t t o b e documented wer e hereditary predisposition an d chemical carcinogens . The consensu s o f th e cance r researc h communit y i n th e Unite d State s took tw o forms: a consensu s o n etiolog y an d a consensu s o n therapy . A t the 192 6 conferenc e i n Lak e Mohonk , Ne w York—th e on e tha t Cole y attended an d described—the majo r cause s of cancer being considered were local trauma, heredity , an d chroni c irritation . I n othe r words , by th e 1920 s the infectiou s theor y ha d alread y bee n marginalized . B y th e 1980 s an d 1990s heredit y continue d t o occup y a n importan t plac e i n th e consensu s knowledge o f cance r etiology , bu t environmenta l factor s suc h a s chroni c irritation an d loca l traum a ha d give n wa y t o diet , smoking , an d sexual / reproductive behavior as major environmenta l an d lifestyle cause s of cancer. Although ther e wa s a lac k o f suppor t fo r vira l oncolog y durin g th e formative decade s o f th e NCI , vira l oncologist s slowl y amasse d a larg e

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number o f studie s tha t linke d som e anima l cancer s t o viruses . I n th e 1960s , after th e developmen t o f th e poli o vaccines , vira l researc h returne d a s a priority i n th e N C I researc h agend a (Wad e 1971) . However , b y thi s poin t viruses wer e viewe d a s possibl e etiologica l agent s onl y fo r a fe w type s o f human cancer . Furthermore , th e NCI' s Viru s Cance r Progra m becam e controversial b y th e earl y 1970s , i n par t du e t o it s exclusiv e clu b qualit y (Rettig 1977 ; Cullito n 1974) . A s ST S analys t Joan Fujimur a (1995 ) argues , the proto-oncogen e theor y provide d a justification fo r expenditure s o n th e viral researc h program , becaus e vira l oncogene s no t associate d wit h huma n cancers wer e show n t o hav e homolog s i n huma n proto-oncogenes . T h e proto-oncogene theor y therefor e move d vira l oncolog y int o th e cente r o f consensus cance r research , albei t unde r th e encompassin g win g o f a genera l molecular-biology researc h program . O n th e therapeuti c side , a simila r consensu s emerge d i n th e cance r research communit y tha t develope d fro m th e earl y twentiet h centur y e m phasis o n surger y wit h adjuvan t radiotherapy . A s occurre d wit h theorie s o f the caus e o f cancer , b y th e 1980 s an d 1990 s th e lis t o f accepte d therapie s among mainstrea m cance r researcher s i n th e Unite d State s was considerabl y more diverse . Chemotherap y an d hormona l therap y ha d com e t o occup y an important par t o f mainstream cance r therapies , an d mor e recentl y hyper thermia an d specifi c immunotherapie s achieve d som e acceptance . Eve n some nonspecifi c immunotherapie s tha t use d bacteria , suc h a s Coley' s toxins o r th e B C G tuberculosi s vaccine , ha d achieve d a modicum o f recog nition amon g immunotherapist s an d som e limite d testing . However , thera pies tha t wer e explicitl y base d o n th e bacterial-etiolog y theory , suc h a s Glovers seru m an d Livingston' s vaccines , wer e no t eve n withi n th e horizo n of consideration , an d man y othe r alternatives—includin g severa l nutri tional an d metaboli c therapie s wit h som e experimenta l an d clinica l dat a t o support t h e m — c o n t i n u e d t o b e suppressed . This brie f sketc h i s sufficien t t o mak e th e poin t tha t mainstrea m cance r research i s no t a monolith . It s theorie s an d therapie s change d substantiall y over tim e ami d numerou s an d intens e interna l controversies . Fo r example , for a long tim e smokin g wa s no t considere d a n importan t caus e o f cancer , and toda y a simila r debat e ha s erupte d ove r epidemiologica l studie s tha t suggest tha t chemica l carcinogen s an d pollutio n hav e bee n greatl y underes timated a s ris k factors . Ye t beyon d th e interna l controversie s ther e i s a n unquestioned se t o f assumptions—th e dox a or , i n th e term s o f philosophe r Imre Lakato s (1978) , th e har d cor e o f th e researc h program—tha t include s the theor y tha t huma n cance r is , for th e mos t part , no t a n infectiou s disease .

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Stated positively , cance r researc h toda y ha s increasingl y com e unde r th e encompassing win g o f th e molecular-biolog y researc h program . Fro m thi s perspective, cance r i s the outcom e o f a mutagenic proces s base d o n multipl e hits t o th e D N A , a proces s tha t allow s researc h program s o n heredity , viruses, an d chemica l carcinogen s t o coexis t peacefull y ami d researc h o n other promotin g factor s suc h a s hormones . Withi n thi s se t o f assumptions , viruses ar e see n a s relatively unimportan t fo r th e majo r huma n cancers , an d bacteria ar e see n onl y a s opportunistic infection s tha t pla y n o rol e i n tumo r genesis o r promotion . Together , thes e assumption s for m th e intellectua l core o f th e moder n cultur e o f cance r research . To describ e mainstrea m cance r researc h a s havin g a cultur e doe s no t imply tha t th e cultur e i s a n unscientifi c on e tha t canno t b e justifie d wit h sound arguments . A s advocate s o f th e infectiou s theor y o f cance r realized , they suffere d fro m studie s i n th e 1890 s an d int o th e firs t year s o f th e twentieth centur y tha t unsuccessfull y attempte d t o cultur e bacteri a fro m malignant tissue s (Glove r an d Engl e 1938 : 9; Villequez 1969) . Furthermore , the studie s tha t di d cultur e bacteri a o r fung i di d no t isolat e a specific , unique organis m a s i n th e cas e o f othe r bacteria l diseases , an d th e tech niques require d fo r successfull y culturin g th e purported cance r microorgan isms wer e no t widel y enoug h diffuse d t o mak e replicatio n easy . Therefore , the theor y tha t bacteria l culture s fro m cance r tissue s wer e onl y contami nants wa s a reasonable interpretatio n o f th e inconsistencie s o f th e data . Furthermore, durin g th e firs t decade s o f th e twentiet h century , researc h pointed t o th e noninfectiou s cause s o f cancer . Fo r centurie s th e correlatio n of scrota l cance r an d chimne y sweep s ha d bee n known , an d thu s chemica l carcinogenesis wa s b y n o mean s a ne w idea . A fe w year s afte r th e tur n o f the centur y th e theor y receive d ne w impetu s w h e n Toky o Universit y researchers Katsusabur o Yamagiw a an d Koich i Ichikaw a (1916 ) induce d cancer i n rabbit s b y applyin g coa l tar . I n th e nex t decad e Ernes t Kennawa y (1955) a t th e Roya l Cance r Hospita l i n Londo n produce d th e firs t chemica l carcinogens an d identifie d th e firs t chemica l carcinogen : 3,4-benzyrene . Another majo r developmen t wa s X-ra y an d radiu m therapy , whic h cam e into widesprea d us e durin g th e firs t decade s o f th e twentiet h centur y an d resulted i n man y case s o f radiation-induce d cancer s amon g health-car e professionals. B y th e 1920 s report s wer e als o showin g tha t patient s w h o received radiatio n treatmen t an d worker s w h o painte d radiatio n dial s o n clocks an d watche s wer e sufferin g fro m cancer s relate d t o thei r exposur e t o X-rays an d radium . Ye t anothe r developmen t b y th e 1920 s wa s th e experi mental researc h o n cance r i n mice , whic h provide d convincin g evidenc e

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for hereditar y factor s i n th e etiolog y o f cancer . Thus , a reasonabl e scientis t at tha t tim e coul d defen d a positio n tha t cance r wa s no t a n infectiou s disease. 2 Conversely, a reasonabl e scientis t w h o defende d infectiou s theorie s o f cancer coul d als o argu e tha t irritant s suc h a s coa l ta r mad e i t possibl e fo r latent viruse s o r othe r microorganism s t o becom e activ e (Gy e 1925a : 116) . In othe r words , soun d argument s coul d als o b e foun d t o justify th e theor y that cance r ma y b e a n infectiou s disease . Roughl y contemporar y wit h th e coal-tar studie s wer e th e firs t documente d vira l studie s o f cancer . I n th e first decad e o f th e twentiet h centur y scientist s foun d a virus tha t induce d a type o f leukemi a i n chickens , an d withi n th e nex t thre e year s thi s researc h was followe d b y th e wor k o f Peyto n R o u s an d Japanes e scientists , w h o demonstrated tha t viruses coul d caus e sarcoma s i n fowls. 3 T h e earl y researc h on viruse s focuse d o n nonmammalia n vertebrates , an d thi s account s fo r some o f th e lac k o f interes t i n vira l researc h durin g th e firs t decade s o f th e twentieth century . However , th e evidenc e continue d t o m o u n t ove r th e decades, an d som e tumo r virologist s continue d t o defen d th e theor y tha t many huma n cancer s hav e a vira l origi n an d ma y b e passe d o n b y vertica l transmission fro m parent s t o offsprin g (Gros s 1983 : 1003) . Although th e vira l studie s wer e keepin g th e doo r ope n t o infectiou s theories o f cancer , ther e i s als o som e evidenc e tha t th e virologist s wer e drawing boundarie s o f thei r ow n a s their fiel d wa s constituted . A t th e 192 5 annual meetin g o f th e Britis h Medica l Association , pathologis t Willia m Gye le d a discussio n o f hi s researc h o n cance r an d filter-passin g viruse s tha t carefully rule d ou t th e bacteria l theor y (Gy e 1925a , 1925b) . Althoug h h e noted tha t cocc i wer e usuall y present , h e referre d t o the m a s "contaminat ing" (1925 b : 189) . Regardin g th e bacteria l theory , h e wrote : Contaminations hav e been interpreted differently , however , by other authors; to some , especiall y i n th e fiel d o f cancer research , the y represen t a n interest ing phenomenon . Th e filterabl e viru s i s regarde d a s merel y a phas e i n th e life-history o f th e organism , th e contaminan t constitutin g a secon d phase . Taking thi s vie w an d disregardin g classica l doctrin e o f th e fixit y o f form o f bacteria—or a t least strainin g beyond justification th e fac t tha t variation s i n size and for m occur—suc h author s ar e no t deterre d fro m lumpin g togethe r as one organis m a mixture o f virus, cocci , and bacilli. The vie w seems to m e to be fantastic. (1925b : 191) William Crofton , a lecturer i n patholog y a t Universit y College , Dublin , criticized tha t interpretatio n an d th e empirica l clai m tha t th e tumo r virolo -

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gists ha d bee n unabl e t o cultur e bacteri a from cance r samples . Convince d that research o n the bacterial etiolog y theory was not gettin g a fair hearing , Crofton performe d experiment s tha t h e believe d replicate d th e work . However, h e coul d not interest eve n the tumor virologists. As he wrote: But in spite of the complet e satisfaction o f Koch's postulates in these cases, this work has had no better result on the minds of such workers as Murray, Gye, o r Lumsden than the original work of the Ley tons. It is very unfortu nate, an d ver y muc h t o b e deprecated . Gye— I shoul d hav e thought — would be interested, but he is obsessed with the virus theory of the workers for th e Medical Research Council— a sacrosanc t theor y to questio n which appears to be considered blasphemy. (1936: 117) This passage , togethe r wit h correspondenc e from Gy e t o Cole y tha t at tempted t o dissuad e Cole y fro m th e genera l microbia l theory , suggest s tha t Gye and other tumo r virologists were hostile to th e bacterial theory. How ever, ther e ma y hav e bee n exceptions . Fo r example , recal l tha t Livingsto n noted tha t whe n sh e discusse d he r researc h wit h Rous , h e wa s intereste d and, whe n the y reporte d tha t the y ha d grow n th e Rou s agen t i n artificia l media outsid e th e livin g cell , th e tumo r virologis t sai d "h e di d no t thin k this wa s unlikel y o r impossible " (Livingsto n 1984 : 79) . Thus , ther e wa s room fo r a range o f opinions amon g tumor virologists , an d some may have been relativel y ope n t o bacteria l an d funga l research . Nevertheless , th e virus an d th e bacteri a researcher s wer e no t necessaril y allies . As Crofton' s comments o n Gy e suggest , th e tumo r virologist s ma y hav e eve n see n th e bacterial researcher s a s competitor s wh o wer e discreditin g thei r alread y controversial position . Coley suggested a very different cours e for cance r research than the lines that i t wa s takin g i n th e 1920 s an d 1930s . Regardin g th e Lak e Mohon k conference i n 1926 , he wrote, "It was curious to note that o n the very page of one o f the leadin g dail y newspapers containin g report s o f the paper s o f Dr. Wood and Dr. Roussy in which they emphasized that, in their opinion , cancer canno t b e du e t o a ger m o r parasite , ther e appeare d a n articl e entitled: 'Cance r Parasite s Bred an d Observe d unde r Microscope ' " (1926 : 224). Cole y the n describe d th e wor k o f scientist s i n Berli n wh o reporte d before a German scientifi c congres s that they had isolated a cancer microb e and ha d use d i t t o produc e cance r i n animals . Regardin g th e researc h program tha t h e sa w bein g rule d ou t a t th e Lak e Mohon k conference , Coley wrote, "Unti l i t is settled beyond th e shado w o f doubt tha t cance r is not du e t o a microorganism, w e believ e tha t ever y effor t shoul d b e mad e

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to stimulat e t o th e utmos t cance r researc h alon g thes e line s rathe r tha n t o attempt t o hinde r o r t o discredi t it " (1926 : 224) . H e the n warned , i n passages tha t coul d b e spoke n toda y wit h littl e change , tha t ther e wa s dangerously slo w progres s i n th e contro l o f cance r an d a n apparen t increas e in cance r rates . Foreseeing epidemiologica l advance s tha t wer e no t achieve d unti l de cades later , Cole y als o calle d o n th e America n Cance r Societ y (the n th e American Societ y fo r th e Contro l o f Cancer ) t o conduc t comparativ e epidemiological studies , particularl y o f diet . H e note d tha t Sout h Asian s had relativel y lo w rate s o f cance r bu t tha t thes e rate s increase d w h e n the y adopted th e habit s an d die t o f th e English , an d h e suggeste d tha t ther e might b e som e biochemica l facto r i n th e die t tha t "woul d b e o f grea t valu e in th e preventio n i f no t th e cur e o f th e disease " (225) . I n othe r paper s published o n th e "proble m o f cance r control, " Cole y als o defende d th e microbial theor y an d th e nee d fo r mor e researc h o n epidemiolog y an d die t (Coley 1928 , 1931) . W h y di d researcher s an d organization s no t follo w Cole y s suggestions o n possible dietar y an d infectiou s etiologies ? W h y di d the y no t follo w u p o n the man y report s durin g th e firs t decade s o f th e twentiet h centur y tha t suggested a vira l o r bacteria l etiology , o r both ? T o argu e tha t th e earl y cancer researcher s coul d justify thei r choic e o f a noninfectiou s theor y wit h sound argument s misse s th e point ; the y coul d hav e als o justified a choice i n favor o f mor e researc h unde r a viral, bacterial , o r genera l microbia l theor y as well a s therapeutic studie s o f vaccines an d diet . O n e migh t argu e tha t th e advocates o f the infectiou s theorie s wer e poorl y organized , ba d a t enrollin g alHes, and , t o us e everyda y parlance , jus t plai n lous y a t marketin g thei r research. The y shoul d hav e bee n abl e t o interes t th e leader s o f th e medica l profession an d captur e th e emergin g cance r industry . The y wer e merel y bad scientifi c entrepreneurs ; i f only the y ha d studie d Pasteu r mor e carefully , they migh t hav e learne d th e valuabl e lesson s o f scientifi c entrepreneurshi p and w o n th e cas e agains t colleague s suc h a s Ewing. However , thi s argumen t leads t o a blame-the-victim typ e o f history tha t celebrate s th e superio r skill s of th e winners . Ca n w e no t fin d a mor e sociologica l explanatio n o f th e failure o f the infectiou s theories , particularl y it s bacterial variants ? Certainly, consideration s o f evidence—such a s the difficult y o f culturin g consistently th e sam e microb e fro m cance r samples , th e undefine d natur e of viruse s durin g th e firs t decade s o f th e twentiet h century , th e lac k o f general knowledg e o n bacteria l variation , an d th e limitation s o f microbio logical technolog y i n a n er a prio r t o electro n microscop y an d molecula r

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biology—provide som e causa l factor s tha t shape d th e failur e o f infectiou s theories. However, i t is clear that for some serious researchers there was not enough evidenc e t o abando n infectiou s theorie s o f cancer a t the time . Yet, opinion i n the cance r research communit y solidifie d rapidl y in the face o f a great dea l o f interpretive flexibility i n th e evidence . Withou t ignorin g th e power o f evidenc e t o chang e mind s i n scienc e (whic h is , o f course , th e attraction o f science a s a way of life), a complete accoun t o f the emergenc e of a consensu s o f cance r researc h agains t infectiou s theorie s need s t o g o beyond the issues of evidence to social factors tha t also shaped the directio n of th e emergin g consensu s o f cance r research . Interes t theor y provide s a starting point, bu t a s we shall see it is only a starting point.

Interest Theory, Version I The alternativ e medicine literatur e ofte n suggest s that th e basic contours o f orthodox cance r researc h wer e shape d b y outsid e industria l interests , tha t is, interest s exterio r t o th e medica l profession . Fo r th e Nort h America n case, an d t o som e exten t fo r Britai n an d othe r countries , th e categor y "industrial interests " coul d b e operationalize d a s th e financia l interest s o f the Rockefelle r empir e an d affiliate d empire s suc h a s tha t o f Andre w Carnegie. Becaus e version s o f Rockefeller interes t theor y appea r through out th e alternativ e medicin e literature , sometime s i n th e for m o f almos t Trilateralist conspirac y theories , thi s versio n o f interes t theor y warrant s some analysi s eve n i f mos t o f i t wil l b e rejected . Conside r thre e centra l propositions o f this theory: i ) industrialist s suc h a s Rockefeller an d Carne gie wanted t o hav e health y workforce s an d t o deflec t attentio n fro m envi ronmental an d socia l aspect s o f health , s o the y supporte d researc h o n biomedicine; 2 ) thei r foundation s completel y reshape d th e contour s o f medicine, particularly in th e United States ; 3) by the middle decade s o f the twentieth century , the Rockefeller financia l empir e had become interwove n with th e chemica l an d pharmaceutical industry , an d a s a result Rockefelle r financial interests—vi a it s foundation s an d othe r ties—pushe d cance r re search toward chemotherapy . Let u s conside r th e proposition s a s researc h hypotheses . First , t o limi t the argumen t t o th e Unite d States , wha t wer e th e motivation s o f John D . Rockefeller, Sr. , in allowing large amounts of money to be directed throug h foundations int o medica l research ? Th e historica l recor d hardl y depict s th e man a s a mastermind wh o manipulate d th e medica l professio n a s his pup -

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pet. T h e so n o f a "quack " doctor , Rockefelle r wa s a believer i n homeopa thy w h o ha d a homeopat h a s hi s persona l physician . H e eve n trie d t o ge t the Universit y o f Chicag o t o includ e homeopath y i n th e curriculu m i n hi s offer i n 189 4 t o f u n d a medica l schoo l fo r th e university . Accordin g t o historian Andre a Blumenthal , "Thi s allianc e i s though t no t t o hav e materi alized because th e senio r Rockefeller , devote d t o homeopathy , di d no t wan t to suppor t a n allopathi c school , an d als o becaus e [Rockefelle r foundatio n director Frederick ] Gate s wa s skeptica l abou t ho w muc h contro l th e Rockefeller philanthropie s woul d hav e ove r th e researc h don e b y a n inde pendent university " (1991 : 69) . T h e tendenc y t o spea k i n term s o f "scien tific medicine " rathe r tha n homeopath y o r allopath y emerge d i n par t a s a way o f gettin g Rockefeller , Sr. , t o g o alon g wit h th e spendin g plan s advocated b y th e medica l reformer s an d thei r allies . T h e latte r include d John D . Rockefeller, Jr. , an d Frederic k T . Gates , th e forme r Baptis t ministe r w h o becam e th e captai n o f Rockefeller philanthropy . Rockefeller, Sr. , ha d littl e t o d o wit h th e directio n o f medica l fundin g decisions, an d simila r pictur e emerge s fo r Andre w Carnegie . A s historia n Howard Berline r summarizes , " T h e action s tha t foundation s too k wer e more heavil y influence d b y th e staf f o f the foundatio n tha n b y th e founders . Frederick T . Gate s (no t Joh n D . Rockefeller , Sr. ) an d H e n r y S . Pritchet t (not Andre w Carnegie ) wer e actuall y responsibl e fo r th e action s tha t wer e taken i n th e founders ' names " (1985 : 5) . W h y di d Rockefeller , Sr. , g o along wit h th e recommendation s o f Gate s an d hi s son ? Accordin g t o medical historia n Harri s Coulter , th e homeopathi c professio n a t th e tim e was itsel f divide d amon g reformer s w h o advocate d a mor e scientifi c ap proach t o medicin e an d traditionalist s w h o advocate d th e orthodo x H a h nemannian line . Coulte r adds , "Accordin g t o on e undoubtedl y reliabl e report, [Rockefeller , Sr. ] wa s dissatisfie d a t th e inabilit y o f the homeopathi c institutions t o teac h an d promulgat e th e Hahnemannia n doctrines." 4 Rockefeller, Sr.'s , support fo r scientifi c medicin e wa s therefor e motivate d by consideration s othe r tha n thos e suggeste d b y th e firs t proposition . A s fo r Carnegie, i t i s wel l know n tha t hi s Scottis h Calvinis m becam e translate d into th e gospe l o f wealth , whic h include d suppor t fo r medica l education . Rockefeller endorse d Carnegie' s gospe l o f wealth , an d accordin g t o Berli ner h e wa s "deepl y religious " an d "di d no t wan t t o di e disgraced " (1985 : 13, 18) . Although th e effect s o f the foundatio n spendin g migh t hav e been t o legitimate capitalism , transfor m robber-baro n wealt h int o symboli c capital , improve th e healt h o f th e workin g class , an d s o on , th e motivatio n ma y have bee n simpler .

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However, th e foundatio n director s ha d broade r goal s i n min d w h e n the y channeled mone y int o medica l research , an d som e o f thes e goal s wer e linked t o a capitalis t visio n o f th e world . Gate s wrot e o f diseas e a s th e "supreme il l o f human life " an d th e "mai n sourc e o f almost al l other huma n ills, poverty , crime , ignorance , vice , inefficiency , hereditar y taint , an d man y other evils " (Brow n 1979 : 128) . As Richar d Brow n argue s i n The Rockefeller Medicine Men, "I n China , a s throughout th e world , th e Rockefelle r philan thropists soo n conclude d tha t medicin e an d publi c healt h b y themselve s were fa r mor e effectiv e tha n eithe r missionarie s o r armie s i n pursuin g th e same ends " (124) . O n e consequenc e o f thei r medica l evangelism , perhap s not entirel y intende d b y th e philanthropists , wa s tha t th e medicalizatio n o f poverty an d socia l issue s als o contribute d t o thei r depoliticization . Brow n argues tha t Rockefelle r Institut e mone y systematicall y preclude d researc h on th e relationshi p betwee n socia l o r environmenta l factor s an d disease . O f the 65 0 researcher s associate d wit h th e Institut e durin g th e earl y decade s of th e twentiet h century , ver y fe w understoo d "th e rol e o f societ y an d environment a s force s affectin g th e ver y disease s the y studied " (129) . A s medicine becam e rationalized , th e ne w scientifi c medicin e als o becam e more restricte d an d reductionis t b y focusin g th e understandin g o f diseas e on biologica l factor s rathe r tha n seein g i t a s a mixe d p h e n o m e n o n tha t involved a socia l an d environmenta l etiolog y a s well. However , a s historia n Paul Star r points out , man y socialist s supporte d th e ne w scientifi c medicine , and likewis e capitalist s suc h a s corporat e manager s wer e ver y concerne d with publi c hygien e (1982 : 228). Consequently , concer n wit h publi c health , which wa s salien t i n th e Rockefelle r philanthrop y durin g th e year s prio r t o World Wa r I , coul d provid e a bridge acros s political an d clas s barriers . In short , ther e i s n o compellin g evidenc e t o suppor t th e vie w tha t Rockefeller, Sr. , o r Carnegi e supporte d foundatio n spendin g fo r scientifi c medicine i n orde r t o serv e thei r industria l interest s i n a narrow way , suc h a s having a healthie r workin g class . Althoug h th e foundatio n spendin g ma y have ha d positiv e consequence s fo r thei r industria l profits , an d i t ma y hav e legitimated a capitalis t visio n o f th e world , th e directio n o f th e spendin g was no t guide d b y thes e interests . Furthermore , ther e wa s n o reaso n wh y the foundatio n mone y woul d no t suppor t researc h o n th e infectiou s theor y of cancer . Gate s ha d rea d Principles and Practices of Medicine, b y Johns H o p kins professo r Willia m Osier , an d h e ha d becom e fascinate d b y th e ger m theory o f diseas e (Berline r 1985 : 56) . A s industria l companie s no w know , research o n chemica l carcinogen s migh t lea d t o studie s o f workplace hazard s

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that coul d cu t into corporat e profits, wherea s research on infectiou s origin s of cancer would no t lead to thi s kind o f question. In fact, on e consisten t institutional home for research o n tumor virolog y in th e Unite d State s durin g th e firs t decade s o f the twentiet h centur y wa s the Rockefelle r Institut e fo r Medica l Research , wher e no t onl y Rou s bu t other majo r virologist s di d thei r work . Furthermore , Rou s occupie d a privileged plac e a s a clos e frien d o f Simo n Flexner , th e directo r o f th e Rockefeller Institut e an d a proteg e o f th e Johns Hopkin s medica l schoo l dean an d Rockefeller inside r William Welch . Flexne r wa s clos e enoug h t o Rous tha t h e chos e hi m i n a n unsuccessfu l attemp t t o mak e th e virologis t his successo r a s directo r o f th e Institute. 5 Flexne r als o sponsore d cance r research o n a variet y o f potentia l causa l factor s suc h a s heredity , an d h e even supporte d a stud y o n die t an d cance r i n mice , which , althoug h no t successful, showe d hi s willingnes s t o pursu e ne w idea s (Blumentha l 1991 : 262-63). Thus , th e Rockefelle r researcher s wer e explorin g a numbe r o f approaches t o cancer , an d tumo r virolog y wa s on e o f them . Althoug h the bacteria l theorie s wer e no t explore d i n th e Rockefelle r Institute , th e Rockefeller famil y wa s o n friendl y term s wit h Willia m Coley. 6 I n short , there i s no evidenc e tha t Rockefelle r fundin g o r interest s led t o th e rejec tion o f infectious theorie s o f cancer. Similar problem s emerg e fo r th e secon d o f th e thre e propositions , tha t the foundatio n spendin g completel y reshape d th e contour s o f America n medicine (an d t o som e exten t medicin e i n othe r countrie s a s well) . Th e debate ove r th e relativ e influenc e o f foundatio n mone y o n th e ris e o f scientific medicin e in th e United State s has to some exten t centere d o n th e influence o f th e repor t o n medica l educatio n prepare d fo r th e Carnegi e Foundation b y the educato r Abraham Flexner , th e brother o f Simon Flex ner (Flexne r 1910) . Durin g th e firs t decade s o f th e twentiet h century , medical reformers advocate d muc h highe r standard s t o bring medica l edu cation in the United State s up t o th e levels achieved in Britain, France , an d especially Germany . Th e Flexne r repor t wa s a manifesto o f this movemen t for reformers , whos e wor k include d centralizin g th e America n Medica l Association, increasin g AMA contro l ove r state boards, tightening licensin g requirements, pushing through increase d science requirements in the medi cal education, an d instituting a ranking syste m for medica l school s (Brow n 1979). Man y medica l school s merge d o r close d becaus e thei r fee-base d systems wer e no t enoug h t o cove r th e cost s o f th e expensiv e laboratorie s that th e ne w scientifi c medicin e required . B y th e 1920 s there wer e hal f as

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many medica l school s a s ther e wer e a t th e tur n o f th e century . Financia l support fo r th e ne w medicin e poure d i n fro m foundations , especiall y thos e of Carnegi e an d Rockefeller . T h e standardizatio n o f medicin e mean t tha t minority perspective s wer e ofte n excluded . Althoug h a few blac k universi ties were anointe d t o continu e t o produc e a small elit e o f African-America n doctors, man y other s wer e close d dow n an d th e doctor-patien t rati o fo r African American s fel l considerably . T h e Flexne r repor t als o recommende d closing th e thre e women' s medica l colleges . A numbe r o f alternativ e medi cal traditions—suc h a s homeopathy , naturopathy , an d midwifery—wer e also drive n undergroun d o r int o highl y marginalize d positions . Although man y o f th e recommendation s o f th e Flexne r repor t wer e carried out , i t i s importan t t o kee p straigh t th e line s o f influence . T h e Flexner repor t wa s no t a vecto r o f transmissio n fro m industria l interest s through th e foundation s t o th e medica l profession . Instead , th e directio n o f influence ra n mor e th e othe r way : th e America n Medica l Associatio n wa s involved fro m th e beginnin g i n th e plannin g an d eventua l contour s o f th e report, eve n t o th e poin t o f prevailin g ove r Abraha m Flexne r w h e n h e recommended regiona l norm s an d th e medica l organizatio n wante d na tional norm s (Berline r 1985 : 105—8) . I n fact , severa l year s prio r t o th e researching o f th e Flexne r report , th e A M A ha d alread y forme d a Counci l on Medica l Educatio n tha t calle d fo r man y o f th e reform s tha t Flexner' s report late r advocate d (Coulte r 1987 : 444-45) . Fo r thes e an d othe r reasons , a growin g consensu s i n th e histor y o f medicine hold s tha t th e impac t o f th e Flexner repor t ha s bee n overrated . Historia n Donal d Flemin g summarize s this view : He [Abraha m Flexner] was eloquently articulating , with cautionar y example s to th e contrary , a n idea l tha t wa s alread y o n th e wa y t o prevailin g i f he ha d never publishe d a word o n th e subject . Th e independentl y poten t exampl e of Johns Hopkin s ha d t o preced e hi s own efforts , a s he woul d hav e been th e first t o insist . Nevertheless , Flexne r strengthene d th e han d o f thos e wh o were fightin g t o upgrad e thei r ow n medica l school s an d badl y i n nee d o f reenforcement fro m a n arouse d publi c opinion . An d i f the scandalousl y ba d schools wer e alread y fallin g b y th e wayside , h e undoubtedl y fostere d mas s suicide among the survivors. (1987 : 208-9) This passag e point s t o th e complexitie s o f th e relationship s betwee n th e medical professio n an d th e foundatio n initiatives . I n general , th e historica l record suggest s tha t i f capturin g occurred , i t wa s i n th e for m o f th e influence tha t medica l leader s suc h a s Simo n Flexne r an d Willia m Welc h

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had ove r th e fundin g taste s o f Rockefeller , Jr. , an d Gates , w h o i n tur n influenced th e largess e o f Rockefeller, Sr . There i s som e evidenc e t o suppor t th e shapin g rol e o f th e foundation s in on e aspec t o f the transformatio n o f American medicine : th e transitio n t o the full-tim e plan . Althoug h th e topi c wa s no t par t o f th e origina l Flexne r report, Abraha m Flexne r performe d a subsequen t stud y a t th e reques t o f Gates, w h o becam e a supporte r o f th e ide a afte r hearin g a lectur e fro m another medica l reformer . T h e full-tim e pla n woul d pu t medica l professor s on standar d salarie s tha t woul d replac e private-practic e income . Fro m Gates's viewpoint , thi s chang e wa s crucia l i f professor s wer e t o b e free d from clinica l practic e s o the y coul d devot e thei r tim e t o teachin g an d research, an d therefor e t o complet e th e transitio n t o scientifi c medicin e (Berliner 1985 : 142) . However , th e A M A an d numerou s othe r quarter s o f the medica l establishmen t resiste d th e full-tim e pla n vociferously . Fo r exam ple, th e Harvar d doctor s successfull y fough t th e Rockefelle r foundation' s attempt t o pu t the m o n stric t standar d salarie s with n o outsid e incom e fro m private practice . T h e alternativ e develope d a t Harvar d eventuall y becam e the mode l fo r th e modifie d full-tim e pla n tha t becam e dominan t i n th e United States. 7 However , eve n thoug h th e full-tim e pla n represent s a stron g case o f foundatio n interventio n i n th e developmen t o f th e medica l profes sion, th e reform s wer e carrie d ou t wit h th e blessin g an d suppor t o f promi nent member s o f th e medica l profession , wit h Willia m Welc h a t th e fore front. Rather tha n viewin g th e foundation s a s having a determining rol e i n th e shaping o f medica l refor m i n th e Unite d States , historian s hav e d e m o n strated th e crucia l rol e tha t medica l reformer s playe d i n influencin g th e funding taste s o f th e foundatio n directors . Star r argue s tha t th e medica l profession wa s undergoin g a series o f major structura l change s tha t probabl y would hav e occurre d withou t th e suppor t o f th e foundations . Thes e changes includ e strengthene d professiona l organizatio n an d hospita l power , control o f labo r market s vi a licensin g boards , privatel y endowe d an d p u b licly supporte d medica l research , eliminatio n o f countervailin g powe r i n medical car e b y privat e an d publi c organizations , an d th e emergenc e o f specialties (1982 : 229-31) . Althoug h foundatio n mone y certainl y helpe d the process , accordin g t o Star r th e rationalizatio n o f medicine i n th e Unite d States wa s a relativel y independen t proces s rathe r tha n on e directe d b y industrialists throug h thei r foundations . Thi s positio n i s supported b y histo rian R o b e r t Kohler , w h o ha s confirme d an d delimite d th e genera l impor tance o f foundatio n mone y an d th e Flexne r repor t i n th e shapin g o f

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scientific researc h i n th e Unite d States . A s h e comments , "Flexne r an d th e A M A leader s di d no t originat e reform ; the y onl y routinize d it " (1982 : 126 ; also 1991) . I n short , th e foundation s provide d a spur t o th e ris e o f scientifi c medicine i n th e Unite d States , bu t the y di d no t caus e it . Consider no w th e thir d argument , tha t a s the Rockefelle r empir e devel oped financia l interest s i n th e chemica l an d pharmaceutica l industries , from behind th e scene s i t pushe d cance r researc h towar d chemotherapy . N o t e that th e plac e an d tim e i s differen t fo r thi s argument : th e questio n o f chemotherapy take s u s t o th e Memoria l Hospita l durin g th e 1930 s rathe r than th e Rockefelle r Institut e an d th e medica l school s durin g prio r decades . There i s som e evidenc e tha t b y th e 1930 s th e Rockefelle r empir e wa s building tie s wit h hug e Europea n pharmaceutica l empires , an d tha t thes e organizations oppose d th e infectiou s theor y o f cancer . I n German y th e microbial therap y o f Giinthe r Enderlei n was , accordin g t o th e Swedis h doctor Eri k Enby , "viewe d b y Naz i doctor s a s direc t competitio n fo r th e chemotherapy industry " (1990 : 8) . Thi s commen t suggest s a connectio n between th e Germa n chemica l an d pharmaceutica l industr y an d th e rejec tion o f Enderlein s microbial approac h t o chroni c disease , althoug h throug h the Naz i part y rathe r tha n foundation s a s i n th e Unite d States . Enb y does no t provid e mor e detail s o r references , bu t ther e i s som e historica l documentation i n suppor t o f th e complicit y o f th e grea t chemica l carte l I . G. Farbe n (whos e heir s toda y includ e Bayer , BASF , Hoechst, Agfa , Cassella , and Kalle ) i n th e Naz i build-u p o f power o r th e Naz i regime. 8 Ralph Mos s suggest s on e piec e o f historica l evidenc e fo r a linkag e between I . G . Farbe n interest s an d Rockefelle r mone y i n th e followin g passage: It i s interesting t o not e tha t i n 1926 , one year before th e Rockefeller s bega n their systemati c contribution s t o Memorial , Fran k Howard , a vice presiden t of Esso, paid hi s first visi t t o th e I . G . Farbe n laboratories . H e late r sai d tha t he wa s "plunge d int o a worl d o f researc h an d developmen t o n a giganti c scale suc h a s I ha d neve r seen " (cite d i n Borki n 1978) . H e soo n discovere d that th e German s wer e alread y deepl y involve d i n cance r research . (1989 : 393) Moss cite s a repor t fro m Howar d tha t acknowledge s Germany' s leadershi p in th e dru g industr y o f th e tim e an d it s advance s i n cance r research . H e comments, "I n 192 7 th e Rockefeller s greatl y expande d thei r interes t i n pharmaceuticals w h e n Standar d Oi l o f N ew Jersey (Esso) , which wa s domi -

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nated b y th e Rockefelle r family , signe d a n extensiv e carte l agreemen t wit h the Germa n I . G . Farbe n Company " (1989 : 392) . Although th e tw o grea t globalize d soci o technical system s di d develo p a relationship durin g thi s period , i t seeme d t o involv e mutua l outmaneu vering an d rivalr y a s muc h a s hidde n conspiracy . A s Joseph Borki n write s in The Crime and Punishment of I. G. Farben, th e ide a t o buil d a carte l fro m the variou s Germa n chemica l companie s cam e t o Car l Duisber g o f Baye r during a visit t o th e Unite d State s i n 190 3 t o la y th e cornerston e fo r a ne w Bayer factor y i n Rensselaer , N e w York . Duisber g learne d abou t th e Stan dard Oi l trus t durin g thi s trip , an d h e brough t bac k wit h hi m th e mode l o f Standard Oi l fo r trust-buildin g i n German y Durin g th e 1920 s Standar d Oi l became intereste d i n I . G . Farbe n s projec t t o produc e syntheti c oi l fro m coal, an d I . G . — w o r r i e d abou t it s finance s an d awar e o f th e technica l problems i n th e research—sol d it s worl d right s t o Standar d Oil . Standar d Oil als o appeare d t o b e th e dup e o f I . G . Farbe n durin g thei r variou s swap s of th e 1930s , w h e n Standar d Oi l sol d I . G . a gasolin e additiv e "no t k n o w ing" tha t i t wa s goin g t o b e use d fo r th e Luftwaffe . However , Standar d Oi l apparently evene d th e scor e w h e n towar d th e en d o f th e wa r i t persuade d I. G . Farbe n t o transfe r patent s t o i t i n orde r t o avoi d confiscatio n b y Allie d governments. Thos e patent s remaine d i n Standar d Oi l hand s unti l th e U.S . courts rule d i n 194 8 tha t th e America n governmen t ha d th e righ t t o seiz e the patents . T h e governmen t di d seiz e th e patents , an d the n w h e n i t auctioned the m off , Standar d Oi l bough t the m back . Thus, th e historica l researc h t o dat e suggest s tha t Rockefeller/I . G . Farben connection s ar e ambiguou s an d d o no t provid e a strong basi s for th e argument tha t th e Rockefelle r famil y ha d substantia l pharmaceutica l inter ests via th e Germa n cartel . I t i s possible, however , tha t Rockefelle r interest s in th e pharmaceutica l industr y cam e throug h anothe r channel , th e pharma ceutical behemot h Burroughs-Wellcome . I n Dirty Medicine, medica l j o u r nalist Marti n Walke r writes , Over th e las t hal f century , medica l educatio n an d researc h i n Britai n hav e been dominated by the interests of Wellcome and Rockefeller. . . . Following the recommendation s o f Flexner s European report , Rockefelle r mone y be gan t o pou r int o Britis h medica l researc h an d education , reshapin g th e foundation o f medicine i n Britain a s it had in America. (1993 : 215) And yet , th e connectio n betwee n Rockefelle r an d Burroughs-Wellcom e money i s tenuous . Walke r point s t o th e fac t tha t Henr y Wellcome' s wil l o f

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1932 appointed John Foste r Dulles and Allen Dulles, then o f the Rockefel ler-affiliated la w fir m o f Sulliva n an d Cromwell , t o handl e lega l matter s relating t o th e wil l an d th e continuin g financia l empir e (217) . H e als o argues tha t th e person s associate d wit h th e pharmaceutica l compan y wer e involved in the Trilatera l Commissio n (221) . However, thes e are the exten t of the apparen t linkages. In bot h th e I . G . Farbe n an d Burroughs-Wellcome cases , tw o problem s remain. Th e natur e o f th e connectio n betwee n th e Rockefelle r an d th e other corporat e empire s remain s weak . I n othe r words , th e researcher s d o not poin t t o direc t investment i n specific pharmaceutica l companie s tha t i n turn ha d a financia l interes t i n cance r research . Furthermore , eve n i f on e were to find that the Rockefeller financia l empir e had developed a substantial financial interes t i n pharmaceutical companie s by the late 1920 s or earl y 1930s, there would still be several steps to make before on e coul d clai m that these financial interest s ha d an y impac t o n cance r research . Mos s caution s that althoug h Rockefelle r fundin g o f th e Memoria l Hospita l bega n i n th e 1920s, th e Rockefeller s continue d t o suppor t Ewin g an d ther e wa s n o immediate chang e i n leadershi p tha t ca n b e attribute d t o Rockefelle r in fluence (1989 : 391-92) . However , i n th e 1930 s Howard joined th e Memo rial Hospita l board , an d Rockefelle r influenc e ma y hav e grow n afte r tha t point (393) . The questio n emerges , then, di d persons associated with the Rockefelle r family fortun e pla y an y role i n th e shif t o f cance r researc h towar d chemo therapy? Documents revea l that i n 193 6 the Genera l Education Boar d gav e three millio n dollar s t o Memoria l Hospita l fo r a building , an d i n 193 9 Cornelius Rhoads , wh o ha d worke d i n Simo n Flexne r s laboratory a t th e Rockefeller Institute , becam e th e directo r o f th e hospital. 9 I n 194 1 th e foundation gav e an additional $120,000 to the hospital, with th e reason tha t it ha d improve d wit h th e appointmen t o f Rhoads, an d fro m th e 1940 s o n there i s substantia l interactio n betwee n th e Rockefelle r foundatio n an d Rhoads. 10 However , th e mone y trai l doe s not prov e anything ; mor e inter esting woul d b e informatio n o n Fran k Howard' s motivation s an d hi s rol e (if any) i n Memorial' s transitio n t o chemotherapy . Furthermore , th e inter action betwee n Rhoad s an d th e Rockefelle r foundatio n wa s no t alway s favorable t o Rhoads . I n 194 9 h e wrot e t o Abraha m Flexne r a memo tha t proposed changin g th e staf f organizatio n o f th e hospita l t o a full-tim e system to mak e it a modern research-and-teachin g institution , an d Flexne r passed o n th e mem o t o Rockefeller , Jr. , wit h hi s enthusiasti c endorse ment. 11 Th e foundatio n apparentl y decline d th e offer . Nevertheless , thi s

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failed ventur e ma y tur n ou t t o b e a mino r footnot e compare d t o th e big picture : Rhoad s pursue d th e ne w paradig m o f chemotherap y wit h unwavering faith . Thi s wor k entaile d clos e tie s wit h an d prais e o f th e pharmaceutical industry, including a contract with Burroughs-Wellcome t o synthesize antimetabolites. 12 Bu t thi s i s a s far a s th e rathe r confusin g trai l goes at this point. To summariz e th e argument s regardin g thi s versio n o f interes t theory , the first tw o proposition s di d no t far e wel l whe n compare d wit h th e historical record . (Thos e proposition s wer e tha t Rockefelle r an d Carnegi e supported researc h on biomedicine i n order to have healthy workforces an d to deflec t attentio n fro m socia l an d environmenta l aspect s o f health , an d that thei r foundation s achieve d thos e goal s b y reshapin g th e contour s o f medicine.) A reasonable argument ca n be made that those two proposition s have been falsified . However , ther e i s still no solutio n t o th e thir d proposi tion. Di d th e Rockefelle r empir e develo p clea r financial interest s i n th e nascent pharmaceutica l industry , an d from behin d th e scene s di d thes e interested partie s pus h cance r researc h towar d chemotherap y throug h involvement i n organization s suc h a s Memorial Hospital ? I t i s possible tha t future researc h wil l revea l th e answers , bu t i t i s als o possibl e tha t w e ar e faced wit h th e situatio n o f "queim a d o archivo " (burnin g th e archive) , t o use th e colorfu l Brazilia n phrase . M y conclusion , then , i s tha t notwith standing th e fals e start s o f th e first tw o propositions , th e thir d propositio n leads to mixe d results , including som e positive result s suc h a s the discover y of new historica l facts an d the provision o f a framework i n which t o locat e them. Still , this version o f interest theor y doe s not provide a n answer to th e question o f why th e infectiou s theor y o f cance r fade d int o suc h a n unor thodox position . Theoretically , i t woul d hav e bee n possibl e t o lin k a n infectious theor y o f cance r t o th e interest s o f th e pharmaceutica l industr y via antibiotics . T o solv e th e puzzle , on e need s additiona l explanator y re sources beyon d a versio n o f interes t theor y tha t i s limite d t o th e shapin g role of Rockefeller an d other outsid e industrial interests.

Interest Theory, Version II The secon d version o f interest theor y focuse s mor e o n th e developmen t o f economic interest s internal to th e emergin g profession o f cancer treatment . This muc h mor e complicate d approac h i s develope d i n Ralp h Moss' s in fluential boo k The Cancer Industry. Ther e i s n o questio n tha t professiona l

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interests emerge d i n th e lat e nineteent h centur y aroun d surger y a s th e primary treatmen t modalit y fo r cancer . Surgeon s w h o earne d a substantia l amount o f thei r incom e from cance r clearl y ha d a financia l interes t i n th e continued existenc e o f thei r livelihoo d an d practice . The y woul d b e highl y motivated t o questio n a theory an d treatmen t (suc h a s bacteria an d vaccines ) that coul d conceivabl y pu t the m ou t o f business. However , ther e wa s roo m for alternativ e therapie s whe n surger y wa s no t possible , an d radiotherap y came t o occup y thi s field rathe r tha n bacteria l vaccine s an d othe r i m m u n o therapies. T h e ag e o f th e therapie s wa s no t a factor : wherea s ther e wa s a long researc h traditio n o n microorganism s an d cancer , X-ray s an d radiu m were discovere d durin g th e 1890s . N o r wa s safet y a factor : b y 191 0 th e carcinogenic potentia l o f X-ray s wa s alread y known , an d b y th e 1920 s th e dangers o f radiu m wer e known. 1 3 H o w i s i t tha t radiotherap y carrie d th e day w h e n researcher s suc h a s Coley , w h o ha d introduce d X-ra y therap y t o Memorial Hospital , wer e pointin g th e wa y towar d muc h safe r an d poten tially mor e efficaciou s immunotherapies ? Following th e Memoria l Hospital' s officia l historia n R o b e r t Considin e (1959), Moss argue s tha t interes t i n radiu m therap y a t the hospita l develope d dramatically afte r industrialis t Jame s Dougla s gav e a larg e gif t i n 191 3 an d attached severa l string s t o th e gif t (1989 : 65-66) . Accordin g t o Considine , "Douglas insiste d first tha t hi s persona l frien d an d physician , Dr . Jame s Ewing, b e mad e chie f pathologis t (late r medica l director ) o f th e hospital ; second, tha t th e hospita l trea t onl y cance r patients ; an d third , tha t i t routinely us e radiu m i n tha t treatment." 1 4 Ewin g returne d th e favo r b y dedicating hi s book Neoplastic Diseases, in whic h h e sounde d th e deat h knel l for microbia l theorie s o f cancer , t o hi s frien d an d benefactor . Because Dougla s wa s presiden t o f th e Phelps-Dodg e copper-minin g empire an d becaus e h e becam e involve d i n th e minin g an d processin g o f radium, on e migh t interpre t hi s interventio n a s a n exampl e o f th e financia l interests o f th e minin g industr y shapin g th e cours e o f cance r research . However, ther e i s a s yet n o evidenc e tha t th e Dodge-Phelp s empir e b e n e fited fro m diversificatio n int o radium . Instead , radiu m minin g becam e a n industry o f it s own , wit h it s ow n beneficiarie s an d intereste d parties , including Dougla s an d th e nascen t cance r industry . Douglas's sincer e belie f i n th e medica l efficac y o f radium , eve n t o th e point o f drinkin g radium-treate d fluid s tha t ma y hav e le d t o hi s deat h i n 1918, n o doub t facilitate d th e creatio n o f a radiu m industry . Hi s daughte r Naomi ha d develope d breas t cance r i n 1907 , an d afte r five unsuccessfu l operations the y decide d t o tr y radiu m i n 1909 . Tha t attempt , too , wa s a

Culture and Power in Cancer Research | 6 9 failure, bu t afte r he r deat h i n 191 0 Dougla s continue d t o wor k t o mak e radium availabl e a s a treatment fo r cancer . Nevertheless , i n th e grea t Ameri can traditio n o f combinin g evangelica l zea l with th e profi t motive , Dougla s and hi s allie s i n th e medica l professio n develope d a larg e financia l stak e i n the business . I n 191 3 h e cofounded , wit h th e U.S . Burea u o f Mines , th e National R a d i u m Institute . Hi s partnershi p include d Howar d Kelly , w h o — along wit h Willia m Halsted , Willia m Osier , an d Willia m Welch—wa s known a s on e o f th e fou r foundin g father s o f th e John s Hopkin s Medica l School. Accordin g t o th e radiologis t an d historia n Juan De l Regato , Douglas an d Kell y bought twenty-seve n claim s in Parado x Valley, Colorado , and th e Burea u o f Mine s undertoo k studie s o f ores , locations , method s o f extraction, an d production . Thre e year s later , eac h partne r receive d 3.7 5 grams of radium, which were eventuall y utilized at the Memorial Hospita l o f New York , th e Huntingto n Memoria l Hospita l o f Boston , an d th e John s Hopkins Hospita l of Baltimore. (1993 : 69) T h e valu e o f a gra m o f a radiu m wa s $100,00 0 t o $150,00 0 i n th e currency o f th e time . Kell y buil t a privat e hospita l i n Baltimore , gav e radium treatment s t o John s Hopkin s cance r patients , an d accordin g t o historian Bertra m Bernheim , "becam e th e owne r o f more radiu m tha n an y other docto r i n th e nation " (1948 : 23) . I n 191 7 th e firs t repor t o f radiu m therapy a t th e Memoria l Hospita l reviewe d 42 4 case s an d claime d tha t i t had resulte d i n a t leas t 12 0 case s o f complet e regressio n a t som e poin t i n the cours e o f th e diseas e (Janewa y 1917 : 222) . B y th e lat e 1920 s th e Memorial Hospital , whic h becam e know n a s th e "radiu m hospital, " ha d eight gram s o f radiu m a s wel l a s th e origina l radiu m produce d b y Mari e Curie, w h o ha d t o trave l t o Americ a t o see k financia l hel p t o purchas e additional radiu m fo r he r research. 15 By 192 4 th e hospital s radiu m departmen t becam e th e singl e greates t source o f incom e (Mos s 1989 : 67) . Althoug h th e harmfu l sid e effect s o f radium wer e know n b y th e 1920s , i t continue d t o b e used. 16 Stude r an d Chubin not e tha t w h e n Congres s mad e it s firs t appropriatio n fo r th e N C I in th e lat e 1930s , i t stipulate d tha t hal f th e fund s woul d g o t o th e purchas e of radium. Examinatio n o f Congressiona l testimon y suggest s th e appropria tion fo r radiu m wa s probabl y du e t o th e suggestio n o f cance r researchers , not fro m member s o f Congres s fro m state s with relevan t minera l deposits. 17 In othe r words , b y th e 1930 s th e therap y ha d stabilize d an d develope d a n inertia o f its own . Large corporation s als o develope d a n interes t i n th e continue d us e o f

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radiotherapy. Accordin g t o Rhoads , Genera l Electri c wa s largely responsibl e for developin g th e X-ra y fo r diagnosi s an d treatment. 1 8 A s Moss comments , " O n c e million s o f dollar s ar e investe d i n capita l equipment , ther e i s stron g inducement t o us e tha t equipment , despit e newe r informatio n suggestin g its us e shoul d b e curtailed " (1989 : 67) . R a d i um remaine d a key componen t in orthodo x cance r treatmen t lon g afte r Ewing , Douglas , Kelly , an d thei r partners wer e dead , an d i t wa s onl y abandone d w h e n radiotherapist s foun d less dangerou s radioactiv e substitute s tha t di d no t threate n th e professio n o f radiation oncology . Nevertheless, b y th e 1940 s Memoria l an d othe r hospital s wer e takin g a new directio n tha t woul d ultimatel y provid e a n alternativ e t o radiotherap y for million s o f cancer patients . I n 193 9 Corneliu s Rhoad s lef t th e Rockefel ler Institut e t o becom e th e directo r o f th e Memoria l Hospital , wher e h e led th e transitio n t o chemotherapy . Durin g Worl d Wa r I I h e serve d a s th e chief o f researc h fo r th e Chemica l Warfar e Service , an d th e secre t militar y trials wit h nitroge n mustar d o n 16 0 patient s durin g th e wa r contribute d t o his knowledg e an d advocac y o f chemotherap y (Mos s 1989 : 393-94) . D u r ing th e perio d o f 194 1 t o 1945 , h e als o serve d a s th e America n Cance r Society's director , whic h contribute d t o hi s leadershi p rol e an d genera l influence i n th e field . H e resigne d tha t positio n afte r question s wer e raise d about th e appropriatenes s o f his directin g on e organizatio n tha t gav e mone y to anothe r fo r whic h h e ha d a vested interest , namel y Memoria l Hospital. 19 As a leade r o f th e movemen t t o develo p chemotherap y i n postwa r America, Rhoads' s directorshi p o f th e Memoria l Hospita l an d hi s subse quent foundin g o f th e Sloan-Ketterin g Institut e represente d a genera l tran sition i n researc h program s o n cance r therapy . Rhoads , o f course , wa s no t a lone participan t i n thi s transition ; othe r prominen t cance r researcher s suc h as Sidne y Farbe r als o playe d a leadership rol e (Mos s 1995 : 19) . But Rhoad s had a flair fo r stimulatin g publi c attentio n an d corporat e sponsorship . B y 1949 h e wa s o n th e cove r o f Time Magazine, an d h e wa s deployin g ne w metaphors t o sti r u p publi c enthusias m fo r chemotherap y muc h a s i t ha d been stirre d u p earlie r fo r radium. 2 0 Cance r wa s lik e a weed , h e argued , and th e olde r therapie s o f surger y o r radiotherap y treate d th e wee d b y cutting i t o r burnin g it . Clearly , h e viewe d thes e therapie s a s relativel y crude an d empirical , becaus e the y di d no t attac k th e roo t caus e o f cancer . T h e alternativ e tha t h e defende d wa s t o contro l th e "biochemica l soil " i n which cancer s arise . H e dre w a paralle l betwee n cance r cell s an d bacteria l pathogens; h e hope d tha t chemotherap y woul d selectivel y destro y cance r cells th e wa y antibiotic s destro y bacteria. 21 Anothe r o f Rhoads' s metaphor s

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gives a better pictur e o f his approach ; h e describe d chemotherap y a s "Wag ing th e Chemical-Biologica l Cance r War, " a metaphor whic h i s not surpris ing i n ligh t o f his wartim e experience. 2 2 Although Rhoad s compare d th e chemotherapeuti c treatmen t o f cance r cells t o th e antibioti c treatmen t o f bacteria l pathogens , thi s wa s abou t th e extent o f his us e fo r infectiou s theorie s o n th e topi c o f cancer . Hi s hostilit y to bacteria l theorie s an d therapies , bot h thos e o f Cole y an d Livingston , wa s demonstrated i n th e previou s chapter . Althoug h hi s archive d paper s ar e almost silen t o n th e topic , on e exceptio n i s a pape r give n i n 195 0 befor e the Sterling-Winthro p Researc h Institut e i n Rensselaer , N e w York , wher e Rhoads rejecte d bacteria l theorie s outright. 2 3 H e als o remaine d skeptica l that viruse s cause d an y cancer s i n mammals . H e di d suppor t a conferenc e on oncoviruse s an d h e recognize d th e wor k o f tumo r virologist s suc h a s Peyton Rous , bu t h e though t th e vira l researc h progra m fo r cance r wa s a failure. H e argue d tha t th e researc h progra m ha d no t generate d successfu l cures fo r cancer , an d h e suspecte d tha t purporte d oncoviruse s migh t hav e been confuse d wit h othe r cell-fre e filtrates. 24 Instead , hi s imaginatio n wa s captured mainl y b y th e possibilit y tha t viruse s coul d b e develope d a s possi ble cytotoxi c agent s simila r t o antibiotic s o r phage , an d h e wrot e abou t possible "oncolytic " viruse s tha t coul d b e directe d onl y a t cance r cells. 25 I n other words , chemotherap y guide d hi s thinkin g t o suc h a n exten t tha t h e viewed th e potentia l o f viruses i n simila r term s a s selective cytotoxi c agents . It follow s tha t th e chemotherapeuti c researc h progra m woul d lea d t o cozy relationship s wit h th e pharmaceutica l industry . Thes e relationship s served a s keystones i n wha t Mos s aptl y ha s terme d th e cance r industry . I n a talk o n "Industria l Scienc e an d Cance r Research, " give n fo r th e Genera l Electric Scienc e Foru m an d broadcas t fro m th e "electri c city " (Schenec tady) i n 1947 , Rhoad s praise d industria l laboratorie s fo r turnin g sulf a drug s into reality , an d h e credite d th e pharmaceutica l an d chemica l industrie s fo r contributing t o health. 26 I n anothe r pape r h e praise d th e pharmaceutica l industry fo r contributin g t o thre e ke y area s o f cance r research : steroids , nitrogen mustard , an d antimetabolites. 27 T h e wor k wit h Burroughs-Well come ha s alread y bee n mentioned , an d i n genera l Memoria l Hospita l became a cente r o f dru g testin g fo r th e ne w chemotherap y (Bu d 1978 : 442ff; Mos s 1989 : 83fT.) . However, th e pharmaceutica l industr y wa s no t th e onl y industr y wit h which Rhoad s develope d relationships . H e als o sough t ou t benefactor s fo r his researc h progra m fro m industrialist s outsid e th e pharmaceutica l industry . At th e suggestio n o f Fran k H o w a r d — t h e vic e presiden t o f Ess o an d M e -

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morial Hospita l boar d membe r mentione d above—Rhoad s me t wit h Charles Ketterin g o f Genera l Motors . Negotiation s wit h Ketterin g an d William Sloa n eventuall y le d t o th e foundin g o f the Sloan-Ketterin g Insti tute fo r Cance r Researc h i n 1945 , of which Rhoad s becam e director. 28 I n 1951 h e develope d " A Pla n fo r Corporat e Participatio n i n th e Memoria l Cancer Program, " i n whic h h e sough t donation s o f $10,000 pe r yea r fro m a hundred corporation s i n retur n fo r service s tha t woul d revie w tw o type s of data: cance r case s of individual executive s an d case s of alleged corporat e responsibility fo r cance r problems. 29 As close r relation s wit h th e corporat e worl d developed , Memoria l Sloan-Kettering an d othe r cance r researc h institution s adopte d organiza tional model s fro m industria l research . Rhoad s vehementl y denie d charge s that th e Sloan-Ketterin g donatio n implie d tha t h e was setting up a n industrial researc h laboratory , an d h e argue d i n hi s defens e tha t th e researc h produced a t Sloan-Ketterin g woul d b e publishe d an d share d freely , unlik e the proprietar y researc h o f industria l laboratories. 30 However , th e model s of industrial researc h laboratories influence d cance r researc h in othe r ways. In a n examinatio n o f Sloan-Kettering an d th e Philadelphia-base d Institut e for Cance r Research, scienc e studies analyst R. F . Bud (1978 ) demonstrate d that during the 1940 s these two leading institutions imported organizationa l models fro m industria l researc h laboratories . H e argue s tha t thi s organiza tional style favored th e emphasis on chemotherap y tha t emerge d durin g th e period, whe n "team s with primary responsibility for chemotherap y becam e the largest units" at both Sloan-Ketterin g an d th e Philadelphia-based Insti tute fo r Cance r Researc h (1978 : 441) . Th e importatio n o f industria l re search culture—wit h it s values o f standardization, hierarchica l an d central ized organizations , an d syntheti c products—cloake d th e transitio n towar d chemotherapy i n a sense o f legitimacy becaus e i t seeme d "naturally " t o b e the bes t wa y t o organiz e wor k an d thought . Althoug h othe r line s o f research were allowe d to coexist , the y were given relatively low priority. 31 Rlioads an d Memoria l Sloan-Ketterin g ma y represen t a n extrem e case , but th e transitio n t o widesprea d testin g o f chemotherapies , th e appea l t o corporate funder s fo r support , an d th e industria l organizatio n o f researc h was widespread. The legacy for cance r research today is significant interloc k among majo r corporations , th e majo r cance r researc h organizations , an d the governmen t agencie s tha t fun d an d regulate cance r researc h an d thera pies. I n a n analysi s o f th e boar d membershi p o f th e Memoria l Sloan Kettering Cance r Center , Moss concluded that the pharmaceutical industr y "has great influence o n the MSKCC board , especiall y on the select Institu -

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tional Polic y Committee " (1989 : 443) . H e showe d tha t i n 197 9 "seve n out o f nine—o r 7 8 percent—o f th e member s o f th e Institutiona l Polic y Committee wer e affiliate d (o r interlocked ) wit h companie s wit h a direc t interest i n th e cance r dru g (o r diagnostics ) market " (444) . Likewise, Mos s notes tha t dru g companie s suc h a s Bristol-Myers Squib b directl y influenc e cancer researc h b y givin g award s an d grants , supportin g lectures , updatin g cancer textbooks , an d supportin g clinica l studie s o f thei r patente d agent s (1995: 79). To som e extent , th e curren t situatio n o f interlockin g corporate , non profit, an d governmen t boards , grants , an d researc h project s make s th e Rockefeller versio n o f interest theor y irrelevant . Rathe r tha n examin e th e tenuous propositio n tha t industria l interest s shape d th e histor y o f cance r treatments an d research, I believe the more pertinent question s concer n th e nature, structure , an d interests o f cancer researc h an d treatmen t a s it devel oped int o a n industr y unt o itself . Th e cance r therapeutic s market , whic h itself i s onl y a portio n o f th e entir e amoun t o f mone y spen t o n cance r prevention an d treatment , i s growing a t a rate o f about 1 2 percent pe r year and i s currentl y value d a t abou t te n billio n dollar s pe r yea r (Mos s 1995 : 75). Cance r therapeutic s therefor e represen t a significan t secto r o f th e pharmaceutical industry . Thus, th e secon d versio n o f interests theor y woul d hol d tha t ove r tim e the cance r researc h communit y develope d it s ow n interna l cultura l logi c that wa s interwove n wit h it s ow n financial , institutional , an d professiona l interests. Th e cultura l logi c include d a cor e o f researc h value s suc h a s extreme skepticis m toward th e view tha t viruses play anything more tha n a minor rol e i n huma n an d marnmalia n cancers , an d tha t othe r microorgan isms, particularl y bacteria , ar e anythin g othe r tha n secondar y infections . The consensu s view ca n be justified b y pointing to a long history o f cancer research tha t date s back t o th e foundin g moment s a t th e beginnin g o f th e twentieth century , bu t thi s view als o ignores anothe r researc h traditio n tha t became marginalize d an d tha t ca n als o b e justifie d b y it s ow n bod y o f evidence. Clearly , th e marginalize d vie w ha s quantitativel y les s evidenc e a t this point , bu t a s I wil l sho w i n th e nex t chapter , i t stil l point s t o som e anomalies tha t sugges t bacteri a an d perhaps fung i pla y a n overlooke d con tributing role in cancer etiology . Science studie s o f specialt y formatio n sugges t tha t ther e i s a genera l process i n whic h autonom y increase s a s a field o f researc h become s mor e defined, routinized , an d driven by a generally accepted research program. 32 The cas e o f th e cance r researc h communit y confirm s thi s pattern , bu t I

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would ad d tha t ther e i s a formative perio d w h e n th e basi c direction s o f th e research progra m ar e se t i n plac e (suc h a s th e refusa l t o se e cance r a s a metabolic, nutritional , o r infectiou s diseas e an d on e tha t coul d b e treate d by vaccines , sera , an d nutritiona l therapies) . Furthermore , a s th e fiel d o f research becam e increasingl y technica l an d specialized , th e choice s tha t were s o eviden t a t th e beginnin g wer e largel y forgotten . T h e controversie s that Ewin g an d Cole y wer e par t o f becam e los t t o th e historica l uncon sciousness a s th e noninfectiou s natur e o f cance r becam e c o m m o n sens e t o members o f th e culture . Yet , th e consensu s di d no t emerg e fro m entirel y internal, intellectua l processe s suc h a s th e consideratio n o f evidence . Rather, th e commonsens e consensu s wa s als o adaptiv e t o th e political / economic ecolog y tha t provide d incentive s fo r therapie s oriente d towar d X-ray machines , radium , pharmaceuticals , an d othe r industria l products . Although apparentl y guide d b y an d justifiabl e i n term s o f evidentiar y criteria, th e genera l contour s o f orthodoxy an d heterodox y remai n product s of a mi x o f evidentia l consideration s an d intereste d history . Man y actor s were attemptin g t o buil d thei r networks , bu t thos e w h o advocate d radiu m and chemotherap y prevaile d ove r thos e w h o advocate d bacteria l vaccines , not becaus e th e forme r wer e bette r a t interestin g allie s o r marketin g thei r therapies, no r becaus e th e theoretica l choic e ha d bee n settle d unambigu ously b y evidentia l considerations , bu t becaus e the y offere d therapeuti c research program s tha t wer e bette r adapte d t o th e ecologica l pressure s o f the industrial-capitalis t societ y i n whic h the y wer e operating . Thus , i n contrast t o theorie s o f scienc e suc h a s actor-networ k theor y (Latou r 1987 , 1988), I sugges t tha t althoug h th e ne w network s o f officia l cance r therap y and researc h contribute d t o th e reproductio n o f a n industrial-capitalis t order, the y di d no t mak e tha t order . Rather , tha t orde r exerte d a shapin g ecological pressur e o n th e contour s o f th e researc h culture . I n short , th e seamless we b o f content/contex t ha s t o han g itsel f somewhere . T h e concep t o f a researc h cultur e render s mor e comple x an d sophisti cated th e analysi s o f interest s i n th e histor y o f science , technology , an d medicine. Lik e a language, a culture i s capable o f change, bu t it s basic value s (like a language' s dee p grammatica l structures ) ten d t o remai n stabl e ove r time. T h e Unite d States , fo r example , i s characterize d b y a grea t degre e o f religious, ethnic , lifestyle , an d othe r diversities . Yet , seventeenth-centur y British an d Dutc h Calvinis m ha s cas t a n imprin t tha t remain s eviden t throughout th e culture , an d man y o f th e basi c value s an d institution s described i n Alexi s d e Tocqueville' s Democracy in America ar e stil l recogniz able today . T h e comparativ e perspectiv e o f d e Tocquevill e i s crucia l fo r

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understanding thes e deepe r structure s o f the culture . I n a similar way, ove r time a research communit y develop s a culture that ca n be trace d back to its originary histor y an d th e historica l condition s i n whic h i t wa s embedde d during it s earl y development . Ove r tim e th e cultur e als o develop s a resilience an d logi c o f it s own , suc h tha t i t respond s t o outsid e interest s fro m the perspective o f its values and logic. Thus, my argument is that differen t sort s of interests—or, i f one prefers , ecological factors—shape th e developmen t o f a research culture, but not i n a direc t sor t o f wa y tha t reduce s th e response s o f th e member s o f th e research communit y t o interest dopes . It is much mor e like the relationshi p posited by Marshall Sahlins in Culture and Practical Reason, in which anthro pologists developed a complex solution to the relationship between ecolog y and socia l organization . Rathe r tha n se e change s i n ecolog y a s directl y shaping aspect s o f the cultur e suc h a s social organization , Sahlin s defende d a view simila r t o wha t I a m articulatin g here : the change s i n ecolog y wer e mediated through a culture that structured its responses via adaptive change s in socia l organization tha t tende d t o preserv e th e establishe d cultura l logic. In a similar way, financial interest s do shape some research communities an d research program s i n powerfu l ways , bu t th e interest s becom e inflecte d a s they reverberate i n the historicall y developin g culture s o f research commu nities, disciplines , networks, an d organizations. 33

Monomorphism and Modernism My analysi s up t o this point i s still incomplete fo r severa l reasons. To begin, I hav e no t ye t explaine d wh y bacteriologica l researcher s di d no t rus h into th e vacuu m lef t b y th e cance r researchers . Ther e i s n o reaso n wh y bacteriologists woul d no t develop th e researc h o n ostensibl e vira l an d bacterial cause s o f cancer . On e woul d presum e tha t bacteriologist s woul d have an interest i n expandin g thei r disciplin e t o cove r an important disease , but instea d the y generall y ignore d researc h o n bacteria l etiologies . T o answer this question we need to turn t o the history of bacteriology, o r what is toda y know n mor e broadl y a s microbiology, an d th e paralle l histor y o f the constitutio n o f its cultur e with it s attendant contour s o f orthodoxy an d heterodoxy, o r i f on e prefers , o f commonsens e consensu s an d jettisone d research programs . I n th e process , anothe r laye r t o th e questio n o f th e relationship betwee n industr y an d cance r researc h will b e explored : th e embeddedness o f the cance r researc h consensu s i n modernis t cultura l cate -

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gories an d values that wer e largely products o f the industria l cultur e o f th e time. What Glove r ma y no t hav e realized , bu t probabl y wha t Rif e s partne r Kendall kne w al l to o well , wa s tha t b y positionin g th e so-calle d cance r microbe a s a pleomorphic bacteriu m tha t ha d viruslik e o r filterabl e stages , they had stepped right into th e middle of a raging scientific controversy . To understand thi s controvers y a s i t playe d ou t i n th e 1920 s an d 1930s , i t i s necessary t o ste p bac k i n tim e t o th e lat e nineteent h centur y an d th e originary momen t o f microbiolog y (the n bacteriology ) a s a scientifi c re search culture . One o f th e heroe s o f som e advocate s o f alternativ e cance r theorie s i s Antoine Bechamp , considere d t o b e th e defeate d an d unsun g nemesi s o f Louis Pasteur. Pasteu r capture d th e imaginatio n o f his fellow citizen s i n his day, an d h e ha s continue d t o captur e th e imaginatio n o f historian s an d sociologists sinc e then . A t th e whi g histor y en d o f th e spectrum , Ren e Dubos's Louis Pasteur: Free Lance of Science, Pasteu r is a saintly citizen whos e masters ar e wor k an d science . A t th e constructivis t en d o f th e spectrum , Bruno Latour' s The Pasteurization of France, Pasteur' s brillianc e lie s more i n his abilit y t o mak e himsel f indispensabl e t o group s muc h mor e powerfu l than he. Public health, agriculture, and the food industr y become intereste d in an d the n dependen t o n Pasteur' s scienc e an d technology ; h e Pasteurize s France. In th e alternativ e medica l literatur e ther e i s a radically differen t vie w o f Pasteur; h e i s a plagiaris t an d th e nemesi s o f th e crucifie d Antoin e Be champ.34 Becham p wa s a medica l biochemis t wh o a t on e poin t wa s a professor i n Lille . H e ha s al l but disappeare d from th e mor e accessibl e an d standard historie s o f microbiology , bu t thi s underdo g o f th e histor y o f microbiology retaine d a few loya l champions. Fo r example, in a n ol d boo k dating bac k t o th e 1920s , Bechamp or Pasteur? A Lost Chapter in the History of

Biology, E . Dougla s Hum e argue s that Bechamp deserve s priority fo r man y of th e discoverie s attribute d t o Pasteur . I t i s Bechamp , no t Pasteur , wh o deserves priorit y fo r th e experimenta l demonstratio n tha t fermentatio n i s due t o airborn e living organisms, an d therefore fo r th e definitiv e refutatio n of spontaneou s generatio n prio r t o Pasteur' s conversio n t o th e sam e view . It is Bechamp, not Pasteur, who discovere d the cause of the silkworm blight of the 1860s . Only later did Pasteur change his theory and accept Bechamp's position. However , whe n Becham p sough t recognitio n fo r hi s discoveries , Pasteur an d hi s networ k systematicall y exclude d recognitio n o f Bechamp s priority. I n short , th e narrativ e from som e quarter s o f th e alternativ e

Culture and Power in Cancer Research | 7 7 medicine communit y i s that Pasteu r an d hi s networ k stol e Bechamp's work , then rubbe d hi m ou t fro m th e historica l record . W h y woul d a questio n o f historica l credi t b e importan t fo r scienc e today? Becaus e i t point s t o a n originar y m o m e n t i n th e formatio n o f th e culture o f moder n microbiology , i n whic h som e idea s wer e s o radicall y different tha t the y wer e exclude d fro m possibilit y Rightl y o r wrongl y (an d I wil l argu e somethin g i n between) , th e exclude d idea s becam e pseudosci ence. A summar y o f man y o f Bechamp' s ke y concept s ca n b e foun d i n The Blood and Its Third Anatomical Element, a boo k tha t stand s ou t amon g hi s publications becaus e i t represent s a matur e formulatio n o f hi s theor y an d because i t i s on e o f hi s fe w work s tha t ha s bee n translate d int o English . T h e Englis h translator—Montagu e R . Leverson , M.D. , o f th e Baltimor e Medical School—introduce s Becham p a s "th e Master " an d Pasteu r a s "th e arch plagiarist. " Becham p continue s hi s campaig n agains t Pasteu r i n th e pages tha t follow . H e als o reveal s a radica l theor y o f microbiolog y tha t Pasteur an d hi s follower s neve r accepted , plagiarized , o r wante d muc h t o do wit h a t all : the microzym a theory . It i s difficul t t o summariz e th e microzym a theory , partl y becaus e it s language i s s o radicall y differen t fro m tha t o f microbiolog y toda y Readin g Bechamp's wor k provide s a goo d exampl e o f th e proble m o f paradig m incommensurability o r untranslatabilit y o f term s acros s radicall y differen t global theories . Nevertheless , th e ke y assumption s o f th e microzymia n theory ca n b e approximate d a s follows : 1. Th e smalles t uni t o f life i s no t th e cell , bu t th e microzyma , whic h i s found i n th e cel l cytoplas m an d i n th e bloo d plasma . Microzyma s ca n b e seen i n th e microscop e a s little points , bu t accordin g t o Becham p the y ar e not, a s critic s hav e claimed , artifact s suc h a s Brownian motio n o r bacteria l spores. The y ca n b e foun d i n th e air , th e earth , an d i n fossilize d anima l remains such as chalk. 2. Microzyma s ar e specific t o specie s and tissues; in othe r words, they ar e not al l identical. 3. Microzyma s surviv e th e organis m a t death , an d the y contribut e t o th e decay process. 4. Microzyma s ar e capable of coalescing and causin g the blood t o clot . 5. Whe n th e overal l stat e o f healt h become s compromised , microzyma s can coalesc e an d for m bacteria l pathogen s tha t caus e disease . "Norma l ai r contains neithe r preexistin g germ s no r th e thing s whic h hav e been improp erly termed microbes , suppose d t o ascen d from ag e to ag e to parent s resem -

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bling them " (Becham p 1911 : 393) . Diseas e i s cause d b y a chang e i n th e organism's overal l state of health tha t leads to th e transformatio n o f microzymas into bacterial pathogens. O n hi s deathbed , Pasteu r i s sai d t o hav e change d hi s min d abou t th e infectious theor y o f diseas e an d recante d wit h famou s phrase , " T h e terrai n is everything. " Bechampian s tak e th e deathbe d confessio n a s proo f o f guil t and proo f tha t thei r maste r wa s right . A s I wil l argu e i n th e nex t chapter , I think mos t o f what Becham p sai d was plain wrong . However , h e articulate d two idea s tha t i n a somewha t differen t for m hav e becom e accepte d amon g the advocate s o f a bacteria l theor y o f cancer : microbia l pleomorphis m i s much mor e widesprea d tha n wa s firs t recognized ; an d laten t microbia l pathogens ar e capabl e o f becomin g pathologica l w h e n environmenta l cir cumstances suc h a s host nutritiona l statu s change . Bechamp wa s a n advocat e o f a n extrem e versio n o f pleomorphism ; h e believed tha t bacteri a ar e capabl e o f changin g almos t limitlessl y fro m on e type t o another . N o on e amon g th e advocate s o f a bacteria l theor y o f cancer accepte d thi s position , althoug h Rif e cam e clos e i n hi s discussio n of eigh t majo r bacteria l group s an d Enderlein' s protit s recal l Becham p s microzymas. I n German y th e contemporar y counterpar t o f Becham p among th e extrem e pleomorphist s wa s Car l Nageli . H e believe d tha t bacte ria coul d no t b e divide d int o specie s becaus e the y underg o suc h profoun d changes o f for m ove r tim e an d acros s environments . H e als o becam e involved i n a controvers y i n German y tha t wa s simila r t o tha t betwee n Pasteur an d Becham p i n France . According t o ST S researche r Olg a Amsterdamsk a (1987) , botanis t Ferdi nand C o h n an d bacteriologis t R o b e r t Koc h formulate d thei r positio n of bacteria l monomorphis m i n oppositio n t o th e extrem e pleomorphis m advocated b y Nageli . T h e principl e tha t i s sometime s know n a s the C o h n Koch dogm a o f monomorphis m hel d tha t bacteri a coul d b e divide d int o specific specie s tha t maintaine d constan t form s ove r time . Lik e Loui s Pasteur, Koc h i s generall y considere d on e o f th e foundin g father s o f bacte riology. Koch' s studie s o f anthra x establishe d th e fac t tha t spore s isolate d from pur e culture s o f th e bacillu s coul d caus e disease , an d i n mor e genera l terms h e showe d tha t specifi c infectiou s microorganism s coul d caus e spe cific diseases . Followin g th e wor k o f hi s mento r Jaco b Henle , Koc h sup ported th e ger m theor y o f disease , an d h e develope d Koch' s postulate s fo r defining causatio n i n disease . Amsterdamska invoke s professiona l interest s t o explai n th e controvers y

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between monomorphist s an d pleomorphists . Sh e draw s o n th e researc h o f historian R o b e r t Kohle r (1985 ) t o argu e tha t monomorphis m wa s favore d in par t becaus e o f th e nee d fo r quic k identificatio n an d diagnosi s i n medi cine. Fo r example , Koc h an d hi s supporter s advocate d treatin g choler a b y isolating an d quarantinin g afflicte d individual s base d o n laborator y analyse s of bacteria . A s Amsterdamsk a summarizes , "Monomorphis m transforme d laboratory observation s o f constan t association s int o causa l generalizations , and thereb y als o assure d thei r practica l relevance " (1987 : 666). I n contrast , although th e radica l pleomorphis t Nagel i accepte d th e ger m theor y o f disease, h e denie d it s medica l relevanc e becaus e h e believe d tha t bacteri a could easil y chang e forms . Nagel i wa s associate d wit h th e Germa n hygien ists, an d the y advocate d treatin g choler a b y improvin g sanitation . Consistent wit h th e theor y o f monomorphism wa s th e secondar y theor y that bacteri a reproduce d b y fission . I t wa s no t unti l 1946 , w h e n Joshu a Lederberg an d Edwar d Tatu m publishe d a pape r i n Nature, tha t biologist s recognized geneti c exchang e a s a mean s o f reproductio n i n bacteria . I n 1986 Lederber g publishe d wit h ST S analys t Harrie t Zuckerma n th e pape r "Postmature Scientifi c Discovery, " whic h argue d tha t i n additio n t o th e commonplace occurrenc e o f scientist s w h o mak e "premature " discoveries , it i s also possible , a s in th e cas e o f bacterial sex , fo r discoverie s t o b e behin d the times , tha t is , "postmature. " O n e prim e exampl e (an d perhap s no t a surprising one , give n Zuckerma n s coauthor) wa s th e cas e o f th e Lederber g and Tatu m "discovery. " Zuckerma n an d Lederber g argu e tha t on e o f th e major reason s fo r th e dela y o f th e discover y o f bacterial recombinatio n wa s the belie f i n monomorphism . However, Amsterdamsk a (1987 ) demonstrate d tha t th e doctrin e o f ex treme monomorphis m wa s widel y accepte d onl y unti l th e las t decade s o f the nineteent h century . Thus , t o accoun t fo r th e "postmature " discover y o f Lederberg an d Tatu m on e woul d hav e t o find som e othe r factor s tha t di d not includ e th e doctrin e o f monomorphism . Amsterdamsk a s criticis m i s a significant on e becaus e he r applicatio n o f interest s theor y make s i t possibl e to explai n wh y monomorphis m triumphe d i n th e nineteent h centur y an d why interes t i n bacteria l variatio n reemerge d a t th e tur n o f th e century . W h y di d bacteriologist s becom e mor e intereste d i n a modified , species bound versio n o f bacteria l pleomorphis m afte r th e tur n o f th e century ? After th e Koc h progra m wa s mor e firmly established , bacteriologist s bega n to tackl e th e proble m o f typhoid . I n th e first decad e o f th e twentiet h century, Rudol f Neisse r demonstrate d ho w th e fermentatio n characteristic s of a typhoi d organis m isolate d fro m a patien t wer e subjec t t o change .

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Amsterdamska argue s tha t give n th e prevalenc e o f typhoi d an d relate d diseases, an d th e difficultie s associate d wit h bacteria l diagnosis , interes t i n bacterial variation the n became much more widespread . Even prio r t o 190 0 Koc h wa s no t dogmaticall y oppose d t o th e ide a o f limited bacteria l variation . Accordin g t o microbiologis t Lid a Mattman , i n 1881 the Swedis h researcher Ernst Almquist observe d with Koc h variation s of typhoi d bacteri a (1993 : 2-3) . Th e Germa n scientis t apparentl y di d no t dismiss th e observations , but , a s Almquis t late r noted , Koc h becam e to o involved i n hi s variou s researc h project s t o follo w u p o n them . Almquis t did follow u p o n these and other observations , thus playing a founding rol e in th e researc h traditio n o n bacteria l variation . H e argue d tha t typhoi d bacteria i n foo d o r wate r becom e a n amorphou s mas s tha t regain s it s standard for m an d virulenc e onc e i t enter s th e huma n host . H e als o observed evidenc e o f wha t woul d toda y b e calle d bacteria l recombina tion—long befor e Lederber g and Tatum's "postmature " discovery . Amsterdamska add s that there was some cultura l variation in the contro versy. Eve n durin g th e nineteent h century , Frenc h researcher s wer e rela tively mor e ope n t o recognizin g bacteria l variatio n tha n thei r Germa n counterparts. Sh e explain s thi s differenc e a s du e t o th e Frenc h contro l of diseas e throug h attenuatio n i n contras t wit h th e "precis e etiologica l determinations" o f the German s (1987 : 670). Clearly, however , th e Frenc h Pasteurians wer e no t supportin g th e extrem e pleomorphis m o f Bechamp , which, a s with th e German s for Nageli , was rejected . To summarize , b y th e firs t decad e o f the twentiet h centur y a consensu s had emerge d i n bacteriolog y i n favo r o f a modified theor y o f monomor phism tha t accepte d limite d bacteria l variatio n fo r som e specie s suc h a s typhoid. Thi s consensu s continue d mor e o r les s throughou t th e twentiet h century, althoug h ther e wer e difference s o f opinio n regardin g ho w muc h variation occurs , which bacteria l specie s exhibi t it , an d th e rang e o f stages that coul d legitimatel y b e counte d a s variation. Th e consensu s tha t ther e are specifi c bacteria l specie s wa s crucia l fo r bacteriolog y t o maintai n it s position a s a ke y medica l scienc e tha t coul d contribut e t o th e diagnosis , prevention, an d treatment o f disease. Regarding th e questio n o f the bacteria l theor y o f cancer , th e timin g o f key researc h project s no w become s important . Th e studie s o f th e lat e nineteenth centur y tha t supporte d th e bacteria l theor y occurre d whe n monomorphism wa s stil l ver y popular . Thus , t o th e exten t tha t critic s assumed monomorphism, the y would hav e tended t o se e the contradictor y bacterial cultures (cocci , rods , etc. ) fro m cance r tissue s a s contaminant s

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rather tha n differen t form s o f th e sam e microbe . Furthermore , th e limite d return t o pleomorphis m tha t becam e acceptabl e i n th e twentiet h centur y still di d no t entai l th e extended , multistag e model s tha t Glove r an d Ender lein defende d i n th e 1920 s an d 1930s . This becam e eviden t durin g a secon d major bacteriologica l controvers y tha t erupte d durin g th e 1920 s an d 1930 s and involve d mor e o r les s thi s sam e fundamenta l issue : th e exten t t o whic h microbes ca n vary . In th e secon d controversy , th e ne w advocate s o f pleomorphis m agree d that specifi c bacteria l specie s exis t an d canno t b e transforme d int o eac h other, an d therefor e the y di d no t advocat e returnin g t o th e radica l positio n of Bechamp . However , the y di d advocat e a stron g for m o f pleomorphis m within som e bacteria l species . Thi s stron g for m o f pleomorphis m include d two ke y bu t separabl e ideas : th e observation s o f bacteria l pleomorphis m could b e arrange d int o a lif e cycl e (cyclogeny) , an d i n a t leas t som e case s the cycl e include d a stag e tha t wa s largel y invisibl e unde r th e ligh t micro scope an d tha t coul d pas s throug h a filte r tha t blocke d bacteri a (filtra tionism). Durin g thi s period , whic h antedate d th e electro n microscope , viruses wer e generall y no t visibl e throug h ligh t microscopes , an d filter s were use d t o distinguis h viruse s fro m bacteria . A s wit h prion s today , ther e was a great dea l o f confusio n abou t wha t viruse s were : livin g agent s o r not , capable o f survivin g outsid e th e cel l o r not , eve n rea l entitie s o r merel y artifacts. A t tha t time , th e ter m "filterabl e virus " wa s ofte n used , an d advocates o f the theor y tha t bacteri a passe d throug h well-define d lif e cycle s like thos e o f fung i wer e als o know n a s "filtrationists. " I t wa s possible , however, t o b e a filtrationis t withou t acceptin g th e cyclogeni c theory , although th e tw o position s tende d t o coincid e durin g thi s period . In a secon d pape r Amsterdamsk a (1991 ) take s u p th e cyclogenic/filtra tionist controvers y tha t bega n durin g th e lat e 1920 s an d laste d int o th e 1930s. T h e controvers y emerge d ove r attempt s t o synthesiz e divers e obser vations int o a genera l theor y tha t bacteria l variatio n occur s i n lif e cycle s similar t o thos e o f fungi . O n e o f th e ke y paper s i n th e controvers y i n th e United State s wa s a review essa y published i n th e Journal of Infectious Diseases in 192 7 b y Phili p Hadley , a n agricultura l bacteriologis t w h o afte r 192 0 wa s at th e Universit y o f Michiga n Medica l School . I n additio n t o synthesizin g previous wor k o n bacteria l lif e cycles , Hadle y argue d tha t morphologica l changes wer e linke d t o virulence , an d therefor e tha t th e cyclogeni c theor y had tremendou s implication s fo r medicine . Furthermore , h e supporte d th e argument tha t th e bacteria l lif e cycl e could , i n a t least som e cases , includ e a viral phase . Anothe r importan t figure—on e cite d i n th e literatur e an d

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recognized i n a historical commen t b y microbiologis t Lid a Mattma n i n he r textbook o n bacteria l variation—wa s Rife' s colleagu e Arthu r Kendall , who, accordin g t o Mattman , wa s th e founde r o f " a schoo l o f filtration " (1993: 209) . From th e lat e 1920 s int o th e 1930s , bacteriologist s argue d ove r th e evidence fo r cyclogen y an d filtrationism . I n 193 7 Hadle y publishe d a pape r that summarize d th e result s o f bot h side s o f th e controvers y an d cede d some groun d t o th e critics . However , th e pape r di d no t mar k a closur e o f the controversy , no r di d th e controvers y eve r see m t o achiev e a decisiv e closure. "Rather, " Amsterdamsk a argues , "a s bacteria l genetic s replace d th e studies o f bacteria l variatio n an d dissociation , an d a s virologist s cam e t o a consensus tha t viruse s ar e biologicall y completel y differen t from bacteria , both side s t o th e life-cycl e controvers y becam e irrelevan t an d forgotten " (1991: 220) . Mattman suggest s tha t th e filtrationis t controvers y wa s resolve d by "th e demonstratio n b y [Emmy ] Klieneberge r an d b y [Louis ] Diene s tha t filterable organism s coul d b e grow n o n soli d mediu m an d thei r sequentia l reversion step s followed " (1993 : 209) . Sh e conclude s th e chapte r wit h th e statement tha t al l bacteri a appea r t o b e abl e t o ente r int o a filterabl e stage , and i t seem s "strange " tha t th e topi c "wa s a t on e tim e a highly controversia l subject" (214) . However, th e fat e o f the cyclogeni c theor y wa s quit e th e opposit e o f th e filtrationist theory. 35 A revie w essa y published b y th e U.C . Berkele y biolo gist Werne r Brau n rejecte d th e cyclogen y theor y (1947) . Likewise , i n another revie w essa y published a few year s later , Klieneberger-Nobe l sum marily dismisse d Enderlein s work : "Enderlein s boo k Bakteriencyclogenie presents a philosophica l treatis e rathe r tha n a discussio n o f scientifi c fact s based o n exac t observation s an d i s therefor e no t furthe r discusse d here " (1951: 93) . Model s o f extende d bacteria l lif e cycle s o f the typ e propose d b y Glover, Enderlein , an d vo n Brehme r ( a tradition continue d toda y b y Naes sens) hav e bee n rar e i n th e subsequen t microbiologica l literature . W h y wer e th e cyclogenist/filtrationis t theorie s s o controversial ? Amster damska argue s tha t Hadley' s claim s receive d attentio n becaus e h e mad e them medicall y relevant . Hi s claim s wer e dispute d becaus e eve n thoug h h e did no t retur n t o th e radica l pleomorphis m o f Becham p o r Nageli , h e questioned som e o f the basi c assumption s o f his contemporaries . H e admit ted tha t domesticate d laborator y strain s coul d b e maintaine d i n artificia l conditions an d tha t thes e strain s wer e "amenabl e t o consisten t laborator y findings an d hav e therefor e becom e th e favorit e subject-matte r o f th e systematists" (Hadle y 1927 : 289). However, h e believe d tha t th e "free-livin g

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microorganism i s potentiall y a kaleidoscopi c thing , i n whic h th e powe r o f responding t o a changin g environmen t b y alteration s i n th e bod y stat e . . . stands a s its on e mos t importan t attribute " (289) . H e suggested , "Wha t w e ought t o wis h t o kno w abou t thes e culture s is , for instance , ho w th e variou s types o f pneumococci , o f streptococci , meningococci , o f B . coli , o f th e paratyphoids, o f dysenter y an d othe r bacteria , hav e bee n (w e migh t eve n say 'ar e being' ) formed " (1927 : 290) . Consequently , hi s colleague s shoul d abandon "fo r th e presen t a t least , ou r vai n attempt s t o perfec t scheme s o f classification" (291) . T he bacteriologists ' classificator y bibl e Bergey's Manual, which wa s firs t publishe d i n 192 3 an d wa s i n it s fift h editio n b y 1939 , would hav e bee n throw n ou t th e w i n d o w Amsterdamska argues , "Hadley' s claim s affecte d i n a direc t manne r th e then-current wor k o f member s o f th e establishmen t i n interwa r bacteriol ogy," includin g prominen t bacteriologist s a t Johns Hopkins , Yale , an d Har vard (1991 : 209 , 213) . Fo r example , Le o Rettge r an d Haze l Gillespi e o f Yale wrote , The question s a t issu e her e ar e o f extrem e importance , an d upo n a satisfac tory solutio n o f them wil l depend th e future developmen t o f bacteriology. I f bacteria mus t pas s throug h variou s lif e cycl e phases , an d i f the y manifes t themselves i n viable forms whic h ar e filterable, ou r conceptio n o f bacteriology wil l requir e a thorough revision , an d wit h i t th e presen t conceptio n o f pathology o f medicine . . . . [I f not, ] th e threatene d cataclys m i n systemati c bacteriology ma y be indefinitely deferred . (1933 : 290) Likewise, Marti n Frobishe r o f Johns Hopkin s wrot e tha t systemati c bacteri ology base d o n th e stud y o f culture s subjec t t o suc h variatio n "woul d see m based upo n a fallacy, " an d "unde r thes e circumstance s chao s exist s i n bacteriology." 3 6 Similar comment s fram e th e filtrationis t debat e betwee n Kendal l an d hi s opponents tha t occurre d a t th e 193 2 annua l meetin g o f th e Associatio n o f American Physicians . Harvar d bacteriologis t Han s Zinsse r attacke d Ken dall's filtrationis t view s an d argued : If hi s surmis e i s correct , th e entir e structur e o f ou r attitud e towar d th e biology o f disease must be changed . I t is almost as important a s the theor y o f spontaneous generation , an d nothin g shor t o f absolut e proo f shoul d b e accepted o r w e ma y ris k makin g researc h eve n mor e difficul t tha n i t alread y is. . . . I f hi s conclusion s ar e correct , h e ha s brough t abou t a revolutio n i n bacteriology, bu t w e d o no t believ e tha t h e obtaine d th e organism s fro m th e filtrate afte r repeate d invisibl e cultivatio n i n th e K medium . (Kendal l e t al . 1932, 68 )

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Zinsser coul d hav e bee n particularl y affecte d b y Kendall' s researc h an d hi s publications tha t claime d a hig h leve l o f pleomorphis m fo r th e typhoi d bacterium. I n th e earl y 1930 s Zinsse r wa s attemptin g t o develo p a vaccin e for typhus , a disease cause d b y a similar bacterium , an d i f claims o f extrem e pleomorphism wer e extende d t o typhus , hi s effort s t o develo p a vaccin e could hav e bee n complicated. 37 Rockefeller Institut e virologis t Thoma s River s ha d othe r reason s fo r questioning th e filtrationis t theory . I n 192 6 h e announce d th e theor y tha t viruses coul d no t reproduc e outsid e cells , an d h e adde d hi s ow n argument s and evidenc e agains t Kendall s filtrationis t theory : " N o on e ha s brough t convincing evidenc e tha t filterabl e viru s exist s i n th e absenc e o f livin g tissue" (Kendal l e t al . 1932) . Kendal l apparentl y ha d fe w defenders , bu t ironically on e wa s Willia m Welch , w h o i n additio n t o bein g on e o f th e founders o f John s Hopkin s an d th e presiden t o f th e boar d o f scientifi c directors o f th e Rockefelle r Institute , wa s als o th e teache r o f Peyto n R o u s . 3 8 I n th e exchang e amon g Zinsser , Rivers , an d Kendall , Welc h stepped i n wit h grandfatherl y graciousnes s t o not e tha t howeve r erroneou s Kendall's interpretation s were , h e a t leas t ha d contribute d som e ne w obser vations o n th e recognize d phenomen a o f granule s forme d withi n bacteri a (Kendall e t al . 1932) . To summarize , cyclogenist s lik e Hadle y an d filtrationist s lik e Kendal l threatened t o destabiliz e th e fundamenta l categorie s o f bacteriology . Bu t why di d th e bacteriologica l establishmen t plac e suc h a high valu e o n havin g stable categories ? O n e migh t propos e a psycholog y o f conservativis m an d inertia, o r a quasisacred dogm a o f modified monomorphism , bu t a psychol ogizing explanatio n o f thi s sor t amount s t o littl e mor e tha n sociologica l phlogiston theory . A bette r bu t stil l inadequat e explanatio n i s tha t th e cyclogenist an d filtrationist theorie s conflicte d wit h th e professiona l inter ests o f medical bacteriologists , whic h reste d o n thei r rol e i n fightin g disease . This explanatio n i s no t completel y adequat e because , accordin g t o Hadley , patterns i n bacteria l variatio n coul d b e correlate d wit h medicall y relevan t knowledge suc h a s virulence. Hi s theor y coul d hav e enhance d th e medica l applicability o f bacteriology . T h e proble m seeme d t o b e tha t h e coul d no t make th e knowledg e relevan t enoug h s o tha t i t wa s wort h acceptin g a n overhaul o f bacteriolog y an d a n effor t t o develo p therapie s tha t linke d variable pathogenicit y t o microbia l stages . Hadle y ha d attacke d a cor e ide a of th e bacteriologica l culture— a negativ e heuristi c o f it s researc h pro g r a m — t h e ide a tha t bacteri a coul d b e safel y classifie d int o readil y identifi able an d relativel y stabl e specie s an d studie d experimentall y an d systemati -

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cally. Widesprea d an d wide-rangin g variatio n mean t tha t th e projec t o f systematic bacteriolog y woul d hav e t o b e pu t o n hold , an d tha t effort s t o develop therapie s woul d b e mor e complicate d tha n a t firs t anticipated . More tha n a conflict o f interests, th e filtrationist/cyclogenis t controvers y involved a conflict o f cultures. T h e heterodo x positio n wa s a t dramati c odd s with th e emergin g cultur e o f scientific medicin e tha t include d bacteriology . Across a wid e variet y o f cultura l domains—industria l production , medi cine, literature , th e arts , socia l theory , architecture , religion , education , social organization , politics , an d s o o n — a modernis t cultur e wa s formin g in a patter n o f mutua l feedbac k an d reinforcement . I n a previou s book , I emphasized close d syste m principle s an d equilibriu m dynamic s a s charac teristic o f modernis t cultur e (Hes s 1995 : ch . 3) . I n science , close d system s with equilibriu m dynamic s include d th e Boh r atom , Pavlovia n condition ing, Parsonia n functionalism , an d bacteria l systematics . Modernis t cultur e also emphasize d standardizatio n (Marti n 1994) . Durin g th e modernis t p e riod o f assembly-lin e production , Tayloris t management , an d functionalis t architectures an d socia l theories , standardizatio n wa s positivel y associate d with progress , no t negativel y linke d t o a cultura l politic s o f conformit y an d hegemony. John D . Rockefelle r s standardization o f th e oi l industr y an d th e medical professio n s standardizatio n o f it s educatio n an d licensin g policie s are onl y tw o example s o f th e valu e place d o n standardizatio n i n th e m o d ernist period . T h e bacteria l researc h o n cance r an d it s associate d therapie s conflicte d with thes e ofte n taken-for-grante d values . T h e researc h faile d t o produc e a standardized pathoge n fo r cance r a s i n th e cas e o f othe r infectiou s diseases . Furthermore, i t wa s linked t o th e filtrationis t program , whic h threatene d t o destabilize th e basi c uni t o f bacteriologica l analysis . I n a simila r wa y th e therapies tha t wer e associate d wit h bacteria l theorie s o f cance r wer e no t easily standardized . A s Mos s point s out , i n additio n t o th e financia l motiv e that favore d th e selectio n o f radiu m an d X-rays , radiotherap y wa s easie r t o prescribe i n measurabl e dosages , wherea s Coley' s toxin s wer e mor e difficul t to administe r (1989 : 123) . I n th e previou s chapter , I reporte d o n Hele n Coley Naut s pointin g t o som e o f th e difficultie s i n standardizin g Coley' s toxins an d thei r application . W i t h radiotherapie s an d chemotherapies , stan dard dose s coul d b e encode d int o machine s o r syringes . Pleomorphi c bacteria an d variabl e vaccin e potencie s conflicte d no t onl y wit h th e inter ests o f assembly-lin e productio n o f medica l therapeuti c technologies , bu t with a modernist cultur e o f standardization . In th e Unite d State s th e modernis t cultur e o f standard/scientifi c medi -

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cine wa s mos t advance d i n elite , Easter n school s suc h a s Johns Hopkins . These site s represente d no t onl y th e startin g poin t o f the spendin g spree s o f the Rockefelle r an d othe r foundations , bu t als o th e institutiona l h o m e o f some o f th e mos t outspoke n critic s o f cyclogen y an d filtrationism . Obvi ously th e critic s wer e no t motivate d b y a n unspoke n allegianc e t o R o c k e feller financia l empir e interests ; instead , the y ha d a standardized , modernis t vision o f science , nature , an d societ y tha t overlappe d wit h th e industria l worldview an d th e emergen t cultur e o f scientific medicine . There i s als o som e evidenc e tha t th e advocate s o f cyclogen y an d filtra tionism wer e eithe r outsider s o r locate d institutionall y o n th e fringe s o f th e establishment circle s o f th e ne w scientifi c medicine . Historia n Jonatha n Harwood ha s documente d a n interestin g intellectua l divid e amon g elit e and nonelit e geneticist s i n Germany , an d h e point s t o preUminar y evidenc e for a simila r divisio n tha t ma y hav e existe d i n th e Unite d State s betwee n geneticists workin g i n elit e privat e universitie s an d thos e workin g i n th e agricultural facilitie s o f state universities : A casua l prosopographica l surve y o f thes e tw o group s suggest s tha t thos e working i n agricultura l institution s wer e mor e likel y t o com e fro m far m backgrounds, mor e likel y to wor k i n transmissio n genetics , an d less likely t o have "hig h cultural " interest s tha n wer e thos e workin g i n elit e universities . (Harwood 1993 : 356-57) Likewise, i n th e cas e o f th e filtrationist/cyclogen y controvers y i t i s sugges tive tha t som e o f th e advocate s wer e locate d outsid e th e elite , Easter n schools. I t woul d b e interestin g t o loo k mor e carefull y a t th e institution s and background s o f th e majo r defender s an d debunker s o f filtrationism an d cyclogeny i n term s o f thei r proximit y t o th e diffusin g cultur e o f scientifi c medicine. 3 9 Whatever th e interna l socia l stratificatio n dynamic s o f th e cyclogenist / filtrationist controvers y tur n ou t t o be , th e controvers y clarifie s th e meanin g and positio n o f th e wor k o f heterodo x researcher s suc h a s Glover . W h e n the Canadia n docto r publishe d researc h i n th e lat e 1920 s tha t supporte d a microbial cance r agen t wit h a hig h leve l o f pleomorphism , a filterable stage, an d a n organizatio n o f stage s int o a lif e cycle—an d w h e n h e adde d cyclogenist Feli x Lohni s t o hi s citations—h e wa s stepping , perhap s naively , directly int o a wide r controversy . Furthermore , h e wa s alignin g himsel f with a side tha t wa s outsid e th e mai n line s o f the Eastern , elit e establishmen t of bacteriology . Other member s o f th e filtrationist schoo l probabl y wer e mor e awar e o f

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the linkage s amon g pleomorphism , filtrationism , an d th e microbia l theor y of cancer . Ralp h Mellon , a cyclogenis t from th e Highlan d Hospita l o f Rochester, Ne w York, and his colleagues isolated pleomorphic tuberculosi s microbes from tissues of Hodgkins diseas e and sarcoidosis, a chronic diseas e similar t o tuberculosi s (Mello n an d Fishe r 1932 ; Beinhaue r an d Mello n 1938). Kendall, a key participant i n th e controversy , carefull y appropriate d the Rif e researc h t o defen d hi s ow n positio n a s a filtrationis t withou t endorsing in print Rife' s claim s about a cancer microbe. As Kendall probably recognized, th e adven t o f a new technolog y suc h as the Rif e microscop e offere d th e possibilit y o f technica l closur e t o th e controversy—at leas t th e filtrationis t sid e o f it—b y makin g filterabl e vi ruses observable phenomena rathe r than theoretical postulates. He was only wrong t o th e exten t tha t h e choos e th e Rif e microscop e rathe r tha n th e electron microscope . (Indeed , becaus e th e Rif e microscop e allowe d fo r observation o f living phenomena, lik e other darkfiel d microscope s it woul d have favore d th e pleomorphi c interpretation. ) Later , whe n th e adven t o f molecular biolog y mad e genome s mor e th e principl e marke r o f specie s categories tha n morphology , nutritiona l parameters , an d stainin g patterns , it becam e easie r t o tolerat e variation . Th e stud y o f cell-wal l deficien t bacteria an d pathology was able to return t o life without bein g so threaten ing. I n today' s postmoder n worl d o f shape-shifting cyborgs , flexible accu mulation (Harve y 1989) , an d wha t Emil y Marti n (1994 ) call s "flexibl e bodies"—where cultura l an d geneti c diversit y ar e ofte n positivel y value d and standardizatio n i s associate d wit h cultura l hegemony—i t i s easie r t o imagine mor e flexible classificatio n system s fo r microorganisms , system s that woul d mak e eve n Hadley' s an d Glover' s bacteria l lif e cycle s see m standardized an d unduly stabilize d (se e Domingue 1995 , 1996).

The Gendering of Microbes, Researchers, and Therapies So fa r my applicatio n o f the cultur e concep t ha s been restricte d t o identi fying th e orthodoxie s an d heterodoxie s o f th e emergin g professiona l cul tures o f cance r researc h an d bacteriology , an d thei r relationship s t o th e values an d interest s o f industria l culture . I hav e show n ho w consensu s cultures emerge d i n cance r researc h an d bacteriology , an d ho w thos e cul tures were consisten t wit h professiona l an d financial interests , a s well as the general modernis t cultures , i n whic h the y wer e embedded . Th e nex t ste p synthesizes an interests analysis of the morphology o f research culture s wit h

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an analysi s o f gende r tha t i s roote d i n feminis t theory . Thi s ste p implie s more tha n merel y addin g a laye r ont o th e interest s theor y o r anothe r dimension t o th e analysi s o f th e researc h cultures . Instead , gende r trans forms a n interests-and-cultur e analysi s int o a culture-and-powe r analysis . Interests ar e no t forgotten ; fo r th e analysi s o f gende r involve s recognizin g the materia l interes t o f me n i n maintainin g fo r themselve s position s o f prestige an d power . However , gende r als o allow s fo r a rereading o f interest s theory t o sho w h o w th e instrumenta l aspect s o f protectin g one' s sacre d theories o r materia l positio n ar e complicate d becaus e the y ar e suspende d i n a networ k o f mor e genera l cultura l value s an d categories . Thi s argumen t will procee d i n tw o steps : t o demonstrat e th e gendere d logi c a t wor k i n th e culture o f microbiology , an d t o demonstrat e th e gendere d logi c i n th e culture o f orthodo x cance r therapies . In th e cas e o f microbiology , th e relativel y marginalize d positio n o f research o n bacteria l variation , w h e n viewe d throug h th e len s o f studie s of gende r an d socia l stratificatio n i n science , woul d sugges t tha t th e fiel d of researc h o n bacteria l variatio n migh t hav e a relativel y larg e numbe r o f women, o r a t th e minimu m t o b e perceive d t o hav e a larg e numbe r o f women. 4 0 Thi s i s indeed th e case . I n th e firs t (1974 ) editio n o f the textboo k Cell-Wall Deficient Bacteria, microbiologis t Lid a Mattma n introduce s th e topic o f the rol e o f w o m en i n th e concludin g chapter , whic h sh e title d "In variants an d th e X X Chromosomes. " I n th e secon d edition , publishe d i n 1993, Mattma n retitle d th e chapte r " T h e X X Chromosome. " Becaus e th e chapter i n th e firs t editio n mor e explicitl y raise s som e interestin g gende r issues, I will focu s o n Mattma n s discussion there . T h e ter m "L-variants " o r "L-phas e variants, " whic h appeare d i n th e titl e of th e chapte r o n gende r i n th e firs t edition , refer s t o cell-wal l deficien t bacterial colonie s tha t loo k lik e frie d egg s an d ar e capabl e o f revertin g bac k to classica l bacteria . (Th e ter m " L Forms, " whic h toda y i s on e ke y wor d for pickin g u p researc h o n cell-wal l deficien t bacteri a i n Medlin e o r othe r research databases , wa s coine d b y Emm y Klieneberger-Nobel . Sh e name d the bacteria l variant s afte r th e Liste r Institute , wher e sh e worked. ) I n th e chapter o n L-Variant s an d th e X X chromosome , Mattma n comment s o n the larg e numbe r o f w o m en w h o wer e doin g researc h o n cell-wal l deficien t bacteria. I n a n appendi x t o th e book , sh e provide s a portrait galler y o f th e many w o m e n w h o contribute d t o th e field . Sh e offer s he r ow n psychologi cal explanatio n fo r th e prominen t rol e o f women: "Workin g wit h cell-wal l deficient form s require s grea t patience , a characteristi c usuall y considere d

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feminine. Or , facetiously , on e migh t stat e tha t followin g cultura l growt h b y the microscop e i s a sedentar y occupatio n an d thu s appeal s t o w o m e n " (1974: 386) . Microbiologist Kennet h Bisse t use s a simila r explanatio n i n hi s c o m ments o n th e relationshi p betwee n difficult y an d controversy : "Wor k o n these fragil e organism s [L-form s an d mycoplasma ] i s no t easy , an d i t ha s been highl y controversia l . . . partl y fo r th e simpl e reaso n tha t i t is s o technically difficult. " H e add s tha t thi s i s amon g th e mai n reason s wh y "i t is th e courageou s se x tha t ha s persevere d a t th e task , almos t unsupported " (1969: 581) . Yet, technica l difficult y alon e i s not enoug h t o explai n th e lo w status o f th e field . A ful l understandin g require s referenc e t o th e lingerin g effects o f th e variou s controversie s ove r filtrationis m an d cyclogeny , a s wel l as th e purporte d lac k o f practica l valu e o f th e researc h becaus e man y researchers d o no t thin k o f C W D organism s a s pathogens . Togethe r wit h the technica l difficult y thes e feature s ca n explai n th e lo w statu s o f the field . Because me n ten d t o occup y th e highe r statu s fields , lo w statu s ca n explai n the preponderanc e o f women , o r a t leas t th e perceptio n tha t th e fiel d belongs t o women . Thi s explanatio n seem s mor e appropriat e tha n th e psychological theor y foun d amon g microbiologist s suc h a s Mattma n an d Bisset. A relate d issu e t o th e rol e o f w o m e n i n th e subfiel d i s th e gendere d cultural meanin g o f th e research . Mattma n provide s a startin g poin t wit h the followin g passage : Women wh o persis t in L-variant researc h after marriag e ma y find themselve s subject t o ope n slander . The y ma y b e accuse d o f serving shis h keba b t o th e family, mad e o f protoplasts an d spheroplasts alternatel y arrange d o n a skewer. Likewise, suc h female investigators , i f they have smal l children, ar e suspecte d of startin g bedtim e storie s wit h th e phras e "onc e upo n a tim e ther e wa s a poor little bacterium who ha d lost his cell wall." (1974 : 387) Mattman i s clearl y referrin g t o som e aspect s o f th e sexis m prevalen t i n science, a problem tha t wa s muc h w o r s e — o r a t leas t mor e overt—fo r he r generation tha n fo r younge r ones . A t th e ris k o f reading to o muc h int o he r comments, th e symbolis m shoul d b e underscore d fo r th e psychoanalyticall y unattuned reader . T h e imag e o f a gendere d "poo r littl e bacterium " w h o had los t his cel l wall , lik e a littl e bo y w h o ha s los t hi s phallus , suggest s a sexist compariso n o f C W D bacteri a an d w o m e n researcher s a s deficient . This compariso n i s eve n mor e invitin g w h e n on e realize s tha t Mattma n

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prefers t o thin k o f C W D a s meanin g cell-wal l "divergent " rathe r tha n deficient. A s sh e notes , "th e ter m 'deficient ' implie s fragilit y an d othe r labile trait s whic h ar e no t alway s present" (1974 : 9) . Whether o r no t Mattma n intende d th e compariso n betwee n w o m e n microbiologists an d cell-wal l divergen t bacteria , le t u s mak e i t explici t here : women, lik e C W D bacteria , wer e capabl e o f surviving , an d eve n prosper ing, unde r condition s tha t woul d b e impossibl e fo r mos t well-connecte d male scientists . Workin g i n th e interstice s o f th e fundin g system , o r some times insid e th e laboratorie s o f men , the y patientl y persevere d wit h thei r work fo r decades . Researc h o n bacteria l variatio n continue d throughou t the twentiet h century , bu t i n a relativel y hidde n an d unrecognize d state , much lik e cell-wal l deficien t bacteri a ma y persis t i n a latent stat e insid e hos t cells. I n today s w o r l d — w h e r e diversity , variety , an d flexibilit y ar e value d attributes o f organization s an d p e o p l e — t h e long-hidde n researc h traditio n on stealt h pathogen s ma y b e makin g a comeback, muc h lik e laten t bacteria l pathogens tha t reappea r i n a hos t wit h a compromise d immun e syste m o r nutritional status . I n a simila r way , th e hidde n researc h traditio n o n C W D bacteria—one whic h ha s a n apparentl y marke d prominenc e o f w o m e n researchers—may als o gai n som e recognition . T h e genera l poin t i s that i n th e cultur e o f microbiology th e controversie s over variatio n hav e a riche r meanin g tha n merel y th e defens e o f a cor e theory o f modifie d monomorphis m tha t wa s se t i n plac e durin g th e m o d ernist era . T h e researc h traditio n o n bacteria l variatio n i s no t onl y margin alized bu t gendered . Standardize d an d cell-wal l divergen t bacteri a ar e tech nototems tha t mar k of f cultura l space s withi n microbiology , jus t a s the y have historicall y tende d t o mar k a divisio n o f labo r tha t symbolicall y linked w o m e n wit h bacteria l variation . Cell-wal l divergen t bacteri a ar e microbiological deviants , jus t a s Hadley , Glover , an d Livingsto n wer e m i crobiology an d cancer-researc h deviants . Even toda y C W D bacteri a ar e stil l considered aberration s agains t th e n o r m o f standard bacteri a wit h cel l walls. Lacking a cel l wall , thes e bacteri a ar e presume d t o b e defenseless , an d the y are frequentl y assume d t o b e harmles s an d fragil e (o r passive ) becaus e the y are supposedl y destroye d unde r osmoti c pressure . T h e genderin g o f bacteri a has accompanie d th e relativ e lac k o f recognitio n o f thei r possibl e rol e i n chronic disease. 41 A s a result , opportunitie s hav e bee n los t fo r a bette r understanding o f disease, perhaps eve n importan t disease s suc h a s interstitia l cystitis, arthritis , an d cancer . A simila r argumen t regardin g th e permeatio n o f gende r value s ca n b e made fo r cance r research . A n outstandin g aspec t o f the researc h o n bacteria l

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variation an d cance r i n N o r t h America , particularl y afte r Worl d Wa r II , wa s the prominenc e o f women' s networ k withi n th e field . Virgini a Livingston , Eleanor Alexander-Jackson , Iren e Diller , an d late r Florenc e Seiber t al l too k on a leadership rol e i n thi s fiel d fro m th e 1950 s throug h th e 1980s . Seibert' s autobiography Pebbles on the Hill of a Scientist point s t o th e man y w o m e n scientists sh e knew , an d i t seem s tha t par t o f th e legac y sh e wishe d t o leav e behind wa s a mode l fo r w o m e n i n science . Likewise , Livingsto n neve r explicitly identifie s hersel f i n he r writing s a s a feminist , bu t w h e n I dis cussed thi s questio n i n 199 5 wit h Patrici a Huntley , th e directo r o f th e Livingston Foundation , sh e state d tha t Livingsto n wa s clearl y a feminis t i n deed an d though t i f no t i n explici t label . Livingston' s writing s sho w tha t she wa s clearl y awar e o f the prejudice s tha t sh e experience d a s a woman. A s early a s her medical-schoo l year s an d he r struggle s a s a residen t amon g th e venereally infecte d prostitutes , sh e develope d a n acut e awarenes s o f ho w she wa s workin g i n a world controlle d b y men . As Livingston' s caree r developed , he r network s an d allie s include d men , but clearl y w o m e n wer e crucia l an d prominen t i n he r researc h efforts , particularly Alexander-Jackso n an d Diller . Severa l o f he r earl y publication s were i n th e Journal of the American Women's Medical Association, an d research ers sometime s aske d he r wha t sh e ha d publishe d becaus e the y di d no t rea d the journal s i n whic h sh e published. 42 Livingsto n becam e a n exampl e o f what Margare t Rossite r (1993 ) ha s calle d th e Matild a effect : th e tendenc y for w o m e n t o suffe r fro m under-recognitio n an d cumulativ e disadvantag e feedback loop s i n thei r caree r trajectories . Although Livingsto n di d hav e affiliation s wit h Rutger s Universit y an d the Universit y o f Sa n Diego , he r caree r di d no t follo w th e standar d path ways o f a universit y researcher . Sh e worke d a s a schoo l docto r fo r som e time, an d sh e di d no t hav e powerfu l network s tha t coul d protec t he r w h e n needed. W h e n sh e wen t t o wor k i n a clini c i n Sa n Diego , sh e wa s acutel y aware o f he r positio n a s th e las t physicia n hire d an d a s a n "olde r w o m a n " (1972: 81) . Sh e note s tha t althoug h sh e receive d a man' s salar y sh e ha d t o work muc h harde r fo r th e pay , ofte n whil e th e m e n wer e gathere d i n thei r offices smokin g an d talkin g abou t baseball . Sh e writes , " W h e n I woul d suggest tha t the y migh t lik e t o tak e som e o f m y overflow , th e repl y was , 'You don' t smok e an d yo u don' t kno w anythin g abou t baseball . You'r e no t one o f th e boys ' " (81) . Later , sh e adds , " W h e n I becam e well-know n a t the clinic , I wa s a threa t t o thei r prestige " (85) . Withou t a doub t th e fac t that sh e ha d t o wor k a s a clinicia n a t variou s point s o f he r caree r too k it s toll o n he r abilit y t o produc e research . B y mos t account s o f peopl e w h o

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knew her , Livingsto n wa s a stubbor n an d arrogan t individual , bu t he r colleagues rapidl y ad d tha t thos e trait s wer e necessar y fo r he r succes s an d survival i n a doubl y uphil l battl e a s a woma n medica l researche r an d a doctor w h o advocate d alternativ e cance r therapies . Some o f th e image s i n he r autobiographica l storie s als o giv e a sens e o f her experience s o f researchin g a s a woman . Sh e write s o f th e sadnes s o f extracting tissue s fro m recentl y remove d breasts , whic h wer e idea l fo r thei r work becaus e th e cancer s wer e usuall y enclose d i n th e breas t an d no t contaminated a s i n th e cas e o f bowe l cancers . I n contrast , on e o f he r occasional moment s o f gendere d humo r appear s i n a descriptio n o f a n adventure wit h foreski n tissues . Sh e foun d tha t th e foreskin s o f circumcise d babies wer e a good sourc e o f healthy huma n tissu e fo r culture : So o n a n icy , cold , dar k Februar y morning , ou r tissu e culturist , Marily n Clark, went ove r to collec t the morning's harvest o f fresh foreskins . I glanced out o f th e windo w o f th e tissu e cultur e roo m a s Marilyn starte d acros s th e icy courtyar d carryin g th e neatl y covere d tra y o f foreskins. Sh e was col d an d she was hurrying. All of a sudden her feet fle w ou t from unde r her and dow n she went , scootin g alon g th e ice . Th e tra y flew ou t o f her hands , scatterin g foreskins int o th e air . Scarcely before the y had a chance to reac h the ground , a flock o f sparrow s hunche d o n a neighborin g telephon e wire , swoope d down an d i n a twinkling , al l th e littl e pin k an d whit e delectabl e foreskin s were snappe d u p muc h lik e th e pin k worm s tha t appea r o n a grass y law n after a summe r shower . Marily n go t up , brushe d hersel f off , picke d u p th e tray an d gathere d u p th e gauze. Whe n I sa w tha t sh e wa s no t hurt , I wa s convulsed with laughter. Th e though t tha t thos e cold , hungr y little sparrow s were unexpectedl y treate d t o a delicious mea l cheere d m e u p fo r th e res t o f that gloom y da y (1972 : 39-40) Another instanc e o f he r humo r i s he r protes t agains t th e drea m o f Dr. Joh n Lawrenc e o f Lawrenc e Radiatio n Laboratorie s (late r Lawrenc e Livermore Laboratories) , whic h h e announce d durin g th e 196 6 semina r fo r science writer s sponsore d b y th e America n Cance r Society . Lawrenc e calle d for " a cobal t machin e i n ever y tow n an d villag e i n th e Unite d States " (Livingston 1984 : 94) . I n th e contex t o f th e c o m m o n linguisti c memor y o f most Americans , th e phras e "cobal t machin e i n ever y town " i s likel y t o bring t o min d th e ol d campaig n phras e " a chicke n i n ever y pot. " I n late r chapters includin g th e on e title d "Chicken : Cance r i n Ever y Pot, " Living ston discusse s th e R o u s viru s an d th e danger s o f cance r crossin g specie s t o humans w h o ea t undercooke d poultry . Sh e clearl y preferre d he r i m m u n o therapies an d dietar y therapie s t o th e cobal t machine , whic h Rhoad s ha d

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tried t o forc e o n he r afte r h e ha d take n awa y he r grant . A s sh e comments , w h e n Lawrenc e mad e hi s statemen t abou t a cobal t machin e i n ever y town , "I becam e excite d an d bega n t o wav e a petri dis h (use d fo r makin g cultures ) over m y hea d an d sai d tha t i t coul d b e mightie r tha n al l th e high-powere d radiation machine s i n th e world " (94) . T h e contras t o f a machin e tha t zap s cance r versu s a dis h tha t culture s microorganisms i s implicitly gendered , an d her e w e pas s from th e individua l experience o f Livingsto n a s a woma n researche r t o th e gendere d contour s of th e cultur e o f cance r research . O n e migh t argu e th e cas e psychoanalyti cally base d o n homologie s betwee n radiatio n machine s an d gun s versu s those betwee n petr i dishe s an d cookin g (o r phalli c versu s vagina l symbols) , but ther e i s a mor e direc t wa y o f understandin g th e gendere d oppositio n between mos t orthodo x cance r therapie s an d man y alternativ e ones . In deed, onc e on e begin s t o se e gende r i n th e cultura l constructio n o f cance r therapies, th e whol e divid e betwee n th e nutritional , nontoxic , an d nonspe cific immunotherapie s o n th e on e sid e versu s th e conventiona l cance r therapies o f "slash , burn , an d poison " shift s fro m simpl y a cas e o f interests , in whic h th e everyday , common-perso n o f alternativ e medicin e i s paire d off agains t th e bi g mone y o f the medica l an d pharmaceutica l establishment . Although man y researcher s hav e see n thi s struggl e a s a clas s o r economi c division, th e gende r dimensio n o f th e imager y o f "warfare " i n th e wa r i n cancer ha s remaine d underexplored. 4 3 Cancer researcher s ofte n signa l thei r aggressiv e approac h t o cance r treat ment throug h metaphors . Moss , followin g Irwi n Bros s o f Roswel l Park , notes tha t militar y metaphor s ar e deepl y ingrained : We hav e no w becom e accustome d t o tal k o f "weapons, " "strategies, " an d a whole "armamentarium " o f cell-killin g drugs . Combination s o f drug s bea r aggressive-sounding acronyms like BOLD, CHOP , COP , COP-BLAM, ICE , MOP an d ProMACE. (1995 : 22) Furthermore, th e aggressiv e an d heroi c value s i n th e cultur e o f cance r treatment ar e particularl y stron g i n th e Unite d States . America n medicin e has lon g bee n recognize d a s havin g a relativel y aggressiv e cultura l style , particularly i n cance r therapy . I n Medicine and Culture journalist Lyn n Paye r writes: Even a s Europeans were developin g th e simpl e mastectomy an d th e lumpec tomy a s less mutilatin g way s t o trea t breas t cancer , America n doctor s wer e advocating th e super-radica l mastectom y an d prophylacti c remova l o f bot h breasts to prevent breast cancer .

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American medicin e i s aggressive . . . . America n doctor s perfor m mor e diagnostic test s tha n doctor s i n France , Wes t Germany , o r England . The y often esche w dru g treatmen t i n favo r o f more aggressiv e surgery , bu t i f they do us e drug s the y ar e likel y t o us e highe r dose s an d mor e aggressiv e drugs . (1988: 124-25 )

O n e migh t counterargu e tha t w o m e n wit h breas t cance r hav e com e a lon g way sinc e Paye r wrot e thi s passag e i n 1988 , bu t tha t progres s i s largel y du e to a grea t dea l o f har d wor k an d organizin g b y man y people , includin g many w o m e n patients . Certainl y medica l opinio n i n th e Unite d State s ha s shifted o n th e questio n o f radica l mastectomies . Ye t eve n a s us e o f th e radical mastectom y ha s becom e mor e limited , aggressiv e us e o f chemother apy ha s tende d t o fil l th e voi d (Mos s 1995 : 89) . T h e aggressiv e an d heroi c treatmen t o f cance r i n th e Unite d State s ha s elective affinities , t o us e th e ter m Ma x Webe r (1958 ) brough t int o th e social sciences , wit h othe r majo r valu e complexe s i n th e genera l culture . T h e metaphor s an d valu e syste m tha t undergir d a n aggressiv e approac h t o cancer ar e draw n from th e constructio n o f evi l i n th e America n cultura l tradition. B y deployin g th e warfar e metaphor , Rhode s an d Nixo n trans formed, respectively , th e Worl d Wa r I I rhetori c abou t th e fascis t Othe r an d the Col d Wa r rhetori c abou t th e communis t Othe r int o a powerfu l imag e of cance r a s a dangerou s an d evi l Other . I n tur n th e warfar e imag e i s supported b y th e Calvinis t religiou s heritag e tha t view s alterit y no t a s a difference t o b e tolerate d bu t a s an evi l t o b e eradicated , defeated , o r drive n out o f existence. 44 T h e fina l linkag e o f evi l Other s tha t mus t b e destroye d shifts th e chai n ye t on e mor e time : fro m Sata n t o Nazi s (o r Communists ) to cance r t o th e cance r quacks . W h e n th e quackbuster s an d cancer-estab lishment researcher s (i n contras t wit h th e ofte n patient-sensitize d clinicians ) pronounce o n alternativ e medicine , thei r self-righteousnes s i s bot h a n expression o f a sincere , quasi-Calvinis t belie f i n th e sacrednes s o f scienc e and o f a mor e genera l cultura l logi c tha t tend s t o polariz e th e worl d int o good guy s an d ba d guy s (DaMatt a 1991) . Medicin e wrap s itsel f i n th e sacredness o f scienc e muc h a s the politica l cultur e legitimate s itsel f throug h reference t o th e masculine , Calvinis t God . Markings o f mal e an d femal e characteriz e no t onl y th e boundar y b e tween scientifi c medicin e an d it s Other s tha t ar e unproven, unconventional , alternative, adjuvant , o r complementary , bu t als o th e variou s boundarie s within th e domai n o f orthodo x medicine . Fo r example , on e o f th e to p subfields, i f not th e peak , o f th e medica l professio n i s surgery , a field tha t i s historically a s masculine a s nursing, pediatrics , nutritiona l counseling , socia l

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work, o r othe r lower-statu s field s ar e feminine . Surger y i s als o th e hear t o f conventional cance r therapy . T h e surgeon' s relationshi p t o cance r i s a mas culine one : h e defeat s th e fo e b y cuttin g i t ou t an d removin g it , no t b y nutritionally o r immunologicall y rebalancin g th e body . I n th e Unite d State s the surgeon s a t Memoria l Hospita l an d a t Johns Hopkin s se t th e ton e fo r the aggressive , masculin e styl e i n th e America n treatmen t o f cancer . Fo r example, i n th e 1890 s Willia m Halste d o f Johns Hopkin s inaugurate d th e American traditio n o f th e radica l mastectomy , an d som e o f th e subsequen t surgical procedure s a t th e Memoria l Hospita l wer e eve n mor e heroic . Thei r procedures include d th e infamou s hemicorporectomy—remova l o f th e lower hal f o f th e bod y (Mos s 1989 : 49) . Surgery wa s als o gendere d i n a secon d way : it s tendenc y t o b e directe d disproportionately a t w o m e n an d especiall y a t women' s diseases . Anothe r founding fathe r o f cancer surgery , J. Mario n Sims , w ho triple s i n th e histor y of America n medicin e a s th e fathe r o f moder n gynecolog y an d als o a founder o f th e firs t privat e cance r hospita l (th e predecesso r o f N e w York' s Memorial Hospital) , remain s controversia l eve n toda y fo r th e excesse s o f his work. 4 5 T h e overus e o f surger y fo r women' s disease s o f al l sort s i s a well-established findin g i n th e histor y o f medicine, especiall y fo r th e earlie r phases o f psychiatr y tha t predate d psych o dynamics an d th e talkin g cure . I n comparison wit h psychiatry , th e aggressiv e us e o f surger y ha s onl y bee n challenged muc h mor e recentl y fo r cance r an d relate d disease s suc h a s fibroid tumors . O f course , surgery—eve n radica l surgery—survive d a s a practic e no t only becaus e o f it s cultura l meanin g bu t als o becaus e o f it s efficacy . Ther e is no denyin g tha t surger y provide s a valuable optio n i n som e cases , particu larly earl y stage s o f soli d tumors . A ke y stud y fro m th e alternativ e c o m m u nity demonstrate s tha t fo r melanom a patient s surger y combine d wit h th e Gerson dietar y therap y i s mor e efficaciou s tha n th e dietar y therap y alon e (Hildenbrand e t al . 1996) . However , interwove n i n th e referentia l an d pragmatic questio n o f efficac y i s a serie s o f ofte n unquestione d cultura l assumptions abou t th e natur e o f cancer , assumption s tha t colo r attempt s a t scientific evaluatio n o f alternativ e therapies . A t th e roo t o f th e cultur e o f conventional cance r theor y an d therapy , fro m a t leas t th e lat e nineteent h century t o th e present , i s the ide a o f eradicatin g th e enemy , o f gettin g i t all , with al l of its resonances i n warfare , masculin e heroism ® and a quasireligiou s Evil Other . Radiatio n an d chemotherapy , firs t introduce d a s adjuvant thera pies, continu e thi s cultura l logi c o f th e cytotoxi c therap y tha t aim s t o ge t i t all. Eve n th e mor e recen t immunotherapie s ar e constitute d a s specifi c i n

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the sens e tha t the y targe t cance r cell s lik e hi-tec h missiles , an d geneti c therapy i s presente d i n simila r terms . Fo r example , a headlin e fro m 199 6 reads, "Geneti c Tim e Bom b i s Designed t o Delive r Kille r Forc e t o Cance r Cells." 4 6 Rhoads' s cance r wa r continue s i n th e ag e o f molecular biology . T h e alternativ e approach , whic h ca n an d shoul d b e constitute d a s a modality tha t complement s a more perspicaciou s us e o f surgery , focuse s o n changing th e metaboli c o r nutritiona l environmen t o f th e cell s an d o n strengthening th e immun e system . Fro m thi s viewpoint Rhoads' s metapho r of treating th e roo t caus e o f cancer , th e "soil " i n whic h i t grows , appear s t o be simila r th e metaphor s o f th e alternativ e metaboli c an d nutritiona l thera pies, whic h propos e controllin g cance r b y rebalancin g th e nutrient s an d metabolic processe s o f the cel l an d it s environment . However , Rhoads' s soi l metaphor go t swallowe d u p i n hi s metapho r o f warfar e an d hi s concer n with developin g chemotherapie s tha t coul d searc h ou t an d destro y cance r cells. T o continu e th e soi l metaphor , Rhoad s wa s advocatin g pesticid e control, no t organi c farming . Livingston an d othe r advocate s o f nontoxi c cance r therapie s focu s no t on destroyin g tumor s bu t o n buildin g u p th e bod y throug h die t an d nontoxic immunotherapie s suc h a s bacteria l vaccines . Fo r he r th e nutri tional statu s o f th e bod y wa s closel y linke d t o th e immun e system' s abilit y to contro l microbia l infections . H e r boo k The Conquest of Cancer ends wit h an eighty-pag e collectio n o f recipe s fo r th e cancer-fre e diet . Ther e i s no w a massiv e amoun t o f researc h an d a widesprea d consensu s tha t die t an d lifestyle ar e crucia l variable s i n th e ris k facto r equation s fo r cance r preven tion. Yet , a s treatment s the y ar e gendere d an d marginalize d fro m th e perspective o f a therapeuti c ideolog y tha t posit s heroic , masculin e method s of destroyin g cancer , no t t o mentio n a genera l cultur e tha t ha s lon g associ ated cookin g wit h th e female . Fro m thi s perspective , t o th e exten t tha t nutrition i s recognized a s having a role i n cance r therapy , i t i s as an adjuvan t treatment t o cytotoxi c therapy , thu s continuin g a gendered cultura l logi c o f supplementarity (Culle r 1982) . In short , bacteria l approache s t o cance r wer e marginalize d fo r mor e complex reason s tha n financia l an d professiona l interest s o r eve n th e m o d ernist preference s fo r standardization . Bacteria l approache s becam e caugh t up i n a gendere d cultura l logi c i n whic h bot h th e objec t o f analysis , pleomorphic microtfes , an d th e nontoxi c therapeuti c approache s o f nutri tion an d vaccine s wer e gendere d a s female . I n a heroi c cultur e o f microb e hunters w h o achieve d place s i n th e scientifi c hal l o f fam e becaus e the y could captur e an d displa y stabl e microorganisms , an d o f surgeon s an d

Culture and Power in Cancer Research | 9 7 oncologists w h o mad e promise s o f doin g battl e wit h th e cance r fo e an d getting i t all , th e alternativ e approac h resonate d wit h sexis t view s o f u n d e sirable femal e traits . Bacteria l approache s t o cancer , lik e othe r alternativ e therapies, seeme d destine d fo r th e dustbi n o f scientifi c an d medica l histor y . . . except fo r on e smal l variable : patients .

Cancer in a Multicultural World T h e fina l aspec t o f a cultura l an d politica l interpretatio n o f cance r researc h to b e discusse d her e involve s th e comple x issu e o f globalization an d interna tional flows o f patient s i n searc h o f cance r cures . Includin g thi s leve l o f analysis i s crucia l fo r tw o reasons : i t reveal s th e limitation s o f curren t policies, suc h a s th e quackbustin g strategy , an d i t furthe r develop s a n analytical framewor k fo r a n explanatio n o f medicine i n term s o f culture an d power. Fro m thi s perspective , culture s ar e no t merel y contrastin g an d sometimes conflictin g bodie s o f assumptions , values , an d way s o f bein g i n the world , bu t the y ar e resource s t o whic h peopl e ma y tur n i n thei r effort s to maneuve r aroun d th e mechanism s o f suppression . At th e tim e w h e n th e microbia l theor y o f cance r wa s rejected , ther e was n o p h e n o m e n o n o f organize d patients ' advocac y group s an d referra l organizations tha t share d informatio n an d conteste d th e knowledg e re ceived fro m th e leader s o f th e medica l profession . Patient s live d i n muc h more localize d worlds ; thei r informatio n wa s mor e limited , an d th e abilit y to trave l t o othe r countrie s fo r differen t therapie s wa s muc h mor e narrowl y limited t o th e rich . T h e globalizatio n o f the worl d tha t ha s occurre d durin g the twentiet h centur y ha s crucia l implication s fo r medica l consensu s an d the rol e o f th e publi c i n shapin g it . Globalizatio n i s accompanie d no t onl y by increase d diversit y o f opinions , bu t b y increase d acces s t o informatio n and alternativ e therapie s themselves . T h e medica l profession' s repressiv e strateg y fo r managin g th e growt h o f alternative medicine , whic h i s stil l i n forc e today , i s a produc t o f th e modernist period . I like t o thin k o f th e strateg y a s a sociologica l equivalen t of tyndallization . I n scienc e an d technolog y studies , th e Englis h scientis t John Tyndal l i s know n a s a n exempla r o f wha t Thoma s Giery n (1983a , 1983b) ha s calle d boundary-work , tha t is , attempt s b y scientist s a s publi c figures t o distinguis h scienc e fro m othe r cultura l domain s i n th e effor t t o gain prestige , autonomy , an d fundin g fo r thei r activities . A s professo r an d superintendent a t th e Roya l Institutio n i n Londo n an d presiden t o f th e

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British Associatio n fo r th e Advancemen t o f Science , Tyndal l use d hi s cre dentials t o improv e th e positio n o f science wit h respec t t o th e tw o compet ing cultura l domain s o f religio n an d engineering . I n th e process , h e de bunked popula r superstition s i n way s tha t ar e reminiscen t o f today s skeptics and quackbusters . In biolog y Tyndal l i s remembere d fo r anothe r reason . W h e n attemptin g to replicat e Pasteur' s work , h e foun d tha t bacteri a continue d t o exis t i n heat-resistant form s tha t coul d surviv e pasteurization . H e foun d tha t re peated heatin g o n variou s day s wa s necessar y t o destro y th e endospores . Consequently, tyndallizatio n becam e a mor e powerfu l for m o f pasteuriza tion. A metapho r o f tyndallization—o f repeate d sterilization—seem s ap propriate a s a descriptio n o f th e cance r establishmen t s repressiv e strateg y toward alternativ e cance r therapies . However, th e repressiv e strateg y ha s becomin g increasingl y ineffective . Because cance r rate s continu e t o gro w an d becaus e long-ter m surviva l rate s have show n littl e i f an y improvement , contemporar y cultur e i s a fertil e terrain fo r th e growt h o f alternativ e cance r therapies . I t woul d probabl y b e impossible fo r th e governmen t t o sto p al l alternativ e cance r treatments ; lik e microbes, the y see m t o b e omnipresen t i n th e environmen t i f no t laten t like th e intracellula r pathogens . Instea d o f providin g complet e repression , the lega l apparatu s i s used strategicall y an d repeatedly , lik e tyndallization . I n other words , repressio n i s reserve d fo r thos e case s tha t gai n enoug h publi c attention t o reac h a critica l leve l o f visibility , suc h a s Rif e o r Livingston . Once visible , the y becom e example s fo r th e res t o f th e movemen t (thu s reinforcing th e valu e o f maintaining a low profile ) an d t o th e public , whic h is treate d t o sanctimoniou s lecture s o n quacker y tha t ar e reminiscen t o f th e old Purita n tale s o f witchcraft . T h e man y storie s o f th e persecutio n o f alternative doctor s an d scientists—an d I hav e onl y scratche d th e surfac e i n this examinatio n o f on e researc h tradition—ar e widel y circulate d i n th e books, articles , an d conference s o n alternativ e cance r therapies . Thos e stories hav e a warnin g effec t o n other s w h o migh t wis h t o becom e activ e in th e area . However, becaus e tyndallizatio n occur s i n a n ope n cultur e tha t i s inter nationalized an d media-saturated , th e ol d strateg y i s increasingl y ineffectiv e and eve n counterproductive . Alternativ e therapie s continu e t o proliferate . Some practitioner s ma y b e cowe d b y th e repressiv e strategy , bu t th e en d result i n th e contemporar y worl d i s likel y t o b e th e opposite . Storie s o f repression ar e grea t gris t fo r th e medi a mill , an d th e medi a ten d t o presen t controversies i n a neutralis t vein . A s w e know n fro m th e science-studie s

Culture and Power in Cancer Research | 9 9 literature, neutra l account s ten d t o b e capture d b y th e out-grou p (Scott , Richards, an d Marti n 1990) . I n short , th e tyndallizatio n strateg y ma y en d up advertisin g alternativ e medicin e a s much a s repressing it . T h e repressiv e strateg y als o suffer s fro m a quantitativ e problem . N e w ideas an d ne w therapie s sprea d eve n mor e rapidl y tha n i n th e past . Cance r patients hav e benefite d fro m th e wor k o f th e much-better-organize d AID S movement an d als o fro m th e burgeonin g N e w Ag e movement . Ther e i s a growing supplement s industr y tha t finance s scientifi c researc h o n nutri tional supplement s an d popula r magazine s t o rela y thi s researc h t o th e public. T h e literatur e o n alternativ e cance r therapie s i s readil y availabl e i n N e w Ag e bookstores , health-foo d stores , an d eve n i n som e o f th e healt h sections o f chai n stores . Numerou s institution s provid e information , news letters, an d conferences . Althoug h labellin g law s preven t th e linkag e o f health claim s t o packagin g o f nutritiona l supplements , consumer s ar e onl y slowed b y thi s attemp t t o preven t th e fre e flow o f information , an d the y find th e informatio n the y nee d i n books , magazines , an d newsletters . B y the middl e o f th e 1990s , i t wa s als o becomin g increasingl y eas y t o fin d thi s information on-line . I n short , th e repressiv e strategie s tha t worke d durin g the pea k year s o f th e modernis t p e r i o d — t h e middl e decade s o f thi s cen tury—operate toda y o n a movemen t tha t ha s changed . Lik e th e ne w antibiotic-resistant microbes , advocate s o f alternative cance r therapie s toda y are muc h mor e resistan t an d resilient . Globalization ha s playe d a n importan t rol e i n th e resilienc e o f alternativ e medicine. O n e wa y i n whic h alternativ e medica l practice s ca n escap e th e strong ar m o f state-sanctione d repressio n i s b y movin g acros s cultura l bor ders. Whil e th e leader s o f th e cance r establishmen t an d quackbuster s stil l act a s if they wer e seventeenth-centur y Puritans , w h o attempte d an d faile d to establis h a religiou s stat e wit h n o toleratio n fo r sectaria n diversity , M e x ico an d th e Caribbea n serv e a s th e ne w R h o d e Islan d an d Pennsylvania . A dynamic mode l o f h o w alternativ e medicin e work s toda y i n th e Unite d States (an d perhap s i n som e othe r highl y regulate d countries ) mus t tak e into accoun t th e relationshi p betwee n globalizatio n an d th e growt h o f medical pluralism . Cultura l border s provid e a countervailin g forc e t o th e repressive strateg y becaus e the y ca n serv e a s resources fo r lega l end-runs . I n the contex t o f th e la w th e ter m "loophole " migh t b e use d a s a n approxi mate translatio n o f a well-understoo d concep t i n Brazilia n cultur e know n as th e jeitinho, tha t is , th e abilit y t o ben d rule s an d figur e ou t a way aroun d official restriction s (Barbos a 1995 , DaMatt a 1991) . Often , however , th e jeitinho implie s goin g outsid e o r aroun d th e law , i n th e sens e o f th e Ameri -

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can football metapho r o f the end-ru n aroun d the wall of players constitute d by the defense . One o f th e way s i n whic h alternativ e medicin e survive s i s b y crossin g cultural border s an d findin g a ne w hom e i n othe r countries . Medica l regulation no w operate s i n a globalize d worl d i n whic h nationa l frontier s are increasingl y permeable . Conside r a few example s fro m th e researc h o n bacteria an d cance r tha t I hav e examine d i n thi s book . I n recen t year s Coley s toxin s hav e begu n a comebac k i n th e internationa l context . Al though clinica l trials and uses of Coley s toxins have been all but abandone d in thi s country , the y hav e foun d a second lif e i n th e Peopl e s Republic o f China. Dr. Gu o Zhere n establishe d the Cole y Hospital in 1990 , and he an d another Chines e researche r hav e publishe d outcome s researc h o n thei r successful us e o f th e Cole y s toxins (Zhere n an d Naut s 1991 ; Tang e t al . 1991).

Another exampl e o f a researche r wh o accepte d th e microbiologica l theory o f cancer in some case s was William Frederic k Koch . H e develope d an oxidatio n produc t know n a s gloxilide , whic h accordin g t o hi s forme r "disciple," Dr . Jayme Treiger , wa s "based o n th e correc t activatio n o f th e carbonyl groups existing in the cells, through th e creation of an intracellular chain reactio n t o neutraliz e pathogens." 47 Koc h wa s awar e o f the wor k o f the bacteria-and-cancer researchers , an d he believed that th e beneficial fre e radicals o f hi s produc t coul d destabiliz e cance r pathogens . I n th e 1950 s Koch lef t th e Unite d State s durin g a perio d o f prosecutio n b y th e FDA , and h e relocate d i n Brazil . Hi s therap y continue s t o b e used i n Brazi l b y Treiger. By fa r Mexic o ha s been th e greates t have n fo r alternativ e cance r thera pies. Th e 714- X dru g o f Naessens , wh o lef t Franc e t o liv e i n Quebec , i s available legall y a t Mexica n clinic s i n Ver a Cru z an d Tijuana . Bacteria l vaccines ar e bein g used i n th e Centr o Hospitalari o Internaciona l Pacifico , SA, itself a product o f the suppressio n o f Max Gerso n i n th e United States . Likewise, Dr . Geronim o Rubi o o f th e America n Metaboli c Institut e i n Tijuana use s a Rife machin e as part of an overall program of immunological treatment fo r som e o f their patients . Amon g th e immunotherapie s offere d by the hospital are autogenous vaccines for cance r viruses that ar e similar to the Livingston vaccines. 48 The Tijuan a cance r clinic s an d hospital s ar e perhap s th e mos t well known exampl e o f this abilit y fo r therapie s t o surviv e b y crossin g cultura l borders. Th e phenomeno n ha s reache d suc h a point o f institutionalizatio n that th e Lo s Angeles—based Cance r Contro l Societ y host s annua l meeting s

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where representative s o f th e clinic s spea k alon g wit h man y othe r leader s o f the alternativ e cancer-therap y community . Patient s w h o ar e intereste d i n selecting a Mexica n clini c ar e abl e t o tak e bu s tour s o f th e Tijuan a cance r clinics. For anthropologist s th e transnationa l flows o f patients , clinicians , re search, an d therapie s ar e ol d hat : contemporar y anthropolog y n o longe r sees cultura l border s a s impermeabl e wall s acros s whic h comparison s ar e made. T h e multipl e internationa l flows o f people an d practice s i n th e globa l village hav e bee n catalogue d i n genera l i n th e well-know n wor k o f Arju n Appadurai (1990 ) an d fo r scienc e i n th e wor k o f Sharo n Trawee k (1992) . However, th e transnationa l flows o f th e alternativ e cance r movemen t ma y also hav e somethin g t o teac h socia l scientist s abou t cultur e i n th e globalize d postmodern world . I n som e cases , cultura l border s ar e les s boundarie s t o be transgresse d b y transnationa l flows tha n resource s tha t actor s ca n us e strategically t o alte r powe r equation s i n negotiation s ove r scientifi c legiti macy an d medica l legality . As a resource , globalizatio n work s fo r bot h alternativ e medica l prac titioners an d thei r would-b e regulators . Thes e day s on e doe s no t simpl y disappear fro m th e panoptica l gaz e o f th e America n governmen t s regula tory apparat i b y relocatin g t o th e Caribbea n o r Mexico . Fo r example , i n the 1970 s th e N e w York-base d docto r Lawrenc e Burton , know n fo r hi s immunoaugmentative therapy , se t up practic e i n th e Bahama s afte r th e FD A blocked Investigationa l N e w D r u g status . H e practice d unhindere d fo r a while, bu t i n 198 5 a patient brough t vial s o f immunoaugmentativ e therap y serum fro m th e Bahamia n clini c t o a bloo d ban k i n Washingto n state , where test s o f th e sample s indicate d tha t the y wer e positiv e fo r th e AIDS virus . T h e claim s wer e probabl y base d o n fals e positive s fro m th e nonsensitive ELIS A test , an d subsequen t testin g b y th e mor e sensitiv e Western blo t tes t an d o f ove r fift y Burto n patient s indicate d n o evidenc e for seropositivity . Furthermore , i n th e mid-1980 s th e U.S . blood suppl y wa s widely contaminate d wit h H I V antibodies , an d th e Burto n clini c wa s probably bein g single d ou t fo r politica l reasons . However , th e scar e cam paign ha d it s effect : th e Bahamia n Ministr y o f Healt h close d th e clini c temporarily. 49 T h e Burto n cas e demonstrate s tha t eve n w h e n clinic s mov e offshore , they ma y stil l hav e t o negotiat e wit h th e regulator y ar m o f America n medicine an d science . However , countrie s suc h a s Mexico , th e Bahamas , and Brazi l ten d t o regar d a s imperialism an y pressur e fro m th e U.S . govern ment o r U.S.-influence d internationa l organizations , an d the y ma y re -

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act negativel y t o outsid e interference . Th e en d resul t a t thi s poin t for the Burton clini c is interesting: notwithstanding the reach of the American stat e int o th e Bahamas , th e clini c continue d t o operat e afte r a brie f closing. Moreover, alternativ e medicin e i s taking it s place i n th e constructio n o f national identities . I n Brazi l whe n I di d anthropologica l fieldwor k amon g the Spiritists , I constantly encountere d critica l references t o th e "orthodo x medicine" o r "orthodo x science " o f the ric h countrie s (Hes s 1991) . Fro m this perspective , politicize d leader s o f poore r countrie s se e thei r embrac e of alternativ e America n medicin e les s a s acceptin g cross-cultura l medica l dumping tha n a s showing critical , anti-imperialis t independence . Wherea s both advocate s an d skeptic s o f alternativ e medicin e i n th e ric h countrie s may se e th e offshor e clinic s a s lega l end-runs , thei r advocate s acros s th e border ofte n vie w th e sam e maneuver s i n differen t terms . I n othe r words , support fo r unwante d alternativ e medicin e i n th e poore r countrie s ca n mean showing the superior open-mindedness an d freedom o f their cultures, in star k contras t t o Yanke e rhetori c abou t it s international rol e a s the lan d of the free . In Mexico , fo r example , th e leader s o f th e alternativ e clinic s se e th e relatively deregulate d Mexica n medica l syste m no t a s a sig n o f inferiorit y but a s a sourc e o f medica l freedom . I n Brazi l th e doctor s wit h who m I spoke in 1995—bot h orthodo x an d un—were wel l aware tha t th e chaoti c regulatory apparat i o f their government , medica l syndicates , an d insuranc e providers mean t tha t the y ha d muc h mor e medica l freedo m tha n thei r counterparts i n th e Unite d States . O f course , lowe r level s o f regulatio n open th e doo r t o charlatanis m an d fraud , whic h ar e mor e commo n i n Brazil, bu t th e Brazilia n doctor s I kne w wer e no t willin g t o trad e thei r medical freedom fo r the highly regulated environment o f the United States. The poin t i s tha t a s alternativ e medicin e become s globalized , th e leve l o f regulation i n othe r countries , particularl y i n Lati n America , i s unlikel y t o match that o f North Americ a an d Europe. The appropriat e policy respons e to th e d e fact o deregulatio n implie d b y globalizatio n i s no t t o tr y t o negotiate som e kin d o f international standar d (whic h wil l b e lef t honore d on paper onl y i n countrie s lik e Brazil), nor t o heighte n th e antiquackbust ing rhetoric (whic h will only advertise alternative medicine), but to suppor t publicly funded researc h and education o n the relative efficacy o f alternative therapies. I n othe r words , th e solutio n i s not tyndallizatio n bu t evaluation : test th e alternatives , tes t the m fairly , an d le t th e publi c kno w th e result s o f the tests.

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To conclud e b y wa y o f th e metapho r o f cell-wal l divergen t bacteria , from th e perspectiv e o f orthodo x medicin e an d th e regulator y scienc e o f large, randomized , controlled , prospective , multisite , double-blind , cross over clinica l trial s i n th e ric h countries , alternativ e cance r therapie s ar e constructed a s deficient . I n mos t case s alternativ e cance r therapie s lac k acceptable empirica l suppor t i n th e for m o f anima l experimentatio n an d clinical trials , an d usuall y the y als o lac k officiall y sanctione d lega l status . To surviv e i n thi s milieu , th e alternativ e medicines , lik e filterabl e bacteria , shed thei r loca l organizationa l encumbrance s an d cros s th e semiperme able boundarie s o f nationa l frontiers , ^ s occurre d wit h slav e religion s when importe d int o th e Ne w World , i n th e ne w cultur e th e alternativ e medicines may regain their institutional settings and clinical functions (Bas tide 1978) . The complexitie s o f the co-constructio n o f national, legal, and scientifi c borders provides a lesson for theorie s o f science, technology, medicine , an d society. In the case of alternative medicine (a s in other kinds of heterodoxy), it i s entirel y inadequat e t o remai n insid e framework s tha t se e scientist s a s entrepreneurs wh o achiev e succes s b y buildin g networks , accumulatin g symbolic capital , o r servin g occupationa l o r clas s interests. Instead , cultur e is al l aroun d us : i n th e formatio n o f researc h culture s wit h thei r negativ e heuristics an d commonsensica l doxas , i n modernis t an d postmoder n ap proaches t o classificatio n an d standardization , i n th e genderin g o f microbes and cance r therapies , i n cross-cultura l variation s o f lega l an d institutiona l apparati, i n th e jeitinhos found i n respons e t o th e regulator y disciplining , and i n th e pervasivenes s o f share d an d conteste d understanding s o f ethni c and national identity . Muc h a s Pasteur o n hi s deathbe d i s said to hav e said , "The terrai n i s everything, " s o I woul d en d thi s discussio n o f science , medicine, an d societ y b y advocatin g a thicke r appreciatio n o f th e rol e o f cultural border s that , lik e cel l walls , operat e a s resources tha t ca n b e buil t up, tor n down , o r transgressed o n a strategic basis. The implications o f cultural borders, however, ar e more than theoretical . For ten s o f thousand s o f cance r patients , cultura l border s ma y mea n th e difference betwee n lif e an d death . I f thei r righ t t o medica l freedo m o f choice i s denie d i n th e Unite d States , man y hav e opte d t o g o outsid e their hom e countr y wher e the y ca n encounte r th e therapie s that , i n thei r evaluation, ar e worth trying . The situatio n is similar to the flight of women to othe r countrie s durin g th e perio d prio r t o Roe v. Wade i n th e Unite d States. I n bot h case s medical freedo m i s a privilege o f those wh o hav e th e financial an d intellectua l resource s t o pursu e it . I n effec t medica l freedo m

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becomes no t a n explicit , de jure right o f all citizens bu t a n implicit, de facto right o f th e wealthy . Th e situatio n i s i n shar p conflic t wit h th e genera l value o f equality . Th e solutio n i s t o evaluat e th e alternativ e theorie s an d therapies, and to change policy so that the public s right to medical freedo m is guaranteed. A t this point descriptio n end s and prescription begins .

4 But I s I t Goo d Science ?

So wha t abou t th e "science" ? I s i t credible ? Le t u s begi n th e question o f evaluatio n wit h a clea r definitio n o f wha t i s bein g evaluated . Although I have classified thi s research traditio n a s falling under th e genera l theory tha t bacteri a ar e causativ e agent s i n cancer , i t shoul d b e clea r tha t some o f the work woul d be better terme d microbial . Rather tha n thinkin g in term s o f pleomorphi c bacteria , som e o f th e researcher s advocate d th e existence o f a ne w typ e o f microorganis m tha t ha s feature s simila r t o fungi, bacteria , viruses , an d (i n th e cas e o f Enderlein ) eve n somethin g approximating prions . However , i n th e English-languag e literatur e o f th e second hal f of the twentiet h century , th e organis m i s conceptualized mor e as a bacterium tha t ha s a filterable for m a s well a s funguslike form s simila r to th e mycobacteria . Th e poin t i s that wha t I will cal l the bacteria l theor y of cancer can be distinguished from othe r infectious theorie s o f cancer. Th e other theorie s includ e no t onl y th e work o f tumor virologist s bu t als o tha t of relativel y unknow n researcher s wh o propose d tha t parasites , yeast , o r amoeba—rather tha n a pleomorphic bacterium—pla y a n etiologica l rol e in cancer. 1 In additio n t o competin g theorie s tha t assum e som e othe r typ e o f microbial infection , th e mor e conventiona l poin t o f compariso n i s th e secondary-infection theory . Under thi s null theory, bacteria associate d wit h tumors represen t secondar y infection s tha t pla y n o rol e i n tumo r genesi s and little if any role i n tumo r growth . Not e tha t eithe r th e bacteria l o r th e secondary-infection theor y coul d be encompasse d b y th e broader molecu lar theor y o f cancer . Thi s standard , mainstrea m theor y hold s tha t cance r emerges fro m geneti c damag e suc h a s inherite d defect s an d unrepaire d lesions i n th e DN A o f th e hos t cell . Because th e molecula r theor y repre sents consensu s knowledge , i t mus t b e viewe d a s the encompassin g theory . The compariso n take s plac e a t th e leve l o f tw o su b theories: ar e bacteria l infections unimportan t t o tumo r genesi s an d development , o r d o the y represent a n overlooked facto r i n the cance r process?

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Guidelines for Evaluating a Theory Because th e proble m involve s comparin g theorie s (an d thei r affiliate d re search programs) , i t follow s fro m wor k i n th e philosoph y o f scienc e tha t there i s no simpl e crucia l experimen t o r falsifyin g instanc e tha t ca n refut e one of the theories beyond doubt . On e ca n always come up with subsidiar y ad ho c theorie s t o explai n th e contrar y result s an d anomalies . Likewise , there i s no algorith m o r compute r progra m int o whic h someon e ca n ente r the dat a an d com e ou t wit h a n answe r tha t determine s whethe r th e bacte rial-etiology theor y o r secondary-infectio n theor y i s better . Evaluatin g a theory i s a much mor e complicate d process . I t i s more lik e a court tria l o r a medica l diagnosi s tha n a mathematica l proof ; distinction s betwee n tru e and false , o r goo d an d bad, ca n be made , bu t the y lac k th e exactitud e o f a mathematical formula . Ther e ar e onl y guidepost s tha t ca n sugges t whethe r the theory is worth pursuin g or not . Elsewhere I revie w a number o f positions i n th e philosoph y o f scienc e and focu s o n th e guidepost s the y sugges t fo r theor y choic e (Hes s 1997) . Here I apply those idea s by dividin g theor y choic e criteri a int o fou r majo r groups tha t I term positivist , conventionalist , pragmatic , an d feminist . Thi s set o f criteria make s it possible t o provid e a fair an d balanced evaluatio n o f the theorie s b y examinin g issue s suc h a s evidence , theoretica l consistency , therapeutic potential, an d possible social biases. The firs t grou p o f criteri a focuse s o n th e questio n o f accurac y o r evidence, an d withou t a doub t i t i s th e mos t important . Th e powe r an d attraction o f the gam e o f scienc e reside s i n it s abilit y t o allo w evidenc e t o play an important role in resolving many disputes. As Rudolf Carnap (1995 ) argues, a fundamental startin g point i s that th e better theor y explain s mor e facts an d makes better predictions. The firs t part , empirica l subsumption, is not alway s eas y to determin e becaus e th e har d core s o f theoretical system s may not be exactl y comparable , an d thus exac t empirica l subsumptio n ma y not b e possible . I n othe r words , i n som e case s the subsumin g theor y doe s not cove r al l th e empirica l researc h o f th e subsume d theory , a situatio n known a s "Kuh n loss " (Fulle r 1988 : 223) . Still , som e for m o f evidenc e remains crucia l t o makin g a choic e amon g theorie s o r researc h programs . Recognizing th e Kuhn-loss problem but als o recognizing its limitations, let us sa y that th e ne w theor y shoul d b e a t least empiricall y equivalen t ove r a large range of crucial facts. Most i f no t al l th e philosopher s ar e als o i n agreemen t tha t th e bette r

But Is It Good Science? \ 10 7

theory shoul d produc e som e ne w successfu l predictions . Thoma s Kuhn' s criterion (1977 : 322) tha t a good theor y b e fruitful coul d b e interprete d a s another expressio n o f th e abilit y fo r goo d theorie s t o produc e new , eve n successful an d surprising , predictions . Likewise , th e realis t criterio n tha t over tim e th e theoretica l term s o f the bette r theor y wil l become observa tional term s (suc h a s viruses i n th e histor y o f microbiology) migh t als o b e included her e a s a subse t o f th e accurac y group . I n summary , ther e i s a group o f criteria tha t I like t o thin k o f as the positivis t criteri a i n tha t the y emphasize accuracy, eithe r in terms o f existing evidence o r in terms o f new predictions. However, I use the ter m "positivist " ver y loosely because I am including arguments abou t accurac y that have been mad e by nonpositivists. I interpre t th e accurac y criterio n t o mea n tha t th e bacteria l theor y wil l have to be supported by observations tha t its competitor canno t explain . I n turn, a n advocat e o f the secondary-infectio n theor y wil l hav e t o presen t a large body o f facts pointing t o artifac t an d contaminatio n tha t th e bacteria l theory canno t explain . Th e artifac t counterargument s nee d t o b e consid ered i n detail , becaus e th e accurac y argumen t coul d easil y fal l apar t i f counterarguments suc h as contamination ca n be convincingl y defended . In my opinion , th e secon d mos t importan t grou p o f criteri a i s what I think o f a s th e conventionalis t group . Followin g Pierr e Duhe m (1982) , these criteri a emphasiz e consistenc y issues . I als o includ e simplicit y an d parsimony a s par t o f th e consistenc y grou p becaus e thes e issue s mus t b e judged agains t a backgroun d o f othe r theorie s an d therefor e agains t a general concer n wit h consistency . However , Hele n Longin o (1994 ) ha s introduced anothe r criterion , tha t a new theor y be novel, which appear s t o be i n conflic t wit h th e consistency/simplicit y group . He r novelt y criterio n is a valuable reminde r tha t th e consistenc y grou p ha s conservative implica tions. Fo r example , i f scientists wer e t o rel y to o heavil y o n consistenc y (a t the expense o f othe r criteria) , the y woul d fin d i t impossibl e t o accep t revolutionary theorie s becaus e thes e radica l ne w theorie s wer e no t consis tent wit h consensu s knowledge . A solutio n t o th e proble m pointe d ou t b y Longino i s t o accep t novelt y whe n othe r criteri a ar e met : th e existin g theory o r research tradition ha s accumulated man y anomalies o r has not led to predictiv e o r technologica l successe s desired , th e ne w theor y i s simpl e and parsimonious , and/o r th e nove l theor y restore s theoretica l harmon y among apparentl y contradictor y theories . I n short , th e consistenc y crite rion i s a very importan t one , bu t i t mus t b e used wit h som e flexibility s o that on e i s no t trappe d b y it s conservativ e implication s an d doe s no t rul e

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out revolutionar y theories . However , th e flip sid e o f revolutionar y theorie s is tha t the y ma y tur n ou t t o b e wrong , an d thi s i s why th e othe r criteria — especially th e accurac y group—ar e important . Although man y scientist s an d philosopher s limi t thei r evaluatio n criteri a to som e combinatio n o f m y firs t tw o groups , I woul d sugges t tha t tw o other criteri a ar e ver y important . Thes e criteri a becom e particularl y im portant w h e n evaluatin g th e mor e genera l issu e o f researc h programs , especially i n th e applie d sciences , wher e question s o f practical potentia l an d social bia s ar e mor e likel y t o b e important . M y thir d grou p o f criteri a emphasizes issue s derive d fro m th e pragmatis t traditio n i n th e philosoph y of science. T o som e exten t th e requiremen t o f successful, surprisin g predic tions fall s int o thi s group , especiall y w h e n thos e prediction s hav e ne w technological o r therapeuti c implications . Longin o (1994 ) develop s th e pragmatic criteri a w h e n sh e suggest s tha t a goo d ne w theor y o r researc h program b e applicabl e t o curren t huma n need s an d tha t i t favo r "diffusio n of power, " tha t is , tha t th e ne w theor y b e les s limitin g tha n a riva l theor y in term s o f acces s an d participation . Certainly , advocate s o f th e bacteria l approach believ e tha t i t ha s led t o th e discover y o f new therapeuti c applica tions tha t ar e relativel y accessibl e an d lo w cost . I n practice , then , thi s grou p of criteri a lead s t o a n evaluatio n o f th e efficac y an d practicalit y o f therapie s such a s bacterial vaccines . Finally, Longin o (1994 ) ha s propose d theory-choic e criteri a tha t I grou p as feminist (o r multicultural) criteria . O n e criterion , "ontologica l heteroge neity," refer s t o 1 ) a concer n wit h diversit y i n th e objec t o f study , a s i n Barbara McClintock' s attentio n t o th e diversit y o f the kernel s o f a corn co b (Keller 1985 ) o r w o m e n primatologists ' attentio n t o diversit y withi n an d among primat e group s (Harawa y 1989) ; an d 2 ) th e rejectio n o f theorie s o f inferiority, tha t is , theorie s tha t se e differenc e a s substandard , deviation , o r a failure . T h e secon d criterion , complexit y o f relationship , refer s t o th e rejection o f "single-facto r causa l model s fo r model s tha t incorporat e dy namic interaction " (Longin o 1994 : 479) . Bacteria l pleomorphis m woul d probably scor e highl y o n th e ontologica l heterogeneit y criterion , becaus e i t points t o diversit y i n organism s wher e diversit y ha s previousl y bee n over looked. O n th e criterio n o f complexit y o f relationship , th e bacterial etiology theor y woul d see m t o reduc e complexit y b y reducin g cance r t o a n infectious disease . However , t o th e exten t tha t th e rol e o f bacterial infectio n and diseas e i s latent rathe r tha n contagious—an d therefor e stemmin g fro m overall systemic , nutritional , an d environmenta l stressor s rathe r tha n fro m exposure t o carriers— a cas e coul d b e mad e fo r complexit y o f relationship .

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Although I find thes e criteri a vague , I have included the m her e becaus e there i s an increasing diversificatio n i n bot h scienc e an d scienc e studie s (i n terms o f gender, race , an d nationality) , an d consequentl y thes e criteri a ar e likely t o becom e increasingl y legitimat e t o a larg e numbe r o f researcher s over time. The y ar e probably als o likely to becom e mor e refined . I am no t especially happ y wit h thes e criteri a a s Longin o ha s formulate d the m be cause they see m to b e vague enoug h tha t on e coul d probably fin d a way in which almos t an y theor y satisfie s them . A s a result , I wil l propos e a n alternative criterio n tha t maintain s th e spiri t o f thei r inten t bu t doe s no t suffer a s much fro m th e vaguenes s problem . Thi s criterio n i s simply lowe r social prejudice tha n the rival theory (i n terms o f sexism, racism, etc.) . This criterion ma y no t b e applicabl e t o al l theory choices i n science , bu t ther e are som e possibl e ground s o n whic h i t ma y b e applicabl e t o th e specifi c problem discussed here. In this chapter I will consider in some detail these four group s of theorychoice criteri a a s a wa y o f evaluatin g th e bacterial-etiolog y theory . A s counterevidence emerges , I will poin t ou t way s in whic h th e theor y mus t be modifie d i n orde r t o pas s th e evaluatio n criteria . I sugges t that , i f properly modified , th e theory ma y be abl e to build a reasonable defens e o n some o f th e criteri a o r group s o f criteri a tha t provid e a groun d fo r goo d theory choice .

Particularistic Criteria and Theory Evaluation So fa r th e fou r group s o f theory-choic e criteria—accuracy , consistency , pragmatic value , an d lo w socia l prejudice—ar e universalisti c criteria . I n other words , the y d o no t tak e into accoun t th e questio n o f who i s proposing the theory. Shoul d an y particularistic criteri a be included in the evalua tion? Som e shoul d b e include d a s negative criteria , an d i n fac t the y rou tinely are included i n peer-review processe s suc h a s grant revie w disclosur e forms. I n othe r words , i f the evaluato r ca n b e show n t o hav e a conflict o f interest vi a favoritis m o r persona l gain , on e ma y ten d t o discoun t th e evaluation. Becaus e I hav e n o persona l connectio n wit h th e advocate s o f the bacteria l theory , n o financia l stak e in an y cance r theory , an d n o stron g commitment t o microbiological theorie s o f cancer, I am relatively free fro m conflict o f interest . I n fact , I cam e upo n thi s theor y largel y b y chanc e ( a book i n a bookstore) , an d I foun d i t s o preposterou s tha t I wa s curiou s enough t o chec k som e o f the sources . Eventually thi s led m e t o rediscove r

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several researc h tradition s o n th e possibl e infectiou s componen t o f chroni c degenerative diseases . Regarding th e social-prejudic e criterion , standpoin t epistemologie s would sugges t payin g particula r attentio n t o theorie s tha t ar e advocate d b y historically exclude d group s (Hardin g 1992) . Althoug h applicatio n o f thi s particularistic criterio n woul d no t affec t theor y choic e directly , i t woul d promise somethin g lik e equa l acces s t o evaluatio n fo r theorie s comin g fro m w o m e n an d historicall y exclude d groups . Relativis m ca n easil y b e avoide d because non e o f th e othe r universalisti c criteri a ar e forfeited ; on e merel y makes sur e tha t thes e theorie s ge t a fai r hearing . O f course , th e proble m i s that thi s argumen t ca n b e use d t o justif y givin g a fai r hearin g t o ever y crackpot theor y fro m ever y historicall y exclude d socia l group . T o avoi d th e problem, I use thi s criterio n alon g wit h al l the other s t o arriv e a t a comple x judgement. However , I woul d argu e tha t thi s criterio n i s relevan t t o th e case o f cance r researc h tha t I a m considerin g here . T h e women' s networ k of Livingston , Alexander-Jackson , Diller , an d Seiber t manage d t o achiev e top-quality researc h durin g a n er a whe n i t wa s particularl y difficul t fo r w o m e n t o engag e i n science . A t th e minimum , thi s women' s networ k i n cancer researc h deserve s a second glance . Probably th e mos t complicate d o f th e personalisti c criteri a i s reputation . T h e empirica l literatur e suggest s tha t reputatio n ma y b e widel y use d a s a criterion fo r theor y choic e o r evaluatio n o f lower-leve l empirica l claim s (Cole 1992) . However , thi s i s a descriptiv e claim ; th e prescriptiv e questio n is, should reputatio n b e elevate d t o on e o f th e prescriptiv e criteri a fo r theory choice ? O n th e on e hand , researcher s w h o hav e prestigiou s degrees , institutional positions , an d journal publication s ca n b e expecte d t o produc e higher-quality researc h o n th e average . Reputatio n i s therefor e probabl y a n economical inde x fo r makin g a preliminar y cu t betwee n goo d an d ba d research. O n th e othe r hand , thos e w h o d o no t hol d thes e marker s o f reputation ten d t o b e th e ver y outsider s w h o brin g i n badl y neede d ne w ideas, o r the y ma y b e victim s o f th e kind s o f suppressio n describe d fo r th e alternative cance r researchers . Keepin g thes e tw o conflictin g possibilitie s i n mind, reputatio n ha s entere d int o m y evaluatio n i n th e followin g way : w h e n I selected whic h advocate s o f the bacterial-etiolog y theor y t o includ e in th e evaluation , I decide d t o restric t i t mostl y t o th e Anglophon e N o r t h American grou p runnin g from Glover , Scott , an d Clar k t o Livingston , Alexander-Jackson, Diller , Seibert , an d colleagues . M u c h o f th e wor k o f this America n networ k i s publishe d i n scientifi c an d medica l journals , fo r which ther e wa s pee r revie w i n som e cases . A s a resul t thi s researc h i s th e

But Is It Good Science? 11 most "sanitized " o f thes e heterodo x researc h networks , t o invok e Ro y Walliss (1985 ) term , an d i t i s the mos t likel y t o provid e a best cas e for th e bacterial theory. I f my evaluation find s th e research lacking in this network , it is likely that the othe r research will suffer from th e same problems. 2

Problems with Bechamp I wil l exclud e Becham p becaus e o f gros s failur e t o pas s accurac y an d consistency tests . Nevertheless , becaus e som e writer s i n th e alternativ e medical literatur e no w presen t Becham p a s a los t her o i n th e histor y o f medicine, i t i s wort h pausin g fo r a momen t t o addres s th e questio n o f whether o r no t h e wa s right. I n m y opinion , mos t o f what h e sai d is plain wrong. Disease is often cause d by contagious infection , an d there ar e many bacterial, viral , an d funga l pathogen s i n th e environment . Th e mechanis m of blood coagulatio n an d th e type s o f proteins involve d ar e no w textboo k knowledge, an d microbe s ar e no t par t o f th e story . Becham p wa s als o a n extreme pleomorphist ; tha t is , h e believe d tha t th e numerou s specie s o f bacteria coul d emerg e fro m microzym a "b y evolution. " Eve n whe n on e takes into accoun t ho w th e meanin g o f the word "evolution " ha s changed , we no w hav e molecula r technologie s t o determin e th e geneti c difference s that characterize different bacteria l and viral species. It is possible that futur e science wil l uncove r a worl d i n whic h prion s combin e freely t o for m viruses, an d viruse s combin e genome s t o mak e bacteria , bu t s o fa r th e possibilities o f genetic recombination see m more restricted . Although muc h i n Bechamp s theory is , in m y evaluation , incorrect , h e did propose a few idea s that ca n be see n a s precursors o f some idea s o f th e middle and late twentieth century . For example, it is now consensus knowledge tha t hos t cell s ar e abl e t o harbo r microorganism s i n laten t state s fo r long periods o f time, an d tha t thes e microorganism s ar e capabl e o f causin g disease whe n th e hos t i s weakened . A noncontroversia l exampl e i s th e herpes virus, but, a s will be discusse d shortly, ther e is growing research tha t suggests tha t som e type s o f bacteria may exhibi t simila r patterns o f latency and pathogenicity. Second , th e ide a tha t th e bloo d o f healthy individual s is not steril e is no longe r dismisse d out-of-hand. Althoug h I will not evaluat e the blood-born e microbia l theorie s o f Enderlein, vo n Brehmer , Villequez , and Naessens , subsequen t researc h o n bacteria l bloo d pathogen s confirm s the genera l findin g o f microbia l bloo d colonizatio n i n apparentl y health y persons. Fo r example , in th e 1970 s researchers a t the University o f Camer -

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ino Medica l Schoo l publishe d finding s o n staphylococc i i n th e red-blood cells o f health y individuals , an d thi s wor k o n re d bloo d cel l parasitis m ha s been confirme d an d extende d b y othe r laboratories , includin g tha t o f Gerald Domingue, a microbiologist, immunologist , an d urologist a t Tulane University Medica l School. 3 Third , th e ide a tha t a t leas t som e specie s o f bacteria ca n underg o variation , includin g cell-wal l deficien t an d filterabl e forms, i s now an accepted part of microbiology. However, a s far as is known today thes e change s ar e muc h mor e limite d tha n thos e envisione d b y Bechamp o r Enderlein. Finally , the idea that there may be life forms smalle r than viruse s i s no w receivin g attentio n i n researc h o n prions , som e o f which ar e now recognize d a s pathogens. Although i t ma y b e tim e t o gran t t o Becham p an d othe r nineteenth century student s o f bacterial variation a larger role in th e histor y o f microbiology, particularl y regardin g som e o f th e specifi c discoverie s tha t ante dated Pasteur' s work , i t i s simplisti c t o vie w hi m a s th e fearles s underdo g who spok e th e trut h a s scienc e becam e pasteurized . Becham p ha d som e very far-ou t idea s tha t will probabl y alway s remai n so . I t i s instructiv e t o note tha t Lid a Mattman's introductor y historica l chapte r o n bacteria l variation i n he r textboo k Cell-Wall Deficient Forms doe s no t mentio n Bechamp . She begin s instea d wit h th e Swedis h biologis t Erns t Almquist , whos e contributions o n bacterial variation di d not presume suc h radical pleomor phism. Having thus situated Bechamp without dismissin g his place in the history of microbiology, le t us consider now the evaluatio n o f the North America n research traditio n o n bacteri a an d cancer . M y evaluatio n wil l be organize d around topics derived from th e four major group s of theory-choice criteria . Because th e consistenc y argument s provid e a firs t lin e o f evaluation , an d because the materials included under these arguments provide helpful back ground information , the y ar e discussed first. I have divide d th e consistenc y arguments into tw o groups based on background research in the microbiol ogy of cell-wall deficient (CWD ) bacteri a and in the molecular biology an d immunology o f cancer.

The Consistency Argument I: CWD Bacteria Research To evaluate th e possibility tha t bacteria ma y be etiologica l agent s in cancer , it i s helpfu l t o begi n wit h th e statu s o f researc h o n bacteria l variatio n o r pleomorphism. B y the late 1940 s and 1950 s the cyclogenist controvers y was

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largely resolve d agains t cyclogeny , a t leas t i n th e stric t form s propose d b y Enderlein an d Hadley , bu t th e filtrationis t controvers y wa s resolve d i n favo r of filtration. 4 I n a chapte r o n filterabl e forms , Mattma n writes , " D e m o n strating filterabl e lif e i n microbia l specie s frustrated som e investigators , wa s accomplished b y many pionee r microbiologists , an d no w ca n b e a classroo m exercise" (1993 : 209) . Furthermore , eve n a t th e heigh t o f thes e controver sies durin g th e 1920 s an d 1930s , th e genera l phenomen a o f variatio n wer e accepted, an d instance s o f bacteria l variatio n ar e eas y t o se e unde r th e microscope. B y i96 0 th e topi c o f bacteria l variatio n wa s well-enoug h accepted tha t a major multivolum e collectio n o n bacteri a include d a n essa y on th e topi c (Klieneberger-Nobe l i960) . T h e phenomeno n o f bacteria l pleomorphis m i s s o widel y accepte d i n microbiology today , a t leas t fo r certai n group s o f bacteria , tha t i t ca n be considere d consensu s knowledge . Fo r example , a majo r microbiolog y textbook mention s bacteri a pleomorphis m a s a common-knowledge , taken-for-granted p h e n o m e n o n tha t need s n o citatio n (Atla s 1988) . O n e needs onl y t o chec k Medlin e o r anothe r c o m m o n inde x unde r C W D bacteria o r L-form s ( a plasmalike , fried-egg colon y appearance ) t o se e tha t there i s continuin g researc h o n th e topi c i n th e majo r peer-reviewe d journals. Nevertheless, ther e i s stil l som e stigm a attache d t o th e topic . I n a conversation I ha d wit h Geral d Domingue , on e o f th e foremos t expert s i n the field , I learne d tha t althoug h th e existenc e o f L-Form s an d C W D bacteria i s no t controversia l amon g microbiologists , th e theor y tha t the y can persis t i n th e hos t an d pla y a rol e i n patholog y i s stil l controversial . A s he note s i n th e volum e Cell Wall Deficient Bacteria: Basic Principles and Clinical Significance, "These aberran t bacteri a hav e bee n regarde d a s labora tory curiositie s o f little o r n o clinica l significance " (1982 : ix). That perspec tive seem s t o b e changing , particularl y wit h th e publicatio n o f Domingu e s book an d th e secon d editio n o f Mattma n s book (1993) , whic h carrie s th e subtitle "Stealt h Pathogens. " Man y medica l expert s believ e tha t withou t cell walls bacteri a tha t remai n i n th e hos t bod y woul d simpl y ruptur e unde r osmotic pressure . However , Domingu e an d other s argu e tha t C W D form s of bacteri a ma y surviv e b y enterin g hos t cell s (possibl y integratin g wit h host-cell organelles ) wher e the y ma y persis t a s burie d bacteria l genomes . T h e theor y i s bolstere d b y th e widel y accepte d evolutionar y theor y tha t mitochondria wer e onc e capture d bacteri a tha t eventuall y evolve d int o necessary cel l organelles . Domingue s wor k ha s bee n centra l t o documentin g th e rol e o f burie d

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bacterial genome s a s crypti c agent s o f chroni c disease . H e an d associate s documented fo r th e firs t tim e i n 197 4 tha t a relativel y stabl e L-for m wa s definitely linke d t o th e phenomen a o f persistence an d reversio n i n a huma n embryonic tissu e cultur e system . Small , dens e bodie s derive d fro m a n unstable L-for m i n th e tissue-cultur e syste m wer e observe d t o persis t fo r a prolonged time , afte r whic h th e bodie s reverte d t o th e classica l paren t organism. Thi s wa s accompanie d b y deat h o f th e tissue-cultur e cells . A s a result o f thes e studie s Domingu e argue d tha t th e bacteri a hav e a reproduc tive cycl e i n whic h undifferentiate d dens e form s ("ste m cells" ) ar e extracte d from th e vesicle s o f th e "mother " L-for m alon g wit h elementar y bodies . (Thus, th e concep t o f a bacterial cycl e reenter s th e literature , bu t i n a muc h different wa y fro m th e cyclogeni c theorie s o f th e 1920s. ) Domingu e argue s that th e undifferentiate d dens e form s increas e i n siz e an d ar e capabl e o f maturing int o th e vesiculate d mothe r form s a s wel l a s reproducin g o r reverting t o th e bacteria l form . Hi s curren t researc h (especiall y fo r idio pathic hematuria ) support s hi s hypothesi s tha t intracytoplasmi c dens e bod ies ar e a mechanis m fo r bacteria l persistenc e an d ma y caus e infection s systematically overlooke d i n clinica l medicine . H e adds , "Persistin g small , electron dense , elementar y bodie s derive d fro m bacteri a wit h aberran t cel l walls see m t o hav e cel l an d tissu e tropism s correlate d wit h a variet y o f chronic huma n diseases , notabl y chroni c infection s o f the urinar y tract." 5 Domingue argue s tha t unde r condition s o f immun e deficienc y o r trauma, C W D bacteri a ma y regai n thei r standar d morpholog y an d thei r pathogenicity Hi s colleague s sometime s teas e hi m abou t hi s researc h o n "funny bugs, " bu t the y als o sen d hi m sample s t o analyz e w h e n the y ar e having difficultie s wit h diagnosi s an d treatment . I n addition , h e ha s receive d continued N I H fundin g fo r hi s wor k o n C W D bacteri a an d thei r possibl e role i n interstitia l cystitis , an d h e ha s successfull y treate d man y patient s w h o have bee n afflicte d b y chroni c urinary-trac t disease s associate d wit h C W D bacterial infections . Ther e i s growin g interes t i n th e recen t researc h o n C W D bacteri a an d disease , an d Domingu e regularl y receive s invitation s t o speak befor e group s o f scientist s an d doctor s o n thi s increasingl y ho t topic . T h e recen t researc h o n C W D bacteri a ca n hel p mak e diagnosi s an d cultur ing mor e sensitiv e t o possibl e bacteria l variatio n tha t ma y hav e bee n misse d under standar d procedures . Diagnosi s o f C W D bacteri a ma y als o lea d t o better selectio n o f antibiotics , suc h a s one s tha t operat e throug h pathway s other tha n destroyin g cel l walls . As stealt h pathogens , C W D bacteri a hav e bee n implicate d i n a numbe r of chronic , degenerativ e diseases . Mattman' s revie w (1993 ) o f thes e disease s

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includes urinary-trac t infections , Crohn' s disease , leprosy, meningitis , multi ple sclerosis , myocarditis , rheumati c fever , sarcoidosis , septicemia , an d ul cerative colitis . Probabl y th e mos t well-know n cas e i s arthriti s an d othe r collagen diseases , wher e ther e i s a lon g traditio n o f researcher s w h o hav e advocated a bacterial etiolog y (Hughe s 1994) . I n th e Unite d State s Thoma s Brown wa s fo r man y year s a relativel y isolate d medica l docto r w h o sup ported th e us e o f antibiotic s i n th e treatmen t o f arthritis . However , b y th e 1990s th e fiel d wa s i n th e mids t o f a majo r controvers y a s randomize d clinical trial s o f monocyclin e indicate d a statisticall y significan t improve ment ove r placeb o controls. 6 What d o th e leadin g C W D researcher s thin k abou t bacteri a a s agents o f possible etiologica l significanc e i n cancer ? Domingue , Mattman , an d othe r researchers i n thi s are a ar e carefu l no t t o exten d th e claim s o f researc h o n pathology an d C W D bacteri a t o cancer . Base d o n m y conversatio n wit h Domingue, I would characteriz e hi s attitud e a s open-minded an d intrigue d but skeptical . Mattma n include s a chapter o n th e topi c i n he r textbook , bu t she als o cautions , "Ther e i s n o subjec t generall y viewe d wit h greate r skepticism tha n a n associatio n betwee n bacteri a an d huma n cancer. " Sh e then adds , However, th e medica l professio n ma y loo k bac k wit h iron y a t th e ston y reception give n by his colleague s t o Koch' s paper elucidatin g th e etiolog y o f tuberculosis. Similarly , medica l student s wer e onc e taugh t tha t whoopin g cough vaccinatio n wa s an unrealisti c drea m reporte d onl y by tw o wome n a t the Michiga n Publi c Healt h Laboratorie s an d b y a derange d pediatricia n named Sauer . (1993 : 318) T h e questio n no w seem s t o b e no t whethe r C W D bacteri a pla y som e rol e in a t leas t som e case s o f chronic , degenerativ e disease , bu t h o w importan t that rol e is . T h e expert s o n C W D bacteri a ar e no t willin g t o exclud e th e possibility tha t cance r ma y b e amon g th e disease s fo r whic h bacteri a pla y some role . T h e cas e o f ulcer s i s on e exampl e o f a hug e shif t i n medica l opinio n involving th e reexaminatio n o f bacteri a an d chronic , degenerativ e disease . Long considere d a noninfectiou s diseas e cause d b y stres s an d lifestyl e fac tors, th e maveric k researc h o f the Australia n docto r Barr y Marshal l le d t o a consensus shif t i n medica l opinio n durin g th e lat e 1980 s an d earl y 1990 s (Marshall e t al . 1988 ; Marshal l 1994) . I n 1994 , th e Nationa l Institute s o f Health hel d a consensu s conferenc e tha t resulte d i n substantia l change s i n the recommende d treatmen t fo r ulcer s i n recognitio n o f th e ne w theory .

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During th e 1990 s a n increasin g numbe r o f researc h report s linke d Helicobacter pylori infection t o stomac h cancer s (e.g. , Eurogast 1993 ; Parsonnet e t al. 1994) . Here i s one case , then, o f a relatively noncontroversia l linkag e o f bacterial infections t o cance r etiology . The reevaluatio n o f ulcers , no t t o mentio n th e potentia l change s i n medical opinio n o n th e etiolog y o f arthriti s an d othe r chroni c diseases , suggests that research o n bacteria an d cancer could become par t o f a general reevaluation o f th e rol e o f bacteria , particularl y CW D forms , i n chroni c disease. I n othe r words , ther e i s n o cas e fo r prim a faci e dismissa l o f th e bacterial theor y a s inconsistent wit h exper t opinio n o n CW D bacteri a an d pathology. The more on e reads in the area of biomedical research, the mor e one realize s ho w littl e w e al l know an d ho w foolis h ar e thos e wh o dismis s reasonably grounded medica l hypotheses ou t o f hand.

Consistency Argument II: Cancer Research The secon d are a o f background knowledg e tha t provides a reference poin t for evaluatio n b y consistenc y i s contemporary cance r research . A relativel y noncontroversial are a o f contemporar y cance r researc h involve s th e us e o f bacteria o r bacteria l product s t o stimulat e th e immun e syste m (e.g. , Jeljaszewicz, Pulverer , an d Roszkowsk i 1982) . Th e mos t well-know n product s are Coley' s toxin s an d th e tuberculosi s vaccin e BCG . Thi s are a o f research is relativel y noncontroversia l becaus e i t i s no t guide d b y th e theor y tha t bacteria ma y b e etiologica l agent s i n cancer . Mechanism s propose d t o explain the efficacy o f bacterial vaccines involve theories such as the cascade of cytokines tha t th e bacteria l vaccine s ar e presumed t o releas e (e.g. , Wie mann an d Starne s 1994) . Thes e mechanism s locat e th e us e o f bacteria l vaccines within contemporar y immunolog y an d molecular biology . As i n mos t othe r area s o f biomedica l research , molecula r biolog y ha s become th e obligator y point o f passage for th e bulk o f cancer research, an d since the 1970 s a large number o f researchers has climbed aboard the protooncogene theor y bandwago n (Fujimur a 1995) . Unde r thi s theory , cance r emerges whe n proto-oncogene s ar e activate d t o for m oncogenes , o r con versely whe n tumo r suppresso r gene s becom e inactivated . Th e proto oncogenes regulat e th e expressio n o f growt h factor s an d growth-facto r receptors. When the y are not functioning properly , the cells growth regula tion mechanism s ar e throw n off . Cance r researche r Rober t Weinber g de scribes the curren t understandin g o f this process with a n automotive meta -

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phor: "I n effect , a cance r cell s growt h ma y deriv e fro m a stuc k accelerato r (an activate d oncogene ) o r a defectiv e brakin g syste m (inactivate d growth suppressor gene) " (1994 : 166) . T h e geneti c change s tha t lea d t o cance r generally occu r graduall y ove r time ; thus , cance r i s a multistage proces s tha t can begi n wit h inherite d geneti c defect s tha t provid e a predispositio n an d that ma y requir e additional , subsequen t geneti c damag e fro m carcinogens. 7 T h e molecula r biolog y o f cance r therefor e highlight s multistag e geneti c damage, a s wel l a s protei n an d growth-facto r expressio n ofte n a t th e cel l walls. Tha t emphasi s provide s a poin t o f connectio n amon g molecula r biology an d relate d science s suc h a s immunolog y an d endocrinology . Thi s theory o f carcinogenesi s i s sometime s calle d th e mutageni c theory ; h o w ever, I prefe r th e ter m "molecular " becaus e th e contemporar y understand ing o f tumo r genesi s an d growt h include s othe r phenomen a suc h a s th e failure o f gene-repai r mechanisms . In contras t t o contemporar y molecula r approache s t o cancer , researc h on bacteria l pathogen s appear s t o b e ou t o f another epoch , th e bacteriolog y of th e modernis t perio d rathe r tha n th e molecula r biolog y o f researc h today. T h e morphologica l natur e o f most o f the bacteria-and-cance r studie s prior t o th e 1960 s i s i n strikin g contras t t o th e molecula r natur e o f muc h cancer researc h today . T h e tw o researc h traditions , on e grea t an d th e othe r little, spea k differen t languages , us e differen t technologies , and , t o invok e Kuhn s term , appea r t o operat e unde r incommensurabl e paradigm s (Kuh n 1970). Thi s appearanc e o f incommensurabilit y provide s reasonabl e ground s for th e argumen t tha t ther e i s genera l inconsistenc y betwee n th e bacterial etiology theor y an d th e bul k o f contemporar y cance r research . Therefore , on firs t inspectio n th e theor y tha t bacteri a ar e carcinogeni c agent s coul d b e rejected fo r inconsistenc y wit h contemporar y cance r research . However, th e inconsistenc y i s no t necessaril y a s grea t a s i t firs t appears . Almost al l of the contemporar y researc h o n th e molecula r biolog y o f cance r began wit h th e stud y o f oncogene s o r proto-oncogene s tha t wer e firs t associated wit h tumo r viruses . I n th e process , vira l oncolog y becam e a n integrated par t o f moder n human-cance r researc h (Fujimur a 1995 ; Retti g 1977). Fo r bacteria l researc h t o accomplis h a simila r transition , i t woul d have t o b e translate d int o th e languag e o f molecula r biology , immunology , endocrinology, an d relate d field s tha t constitut e th e cor e o f contemporar y cancer research . Thi s translatio n proble m i s no t restricte d t o th e bacteria l theory; instead , i t i s a genera l proble m amon g man y o f th e alternativ e cancer theorie s an d therapies . Mos t o f th e so-calle d metaboli c researcher s are concerne d wit h nutritiona l aspect s o f cellula r metabolism , an d the y

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tend t o thin k i n term s o f th e biochemistr y o f metabolism rathe r tha n th e molecular biolog y o f gen e expressio n o r gen e repair . Th e failur e t o mak e the necessary translations into the language of molecular biology and related fields therefor e constitute s a majo r hurdl e t o acceptabilit y o n th e par t o f many alternative cance r theories an d therapies. Notwithstanding th e apparen t incommensurability , on e migh t recal l th e lesson of STS analysts Barry Barnes and Donald MacKenzie, whose critiqu e of Kuh n s paradigm-conversion theor y pointe d t o th e empirica l proble m with hi s theory : opponent s fro m clashin g paradigm s o r researc h tradition s often ca n become quit e adep t a t understanding th e term s o f the othe r sid e (Barnes and MacKenzie 1979 : 200). Although the molecular researchers and the metabolic/nutritional researcher s may not spea k each others' languages, translation i s possibl e i n principle . I n othe r words , th e tw o field s ar e no t contradictory o r incommensurable a s much a s operating at different levels . Mattman review s a number o f possible mean s b y whic h bacteri a coul d play a role in tumor genesi s and growth from th e perspective o f contemporary immunologica l an d molecula r theorie s o f cancer (1993 : 314—16) . On e set o f possibilitie s involve s blockin g hos t immun e response . Vira l model s include th e Frien d leukemi a virus , whic h prevent s norma l antibod y re sponse, an d th e Gros s leukemi a virus , whic h leave s antibod y formatio n intact bu t prevent s cellula r defense . Fo r bacteri a th e majo r candidat e a t present i s thei r productio n o f a substanc e simila r t o th e huma n hormon e choriogonadotropin, whic h i s found alon g the cel l walls of cancer cell s and may bloc k immun e response . Th e vira l model s o f blockin g immun e re sponse hav e n o bacteria l researc h yet t o suppor t them , bu t th e choriogo nadotropin theor y ha s been researche d i n som e detai l for bacteri a an d wil l be discusse d shortly. Mattman als o provide s tw o othe r possibilitie s tha t coul d involv e a relationship betwee n bacteri a an d oncoviruses . First , som e studie s sugges t tha t viruses an d bacteria togethe r ma y be necessary t o produce a murine leuke mia. Second , bacteri a ma y hos t pathologica l oncoviruses , followin g th e model o f Aerobacter aerogenes an d Influenza- A virus , whic h th e bacteriu m holds o n it s surfac e (Mattma n 1993 : 314—16) . A simila r mechanis m i s influence o n th e hos t DN A vi a plasmi d transfers , a mechanis m tha t wa s first suggeste d fo r th e plan t pathoge n Agrobacterium tumefaciens (Macombe r 1990).

Another possibilit y i s tha t bacteri a ma y produc e a carcinogeni c com pound know n t o damag e hos t DNA . Th e mos t well-know n cas e i s aria toxin, a carcinoge n produce d b y th e plan t fungu s Aspergillus flavus and

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known t o contaminat e huma n food s suc h a s peanuts. Ther e i s als o som e evidence for thi s kind o f mechanism in murine model s (Laquer , McDaniel , and Matsumoto 1967) . Although futur e researc h coul d prov e tha t som e o r al l of these possibili ties ar e dea d ends , th e lis t i s sufficien t t o mee t th e incommensurabiUt y o r nontranslatability argument . I n othe r words , i t i s possibl e t o mak e th e theory o f bacteria a s carcinogenic agent s consisten t wit h th e contemporar y molecular biology , immunology , and/o r endocrinolog y o f cancer . How ever, a secon d proble m immediatel y face s th e theor y o n consistenc y grounds. Unde r th e contemporar y molecula r researc h program , th e etiol ogy o f cance r i s understood a s a multifaceted proces s tha t involve s a wid e range of possible carcinogens. To bring bacteria into th e picture, on e migh t relegate them to minor factor s i n a few cancers , such as Helicobacter pylori in gastric cancer . Thi s strategy , simila r to th e rol e o f viral oncology , woul d b e the easies t way to transfor m th e bacterial theory int o somethin g acceptabl e and usefu l t o contemporar y cance r research . However , th e strateg y woul d involve a very different understandin g o f the role of bacteria in cance r from that envisione d b y mos t o f th e researchers , an d thu s befor e endorsin g that strateg y i t i s necessar y firs t t o conside r an d rejec t th e older , mor e comprehensive bacteria l theory . Under th e molecula r theory , th e direc t caus e o f cance r (a s oppose d t o indirect variable s suc h a s lifestyl e o r poverty ) i s an y agen t tha t ca n brin g about genetic changes to alter sufficiently th e growth signalling mechanisms of the cell . Under th e subtheor y o f multistep carcinogenesis , geneti c trans formation fro m a norma l cel l t o a cance r cel l i s assume d t o involv e a mixture o f inherite d predispositio n an d environmentall y induce d geneti c hits tha t accumulat e ove r a n organism' s lifetim e an d lea d graduall y t o carcinogenesis. Recognize d agent s tha t ar e direc t cause s o f mutation s in clude radiation , chemica l carcinogens , oncoviruses , an d inherite d defects . In additio n t o causin g direct geneti c damage , risk factors ca n contribut e t o tumor-promotion mechanism s an d t o th e failur e o f gene-repai r mecha nisms o r immune-syste m surveillance . Lifestyl e factor s suc h a s poo r die t and (i n women) numbe r o f estrogen cycle s may fit mor e into thi s category . Some o f the earl y researchers discusse d i n th e secon d chapte r develope d a vie w o f carcinogenesi s tha t appear s t o b e ver y inconsisten t wit h th e contemporary theor y tha t radiatio n an d chemica l carcinogen s caus e cance r directly. Recal l tha t Rif e an d Cran e argue d tha t th e dea d tissu e lef t b y X rays forme d a "natura l parasiti c feast. " Glove r mad e a simila r bu t muc h more develope d argumen t regardin g the Japanese coal-ta r studies:

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The outstandin g facts in thes e tar experiments are: i) Th e irritatio n mus t b e continue d fo r a long tim e befor e cance r de velops. 2) Onl y a smal l percentag e o f th e experimenta l animal s eve r develo p cancerous tumors , whil e th e majorit y sho w inflammator y o r papillo matous lesions. 3) Th e carcinomat a [sic] alway s star t i n smal l isolate d area s an d neve r i n the whole o f the irritated areas. 4) Mos t o f thes e irritate d area s hav e continuou s ope n wound s whic h render them vulnerable t o infection . It ha s bee n argue d tha t som e chemica l substanc e i n th e irritan t act s o n certain smal l group s o f cell s i n th e stimulate d area , changin g the m int o proliferating cell s and that the proliferative powe r o f the cel l itself is the caus e of the malignancy. This does not see m plausible in view o f the fact tha t Rou s Sarcoma No . 1 , which i s a true malignan t tumor , ca n b e transmitte d b y a n inoculation o f dead cells or a cell-free filtrate . (1926 : 165) In short , Glove r an d Rif e sugges t tha t radiatio n an d chemica l carcinogen s do no t directl y caus e cancer ; rather , the y se t th e stag e fo r th e actio n o f a microbial pathogen . O n e ca n fin d mor e o r les s th e sam e vie w amon g som e o f th e tumo r virologists durin g th e perio d prio r t o th e molecula r biolog y o f cancer , suc h as Peyton R o u s (1941 ) an d Francisc o Duran-Reynal s (1950) . R o us provide s perhaps th e cleares t statemen t o f th e theor y tha t chemica l carcinogen s activate laten t viruses : Experiments wit h carcinogeni c chemical s hav e disclose d th e fac t tha t ever y mammal carries within its tissues thousands of potentialities for tumor forma tion, an d ye t n o growt h result s fro m an y o f the m unles s th e circumstance s are peculiarly favorable . I f viruses furnis h th e potentialitie s mentioned , the y may ente r th e bod y i n infancy , a s d o bacteria , an d b e distribute d t o th e tissues, persistin g ther e a s harmles s inhabitant s associate d wit h cell s unti l altered circumstance s rende r the m injurious . . . . The "carcinogeni c agents, " so called , ma y b e though t o f a s providing th e condition s require d fo r som e innocuous residen t viruse s t o alte r an d becom e tumor-producin g viruses . (1941: 39-40 )

T h e view s o f Glover , Rife , an d tumo r virologist s suc h a s R o u s an d Duran-Reynals ar e n o longe r consisten t wit h curren t knowledge . Radia tion an d chemica l carcinogen s appea r t o caus e geneti c damag e tha t lead s directly t o carcinogenesi s withou t necessar y mediatio n fro m microbia l agents. Thus , fro m th e poin t o f view o f todays molecula r theor y o f cancer ,

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Glover s argument tha t "irritatio n mus t b e continue d fo r a long time " coul d be me t b y explainin g tha t th e lon g tim e laps e wa s th e resul t o f th e nee d fo r a multistag e sequenc e o f geneti c damag e o r a gradua l failur e o f gene repair mechanism s throug h constan t stres s an d irritation . Furthermore , hi s argument tha t onl y a smal l percentag e o f animal s develo p tumor s coul d b e explained eithe r becaus e chemica l carcinogenesi s usuall y involve s a n initia tor an d a promoter o r becaus e th e laborator y animal s use d a t th e tim e wer e not al l geneticall y similar . Althoug h Glove r use s th e argumen t o f cance r foci a s evidenc e fo r hi s theory , th e opposit e i s th e cas e today , w h e n th e evidence no w i s in favo r o f monoclonal tumor s (tha t is , tumor s originatin g from on e cel l rathe r tha n many) . Thi s findin g i s generall y interprete d a s evidence i n favo r o f a noninfectiou s etiolog y (e.g. , Varmu s an d Weinber g 1993: ch . 2) . Thus , i t i s eas y t o answe r Glover s an d Rife' s argument s fro m the perspectiv e o f the secondary-infectio n theor y neste d withi n a molecula r theory. However, rathe r tha n rejec t Glove r an d R o u s ou t o f hand , le t u s giv e them th e benefi t o f th e doub t an d imagin e h o w the y an d othe r researcher s might respon d toda y b y drawin g o n th e curren t molecula r understandin g of cancer . A s i n th e cas e o f th e herpe s virus , the y ar e envisionin g a laten t cancer microb e tha t i s th e resul t o f a n origina l infection , perhap s eve n passed o n throug h "vertica l transmission " a t birt h (Gros s 1983) . T h e m i crobe i s probably a n intracellula r pathoge n or , i f extracellular, i t i s inaccessi ble t o th e bloo d syste m an d immunologica l surveillance . I f intracellular, th e microbe probabl y lack s cel l wall s an d ma y b e th e siz e o f a virus . T h e microbe remain s i n a latenc y phas e unti l condition s o f cellula r dysfunctio n caused b y (i n thi s case ) radiatio n o r chemica l irritant s caus e th e microb e t o emerge from a latenc y phase . Smoking , poo r diet , an d othe r know n ris k factors ar e othe r possibl e trigger s fo r a transformatio n fro m th e latenc y phase. O n c e activated , th e microb e the n contribute s t o transformin g th e host cel l into a cancer cel l through on e o r mor e o f the mechanism s outline d above. I f th e viru s o r bacteriu m i s a latent , intracellula r pathogen , i t i s possible tha t man y tumor s woul d b e monoclona l i n origin . I n short , i f w e translate th e bacteria l theor y a little, i t i s possible t o reconcil e i t wit h toda y s theory o f multistage carcinogenesis . Let u s cal l thi s th e "modifie d bacterial-infectio n theory. " A s fo r th e contemporary vira l theor y o f cancer , bacteri a nee d no t b e presen t fo r al l cancers, bu t the y ma y b e include d a s contributor s t o th e multiste p proces s of geneti c damag e an d faile d gene-repai r mechanism s tha t ar e assume d today t o b e th e molecula r mechanis m fo r tumo r genesis . Thi s modifie d

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bacterial-infection theor y woul d pas s th e tes t o f consistenc y wit h respec t t o the contemporar y molecula r understandin g o f cancer . I n othe r words , a modified bacterial-etiolog y theor y coul d replac e th e secondar y infectio n theory. Laten t bacteria l pathogen s therefor e coul d serv e a s contributor s t o some step s i n th e multistag e carcinogenesi s o f a t leas t som e cancers . At thi s poin t a n advocat e o f th e secondary-infectio n theor y coul d rais e another consistenc y argument : i f bacteri a wer e involve d i n cancer , th e us e of antibiotic s i n cance r patient s woul d hav e bee n efficacious . Ther e ar e a couple o f ways to answe r thi s argument . First , i f the bacteri a ar e intracellula r pathogens, o r i f thei r locatio n i s outsid e th e hos t cell s bu t i n position s no t accessed b y th e bloodstream , i t ma y b e difficul t fo r antibiotic s t o reac h them. Second , becaus e th e bacteri a hav e a long-term relationshi p wit h th e host, the y ma y hav e develope d strain s tha t ar e resistan t t o antibiotic s (Greg ory 1952 : 132) . I t i s now well-know n tha t som e form s o f c o m m o n bacteri a have develope d strain s tha t ar e resistan t t o al l antibiotics ; i t i s certainl y possible tha t possibl e oncobacteri a hav e develope d antibiotic-resistan t strains a s well. However, thi s argumen t woul d sugges t tha t w h e n antibiotic s wer e intro duced, thei r us e shoul d hav e le d t o th e successfu l treatmen t o f cancer . I know o f littl e evidenc e t o suppor t thi s clai m excep t th e wor k o f on e American docto r (Gregor y 1952) . Thus , a n alternativ e defens e woul d b e better: th e pleomorphis m o f th e propose d oncobacteri a an d thei r intracel lular locatio n ma y provid e the m wit h a defens e agains t antibiotics . O n thi s point i t i s wort h notin g tha t C W D form s ca n b e induce d experimentall y by som e antibiotics , suc h a s penicillin , whic h work s t o brea k dow n cel l walls. (Thi s fac t raise s th e possibilit y tha t som e o f th e increas e i n cance r rates coul d b e du e t o th e us e o f antibiotics tha t destroye d bacteria l cel l wall s but di d no t kil l th e bacteria. ) I n summary , b y assumin g difficult y o f acces s or resistanc e t o antibiotic s (eithe r throug h th e developmen t o f resistan t strains o r throug h pleomorphism) , i t would b e possibl e t o mak e th e claime d lack o f efficacy o f antibiotics consisten t wit h contemporar y medica l knowl edge. Probably a bette r rebutta l t o th e antibioti c argumen t i s t o not e tha t some antibiotic s i n fac t are efficacious i n th e treatmen t o f som e cancers . Contemporary chemotherapie s suc h a s the anthracycline s ar e efficaciou s fo r some cancers , particularl y Wilms' s tumor , leukemias , an d lymphoma s (Priebe 1995) . O f course , th e mechanis m i s presume d no t t o involv e bacterial infections ; instead , cance r cell s ar e just slightl y les s resistan t tha n healthy cell s t o th e toxicit y o f th e drugs . Nevertheless , th e antibioti c

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treatment o f Helicobacter pylori appear s t o lea d t o regressio n o f gastri c lymphomas (Wotherspoo n e t al . 1994) . A supporte r o f th e bacteria l theor y might argu e tha t th e succes s o f antibiotic s i n som e case s ma y b e du e i n part t o a n effec t o n bacteria l pathogens . Furthermore , i f cancer-associate d bacteria ar e highl y pleomorphic , the n i t i s possibl e tha t th e bes t antibioti c choices hav e no t ye t bee n tested . Fo r example , Domingu e (1996 ) i s carefu l to poin t ou t th e importanc e o f appropriat e antibioti c selectio n (nitrofuran toin) i n hi s successfu l treatmen t a cas e o f hematuri a fo r whic h h e culture d C W D bacteri a fro m catheterize d samples . In conclusion , a n advocat e o f bacteri a a s carcinogeni c agent s ca n mee t the consistenc y argument s tha t ar e raise d agains t it , bu t onl y i f the theor y i s modified significantl y s o tha t bacteri a ar e viewe d a s contributin g agent s t o multistage carcinogenesis . A t it s bes t th e modifie d bacteria l theor y coul d provide som e ne w idea s fo r treatmen t i n conventiona l cance r chemother apy, suc h a s specifi c ne w antibiotics , a s wel l a s possibl y ne w protocol s involving long-ter m treatmen t an d mechanism s fo r appropriat e absorption . T h e consistenc y argumen t fro m antibiotic s ma y the n resul t i n wha t Miche l Callon (1986 ) call s problematization , o r provokin g other s t o becom e inter ested i n a ne w o r differen t theory . B y showin g h o w curren t researc h o n antibiotics an d cance r migh t obtai n ne w successe s w h e n considere d fro m the viewpoin t o f th e bacterial-infectio n theory , th e antibioti c counterargu ment ca n b e turne d o n it s hea d an d use d i n favo r o f th e theory . Politically , of course , thi s interpretatio n als o reposition s th e theor y s o tha t i t i s n o longer oppose d t o th e powerfu l pharmaceutica l industry . Rather , th e theor y maintains a rol e fo r antibiotic s alongsid e vaccines ; i t ma y eve n provid e possibilities fo r ne w an d mor e efficaciou s use s o f antibiotics i n th e treatmen t of cancer . T h e bacteria l theor y ca n als o b e aligne d wit h th e alternativ e (o r ad junctive) nutritiona l therapies . Fo r example , Livingsto n argue d tha t abscisi c acid, a plant h o r m o n e an d Vitami n A analog , neutralize s th e productio n o f substances simila r t o th e h o r m o n e choriogonadotropin , whic h sh e argue d is probabl y th e majo r pathwa y b y whic h bacteria l infection s contribut e t o cancer (Livingsto n 1979) . Thus , th e dietar y par t o f he r therap y becam e aligned wit h th e vegetaria n diet s tha t ar e c o m m o n amon g th e metaboli c cancer treatmen t protocol s suc h a s th e Gerso n therapy , whic h use s ra w vegetable juices, includin g tha t o f carrots . However , Livingsto n stil l viewe d the bacteria l vaccin e a s th e ke y element . I n a subsequen t pape r sh e mea sured percentag e inhibitio n o n murin e sarcom a 18 0 i n viv o an d foun d 2 0 percent fo r Vitami n A , 2 5 percen t fo r abscisi c acid , 7 0 percen t fo r he r

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purified antigen , 5 8 percen t fo r abscisi c aci d an d Vitami n A , an d 7 6 percent fo r al l thre e combined . Sh e conclude d tha t althoug h th e dietar y supplements wer e helpful , he r bacteria l antige n wa s muc h mor e importan t (Livingston an d Majnaric h 1986) . I n a tal k befor e th e Cance r Contro l Society, sh e explicitl y state d tha t whil e sh e though t th e Gerso n therap y wa s important, i t wa s necessar y t o hav e th e additiona l contributio n o f he r vaccines (Livingsto n 1989) . I n an y case , Livingsto n certainl y opene d th e door t o a linkage betwee n nutritiona l therap y an d th e bacteria l program .

The Accuracy Argument I: Contaminants At thi s poin t th e supporte r o f th e secondary-infectio n theor y coul d rais e a different typ e o f argument : eve n i f a modifie d for m o f th e bacterial etiology theor y ca n b e mad e consisten t wit h contemporar y knowledg e i n microbiology an d cance r research , ther e i s n o evidenc e t o suppor t th e theory. T h e bacteria l culture s claime d t o b e associate d wit h huma n tissue s in thes e studie s ar e onl y artifact s o f contaminatio n fro m slopp y laborator y procedures. Thi s counterargumen t shift s u s fro m genera l consistenc y argu ments t o a grou p o f accurac y o r evidenc e arguments . I wil l brea k th e accuracy argument s dow n int o tw o separat e groups : first , th e laborator y techniques use d t o cultur e bacteri a fro m cance r tissue s introduc e environ mental contaminants ; an d second , ther e i s n o evidenc e tha t support s th e existence o f a single pleomorphi c cance r organism . T h e contaminan t argumen t coul d begi n wit h failure s t o cultur e bacteri a from cance r cells . O n e o f th e mai n problem s wit h th e bacteria l theor y during th e crucia l perio d o f it s rejectio n a t th e beginnin g o f th e twentiet h century wa s tha t som e researcher s faile d t o isolat e bacteri a fro m thei r tumo r samples. Eve n today , ther e ar e case s o f researcher s w h o hav e attempte d t o replicate th e wor k an d hav e faile d t o cultur e bacteri a fro m thei r malignan t tissue samples . Fo r example , a biochemist w h o m I me t a t a conferenc e tol d me tha t h e pu t a microbiologis t o n th e projec t usin g th e Livingsto n an d Alexander-Jackson techniques , an d th e microbiologis t wa s unable t o cultur e the bacteria . Likewise , Mattma n als o faile d t o cultur e a purporte d cance r organism i n he r laboratory . I n he r words , Joseph Merline , i n ou r laboratory , culture d ove r tw o hundre d blood s fro m lymphoma patient s an d i n n o instanc e foun d th e bacteriu m o f Glover , Nuzum, o r of more moder n descriptions . Merline was not seekin g a tumor instigating bacterium, an d suc h procedures a s washing the re d cell s to elimi -

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nate antibod y o r agin g th e bloo d a t roo m temperatur e t o voi d complemen t were no t followed . Hi s study rathe r show s tha t carefu l standar d techniqu e t o isolate aerobes , anaerobes , an d CW D form s doe s no t gro w a carcinogen fostering bacterium . (1993 : 316) T h e proble m wit h negativ e instance s i s tha t defender s o f th e bacteria l theory ca n alway s argu e tha t a failur e t o replicat e i s du e t o a failur e t o us e the appropriat e methods . Mattma n leave s roo m fo r thi s interpretatio n i n her descriptio n o f he r laboratory' s failur e t o replicate . Sh e add s tha t som e of th e difficult y t o replicat e i s becaus e muc h o f th e medi a use d i s exotic , such a s "Glover s concoctio n o f sunflowe r seeds , Icelan d moss , an d Iris h moss" (316) . W e ar e therefor e i n th e situatio n firs t delineate d i n scienc e studies b y Harr y Collin s (1985 ) a s th e "experimenter s regress" : defender s of th e bacterial-infectio n theor y ca n alway s argu e tha t a failur e t o replicat e means tha t th e experimenter s mad e a mistake i n thei r procedures . Conversely, attempt s t o refut e th e techniqu e o f culturin g bacteri a fro m mammalian bloo d o r tissu e sample s suffer from th e sam e proble m o f th e experimenters regress . Fo r example , tw o critic s firs t obtaine d a pleomor phic, acid-fas t organis m fro m th e bloo d o f Hodgki n s diseas e patients , bu t later, w h e n the y use d simila r procedure s an d culture s i n mor e asepti c conditions an d unde r a steril e hood , the y wer e unabl e t o cultur e th e organism (Kasse l an d R o t t i n o 1955) . The y suggeste d tha t thei r failur e t o culture th e bacteri a unde r mor e rigorou s condition s provide d th e definitiv e crucial experimen t tha t refute d th e bacteria l theory . However , a defende r of th e theor y ca n alway s argu e tha t R o b e r t Kasse l an d Antoni o R o t t i n o introduced somethin g int o thei r secon d protoco l tha t cause d th e failur e t o replicate. O n e i s onl y limite d b y creativity : th e failur e t o replicat e coul d b e explained b y Chloro x o n th e gloves , th e aeroso l spra y use d t o clea n th e inside o f th e chamber , temperatur e differences , oxyge n differences , ligh t differences, an d s o on . A t best , then , th e experimen t provide s evidenc e i n favor o f th e contaminatio n interpretation—i t i s on e piec e i n th e puzzle — but overal l evaluatio n wil l alway s b e a muc h messie r process . O n c e again , evaluation o f majo r theorie s i n scienc e i s no t reducibl e t o a n algorithm ; i t is muc h mor e lik e arrivin g a t a verdict afte r havin g hear d variou s witnesse s in a court trial . Kasse l an d R o t t i n o ar e tw o mor e witnesse s fo r th e prosecu tion. T h e critic s probabl y woul d hav e bee n mor e convincing , an d ha d a n easier time , i f they ha d adopte d anothe r tactic : t o fin d som e loophol e i n a n experimental desig n an d argu e tha t a n artifac t wa s introduce d becaus e o f

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this design . Critic s therefor e hav e a politically advantage d positio n becaus e they onl y hav e t o rea d th e opponents ' experiment s an d com e u p wit h possible desig n flaws. In contrast , t o mee t th e critics ' arguments , advocate s need to reanalyze or redo experiments, which is much more costl y in terms of time an d resources. Thi s tacti c ca n be deadl y for out-group s tha t d o no t have access to mainstrea m financial resources . Let us adopt thi s position fo r a moment i n favor o f the secondar y infection theory , an d examin e th e best case experiments fo r evidenc e o f possible artifact b y contamination . Glover wa s awar e o f th e contaminan t argument , an d fro m comment s made i n hi s 193 8 repor t h e probabl y ha d hear d man y version s o f it . On e should recal l th e politica l contex t o f th e 193 8 report , i n whic h ther e wa s opposition t o hi s researc h withi n an d outsid e th e Nationa l Institut e o f Health. Man y peopl e wer e probabl y lookin g ove r hi s shoulde r wit h th e hope o f finding artifacts , an d in hi s 193 8 report Glove r was careful t o hea d off thei r potentia l criticisms . H e boile d hi s media , passe d i t throug h a bacterial filter , an d use d steril e equipmen t i n it s manufacture . H e als o incubated al l medi a t o se e i f i t produce d an y microorganism s tha t migh t have been laten t in the media, an d he presented a table that showe d tha t all tests wer e negative . H e use d contro l slide s t o protec t agains t a stainin g artifact, an d he inoculated contro l flasks with steril e saline to make sure that artifacts wer e no t introduce d fro m injection . I n hi s animal experiment s h e used contro l tissue s an d unplante d media , whic h remaine d sterile . I n th e 1938 report , h e als o describe s incubatin g th e organis m from a malignan t breast tissu e tha t wa s receive d i n a seale d steril e containe r fres h from th e operating room . A descriptio n o f th e techniqu e used i n th e 193 0 repor t gives an additional indication o f his concern wit h sterility : In a "sterile" roo m an d unde r asepti c conditions , th e ski n i s reflected, th e surface o f th e abdome n seare d an d opened . B y mean s o f a steril e loo p specimens are taken from th e peritoneal cavit y and rubbed ove r the surfac e of th e slan t medium . Th e ches t i s the n opened , th e hear t seared , bloo d aspirated fro m it s chamber s an d transferre d t o tube s o f the slan t medium . (1930: 102-3 )

One migh t argu e tha t Glove r i s a weak witnes s for th e defense , becaus e of hi s dishonest y regardin g th e issu e o f credi t fo r hi s work . However , n o one claime d tha t hi s researc h pe r s e wa s fraudulent . Furthermore , othe r researchers such as Alexander-Jackson hav e described simila r precautions i n their protocols . He r measure s include d boiling , filtering , an d autoclavin g (even twice ) th e medium . Whe n sh e remove d blood , sh e cleane d th e ski n

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with iodin e an d alcohol , an d expelle d th e firs t drop s o f bloo d prio r t o expelling th e res t int o th e brot h (1954 : 40-41) . Sh e use d control s fro m blood-bank donor s an d healthy , young , tuberculin-negativ e nurses , an d they wer e free o f th e organism . (Sh e di d no t lik e t o us e control s fro m th e general population , becaus e accordin g t o a persona l communicatio n sh e had fro m Glover , h e believe d tha t a s many a s 20 percen t o f normal s an d 4 0 percent o f the elderl y teste d positiv e fo r th e cancer-associate d bacteria. ) A secon d argumen t agains t contaminant s i s tha t man y o f th e studie s showed partia l o r ful l completio n o f Koch' s postulates . Partia l completio n involved isolatin g th e organism , injectin g i t int o th e hos t animal , an d the n analyzing th e anima l fo r sign s o f malignancy . Thi s wa s achieve d a s earl y a s the N u z u m studie s i n th e 1920s , bu t als o i n Willia m Crofton' s wor k an d i n studies i n th e 1960 s an d 1970s , suc h a s those b y Sake a Inou e o f a n acid-fas t microbe associate d wit h tumor s i n th e newt. 8 Dille r als o claime d tha t ove r many experiment s sh e wa s roughl y doublin g tumo r productio n i n on e strain o f mic e tha t wer e injecte d wit h a microorganis m isolate d from ra t sarcoma w h e n controlle d agains t noninjecte d matche d mic e (Dille r 1974 ; Diller, Donnelly , an d Fishe r 1967) . However , th e Inou e an d Dille r studie s do no t coun t a s complet e fulfillmen t o f Koch's postulates , becaus e the y di d not repor t o n reculturin g th e organis m fro m infecte d animals . By fa r th e mos t complet e an d meticulou s repor t o f th e fulfillmen t o f Koch's postulate s wa s agai n Glover' s 193 8 report . H e culture d bacteri a from the anima l ove r si x successiv e subculture s t o reduc e th e possibilit y tha t th e bacteria wer e contaminate d wit h an y substanc e fro m th e tissue s o f th e organism. H e the n reinjecte d th e animal s (guine a pig s becaus e o f thei r lo w natural incidenc e o f cancer ) an d repeate d th e entir e procedur e ove r si x "generations" o r repetitions , eac h tim e wit h differen t set s o f animals . I t i s important t o revie w th e Glove r studie s becaus e misinformatio n continue s to b e disseminate d toda y T h e America n Cance r Societ y repor t o n Living ston's researc h appear s t o b e a t leas t partiall y erroneou s w h e n i t states , "Investigators a t th e Nationa l Institute s o f Health , however , coul d neithe r substantiate th e presenc e o f a microb e no r duplicat e th e vaccin e from organisms supplie d b y Glover " (America n Cance r Societ y 1990 : 104) . Man y years later , on e researche r appointe d b y th e governmen t reporte d tha t h e replicated Glover' s wor k b y reculturin g th e bacteri a fro m dea d guine a pigs (Clar k 1953) . Alexander-Jackso n als o wrot e tha t sh e fulfille d Koch' s postulates completel y an d successivel y b y "repeate d reisolatio n o f infecte d animals o f culture s o f the inoculate d organism " (1954 : 47) . A mor e roundabou t versio n o f th e contaminan t o r artifac t argumen t

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would b e t o gran t th e cas e tha t th e researcher s wer e inducin g a diseas e through bacteria , bu t the n t o den y tha t th e diseas e wa s tru e cancer . Thi s appeared t o b e a t th e hear t o f the scientifi c justification fo r stallin g publica tion o f Glover' s wor k i n th e 1930s . I n th e prefac e t o hi s 193 8 pamphlet , medical docto r Georg e McCoy , th e forme r directo r o f wha t becam e th e N I H , outline d th e controvers y amon g th e histologist s regardin g th e inter pretation o f the guinea-pi g "malignancies. " Becaus e cance r i s rare i n guine a pigs, histologica l proo f o f malignanc y fro m inoculation s wit h th e Glove r organism woul d hav e strengthene d hi s argumen t tha t h e ha d indee d foun d the cance r microbe . I t appear s tha t th e controvers y amon g th e pathologist s was neve r resolve d fo r th e guine a pigs . However , M c C o y add s tha t the y soon turne d t o rats : As was expected , tumo r productio n wa s more readil y secure d i n th e ra t an d there wa s little o r n o differenc e o f opinion amon g th e pathologist s a s to th e nature o f the gros s an d microscopi c appearances . I t i s to b e noted , however , that i n som e experiment s lesion s o f uncertain natur e i n th e guine a pig , an d of unquestioned malignanc y i n the rat , were apparentl y induce d b y the sam e agent; thi s o f cours e suggest s tha t ther e ma y b e a t han d a method tha t wil l throw light o n th e pathogenesis o f new growths . (Glove r and Engle 1938 ) M c C o y als o state s tha t h e coul d no t rul e ou t th e possibilit y tha t th e malignancy wa s cause d b y a viru s tha t accompanie d th e bacteria l culture s or tha t som e componen t o f the medi a wa s carcinogenic . T h e viru s explana tion, however , i s a versio n o f th e infectiou s theory , an d i f th e viru s turne d out t o b e a filterabl e stag e o f a bacteriu m o r a bacteriophage , i t woul d mean returnin g t o th e bacteria l theory . Thus , fro m th e perspectiv e o f th e secondary-infection theory , i t i s a wea k counterargument . T h e carcino genic-media argumen t wa s a goo d on e fo r th e time , bu t sinc e the n man y different medi a hav e bee n used , an d the y hav e varie d significantly , bee n autoclaved, an d culture d a s control s t o demonstrat e sterility . Furthermore , the media-carcinoge n argumen t woul d no t explai n wha t Glove r sa w a s central evidenc e agains t th e contaminatio n argument : th e succes s o f hi s serum. Thi s clai m fo r efficac y o f th e s e r u m — o r vaccine s i n th e Livingsto n and Seiber t research—shade s int o th e pragmatis m criteri a an d wil l b e discussed shortly . In conclusion , althoug h ther e i s n o wa y t o achiev e closur e agains t th e contamination argument , th e standar d o f a "reasonabl e scientist s design " might b e invoked , muc h a s the standar d o f the reasonabl e perso n i s invoke d in lega l disputes . T h e fulfillmen t o f Koch's postulate s i s usually considere d a

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reasonable standar d i n microbiology , especiall y i f ther e ar e control s an d i f vaccines o r ser a protec t agains t challenge s wit h th e pathogen . M y evalua tion, then , i s tha t th e bacterial-infectio n theor y withstand s th e accurac y counterargument i n th e for m o f artifac t b y contamination . O f course , i t would be better to have contemporary studie s using contemporary method s and controls, but given the available evidence, the argument for contamina tion i s no t stron g enoug h a t thi s poin t t o justif y rejectin g th e theory . However, th e theor y doe s no t pas s th e secon d accurac y argument , an d i n order to survive, it will have to be modified a second time.

The Accuracy Argument II: No Single Cancer Organism The secon d accurac y argumen t relie s o n inconsistencie s amon g th e advo cates. Fo r example , Glover , Enderlein , an d Naessen s organiz e th e stage s into a single cycle , whereas Livingston , Alexander-Jackson , Diller , Seibert , and othe r researcher s affiliate d wit h tha t grou p d o not . Thi s return s u s t o the cyclogenis t controversy . Becaus e th e consensu s amon g microbiologist s today—even amon g thos e wh o stud y CW D bacteri a an d it s filterabl e forms—is agains t the strong form o f cyclogeny that was popular during th e 1920s and 1930s , it makes sens e to rejec t th e cyclogeni c theorie s o f Glover , Enderlein, an d Naessen s an d accep t instea d th e multistage , noncyclogeni c phases describe d b y Livingsto n an d colleagues . Furthermore , th e cycloge nist positio n ca n als o b e explaine d a s th e produc t o f modernis t cultura l thinking tha t tende d t o oversimplif y natura l an d socia l processe s int o nea t and close d system s base d o n equilibriu m principle s (Hes s 1995 : ch . 4) . I n contrast, th e Livingsto n networ k admitte d transition s amon g stage s but di d not orde r the m int o a neat cycle . Thi s positio n woul d als o correspon d t o contemporary CW D bacteri a researcher s suc h a s Domingue , wh o ha s outlined a modified o r limited cyclica l model o f pleomorphism. 9 A more difficul t interna l contradictio n i s that th e observe d stage s appea r not t o coincid e acros s researchers . Fo r example , Gerlac h believe d tha t hi s "parasitic fungus" wa s not th e same as the von Brehmer organis m (i n Diller 1962a: 203). Glover postulated a fourteen-stage cycle , but th e stage s do no t coincide, a t leas t no t i n an y obviou s way , wit h thos e o f th e sixteen-stag e cycle o f Naessens o r th e fourteen-stag e cycl e o f Enderlein. Th e Enderlei n cycle include s mor e submicroscopi c o r filterabl e form s tha n eithe r th e Naessens o r Glove r cycle , an d th e Naessen s an d Enderlei n cycle s includ e funguslike phase s tha t appea r t o b e missin g i n th e Glove r cycle . However ,

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many o f the middle stage s of the Enderlein an d Naessens cycles are compa rable t o th e Glove r cycle . Thi s coul d b e interprete d i n tw o ways : Glove r only observe d part o f the cycle , or Enderlein an d Naessen s were observin g multiple microorganisms , suc h a s a fungu s an d a pleomorphi c bacteriu m similar t o th e mycobacteria , corynefor m group , o r actinomycetes . I a m inclined to the view that Enderlein an d Naessens were observing more tha n one microbia l species. This interpretation i s consistent with th e subsequen t observations o f th e Livingsto n network , whos e observation s o f pleomor phism were more restricted an d did not includ e large fungal stages . Thus, t o defen d th e bacterial infection theor y agains t th e argumen t tha t the observation s wer e no t accurat e becaus e the y wer e inconsisten t wit h each other , on e ha s t o sid e wit h som e researcher s ove r others . I sugges t accepting th e post-Worl d Wa r I I Nort h America n grou p a s th e mos t credible. I n general , Nort h America n scienc e afte r Worl d Wa r I I wa s th e best i n th e world , an d thi s researc h grou p wa s interactin g wit h colleague s in this scientific communit y an d publishing in their journals. They als o had the advantag e o f readin g th e earlie r researc h o f Enderlei n an d Glover . I n contrast, th e othe r researchers were eithe r historically prior to this group o r not publishing in scientific an d medical journals. What, then , di d the organis m look like according to thi s group? I n 195 4 Alexander-Jackson presente d a summar y o f th e form s observe d i n th e proposed cance r organism . Th e form s observe d i n tissu e sample s include d submicroscopic bodies of 20-70 m/ji revealed by electron microscopy; intra cellular, Seitz-filterable , acid-fas t bodie s o f O.ZJJL; "large r coccoida l forms , often connecte d b y slende r filaments , [that ] rang e i n siz e fro m 1.5/x , t o cystlike rin g form s 3-4 fJL i n diameter" ; an d large r "globi " reminiscen t o f leprosy tha t sugges t funga l buddin g form s an d ca n b e confuse d wit h th e host cel l nucleu s i f no t differentiall y staine d (Alexander-Jackso n 1954 : 45; also Livingston e t al. 1956). When culture d in their media, the microorgan ism usuall y too k a for m tha t sh e describe d a s a "pleuropneumonialik e zoogleal matrix o r symplasm" (lik e a mycoplasma o r L-form) wit h coccoi d forms tha t lengthe n ou t int o rod s o r int o a cystlik e ring . Th e outline s o f Alexander-Jackson's observation s i n th e 1950 s ar e maintaine d i n a n articl e published b y Livingsto n an d Alexander-Jackso n i n 1970 , whic h summa rized th e purporte d microb e a s havin g seve n majo r phases : virus-size , elementary bodies o f 0.2fi, coccoi d forms , rin g forms, symplasm , rods, and filaments/spores i n rods. Subsequent researc h by Diller (1962b ) confirme d "th e essentia l features " of th e stage s outline d b y Alexander-Jackson , bu t sh e adde d i n anothe r

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publication tha t th e organism s sh e foun d wer e simila r t o thos e studie d b y Glover, Clark, von Brehmer, Villequez, Gerlach, Crofton, an d Scott (1962a : 202). A s I hav e demonstrated , thi s wa s onl y tru e u p t o a point , becaus e only some of the stages corresponded acros s this group o f researchers. Diller also dismisse d th e cyclogeni c orderin g o f th e variou s stage s (1962a : 202) . She di d tes t isolate s fro m vo n Brehme r an d Villequez an d foun d tha t the y developed partial acid-fastness o n appropriat e medi a (203) . In a subsequent paper sh e adde d tha t a n "easil y disrupte d myceliu m occurre d infrequentl y in thes e culture s whe n th e organism s wer e inoculate d int o vo n Brehme r s medium. Ro d form s aros e fro m th e myceliu m b y fragmentation " (Dille r and Medes 1964 : 126) . This commen t suggest s that som e o f the difference s in observations may be attributed t o differen t media , a conclusion tha t Rif e and Grune r als o drew from thei r comparisons . A related accuracy argument switches levels and points to inconsistencie s within th e America n grou p ove r classification . Livingsto n originall y thought o f the bacteriu m a s a new specie s sh e denominate d Mycobacterium tumefaciens because o f its acid-fast stainin g property, an d L'Esperanc e origi nally classifie d th e organis m a s Mycobacterium avians. 10 This woul d plac e cancer i n th e sam e categor y a s lepros y an d tuberculosis , a classificator y decision tha t i s strengthene d b y som e o f th e gros s similaritie s amon g th e three diseases . However , subsequen t research , particularl y tha t o f Diller , indicated tha t th e bacterial samples stained acid-fast onl y in som e phase s o r with some media. Because variable acid-fastness an d the existence o f motile forms ar e indication s agains t classificatio n a s mycobacteria , th e origina l classification cam e into doubt . Gram-positiveness , which Glove r claimed t o find consistently , i s a characteristi c o f corynebacteria , an d tha t possibilit y came under consideration . Dille r found antigen s in commo n wit h Mycobacterium tuberculosis an d sligh t cross-reactivit y wit h antiseru m fo r Corynebacterium diptheria, an d therefore sh e suggested an intermediate position betwee n the two gener a (Dille r and Medes 1964 : 128) . However, Seiber t introduce d additional complications : "Whe n cultura l studie s wer e mad e o n two-da y growths, som e o f ou r bacteri a ha d mos t characteristic s o f Staphylococcus epidermidis and other s o f corynebacteria, bu t withi n thes e group s the y wer e not identical , an d al l ha d som e characteristics , suc h a s motilit y an d acid fastness, tha t ar e not suppose d t o belon g t o thes e tw o prototypes " (Seiber t et al. 1970: 725). Other researcher s identified pleomorphi c bacteria l isolates from malignancie s a s Staphylococcus epidermis (Affronti , Grow , an d Begel l 1975) and Propionibacterium acnes (Cantwel l and Kelso 1984) . In thei r publicatio n i n th e Annals of the New York Academy of Sciences,

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Livingston an d Alexander-Jackso n (1970 ) note d tha t sensitivit y t o bacterio phages an d variabl e acid-fastnes s suggeste d classificatio n a s either mycobact eria o r corynebacteria , bu t othe r criteri a suggeste d similaritie s t o listeri a and th e mycoplasma . The y settle d o n th e actinomycetale s order , tha t i s bacteria wit h branchin g filament s tha t resembl e th e fungi . Withi n tha t order the y propose d a ne w family , "Progenitoraceae, " becaus e Livingsto n believed th e bacteri a ma y b e archaic , an d th e genu s "cryptocides, " whic h means hidde n killer . Probabl y Livingsto n an d Alexander-Jackso n chos e the actinomycetale s orde r becaus e thi s grou p o f bacteri a i s als o k n o w n pharmaceutically fo r thei r us e a s producer s o f antibiotics , an d the y ha d isolated a toxic fractio n fro m thei r culture s tha t the y though t wa s relate d t o the actinomycin s (Livingsto n e t al . 1970) . T h e antibioti c Actinomycin- D i s used i n chemotherap y fo r Wilm s s tumor, Ewin g s sarcoma, an d a few othe r rare cancers . T h e impressiv e classificatio n problem s tha t I have outline d coul d b e use d to argu e tha t th e researcher s wer e no t workin g wit h th e sam e organism . However, becaus e pleomorphi c bacteri a ar e difficul t t o classif y i n general , the divergence s d o no t necessaril y provid e evidenc e agains t th e singl e organism interpretation . Fo r example , anothe r consensu s fac t passe d alon g to student s i n a standard textboo k o f microbiology i s the following : The mycobacteri a an d nocardioform s hav e traditionall y bee n considere d a s related t o th e coryneform s and/o r th e filamentou s actinomycetes , an d th e separation betwee n mycobacteria , corynebacteria , an d variou s pleomorphi c bacteria i s no t easy . Differen t observer s ma y classif y th e sam e strai n a s belonging t o th e gener a corynebacterium , arthrobacter , nocardia , o r myco bacterium. (Atla s 1988 : 294) Thus, th e interna l difference s amon g th e America n grou p can , u p t o a point, b e attribute d t o a genera l proble m encountere d amon g microbiolo gists. T h e classificatio n issue—an d th e singl e organis m argument—i s furthe r complicated b y th e theor y tha t th e R o u s sarcom a viru s an d perhap s othe r oncoviruses ar e filterabl e phase s o f large r microorganisms . Glover , Scott , and colleague s (1926 ) claime d t o cultur e th e Glove r organis m from a tissu e sample o f R o u s chicke n sarcom a N o . 1 tha t R o u s ha d supplie d t o them . They als o claime d tha t the y coul d cultur e thei r organis m fro m malignan t tissue infecte d wit h th e R o u s agent . Furthermore , Alexander-Jackso n (1966) reporte d tha t sh e wa s abl e t o culture , fro m th e bloo d an d tumor s o f R o u s virus-infecte d chicken s a s well a s fro m partiall y purifie d R o u s virus ,

But Is It Good Science? | 13 3 a pleomorphic organis m wit h a cell-wall deficien t phase . Sh e claime d tha t injection o f th e bacteria l isolat e int o chicken s le d t o th e developmen t o f the Rous diseas e in half the chicken s but no t i n controls . Alexander-Jackson (1970 ) als o argue d tha t eve n thoug h th e Rou s sar coma viru s wa s classifie d a s a n RN A virus , DN A o r DN A protei n i s present. Sh e pointe d t o researc h tha t showe d tha t th e Rou s sarcom a viru s can be inhibited from multiplying and transforming norma l cell s by antagonists o f DNA synthesi s (Forc e an d Stewar t 1964) . In addition , sh e culture d the virus in her broth and examined drops of the filtrate unde r an ultraviolet spectrogramic microscope , an d sh e argue d tha t th e absorptio n peak s o f the spectrogram s indicate d presenc e o f DNA . Sh e als o presente d electro n microscopy evidenc e tha t suggeste d pleomorphis m o f th e Rou s virus . Controls o f the broth alon e showed no evidenc e for DNA . I hav e classifie d Glove r s an d Alexander-Jackson' s interpretatio n o f th e Rous viru s a s an accuracy argumen t becaus e toda y th e avian-sarcom a viru s group i s classified a s an RN A retrovirus , an d therefor e on e woul d reason ably suspec t the m o f som e kin d o f observationa l inaccuracy . However , Levinson e t al . (1970 ) als o foun d DN A i n th e Rou s virus , an d the y concluded tha t th e DN A wa s no t du e t o absorptio n o f cellula r DNA . Although i t i s possible tha t th e Rou s viru s ma y b e a filterabl e phas e o f a larger microorganism , th e on e culture d b y Glove r an d Alexander-Jackso n may hav e als o emerge d fro m geneti c recombinatio n wit h hos t bacteria . I n other words, the evidenc e appear s to be ambiguou s again . The emergenc e o f molecular biolog y ha s mad e i t muc h easie r t o asses s the theor y tha t ther e i s a unique, pleomorphi c microb e tha t cause s cancer . As Domingu e explaine d t o me , "Wit h th e ne w molecula r technologies , people ar e forced t o put u p o r shut up." In other words, it is possible to ru n molecular identification s o f bacterial variant s t o determin e whethe r o r no t they ar e species variants. He di d this on tw o occasion s with sample s sent t o him from the Livingston clini c and from a colleague at Rockefeller Univer sity. Fro m hi s DNA-DN A hybridizatio n analyse s h e conclude d tha t som e of th e strain s o f "Progenito r cryptocides " wer e Staphylococcus epidermidis, Streptococcus faecalis, and Streptococcus bovis (Domingue 1982 ; Aceved o e t al. 1987) . Biochemis t Herna n Aceved o als o use d standar d morphological , nutritional, an d biochemica l measure s t o identif y som e o f th e Livingsto n "Progenitor cryptocides " strains, which he decided were Staphylococcus epidermidis an d Staphylococcus haemolyticus (Aceved o e t al . 1985) . He als o identi fied tw o strains from Seiber t a s Staphylococcus epidermidis. In ligh t o f th e studie s o f th e 1980 s b y Domingu e an d Acevedo , on e

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could continu e t o defen d th e theor y tha t ther e i s a specific , pleomorphi c cancer organis m b y arguin g tha t bacteri a classifie d a s ordinar y stap h an d strep ar e i n fac t form s o f highl y pleomorphi c organisms . However , thi s argument woul d b e self-defeatin g becaus e i t woul d mea n violatin g consis tency criteria . Ther e i s on e additiona l possibility . N o t e th e warnin g issue d by Domingu e i n hi s essa y "Pleomorphi c Cel l Wall-Defectiv e Bacteri a a s Cryptic Agent s o f Disease" : The cultura l technique s use d conventionall y b y mos t clinica l laboratorie s report onl y bacteria with cel l walls and fail completely t o recogniz e th e larg e reservoir o f crypti c organism s fro m whic h the y deriv e i n man y chroni c infections. A n appreciatio n o f th e presenc e o f thes e organism s coul d b e achieved i f cultura l technique s appropriat e t o th e growt h o f CWD B an d methods t o identif y thei r DN A profil e wer e used . Suc h studie s would mak e an anachronis m o f Bergey's Manual a s th e grea t diversit y withi n specie s became apparent , an d woul d lea d t o a more meaningfu l appreciatio n o f th e etiology o f man y presentl y idiopathi c diseases . I t i s interestin g t o speculat e that ultimatel y classification s woul d ten d t o b e les s rigid a s it i s realized tha t microbes continuall y chang e a s they adap t t o variou s environments , change s that migh t als o b e foun d t o includ e a shift o f nucleotides betwee n th e hos t and othe r organisms , a kind o f kaleidoscopic continuu m wit h in vivo evolution o f survival traits for microbes . (1996 ) Domingue s comment s recal l Philli p Hadle y (1927) , althoug h withou t the rigidit y o f hi s cyclogeni c theory . Instea d o f th e rigidit y o f th e close d systems o f th e cyclogeni c model s o f th e 1920s , Domingu e s descriptio n o f bacterial variatio n suggest s principle s o f ope n system s an d flexibility tha t have becom e mor e commo n i n scientifi c theorie s tha t hav e appeare d afte r World Wa r I I (Hes s 1995 : ch . 4 ; Marti n 1994) . A mor e complet e under standing o f pleomorphi c bacteri a an d cance r ma y hav e t o awai t les s rigi d approaches t o classificatio n i n microbiology . I f thes e approache s wer e t o materialize, th e attemp t t o reduc e th e variou s stage s to a single pleomorphi c cancer microb e woul d b e a s wrong a s the attemp t t o reduc e the m t o know n categories o f standardize d bacteria . Instead , on e woul d nee d t o wor k onl y with a more flexible framewor k o f constantl y shiftin g genomes . Thi s i s th e direction tha t Domingu e s wor k ha s pointe d t o sinc e 1974 , w h e n h e an d colleagues documente d electron-dense , burie d bacteria l genome s i n em bryonic cel l cytoplas m (Green , Heidger , an d Domingu e 1974a , 1974b) . Let us , however , sta y withi n th e line s o f traditiona l microbiologica l categories an d assum e tha t th e D N A - D N A hybridizatio n analyse s mea n that ther e i s no singl e cance r organism . I n othe r words , th e researcher s wer e

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viewing a variet y o f know n organisms , som e o f whic h wer e pleomorphic . O n th e surfac e thi s appear s t o b e a ver y stron g argumen t agains t th e bacterial-infection theory , an d man y scientist s ma y clos e th e boo k her e an d relegate th e whol e histor y t o th e premolecula r era . However, ther e i s a surprising ne w fac t tha t emerge s ou t o f th e bacteria l research progra m tha t give s th e theor y ne w life , eve n i f on e accept s th e finding tha t ther e i s n o singl e cance r organism . I n 197 4 Livingsto n an d he r husband publishe d a paper tha t detaile d h o w unde r certai n condition s thei r Progenitor cryptocides organis m produce d a substanc e simila r t o th e h o r m o n e h C G o r huma n choriogonadotropin . Thi s h o r m o n e i s know n popularl y because i t i s use d i n drugstor e test s fo r pregnancy ; i f i t i s present , th e woman i s pregnan t (o r sh e ha s cancer) . T h e h o r m o n e i s wel l k n o w n i n cancer research , a s Livingston an d Livingsto n explain : The presenc e o f hCG i n th e cancerou s ha s been observe d fo r ove r 7 0 years. In 190 2 Beard published his work o n the trophoblastic thesi s of cancer (Bear d 1911). [Th e theor y hold s tha t a type o f embyronic cell , the trophoblast , ma y remain dorman t i n th e hos t organism , an d when activate d later in life i t may produce cancer. ] Durin g th e intervenin g year s thi s theor y ha s bee n hotl y debated, a s has the validit y o f testing th e bloo d an d urin e o f cancer patient s for th e presenc e o f chorioni c gonadotropin . Excep t fo r certai n specifi c types of trophoblastic neoplasms such as choriocarcinoma, hybati d mole, an d teratocarcinoma, th e trophoblastic theor y for all cancers is largely discounted . However, interes t in cancer as an endocrine diseas e has mounted enormousl y in th e pas t fiv e years . Cance r i s no w bein g interprete d no t a s a n invasiv e uncontrolled growt h bu t a s a failure o f cell maturation du e t o th e remova l o f growth contro l o r t o a loss or derepressio n o f cell regulatory mechanisms . I t is now postulate d tha t th e regulator y failure s ma y be du e t o variou s type s o f endocrine aberration s mediate d throug h th e DN A an d RN A o f th e cel l nucleus. (Livingsto n an d Livingston 1974 : 572) T h e ide a tha t bacteri a ca n produc e a human growt h h o r m o n e ma y see m ridiculous, bu t th e ke y t o understandin g thi s clai m i s tha t bacteri a produc e an hCG-like substance . Livingston' s clai m tha t bacteri a ca n produc e a n hCG-like substanc e wa s soo n replicate d i n othe r laboratories , an d i t proba bly became th e leas t controversia l par t o f her work . I n 197 6 H e r m a n C o h e n and Alic e Stramp p o f th e Princeto n Laboratorie s confirme d th e bacteria l synthesis o f a CG-lik e materia l fro m th e Livingsto n samples , an d th e laboratory o f Herna n Aceved o i n Pittsburgh , w h o firs t identifie d h C G i n human sper m an d als o discovere d tha t cance r cell s i n cultur e synthesiz e hCG, publishe d confirmatio n i n 1978. 11 Othe r publication s foun d chorio -

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gonadotropinlike substance s i n a variety o f c o m m o n bacteri a isolate d fro m tissue sample s fro m cance r patients. 12 Additiona l wor k fro m Acevedo s la b concluded tha t expressio n o f th e CG-lik e substanc e wa s a strai n (no t a species) characteristic , tha t no t ever y bacteria l strai n fro m cance r patient s expressed th e CG-lik e material , an d tha t CG-like-producin g bacteri a di d not necessaril y indicat e th e presenc e o f activ e disease. 13 Domingue, Acevedo , an d colleague s showe d tha t vaccine s fro m kille d Staphylococcus haemolyticus and Streptococcus bovis elicited antibodie s i n rabbit s that wer e "immunologicall y simila r t o thos e produce d i n respons e t o th e whole huma n trophoblasti c hormone, " an d tha t th e bacteria l CG-lik e material appeare d t o b e locate d o n th e membrane s o f th e cel l wal l ( D o m ingue e t al . 1986 : 97) . I n a subsequen t publicatio n the y use d electro n microscopy t o sho w tha t ther e wer e morphologica l alteration s i n si x o f th e nine strain s o f bacteria tha t wer e producin g CG-lik e substances , an d contro l bacteria di d no t sho w morphologica l alterations . O n e o f their nonproduce r control bacteri a wa s fro m th e urin e o f a pregnan t woman , "containin g therefore hig h amount s o f h C G , thu s suggestin g tha t th e observe d alter ations o f th e hCG-producer s wer e no t du e t o th e trophoblasti c hormone , since thi s contro l bacteriu m wa s growin g naturall y i n th e presenc e o f a hig h concentration o f h C G" (Aceved o e t al . 1987 : 790) . The y add : It is also possible tha t alteration s a t the leve l of the cel l wall during reversio n may produce change s i n th e antigeni c characteristic s o f the bacteria , leadin g to altere d immunologica l response s i n th e host . I t i s no w know n tha t ther e are immunologica l specificitie s associate d wit h certai n CW D bacteri a tha t are no t eviden t whe n intac t parenta l organism s ar e utilize d a s immunogens. . . . Because o f these characteristics , hCG-producin g bacteri a a s CWD vari ants o r revertant s ma y hav e pathophysiologica l importanc e especiall y i f a n association exist s between thes e bacteri a an d th e proces s o f malignant trans formation, sinc e most o f these bacteria hav e been isolate d from patient s wit h clinically manifested cancer . (Aceved o e t al. 1987 : 790) Acevedo s researc h i n th e 1990 s ha s move d awa y fro m th e bacteria l expression o f CG-lik e substance s an d bac k t o hi s origina l interes t i n cance r cells an d thei r relationshi p t o C G (Aceved o e t al . 1995a , 1995b ; Krichevsk y et al . 1995) . Continue d researc h fro m hi s an d othe r laboratorie s ha s show n that th e expressio n o f membrane-associate d h C G i s c o m m o n i n culture d human malignan t cells , bu t no t detectabl e i n nonmalignan t tissue . Thi s research ha s fuele d continue d speculatio n abou t th e similaritie s betwee n embyronic an d cance r cells . I t i s suspecte d tha t placenta l h C G protect s th e embryo agains t rejectio n b y th e mother s lymphocytes . Likewise , h C G

But Is It Good Science? | 13 7

(particularly th e beta chain ) a s a continuous laye r on tumo r cell s may play a similar rol e o f preventin g immun e syste m recognition , perhap s becaus e hCGs negativ e charg e repel s lymphocytes. 14 I n lat e 199 5 Acevedo , Tong , and Hartsoc k publishe d stron g evidenc e tha t a wide variet y o f cancer cell s express hCG-bet a o n thei r membranes ; thi s publicatio n wa s greete d b y some medi a attentio n an d a ver y favorabl e editoria l i n Cancer wit h th e enthusiastic title , "Hav e W e Foun d th e 'Definitiv e Cance r Biomarker'? " (Regelson 1995) . Furthermore , becaus e hC G ca n stimulat e tumo r cel l growth in vitro, it may turn ou t t o be more tha n a tumor marker . Vaccines for birth contro l using hCG hav e been widely tested, an d som e research suggest s tha t simila r vaccine s fo r hC G ma y hav e som e impac t o n tumor genesi s and/or growth . I n 198 2 Acevedo an d colleagues showed tha t rats inoculate d wit h th e bet a subuni t o f choriogonadotropi n develope d antibodies t o C G an d showe d fewe r instance s o f cance r tha n controls , which di d no t sho w C G antibodie s (Kellen , Kolin , an d Aceved o 1982 ; Kellen e t al . 1982) . Vaccines usin g C G hav e begu n t o b e teste d o n cance r patients wit h nontrophoblasti c cancers ; preliminary trial s by Pierr e Triozz i of Ohi o Stat e Universit y an d colleague s sugges t tha t th e vaccin e "i s well tolerated an d ha s biological activit y i n patient s wit h cancer " (Triozz i e t al . 1994: 1447) . Injections o f hCG int o Kaposi' s sarcoma lesions als o appear t o be effectiv e (Gil l et al. 1996). It i s possible , then , tha t th e antiseru m develope d b y Glove r worke d because i t containe d C G antibodie s rathe r tha n antibodie s t o a specifi c cancer bacteriu m o r bacteria , o r tha t th e bacteria l vaccine s o f Livingston , Diller, an d Seiber t wer e successfu l becaus e the y stimulate d CG-antibod y production (Netterber g an d Taylo r 1981 : 82) . Th e researc h o f th e 1980 s suggests tha t bacteri a d o indee d produc e a CG-like substance , s o much s o that th e ter m "hCG " ha s sometime s shifte d t o "CG " (therefor e droppin g out th e "human") . Furthermore , Domingue , Acevedo , an d colleague s noted tha t th e bacterial production o f CG-like materia l suggests that C G is a "primeva l molecule " o r tha t i t aros e i n bacteri a an d vertebrate s b y convergent evolution . They reject a s unlikely the counterargument tha t C G genes in bacteria emerge d fro m geneti c exchang e with alread y transforme d malignant hos t cell s because the tw o subunit s o f hCG ar e made by separate genes an d becaus e "specifi c enzyme s ar e neede d t o ad d th e suga r moie ties." 15 Subsequen t analyse s hav e led othe r scientist s t o th e followin g con clusion: " A gen e wit h homolog y t o th e hC G beta-subuni t famil y exist s i n bacteria, suggestin g that eithe r suc h gene s evolve d independentl y i n bacte ria, o r tha t th e hC G gen e famil y i s older, i n a n evolutionar y sense , tha n i s

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currently believed." 16 Assumin g that bacteri a d o produc e a CG-like mate rial independently o f malignant hos t cells , then autogenou s vaccines—tha t is, vaccine s mor e lik e th e Livingsto n typ e tha n th e Glove r serum—coul d be specific t o the CG-producing bacteria and therefore wor k by eliminating the CG-producin g bacteri a rathe r tha n counteractin g CG-production . However, give n th e wid e numbe r o f strain s o f CG-producin g bacteria , other mechanisms may be more important (suc h as stimulating the immun e system to destro y cell s with C G antigen s on their cel l walls). To summariz e th e argumen t t o thi s point , th e clai m tha t ther e i s n o single cance r organis m appear s correc t i n light o f the best availabl e curren t evidence. However , I woul d sugges t tha t th e powe r o f th e argumen t t o defeat th e bacterial-infectio n theor y i s weakene d b y bot h th e possibilit y that standar d bacterial classification s ma y be overl y rigi d an d b y th e subse quent finding s tha t bacteri a from malignan t tissu e hav e bee n foun d t o express molecule s simila r t o huma n choriogonadotropin . Th e linkag e o f the bacterial-etiolog y theor y wit h C G researc h help s overcom e th e incon sistency problem s discusse d earlier , becaus e i t translate s th e theor y int o contemporary immunolog y an d molecula r biology . A t th e sam e time , th e already-modified bacterial-etiolog y theor y ha s been modifie d agai n i n or der t o recogniz e tha t ther e i s no specifi c cance r organis m bu t onl y specifi c bacterial functions (suc h as CG production ) tha t coul d provide a n etiologi cal rol e fo r commo n CW D bacteria l pathogen s i n tumo r genesi s and/o r growth.

The Pragmatic Argument I: Rarity I divid e th e pragmati c argumen t agains t th e bacterial-infectio n theor y int o two parts , th e rarit y argumen t an d th e vaccine-inefficac y argument . Th e rarity argumen t i s as follows: eve n if one were t o accep t th e possibility tha t bacteria pla y some rol e in th e huma n cancer , i s it not likel y that th e rol e is an extremel y mino r one ? Therefore , i f the rol e i s a minor one , migh t th e theory be ignored as tangential and might the research program legitimatel y be exclude d fro m funding ? Afte r all , according t o curren t estimate s viruse s probably "cause " fewe r tha n 1 0 percen t o f huma n cancers . Bacteri a ar e likely t o pla y a smalle r role . Therefore , i t woul d b e a wast e o f fund s t o invest i n a field that i s likely t o hav e a payoff onl y i n a small percentage o f human cancers . The first counterargumen t coul d b e frame d a s follows: i f bacteria pla y a

But Is It Good Science? | 13 9

role i n tumo r genesi s vi a productio n o f a CG-lik e substance , an d i f C G turns ou t t o b e th e definitiv e tumo r marke r tha t th e Cancer editorial suggested, the n i t i s possibl e tha t th e rol e o f bacteri a i n tumo r genesi s i s substantial. Thi s argumen t i s elegan t bu t i t involve s severa l unconfirme d assumptions. A second counterargumen t i s more empirical : it evaluate s the frequenc y with whic h bacteri a hav e bee n isolate d fro m cance r tissues . Fo r certai n types o f cancer , researcher s see m t o hav e isolate d bacteria l cultures wit h relative eas e an d frequency . Fo r example , a serie s o f studie s i n th e 1960 s suggested tha t mycoplasm a coul d b e isolate d relativel y frequentl y fro m leukemic bon e marro w o r tissu e culture s inoculate d wit h huma n leukemi c bone marrow. 17 A more long-lived and consistent pattern is with Hodgkin' s disease. Early in th e centur y Germa n researcher s isolate d bacteri a fro m th e glands o f Hodgkin' s patients , an d i n subsequen t year s th e Universit y o f Wisconsin pathologis t C . H . Buntin g replicate d thei r wor k an d foun d highly pleomorphic bacteri a in cultures from Hodgkins patients. 18 Buntin g also use d injection s from th e Hodgkin s patients ' culture s t o produc e a blood leukocyt e pictur e i n monkey s tha t h e claime d wa s simila r t o th e Hodgkin s picture in man. Othe r researcher s continued to get similar results into th e 1930 s an d 1940 s (L'Esperanc e 1931 ; Mazet 1941) . A setbac k fo r this researc h suggeste d tha t lymp h gland s may contai n a normal flora , thu s making i t difficul t t o asses s the pathologica l rol e o f bacteria culture d fro m lymph gland s (Adamso n 1949) . However , othe r scientist s subsequentl y found bacteri a i n bloo d cultures fro m Hodgkin s patients , suggestin g dis eased lymph nodes , and they showed tha t the nitroblue tetrazoliu m tes t was positive in all cases of Hodgkin's disease, suggesting infection. 19 Researcher s such as Alan Cantwell, Jr., have kept this research tradition alive by continu ing to find bacteri a in Hodgkin's cultures. 20 Sarcomas ma y represen t anothe r typ e o f cance r fo r whic h bacteria l infections ma y pla y a n importan t role . Th e rang e o f transmissibility o f th e Rous sarcom a viru s acros s specie s remain s unresolved , bu t som e o f th e Livingston networ k researc h involve d murin e sarcoma s an d therefor e sug gested transmissibilit y t o mammal s (e.g. , Livingsto n an d Majnaric h 1986 ; Diller an d Donnell y 1970) . Livingsto n an d colleague s believe d tha t th e microorganism coul d b e transmitte d t o human s throug h undercooke d chicken (Livingsto n 1984 : 80; see Gros s 1983 : ch. 7) . Furthermore, Coley' s toxins ar e though t t o b e particularl y effectiv e i n sarcoma s (Wieman n an d Starnes 1994) . Other researcher s clai m t o hav e isolate d bacteri a fro m a muc h wide r

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range o f cancers . Mos t o f th e researcher s cite d here , suc h a s Glove r an d Livingston, wer e workin g wit h a variet y o f malignan t tissues , an d thei r reports sugges t ubiquit y rathe r tha n rarity . Glover , Scott , an d colleague s claim that the y "hav e been abl e to isolat e an d t o cultur e a morphologicall y similar, Gram-positiv e pleomorphi c organis m from ever y type o f malignant growth wit h whic h w e worked, includin g human carcinoma , mous e carci noma, ra t carcinoma , huma n sarcoma , ra t sarcoma , an d Rou s chicke n sarcoma No. i " (1926 : 50). Gerlach (1948 ) reported successful culture s fro m over on e thousan d sample s o f blood an d tissu e fro m human s an d animal s (Diller 1962a : 203). Likewise, Livingston claimed , "O n examinin g al l kinds of cance r tissu e obtaine d directl y fro m th e surgeo n i n th e operatin g roo m to insur e sterilit y an d absolut e freshness , I found tha t a similar microorgan ism [t o tha t o f he r scleroderm a work ] wa s presen t i n al l o f them " (1972 : 16). Seibert , wh o entere d th e fiel d partl y becaus e o f he r experienc e wit h demonstrating contaminant s i n tuberculosi s research , wrote , "W e foun d that w e wer e abl e t o isolat e bacteri a fro m ever y piec e o f tumor an d ever y acute leukemi c bloo d specime n tha t w e had " (1968) . Dille r provide s an other suggestio n o f frequency i n her study o f one hundred femal e ICR/H a strain mice. At periodic intervals, including at death, sh e bled the mice an d attempted t o cultur e pleomorphi c bacteria . O f th e fifty-si x mic e tha t die d from tumors , forty-nin e ha d successfu l cultures , an d o f the forty-fou r tha t did no t di e fro m tumors , onl y seve n ha d successfu l cultures . O f th e seve n that wer e apparentl y fals e positives , thre e wer e kille d b y cag e mate s (sug gesting possibl e infection ) an d th e remainin g fou r die d from pulmonar y congestion an d edema (suggestin g other infections). 21 The ubiquit y argumen t i s bolstere d b y th e existenc e o f a n interestin g trail of publications by researchers who wer e apparently unfamiliar wit h th e main line s o f th e Nort h America n an d Europea n network s o n bacteria l variation an d cancer , yet the y hav e publishe d article s tha t independentl y suggest they have found indication s o f bacteria o r fungi i n malignant tissue. For example , John Gregory:— a docto r wh o appear s t o b e unawar e o f th e Glover, Rife , an d Livingsto n research—compare d filtrate s fro m sample s taken fro m surger y o f one thousan d malignan t tissue s with anothe r sampl e of on e thousan d benig n tissues . Usin g a n electro n microscope , h e con cluded that "spherica l viruslike bodies .ifJL in diamete r were found i n 100% of th e malignan t tissu e bu t neve r i n th e benig n tumor s o r norma l tissue . These object s hav e cel l detail , includin g cel l wall, nucleus, an d cytoplasm " (1952: 20). 22 In short , th e availabl e researc h suggest s tha t whe n researcher s are looking for bacteria o r fungi an d when the y use electron microscopy o r

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difficult—but—appropriate culturin g methods , the y ar e likel y t o fin d evidence o f microbial pathogens i n large number s o f malignant tissu e cells. Thus, ther e i s credible empirica l evidenc e agains t th e rarit y argument . Certainly, on e woul d wan t muc h mor e researc h wit h moder n technique s in orde r t o evaluat e th e issue properly. I t is possible that future researc h will conclude tha t bacteri a ar e onl y importan t etiologica l agent s i n som e can cers, suc h a s leukemias, lymphomas , sarcomas , an d cancer s o f the digestiv e tract. However , bacteria l vaccine s an d ser a ma y hav e som e efficac y fo r a wide range o f cancers.

The Pragmatic Argument II: Inefficacy The vaccine-inefficac y argumen t ha s tw o genera l types . First , i f on e doe s not accep t th e bacteria l theory , the n bacteria l therapie s o f th e Glove r o r Livingston typ e ar e classified a s nonspecific immunotherapie s simila r to th e BCG tuberculosi s vaccin e o r Cole y s toxins . Presumably , thes e therapie s operate b y stimulatin g cytokine s (regulatin g molecules ) tha t stimulat e th e immune system . I n general , nonspecifi c bacteria l immunotherapie s hav e a checkered histor y o f successes an d failures, an d a s a result many researcher s have questione d th e valu e o f pursuing them . Therefore , on e coul d exten d this argumen t t o th e Glover/Livingsto n therapie s an d argu e tha t the y ar e likely to have a similar history o f spotty successes. A counterargumen t migh t begi n wit h th e clai m tha t nonspecifi c bacte rial vaccine s suc h a s Cole y s toxins ar e o f questionabl e efficacy . Researc h compiled by Helen Cole y Nauts an d others suggests that claim s of a lack o f efficacy fo r Cole y s toxin s hav e bee n overstated , an d ther e i s sufficien t accumulated dat a o n outcome s t o sugges t tha t five-year surviva l rate s fo r patients treate d wit h Cole y s toxin s unde r th e prope r condition s wil l b e equal o r bette r tha n comparabl e five-yea r surviva l rate s fo r conventiona l therapies.23 A second ste p t o th e rebutta l is to recogniz e tha t th e argumen t assumes the conclusion : tha t th e bacteria l theor y i s incorrect. I f the theor y turns ou t t o b e correct , the n vaccine s mad e fro m bacteri a culture d fro m the patien t coul d b e classifie d a s specific, an d consequentl y th e treatment s could be in theor y mor e efficaciou s tha n othe r nonspecifi c bacteria l thera pies. Thus , i f th e bacteria l etiolog y theor y i s correc t an d i f autogenou s vaccines ar e used , th e compariso n wit h th e mixe d outcome s o f othe r nonspecific bacteria l immunotherapie s ma y no t b e appropriate . Further more, a s Coley note d lon g ago , vaccines develope d fo r on e typ e o f bacte-

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rium, suc h a s tuberculosis , ca n b e effectiv e fo r disease s cause d b y othe r bacterial agents , suc h a s leprosy (Cole y 1931 : 614). Thus, i t is possible tha t general bacteria l vaccine s suc h a s Cole y s toxin s ma y operat e t o som e extent b y affectin g cancer-associate d bacteri a directl y o r b y stimulatin g CG-antibody production . The secon d typ e o f vaccine inefficac y argumen t i s based o n actua l trial s in humans an d animals. Unfortunately, th e quantitativ e dat a for human s ar e not conclusive . On e sourc e o f dat a i s Glove r an d White s 194 0 report , which t o m y knowledg e ha s neve r bee n analyzed . Th e repor t include s follow-up statistic s o n th e fift y case s firs t presente d i n 1926 . Becaus e h e used thos e case s to sho w that th e seru m worked, h e provided n o compara tive evaluatio n o f successe s versu s failures . Thus , th e fifty-cas e poo l show s only the frequency o f long-term successe s in cases that had already achieved short-term success , an d therefor e thes e statistic s wil l no t b e considere d here. A secon d se t o f statistic s i s draw n fro m 27 8 case s tha t "represen t groups o f cases as they occurre d i n a few o f our longe r establishe d clinics " (1940: 22). He add s that "case s in thes e clinic s tha t wer e symptom-fre e fo r only a fe w month s wer e no t include d becaus e o f th e insufficienc y o f th e time elemen t for proper evaluatio n o f results" (22). Although thi s statemen t is not entirel y clear, I interpret it to mean that he did not include remission s that, a t th e tim e o f dat a collection , ha d onl y bee n achieve d fo r a fe w months. Ha d h e include d thes e statistics , hi s succes s rat e woul d hav e bee n better. Within th e poo l o f 27 8 cases , th e breast-cance r case s for m th e larges t group tha t ca n easil y b e compare d wit h a contemporar y diagnosti c cate gory. Glove r divide s th e ninet y case s o f breas t cance r int o a grou p o f thirty-two operabl e an d fifty-eigh t inoperabl e cases . I n al l bu t fiv e case s pathologists verifie d th e tissue s a s malignant (Glove r an d Whit e 1940 : 38). The remainin g fiv e cancer s wer e i n patient s wh o refuse d biops y bu t fo r whom clinica l examinatio n reveale d "th e characteristi c lesion s o f malig nancy, s o tha t n o reasonabl e doub t wa s lef t i n th e diagnosis " (38) . Glove r concludes tha t al l ninet y case s wer e indee d correctl y diagnose d a s breas t cancer. In th e operabl e cases , mos t o f th e patient s ha d n o previou s treatment , but i n th e inoperabl e case s man y o f th e patient s ha d experience d recur rences after surger y and/or radiotherap y (se e Table 1) . Those with previou s treatment ha d suffere d a recurrenc e o n th e averag e o f nin e t o fourtee n months afte r treatment . Althoug h th e doctor s used surger y togethe r wit h the seru m i n mos t o f th e operabl e cases , Glove r wa s a n earl y advocat e o f

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TABLE I .

Glover Serum Outcomes for Breast Cancer Operable (32) Previous treatment : 30 non e 2 surger y

Current treatment : 26 seru m an d surger y 6 seru m onl y Outcome: 8: 10-1 2 year s 12: 5- 9 year s 9: 1- 4 year s 2: regressio n an d recurrenc e 1: cerebra l embolis m

R o u g h Five-Yea r Survival : 24.5/(32-1) = 79 %

Inoperable (58) Previous treatment : 19 non e 21 surger y 15 surger y an d radiotherap y 3 radiotherap y Current treatment : 58 seru m onl y Outcome: 8: 10-1 2 year s 5: 6- 9 year s 12: discontinue d 1: regression an d recurrenc e 4: infection s 2: diabete s 1: fractured nec k 22: deat h 3: n o informatio n R o u g h Five-Yea r Survival : 13/(58-12-4-2-1) = 33 %

SOURCE: Glove r and White (1940 : 38-43).

conservative surgery : "Performanc e o f th e mor e radica l operation s wit h manipulation o f th e malignan t area s ha s a pronenes s t o disseminat e th e disease, an d . . . ou r result s hav e bee n bes t w h e n seru m alon e wa s use d o r w h e n w e hav e use d conservativ e surger y precede d an d followe d b y seru m therapy" (Glove r an d Whit e 1940 : 39) . To interpre t th e outcome s properly , th e figur e of , fo r example , eigh t patients aliv e a t te n t o twelv e year s doe s no t mea n the y onl y live d te n t o twelve years . Rather , the y wer e stil l aliv e an d health y a t th e tim e w h e n dat a was collected . I n othe r words , som e receive d treatmen t onl y fou r year s o r one yea r prio r t o th e collectio n o f data . O f th e remainin g patients , tw o ha d complete regression , refuse d additiona l seru m treatmen t eve n thoug h th e blood cultur e wa s positive , an d the n late r ha d metastati c recurrences . O n e patient die d fro m a suspected cerebra l embolis m whil e undergoin g a simpl e surgical excision . O f th e si x patient s treate d onl y wit h serum , tw o eac h were amon g th e thre e survivin g groups . T h e result s fo r th e inoperabl e case s wer e no t a s promising . Twenty-tw o patients, al l o f w h o m wer e a t advance d stage s o f th e disease , died . Glove r comments tha t fo r the m "relie f fro m pai n withou t th e ai d o f narcotic s wa s

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noted i n th e majorit y o f th e cases " (Glove r an d Whit e 1940 : 43) . O f th e other patient s w h o wer e no t i n th e survivo r grou p o r th e grou p tha t discontinued treatment , fou r die d fro m infection s befor e th e treatmen t wa s completed, tw o die d fro m diabete s bu t wit h evidenc e o f som e tumo r regression, on e die d fro m a fractur e o f th e nec k (bu t wit h n o evidenc e o f metastases a t th e sit e o f th e fracture) , on e die d afte r recurrence s fro m complete regressio n (sh e refuse d additiona l seru m afte r regressio n eve n though bloo d culture s remaine d positive) , an d n o informatio n i s give n fo r the thre e remainin g cases . Some o f th e cas e historie s provid e remarkabl e evidenc e fo r long-term , complete regressio n o f tumor s amon g ver y advance d patients . O n e forty four-year-old patien t bega n wit h symptom s o f pai n an d swellin g i n th e lef t breast, an d sh e wa s treate d i n 191 8 b y a n excisio n o f th e lum p fro m he r breast. W h e n th e pai n returne d an d mor e nodule s wer e detected , th e lef t breast wa s remove d i n 1920 , an d pathologist s reporte d adenocarcinom a o f the breast . A ne w tumo r i n th e righ t breas t resulte d i n remova l o f th e righ t breast i n 1921 , with th e sam e pathologica l report . Shortl y afte r thi s opera tion th e patien t experience d shortnes s o f breath , ches t pain s tha t radiate d into th e ar m an d neck , weakness , an d los s o f weight . B y th e en d o f 192 2 she wa s bedridde n an d give n narcotic s t o alleviat e he r pain . Additiona l tumors wer e detecte d o n th e rib s an d lef t arm , an d th e lowe r borde r o f th e liver wa s har d an d nodular . Dr . Duff y o f Troy , N e w York , administere d th e Glover serum , an d withi n si x month s sh e wa s ambulator y enoug h t o trave l 150 mile s b y trai n fo r additiona l treatment . Glove r continues : At th e en d o f on e yea r o f treatmen t n o evidenc e o f an y carcinomatou s involvement coul d b e found . Th e patien t ha d gaine d thirty-thre e pound s i n weight an d was leading a normal existence . The blood cultur e was negative. In Septembe r 1925 , the dutie s o f teaching a large fourt h grad e clas s were resumed, and , excep t fo r seasona l vacations , hav e bee n performe d withou t any brea k u p t o th e presen t time . A t thi s tim e o f writin g th e patien t i s approaching he r sixtiet h yea r withou t recurrence . (Glove r an d Whit e 1940 : 44-45) O f course , cas e studie s suc h a s thi s fal l int o th e categor y o f anecdota l research. T h e advantag e o f Glove r s researc h i s tha t i t provide s som e basi s for a quantitativ e assessmen t o f outcomes . R e t u r n i n g t o th e statistics , on e might ask , h o w doe s Glover s seru m compar e wit h today s statistics ? Five year surviva l rate s fo r breas t cance r amon g whit e w o m e n i n th e Unite d States hav e change d fro m abou t 6 3 percen t i n 1960—6 3 t o 8 2 percen t i n

But Is It Good Science? | 14 5

1983-90.24 Th e gain s ar e probabl y optimisti c an d du e mainl y t o earlie r diagnosis tha n t o mor e effectiv e treatment . T o compar e wit h Glover , let' s take his more optimisti c statistics on operabl e patients, because the operabl e cases include d twenty-on e patient s wh o ha d loca l metastase s an d who m some o f the clinician s though t shoul d b e classifie d a s inoperable. Thi s poo l is therefor e close r t o th e curren t patien t populatio n upo n whic h th e na tional averag e figure s ar e based . Assumin g tha t a t leas t hal f o f th e nin e patients i n th e one-to-four-yea r grou p mak e i t t o five years , the n th e protocol has a five-year survival rate of twenty-four-and-a-half patient s of a group o f thirty-one (droppin g the patient who die d o f the embolism) . Thi s gives a rough five-year-survival figur e o f 7 9 percent, whic h i s comparabl e to today s optimisti c figures . Glove r als o appear s t o hav e ha d a ten-yea r survival rate o f over 6 0 percent, tha t is , a success rate tha t i s closer to wha t many think is a better estimat e of the five-year survival rate for th e nationa l average today. John Whit e (1953) , a doctor wh o used th e Glove r seru m a t his clinic i n Malone, Ne w York , publishe d a secon d repor t o n anothe r on e hundre d cases. For breast cancer , the largest group, he had a five-year survival rate o f 65 percent an d a ten-year surviva l rate o f 5 7 percent. Th e statistic s are very rough becaus e h e apparentl y los t trac k o f som e patient s prio r t o th e fiveand ten-yea r markers , an d som e o f the deaths may no t hav e bee n cancer related. Th e statistic s o n th e Glove r seru m ca n onl y b e roug h estimate s b y today s standards o f measurement , bu t the y ar e al l tha t i s availabl e s o the y are of some value if one understand s thei r limitations. Give n th e likelihoo d that diagnose s i n th e 1920 s an d 1930 s occurre d a t muc h late r stage s o f cancer tha n today , th e statistic s sugges t tha t th e Glove r seru m ma y hav e been efficaciou s eve n whe n compare d wit h today s succes s rates . Further more, hi s seru m treatmen t hel d ou t th e possibilit y o f significantl y lowe r disfigurement an d highe r quality o f life t o th e exten t tha t i t coul d reduc e or replac e othe r treatmen t modalities . Onl y additiona l testin g woul d hav e answered this question . Regarding th e Livingsto n vaccine , ther e i s no w a n apparently bette r measure o f efficac y i n huma n population s tha n th e ver y roug h measure s that I hav e constructe d fo r th e Glove r serum . Ther e i s finall y a matche d cohort study that has been designe d in accordance with th e methodologica l standards o f lat e twentieth-centur y medica l research . Barri e Cassilet h an d colleagues (1991 ) compare d matche d pair s o f patients unde r a mixed con ventional/Livingston protoco l a t Livingston s clinic in Californi a an d unde r conventional treatment (includin g interleukin-2) a t the University of Penn-

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sylvania. The stud y showed no differenc e i n mean survival time, and all but one patien t ( a Livingsto n patient ) die d withi n three-and-a-hal f year s afte r diagnosis. Furthermore , quality-of-lif e measure s assigne d highe r score s t o the conventional patients at the beginning of the study, and the gap between the tw o therapeuti c protocol s remaine d consisten t throughou t th e study . This study could therefore b e interpreted t o provide strong evidence against the vaccine-efficacy argumen t for th e Livingston vaccine. However, ther e ar e some additional consideration s tha t need to be take n into accoun t befor e ful l evaluatio n o f the stud y i s made. I t i s not irrelevan t to includ e i n th e interpretatio n o f the findings o f the stud y a statement i n the pro-alternativ e publicatio n Cancer Chronicles tha t Cassilet h is a member of the American Cance r Society' s Subcommittee o n Questionabl e Method s of Cance r Management , a continuatio n o f th e olde r Subcommitte e o n Quackery. Becaus e o f that membershi p Cassilet h wa s part o f a controvers y among member s o f the advisor y boar d o f the Offic e o f Alternative Medi cine, whose cancer-activis t member s wante d he r t o resig n from on e o r th e other.25 T o he r credit , sh e ha s advocate d controlle d studie s o f alternativ e therapies, a position which itself is controversial among the cancer establishment. O n th e othe r side , Cassilet h wa s quote d i n a U.S. News and World Report article a s criticizing som e OA M advisor y boar d member s fo r usin g their affiliatio n t o promot e specifi c alternativ e therapies. 26 I n othe r words , both side s are claiming that th e othe r ha s vested interests . This backgroun d knowledge lead s me t o rea d the stud y carefull y t o conside r if any aspects o f its interpretation , measurement , o r desig n migh t hav e favored—perhap s unintentionally—the conventiona l therapie s ove r the Livingston therapy. 27 One possibl e exampl e involve s th e interpretatio n o f th e quality-of-lif e measures.28 The abstrac t o f the stud y provides onl y the following summar y sentence: "Quality-of-lif e score s wer e consistentl y bette r amon g conven tionally treate d patient s fro m enrollmen t on " (1991 : 1180) . Yet, th e clai m that quality of life was better among the conventional patients is ambiguous. Fifty-one o f the conventiona l patient s wer e full y ambulator y a t th e begin ning o f th e stud y i n contras t t o forty-si x o f th e Livingsto n patients , an d three o f th e conventiona l patient s wer e bedridde n i n contras t t o seve n o f the Livingsto n patients . I n othe r words , ther e i s a difference i n th e patien t groups tha t favor s th e conventiona l protocol . Th e author s stat e tha t ther e were no interaction effects , "meanin g that the quality of life deteriorate d a t an equa l rate i n th e tw o patien t groups, " and a graph show s a constant an d equivalent ga p i n quality-of-lif e score s ove r tim e (1991 : 1183) . Thus , a n alternative interpretation o f the quality-of-lif e measure s is that ther e was no

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significant differenc e betwee n th e tw o becaus e th e ga p remaine d constan t over time . Furthermore , th e difference s betwee n th e tw o group s o f patient s as reflecte d i n quality-of-lif e score s ma y affec t interpretatio n o f surviva l differences. A s Michae l Lerne r noted : "I f a reanalysi s o f th e dat a i n thi s study wer e t o fin d tha t th e differenc e i n qualit y o f life reflecte d th e fac t tha t the Livingsto n patient s wer e i n fac t significantl y sicke r fro m th e start — purely a hypothetica l possibility—the n th e fac t tha t the y live d a s lon g a s the Universit y o f Pennsylvani a patient s woul d sugges t tha t th e Livingsto n regime wa s slightl y mor e efficaciou s tha n conventiona l therap y fo r patient s with thes e diagnose s an d stage s o f disease " (1994 : 330) . Finally, eve n i f a reanalysi s wer e t o sho w tha t ther e i s n o significan t difference betwee n th e therapie s o n mea n surviva l tim e an d qualit y o f lif e (as measure d b y a constan t gap) , the n on e woul d probabl y selec t therapie s based o n cost . A vaccine/dietar y treatmen t i s muc h les s costl y tha n radia tion, chemotherapy , an d interleukin-2 . T h e alternativ e suggeste d b y th e authors, tha t fo r advance d patient s onl y palliativ e treatmen t ma y b e th e bes t option, i s als o a possibilit y t o entertain . However , patient s ar e likel y t o pursue som e sor t o f treatment tha t give s them hope , an d palliative treatmen t does no t provid e hope . Therefore , th e stud y ca n b e interprete d a s favorabl e to th e Livingsto n therap y becaus e qualit y o f life an d efficac y ar e equivalent , but cos t i s lower fo r th e alternativ e therapy . Additional researc h woul d b e neede d t o investigat e som e othe r question s that emerg e fro m a critica l examinatio n o f th e desig n o f th e study . First , as Cassilet h an d colleague s recognize , a more convincin g compariso n woul d involve a randomize d design . A bette r desig n woul d als o measur e onl y pa tients w h o use d onl y th e mos t conventiona l therapie s (chemotherapy , radia tion, an d surgery ) agains t patient s w h o wer e pursuin g onl y th e Livingsto n protocol (rathe r tha n a mixture o f conventional an d Livingsto n protocols) . I hypothesize tha t patients matched o n quality-of-lif e score s prior t o treatmen t would diverg e i n favo r o f th e Livingsto n protoco l a t leas t o n quality-of-lif e measures an d perhap s o n surviva l a s well. I t i s hard t o imagin e qualit y o f lif e being bette r unde r chemotherap y an d radiatio n i n compariso n wit h carro t juice, organi c foods , an d vaccines , unles s th e latte r protoco l i s s o ba d tha t patients advanc e mor e quickl y t o late stages of cancer . Another desig n improvemen t woul d measur e patient s w h o wer e no t a t such a n advance d stag e o f cancer , preferabl y patient s w h o hav e receive d n o previous treatment . Man y o f th e alternativ e cance r protocols , lik e th e conventional protocols , clai m tha t the y los e effectivenes s fo r patient s w h o are i n th e termina l phase s o f thei r illness . Regardin g Cole y s toxins , Gu o

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Zheren an d Hele n Cole y Naut s (1991 ) writ e tha t th e result s wer e no t a s good wit h th e bacteria l vaccin e whe n th e tumor s wer e enormou s o r recurrent, o r afte r surger y an d chemotherap y ha d bee n give n first . I n general, claim s for long-term surviva l for both alternativ e an d conventiona l treatments ar e buil t aroun d early-to-middle-stag e cases , eve n thoug h cas e studies o f terminal patien t recover y ca n occasionall y b e produce d fo r bot h conventional an d alternativ e therapies . Significan t difference s (eithe r fo r one sid e or the other ) ar e more likely to emerg e in design s that begin wit h patients wh o ar e no t a t advance d stages . Fo r example , th e Gerso n mela noma stud y foun d statisticall y significan t result s amon g Stag e II I an d IV a patients treate d unde r thei r protocol i n compariso n wit h nationa l averages, and a positive dat a trend fo r earlie r stages , but th e advance d patient s (Stag e IVb) al l died (Hildenbran d e t al. 1995). Like th e matched-pair s desig n o f the Cassilet h study , th e Gerso n study' s method o f comparin g outcome s fro m it s protoco l wit h thos e o f othe r studies i s no t a s convincin g methodologicall y a s the gol d standar d o f ran domized, prospective , clinica l trials . (Th e double-blin d requiremen t woul d be impossibl e t o incorporat e i f on e i s comparin g vaccine s an d die t versu s chemotherapy an d radiation. ) However , gold-standar d studie s ar e aptl y named becaus e the y ar e ver y expensive . Randomize d controlle d trial s fo r alternative cance r therapie s woul d hav e t o receiv e governmen t fundin g because mos t o f th e advocate s o f alternativ e cance r therapie s d o no t hav e the resource s t o brea k throug h thi s methodologica l glas s ceiling . I n tur n funding woul d com e onl y fro m publi c pressur e o n member s o f Congress , and eve n i n thi s circumstanc e th e histor y o f th e laetrile , Vitami n C , anti neoplastons, an d othe r randomize d clinica l trial s suggest s that th e random ized, clinica l trial s o f unconventiona l cance r therapie s hav e bee n designe d in way s t o introduc e biase s agains t th e therapie s (Mos s 1989) . Give n th e severe budgetary limitation s o f advocates o f alternative therapies , th e Ger son study is a model o f what ca n be achieve d with limited resources . The argumen t tha t outcome s studie s ar e methodologically wea k shoul d therefore b e taken with a grain of salt, because critics usually are not willin g to wor k towar d gettin g th e fund s fo r gold-standar d studie s fo r alternativ e therapies. It is equivalent to criticizin g someone for no t drivin g a Mercedes when the y ar e o n th e budge t o f a subcompact . Fo r tha t reaso n on e shoul d not b e to o critica l o f Livingston s qualitative outcome s analysis , which wa s based o n on e hundre d chart s draw n randoml y fro m th e clini c s files. Th e cases sugges t tha t he r immunotherap y progra m ma y hav e bee n successfu l for som e patients (Livingsto n 1984) .

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Another low-budge t alternativ e t o randomized , clinica l trial s i s experi mental anima l studies . On e exampl e i s th e Dille r mic e studie s tha t used killed vaccine s o f th e acid-fas t o r partiall y acid-fas t stag e o f organism s harvested fro m th e mous e Sarcom a 180 . Using mic e wit h a known tumo r incidence, Dille r foun d tha t hal f the contro l mic e die d withi n fou r weeks , whereas non e o f the vaccinate d mic e die d withi n tha t period . Th e rat e o f tumor regressio n wa s ove r thre e time s greate r i n th e vaccinate d mic e tha n in the contro l mice. For those mice in the vaccinated grou p tha t eventuall y did no t overcom e th e tumors , th e surviva l tim e wa s increase d (Dille r an d Donnelly 1970 : 671) . Seiber t als o foun d tha t a heat-killed vaccin e fro m a filterable for m of Staphylococcus epidermidis that was isolated from a spontaneous mammar y tumo r o f a C3 H mous e le d t o a statisticall y significan t decrease i n th e incidenc e o f spontaneous tumor s o f vaccinated versu s con trol femal e mice . Sh e believe d tha t a mor e prolonge d effec t migh t b e obtained wit h repeate d booste r doses , whic h ar e par t o f th e standar d Livingston therapy. 29 Livingston' s bacteria l antigen s ar e als o used commer cially in a licensed, killed vaccine for Marek's disease (neurolymphomatosis) , a neoplastic diseas e of chickens cause d by a herpes virus. The anima l studies , combine d wit h th e desig n problem s i n th e on e matched-pair clinica l stud y an d som e very tentativ e sign s of success for th e Glover serum , sugges t tha t th e serum/vaccin e inefficac y argumen t remain s an ope n question . Th e researc h mounte d b y Naut s a s well a s subsequen t clinical trials for Cole y s toxins also provide supportin g evidenc e in favor o f bacterial immunotherapie s i n general , althoug h o f cours e on e mus t tak e into accoun t th e fac t tha t Cole y s toxin s ar e differen t fro m autogenou s bacterial vaccines . Mor e studie s woul d b e neede d t o evaluat e th e efficac y of the Glove r serum, Livingston vaccine, and related therapies based on th e bacterial-etiology theory . However , thes e studie s seem warranted give n th e successes of the anima l studies with heat-kille d vaccine s and the claim s tha t Glover an d White mad e fo r th e succes s o f the Glove r serum. I t seem s very possible an d tragi c tha t highl y efficaciou s bacteria l immunotherapie s fo r cancer have been overlooke d fo r decade s for political reasons. Note tha t advocate s o f the secondary-infectio n theor y coul d argu e tha t any result s tha t sugges t efficac y fo r a bacterial vaccin e coul d b e explaine d under th e "cascad e o f cytokines " theor y advocate d b y th e Cole y s toxin s researchers (e.g. , Wieman n an d Starne s 1994) . Thi s i s a formidabl e argu ment, bu t i t coul d b e teste d by comparin g nonautogenou s (Coley' s toxins ) and autogenous vaccines (Livingston ) fo r efficacy , productio n o f the cascad e of cytokines , an d productio n o f C G antibodies . I t i s possibl e tha t bot h

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mechanisms (e.g. , C G antibodie s an d cytokine s suc h a s tumo r necrosi s factor) ma y b e operan t i n bot h type s o f vaccin e therapies . However , i t i s also possibl e tha t differen t mechanism s ma y b e involve d an d tha t bot h theories (suc h a s C G mechanis m an d th e cascad e o f cytokines ) ma y b e correct t o som e extent . Likewise , i f one wer e t o accep t th e claime d efficac y of th e Glove r serum , an y numbe r o f explanation s i s possible . T h e seru m might provid e antibodie s t o oncobacteria , bu t i t migh t als o wor k throug h some othe r mechanis m o f immune-syste m stimulation . T h e poin t i s tha t this rathe r obviou s an d relativel y inexpensiv e researc h simpl y i s no t bein g done, notwithstandin g th e billion s o f dollar s dedicate d t o cance r researc h each year .

The Feminist Criteria Many readers , particularl y mal e scientists , wil l probabl y cring e a t th e thought o f introducin g feminis t criteri a int o th e evaluatio n o f a scientifi c theory. However , feminis t scienc e studie s analyst s hav e develope d a substan tial literatur e tha t show s h o w scientifi c theories—mostl y i n th e biological , medical, an d socia l sciences—hav e sometime s bee n lade n wit h gende r an d race biases . Thus , thes e consideration s nee d t o b e incorporate d int o a fai r evaluation process . T h e stronges t cas e fo r gende r an d rac e bia s i n natura l scientifi c theorie s (rather tha n institutions ) i s probabl y i n th e medica l an d biologica l science s rather tha n th e physica l o r mathematica l sciences . I n medicine , theorie s related t o th e biolog y o f w o m e n an d peopl e o f colo r hav e historicall y legitimated a numbe r o f sexis t an d racis t practices . Probabl y th e mos t notorious ar e th e nineteenth-centur y science s tha t legitimate d th e exclu sion o f w o m e n an d peopl e o f colo r fro m highe r educatio n becaus e o f th e constitution o f thei r nervou s syste m o r siz e o f th e brain s (Hardin g 1993) . There i s als o a long histor y o f treatin g psychologica l disorder s b y removin g parts o f th e woman' s bod y an d o f medicalizin g natura l occurrence s suc h a s menopause an d menstruatio n (E . Marti n 1987) . I n cance r researc h an d treatment, probabl y th e mos t obviou s are a wher e sexis t biase s hav e bee n challenged i s th e practic e o f radica l mastectom y fo r breas t cancer , whic h only i n recen t year s ha s bee n challenge d i n th e Unite d States . Becaus e vaccines o r ser a hav e ver y differen t implication s fo r w o m e n wit h breas t cancer i n contras t wit h surgery , th e bacteria l theor y coul d b e interprete d a s more favorabl e t o w o m e n tha n th e secondary-infectio n theory .

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A secon d typ e o f bia s i s th e mor e subtl e us e o f implici t gendere d o r racial cultura l categorie s i n scientifi c theories . Thi s typ e o f bia s i s bot h more controversia l an d mor e interestin g becaus e i t i s applie d t o basi c scientific theorie s tha t o n firs t analysi s ma y appea r t o b e pur e "representa tion" o f th e materia l worl d an d fre e fro m "cultura l contamination. " T h e most relevan t exampl e fo r cance r researc h i s the analysi s o f debate s ove r th e assignment o f activit y an d passivit y t o space s withi n th e cell . Historically , the sper m wa s see n a s a n activ e agen t tha t fertilize d a passiv e egg , an d th e gendered activity/passivit y relation s wer e the n mappe d ont o th e relation ship o f nucleu s t o cytoplas m i n th e cell. 30 T h e centra l dogm a o f molecula r biology—the D N A define s th e structur e o f R N A , whic h govern s th e making o f protein—continued th e assignmen t o f activity/passivity relation ships b y retainin g th e "maste r molecule " i n th e nucleu s a s th e locu s o f activity i n contras t wit h a passive cytoplasm . Som e biologists , amon g the m Ernest Everet t Just an d Barbar a McClintock , challenge d variou s version s o f a rigi d chai n o f comman d tha t flow s fro m th e nucleu s t o th e cytoplas m an d cell membrane. 3 1 The y an d other s wer e pioneer s i n arguin g fo r wha t Hele n Longino (1994 ) call s "complexit y o f relationship " i n thei r natura l objects , in thi s cas e a mor e comple x mode l o f th e cel l tha t bring s attentio n t o th e flow o f information an d message s inwar d t o th e nucleus . U n d e r olde r version s o f th e mutageni c o r hereditar y theory , cance r research continue d thi s assignmen t o f activity/passivity relation s b y focusin g the tumo r genesi s proces s o n damag e t o o r change s i n th e chromosome s and late r th e D N A . However , gen e expressio n ha s com e t o b e see n a s a more comple x process , an d th e simpl e mutageni c theor y ha s change d t o allow fo r th e expressio n o r derepressio n o f nuclea r gene s t o b e response s to extranuclea r information . Thi s tendenc y i s increasingl y eviden t a s th e molecular-cancer researc h progra m move s towar d analyzin g th e failur e o f DNA-repair mechanism s a s a major caus e o f cancer , rathe r tha n th e simpl e impact o f carcinogen s an d free radical s o n nucleotides . Fo r example , bio chemist Bruc e Ame s (1995 ) ha s argue d tha t food s contai n a larg e numbe r of natura l pesticides , an d therefor e th e caus e o f cance r rest s i n th e delicat e balance o f D N A damag e an d DNA-repai r mechanisms , no t simpl y th e impact o f externa l carcinogens . I n general , th e molecula r theor y toda y assumes som e impac t o n D N A expressio n pattern s fro m th e flow o f infor mation bac k fro m th e cytoplas m an d cellula r environment . I n othe r words , under th e molecula r theor y toda y assignment s o f activit y an d passivit y ar e more complicate d tha n unde r a simple mutageni c theory . Nevertheless , th e focus o f attentio n remain s o n th e D N A an d it s expressio n patterns . Some -

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times on e read s tha t th e DN A "expresses " itself, wherea s th e environmen t sends "signals," like stereotypes o f airspace-grabbing me n an d subtly signalling women . Thi s linguisti c oppositio n suggest s tha t th e ne w molecula r language ma y continu e som e o f the ol d patterns o f the cultura l geograph y of the cell . Because th e bacteria l theor y locate s activit y i n a cellula r pathogen , it woul d furthe r complicat e th e understandin g o f molecula r informatio n pathways that lead to th e transformatio n o f a normal cel l into a cancer cell . Bacteria an d viruse s ma y b e locate d i n th e nucleu s o r i n th e cytoplas m o r even outsid e th e cell , bu t whereve r the y ar e locate d the y complicat e th e older "maste r molecule" image of DNA-centered carcinogenesis . The pro posed C G mechanis m als o emphasize s activit y a t th e cel l wal l rathe r tha n damage to the cel l nucleus. Another candidat e fo r implici t bia s i s th e belie f tha t cell-wal l deficien t bacteria ar e unlikel y pathogens . I hav e alread y investigate d th e gendere d nature o f th e cultura l meaning s associate d wit h "cell-wal l deficient/diver gent" bacteria . On e coul d the n argu e tha t interpretin g thes e bacteri a a s secondary infections continue s in cancer research the marginal position tha t they occupy in microbiology, where their pathological (active ) role has been under-recognized i n compariso n t o th e recognitio n give n t o conventiona l bacteria wit h cel l walls. Yet another candidat e fo r sexis t bias is the popula r theory o f multiste p carcinogenesi s tha t involve s th e mode l o f oncogene s (like an accelerator) an d tumor-suppressor gene s (lik e a brake), which coul d be contraste d wit h th e theor y tha t i t involve s hC G (lik e a n embry o o r fetus). Althoug h th e tw o theorie s ar e no t necessaril y contradictory , th e metaphors tha t ar e used t o understan d th e phenomen a (automobile/em bryo) hav e gendered connotation s i n ou r culture . Looking fo r hidde n sexis m o r racis m i n th e allocatio n o f gendere d meanings ca n provid e a wa y o f seein g potentia l biase s i n theorie s tha t a t first appea r t o b e transparen t representation s o f a physica l world . Th e counterargument i s that this type of analysis confuses th e metaphor with th e represented object . However , advocate s o f th e counterargumen t generall y assume tha t i t i s possible t o wee d ou t th e biase s o r metaphors , an d conse quently t o produc e a completely transparen t representatio n o f the world . I prefer th e mor e sanguin e vie w tha t i t i s probably impossibl e t o construc t a theory that has no hint of sexism or racism in it, particularly if one interpret s sexism or racism loosely as the use of cultural categories such as activity and passivity. Although some theories may be less racist or sexist than others, and it is worth including these grounds as one set of criteria for theory evaluation,

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it is doubtful tha t a Utopian stat e will ever be reache d in which al l forms o f buried or cryptic bias will be eliminated from scientific theorizing . Further more, the Utopia of a completely culture-free scienc e may not even be desirable, fo r scientifi c theorie s depen d o n th e culture-imbue d imagination s o f scientists and their culture-laden metaphors. In short, culture in science both introduces biases and produces possibilities of new ideas. The point is to ex amine theorie s for thei r potential us e of gender- o r race-associated cultura l categories, an d to us e this form o f cultural critiqu e t o pose alternatives tha t in turn need to be cross-checked agains t the other criteri a o f accuracy, con sistency, and pragmatic value. Antisexist/antiracist criteri a coul d play an important rol e if they revealed very obvious forms o f bias, such as the attribution o f intelligence difference s based o n presume d brain-siz e difference s o r th e remova l o f women's bod y parts based o n dubiou s psychobiologica l theories . I n th e cas e o f the bacte rial-etiology theory , I se e n o evidenc e fo r thi s degre e o f obviou s bias . Probably mor e importan t tha n th e activity-passivit y argumen t i s the possi bility o f usin g vaccine s a s a n alternativ e t o surgery , a s in som e o f Glove r s breast cance r patients. Regarding th e relationshi p amon g th e fou r group s o f criteria , mos t philosophers—including th e feminis t philosophe r Longino—agre e tha t some version of accuracy is the most important. Consistenc y criteri a probably ar e mos t usefu l fo r preliminar y filtering o f highl y inconsisten t an d unlikely theories , an d fo r evaluatin g theorie s tha t approximat e evidentia l indistinguishability. Pragmati c criteri a wil l alway s b e importan t give n th e embeddedness o f science in a society interested i n research applications an d facing th e economi c proble m o f scarcit y o f resources . Finally , give n th e history o f racism an d sexis m in biologica l theories , th e ne w criteri a intro duced b y Longin o (an d draw n fro m othe r feminis t theoreticians ) ad d a valuable perspectiv e t o th e evaluatio n o f a theory . I hav e reoriente d th e feminist criteri a toward an examination o f racist or sexist bias (and of course the list could b e expande d t o includ e othe r "isms") . These criteri a serv e as a usefu l par t o f th e overal l evaluatio n o f a ne w theor y tha t wil l allo w a check o n possible hidden biases that ca n easily be ignored o r forgotten .

Conclusion The origina l theor y tha t a single, pleomorphic microorganis m i s the caus e of cance r i s n o longe r viable . Th e Glover-Rif e interpretatio n o f chemica l

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and radiatio n carcinogenesi s a s precursor s t o microbia l infectio n ma y tur n out t o b e acceptabl e i n som e cases , but ther e ha s been to o muc h subsequen t accumulated evidenc e t o sugges t tha t a singl e microorganis m i s th e uniqu e cause o f all mammalian cancers . T h e singl e microorganis m theor y tha t mos t members o f the researc h traditio n supporte d i s no longe r tenabl e i n ligh t o f the researc h o f the 1980 s tha t use d D N A - D N A hybridizatio n technique s t o identify th e bacteri a a s know n specie s categories . However , a s Domingu e noted, curren t classificatio n categorie s i n microbiolog y ma y b e to o rigi d and unabl e t o encompas s th e possibl y wide-rangin g geneti c exchange s tha t may b e goin g o n i n pleomorphi c bacteria . Although th e origina l theor y i s n o longe r tenable , ther e ma y b e som e life lef t i n a modifie d versio n o f it . Bacteri a ca n chang e form s i n respons e to ne w culture s an d hos t conditions , jus t a s theorie s ca n b e modifie d i n light o f new data . T h e modifie d theor y hold s tha t bacteria l infectio n i s no t the onl y proximat e caus e o f cance r (a s oppose d t o distan t cause s suc h a s poverty) an d tha t ther e i s no singl e pleomorphic oncobacteriu m responsibl e for cance r genesi s an d growth . T h e modifie d theor y recognize s tha t whil e there ar e othe r proximat e cause s o f cance r (e.g. , chromosom e damag e fro m chemical carcinogens , inherite d geneti c susceptibility) , bacteri a coul d stil l play a nontrivial rol e i n tumo r genesi s and/o r growth , perhap s onl y i n som e types o f cancer . T h e modifie d theor y ca n explai n th e pattern s i n th e C G studie s o f th e 1980s discusse d above , a s well a s the fulfillmen t o f Koch's postulate s an d th e apparent succes s o f at least som e o f the ser a an d vaccines . T h e interpretatio n that CG-like-producin g bacteri a d o no t acquir e th e functio n fro m geneti c exchange wit h already-transforme d hos t cell s i s crucia l t o maintainin g th e theory i n it s curren t form . However , a s any goo d studen t o f science knows , the bacterial-etiolog y theor y woul d no t fal l apar t i f larg e amount s o f evidence wer e mounte d agains t th e propose d C G mechanism . Becaus e there ma y b e othe r mechanism s b y whic h bacteria l pathogen s coul d con tribute t o cancer , th e theor y woul d onl y hav e t o b e change d again . O n e example i s hormona l deregulatio n throug h th e bacteria l productio n o f a substance simila r t o actinomyci n (Livingsto n an d Alexander-Jackso n 1965a : 859; Livingsto n e t al . 1970) . Nevertheless , unles s stron g evidenc e wer e mounted i n favo r o f a n alternativ e mechanism , th e failur e o f the subtheor y on th e C G mechanis m woul d mak e th e bacterial-infectio n theor y muc h less appealing . I n othe r words , ther e i s stil l a degre e o f overal l falsifiabilit y involved. W h e n a theor y obtain s a hig h anomal y loa d an d a larg e numbe r of a d ho c subtheorie s t o cove r th e anomalies , peopl e begi n t o abando n

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ship. However , th e modifie d theor y stil l appear s t o float. Indeed , i t ha s le d to som e successful , surprisin g predictions . As par t o f a broade r researc h program , th e theor y als o appear s t o hav e value o n pragmati c grounds . I f research unde r th e theor y wer e funded , th e development o f ne w vaccine s and/o r ser a ma y prov e successfu l fo r huma n cancer patients . T h e ris k o f failur e i s offse t b y th e lowe r cos t an d highe r quality o f lif e expecte d fro m a vaccin e treatmen t i n compariso n wit h surgery, radiation , chemotherapy , an d som e o f th e specifi c immunothera pies. T h e theor y ma y als o ai d effort s a t earl y detectio n an d preventio n b y providing a framework fo r culturin g CG-producin g bacteri a fro m bloo d o r testing directl y fo r antibodies . A s a mechanis m fo r earl y detection , screen ing fo r C G antibodie s migh t prov e superio r i n cost , comfort , an d ris k t o current protocol s suc h a s mammogram s o r prostat e exams . Finally , th e theory ma y provid e som e ne w idea s fo r researc h bot h o n C G an d o n antibiotics a s a chemotherap y fo r cancer . T h e bacterial-etiolog y theory , then , i s no t kooky , wild , o r quackery . Rather, ove r th e decade s i t ha s guide d man y researcher s w h o hav e amasse d a credibl e bod y o f evidenc e t o suppor t it . T h e theor y ma y ultimatel y b e rejected i n favo r o f the secondary-infectio n theory , bu t I would sugges t tha t now i s probabl y th e wors t tim e t o d o so , becaus e th e theor y ma y b e o f some us e i n understandin g th e apparen t advance s tha t ar e bein g mad e i n the C G research . I n ligh t o f th e evidenc e o n th e productio n o f substance s similar t o C G b y bacteri a associate d wit h tumors , th e secondary-infectio n theory coul d b e maintaine d b y arguin g tha t C G productio n occur s afte r host-cell gene s ar e switche d o n i n a proces s independen t fro m microbia l pathogens. T h e evidenc e tha t bacteri a culture d fro m cance r tissue s produc e a CG-lik e substance , an d tha t bacteri a independentl y posses s th e gene s t o express th e material , coul d b e answere d b y arguin g tha t tumo r initiatio n begins i n th e host-cel l genom e bu t i t subsequentl y trigger s bacteria l expres sion o f CG-lik e substance s tha t contribut e t o tumo r promotion . A t thi s point, however , th e line s betwee n th e bacterial-etiolog y theor y an d th e secondary-infection theor y hav e becom e blurred . I t i s possibl e tha t th e host-cell genom e an d bacteria l pathogen s ar e both expressing h C G an d C G like substances . I n othe r words , th e controvers y coul d b e settle d b y ac cepting a new , hybri d theory . I suspec t tha t thi s ma y happe n someday , bu t making long-ter m prediction s fo r scienc e an d societ y i s lik e makin g long term prediction s fo r th e weather .

5 Policy Cures : Forgin g a N e w Cancer Agend a

Whatever th e statu s o f cance r a s a disease , i t als o represent s a pressing political problem . I n th e Unite d State s the Nationa l Cance r Insti tute alon e spends about tw o billion dollar s per year on cance r research, an d the overal l annual cos t o f cancer t o th e U.S . economy exceed s $100 billio n (Brown 1990) . Cance r ha s overtake n hear t diseas e a s th e leadin g caus e o f death i n women age d thirty-fiv e t o sixty-four , an d it i s the secon d leadin g cause of death in al l other categorie s excep t men age d fifteen t o thirty-fou r (Davis, Dinse , an d Hoe l 1994a ; Wing , Tong , an d Bolde n 1995 : 18-19) . Although som e wis h t o assig n th e bul k o f the ris k factor s t o smokin g an d diet, ther e i s growin g evidenc e tha t environmenta l carcinogen s pla y a n important role. 1 I f this evidenc e i s correct , the n effort s a t preventio n wil l need t o b e considerabl y mor e complicate d tha n antismokin g an d dietar y campaigns. Som e reformer s hav e therefor e calle d for a restructuring o f th e NCI budge t t o focu s mor e o n preventio n an d environmenta l carcinogen s (Epstein e t al. 1992). Prevention i s certainl y th e ke y t o endin g th e risin g tid e o f cancer . However, fo r th e million s o f peopl e wh o hav e cance r o r kno w someon e who does , preventio n i s no t a viabl e option . Whe n thei r doctor s d o no t give the m goo d chance s fo r surviva l wit h conventiona l therapies , o r whe n the sid e effect s o f conventiona l therapie s begi n t o loo k wors e tha n th e disease, they begin t o explor e alternatives. Discussions o f the refor m o f the National Cance r Institut e budget , an d tha t o f affiliate d privat e organiza tions, therefor e nee d t o focu s no t onl y o n preventio n an d environmenta l carcinogens, but als o on th e evaluatio n o f alternative therapies . Notwithstanding th e lack of official suppor t fo r alternativ e cance r thera pies, th e America n peopl e ar e examinin g an d tryin g alternativ e cance r treatments o n thei r own . Th e decisio n t o see k suc h treatment s i s part o f a larger patter n o f recours e t o medicin e no t sanctione d b y th e medica l profession an d insuranc e providers . Accordin g t o a nationa l surve y pub 156

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lished i n 199 3 i n th e New England Journal of Medicine, mor e tha n 3 4 percen t of the America n peopl e ha d resorte d t o a t least on e unconventiona l therap y in th e previou s year. 2 Estimate s fo r th e us e o f alternativ e therapie s fo r cancer i n th e Unite d State s ru n from 1 0 t o 5 0 percen t o f th e si x t o te n million American s w h o ar e livin g wit h cance r a t an y give n time ; eve n th e conservative estimat e o f 1 0 percen t suggest s th e vas t siz e o f th e p h e n o m e non (McGinni s 1991) . Becaus e user s o f alternativ e medicin e ten d t o b e better educate d tha n th e populatio n a s a whole , i t i s likel y tha t a s th e population become s mor e educate d abou t treatmen t options , cance r pa tients wil l ten d t o us e mor e alternativ e therapies. 3 I t i s als o likel y tha t th e use o f alternativ e therapie s wil l increas e a s stat e an d federa l official s rela x regulatory barrier s tha t hav e mad e som e alternativ e therapie s eithe r difficul t to fin d o r illegal . Elected publi c official s kno w h o w t o coun t votes . Man y ar e awar e tha t a quiet revolutio n ha s bee n goin g o n i n th e publi c s approac h t o medicine . T h e chang e i s no t a temporar y one ; i t reflect s a numbe r o f structura l transformations i n th e societ y an d economy . Demographically , th e popula tion a s a whol e i s aging , bu t ther e i s als o a cohor t effec t a s th e bab y boomers becom e senio r citizens , refus e t o g o gentl y int o th e night , an d promise t o leav e a legac y i n th e "medica l Vietnam " o f th e wa r o n cance r that echoe s thei r legac y i n th e firs t Vietnam. 4 Anothe r facto r behin d th e quiet health-consciousnes s revolutio n i s that ther e i s more information , an d more readil y availabl e information , tha n eve r before . Health-foo d stores , the vitamin-and-supplement s industry , direct-mai l promotions , smal l presses, patient-suppor t groups , an d mass-circulatio n healt h magazine s al l provide read y source s o f informatio n tha t wa s muc h les s accessibl e thirt y years earlier . We b sites , discussio n groups , an d othe r electroni c resource s o n alternative medicin e emerg e ever y month . There i s also a profound chang e i n th e relationshi p betwee n patient s an d doctors tha t probabl y ha s it s roots i n th e women' s healt h movemen t an d th e AIDS movemen t (Treichle r 1991) . However , tha t chang e ha s no w becom e part o f th e genera l culture , particularl y amon g college-educate d patients . Increasingly patient s wor k wit h thei r doctor s o n thei r diseas e a s a team , rather tha n a s servant s w h o passivel y carr y ou t th e doctor s orders . Finally , as immigrant population s hav e become increasingl y diversifie d an d a s ethni c groups hav e becom e mor e self-conscious , som e alternativ e therapie s hav e become popula r a s expression s o f ethni c identity . I n short , th e profoun d social an d demographi c change s tha t underli e th e ne w pluralis m o f th e medical syste m ar e structura l an d long-term . Alternativ e medicines , h o w -

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ever on e define s them , ar e no t a fa d tha t wil l g o away . Rather , the y represent a diversification o f the medical system in which ne w ideas will be sorted out , sifte d through , an d officially sanctione d t o varying degrees. The change s i n publi c consciousnes s ar e increasingl y bein g translate d into publi c policy , ofte n wit h bipartisa n support . Man y importan t change s have already happened, mos t o f them in the 1990s , but man y othe r reform s are necessary. The tw o majo r area s of policy refor m involv e rights o f access and rights to information .

Rights of Access Probably th e mos t importan t are a o f polic y refor m i s a chang e tha t wa s advocated a s long ag o a s the writin g o f th e Constitution , whe n Benjami n Rush i s alleged to have attempted t o ad d freedom o f medical choic e to th e First Amendment. 5 Tw o centurie s later his concern abou t medical freedo m has proven prophetic. Severa l states have approve d legislation tha t allow s all qualified health-car e practitioners to use so-called unconventional therapies, provided tha t th e conditio n i s life threatening , th e treatmen t o r procedur e is no t dangerou s t o th e patient , an d th e practitione r discusse s al l option s with th e patient . A t th e federa l level , th e "Acces s t o Medica l Treatment s Act" (HR-2019 , S-2140 ) woul d provid e doctor s wit h simila r protection s should the y decid e tha t som e unconventional o r controversia l therapie s ar e efficacious an d safe (Sal e 1995). A secon d an d muc h mor e controversia l are a wher e refor m i s needed i s the Foo d an d Dru g Agenc y o f the U.S . government. Th e polic y dilemm a revolves aroun d th e tradeof f betwee n tw o goods : th e publi c s righ t t o medical choice and freedom, an d the state s interest in protecting its citizens from charlatanism , quackery , an d unsaf e products . I n th e Unite d States , a country know n fo r it s emphasi s o n individua l right s an d freedoms , th e tradeoff has for many years been tilted in favor of the state s interest, whereas in othe r countries , suc h a s Germany , ther e ha s bee n greate r toleranc e o f at least som e alternativ e medica l practices . As documente d i n th e monthl y issues o f th e Townsend Letter for Doctors and Patients, th e FDA' s policin g

power ha s ofte n bee n directe d agains t alternativ e health-car e practitioner s and the nutritional-supplements industry , resulting in raids that seem inconsistent wit h genera l democrati c values . Legislation o f the typ e propose d i n the previou s paragrap h represent s on e modes t ste p towar d preventin g th e FDA fro m abusin g it s complianc e powers . However , th e legislatio n i s

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directed mor e towar d doctor s an d health-car e professionals , an d i t woul d not preven t FD A abuse s directe d a t th e nutritional-supplement s industry . Therefore, som e health-car e reformer s hav e suggeste d puttin g curb s o n th e FDA's policin g power. 6 Clearly, i t wil l prov e desirabl e t o retai n som e policin g function s fo r th e FDA i n case s o f a n immediat e publi c dange r pose d b y contaminate d food , drugs, an d supplements . However , legislativ e refor m i s badl y neede d t o restrict th e agency' s enforcemen t powe r t o preven t unwarrante d raid s o f th e clinics o f holisti c doctors , thei r patients , an d supplemen t companies . I n some cases , supplements manufacturer s hav e bee n virtuall y shu t down , hav e had record s an d product s confiscated , an d hav e bee n unabl e t o fin d ou t w h o accuse d the m o f havin g contaminate d products . Instea d o f allowin g the FD A thi s kin d o f Gestapo-lik e power , federa l la w need s t o restric t th e FDA t o recallin g unsaf e products , rathe r tha n bannin g entir e categorie s of product s an d closin g dow n entir e companies . I n turn , supplement s manufacturers nee d t o hav e th e righ t t o kno w w h o ha s accuse d them , an d to b e abl e t o contes t claim s tha t recalle d product s ar e indee d unsafe . Furthermore, i f cour t cost s fro m raid s o f holisti c doctors , patients , an d supplement companie s excee d a specifie d amount , ther e shoul d b e a n automatic trigge r tha t woul d provid e fo r governmen t suppor t o f the defen dants' lega l costs . M u c h o f th e repressio n o f alternativ e medicin e operate s through a wa r o f lega l costs , i n whic h defendant s canno t matc h th e dee p pockets o f governmen t prosecutor s associate d wit h th e FD A o r wit h state level medica l associations . Another majo r regulator y proble m are a involve s th e classificatio n o f vitamins, minerals , herbs , amin o acids , enzymes , an d othe r foo d supple ments. T h e FD A ha s consistentl y trie d t o regulat e foo d supplement s a s drugs o r chemica l foo d additive s rathe r tha n a s foods. I f successful, thi s shif t in classificatio n woul d requir e tha t companie s engag e i n costl y studie s t o prove tha t thei r supplement s ar e saf e an d effective . I n effect , th e transforma tion woul d destro y muc h o f the supplement s industry , probabl y t o th e grea t benefit o f the pharmaceutica l industr y I n 199 4 Congres s passe d th e Dietar y Supplement an d Healt h an d Educatio n Act , bu t thi s ac t i s problematic fo r a number o f reasons , amon g the m th e barrier s betwee n supplemen t compa nies an d healt h claim s (Sal e 1995) . T h e resul t i s th e rathe r bizarr e situatio n in whic h health-foo d store s mus t kee p th e literatur e o n supplement s sepa rate fro m th e supplements , an d consumer s hav e t o sif t throug h comple x literature i n orde r t o find ou t informatio n abou t particula r supplements . T h e basi c component s o f a goo d la w ar e th e following : i t woul d allo w

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food an d supplemen t companie s t o mak e truthful , nonmisleadin g healt h claims abou t thei r products ; i t woul d preven t th e FD A from classifyin g natural foo d product s an d dietar y supplement s a s drugs ; an d i t woul d clarify th e safet y standar d fo r dietar y supplement s t o preven t unreasonabl e interference fro m th e FD A wit h th e public s righ t o f acces s t o supplements . T h e nonmisleadin g claim s claus e shoul d b e worde d t o allo w supplemen t manufacturers t o provid e brochure s wit h thei r product s tha t discus s scien tific researc h tha t the y believ e support s thei r healt h claims . Thi s coul d include, fo r example , discussion s o f th e peer-reviewe d literatur e o n dietar y supplements an d herb s fo r us e i n cance r preventio n an d therapy . Likewise , the safet y standar d need s t o b e clarifie d s o tha t product s ar e no t perma nently banne d base d o n on e o r tw o ba d batches , a s i n th e cas e o f L tryptophan, whic h som e clai m wa s banne d becaus e i t provide d a low-cost , natural alternativ e t o antidepressants . Additional legislatio n ma y be beneficia l t o protec t consumer s o f vitamin s and foo d supplements . I sugges t legislatio n tha t woul d no t merel y allo w but requir e supplement s companie s t o underg o periodi c audit s o f thei r supplements fro m outside , privat e companie s (bu t no t th e FDA ) i n orde r t o ensure tha t th e vitamins , minerals , o r othe r nutritiona l agent s ar e present i n the supplemen t i n th e quantit y claimed . T h e bette r companie s alread y undergo suc h audit s an d mak e the m availabl e t o th e public ; thi s shoul d become industr y standard . Anothe r audi t shoul d demonstrat e tha t supple ment pill s ar e actuall y digeste d rathe r tha n passe d ou t i n th e feces . In additio n t o change s tha t allo w th e supplement s industr y t o mak e truthful healt h claim s fo r supplements , change s i n th e drug-and-devic e approval rule s ar e necessary . Afte r 196 2 dru g manufacturer s wer e require d to prov e bot h safet y an d efficacy . Becaus e th e standard s fo r establishin g efficacy ar e s o onerous , th e curren t cos t o f gettin g dru g approva l throug h the FD A i s estimate d a t on e hundre d t o fiv e hundre d millio n dollars , an d i t takes ove r te n years . T h e resul t i s tha t ne w drug s an d device s nee d t o hav e the suppor t o f companie s tha t expec t t o recuperat e thei r cost s throug h substantial, long-ter m futur e profits . Eve n fo r th e majo r pharmaceutica l companies, th e approva l proces s seem s Byzantine , an d the y hav e give n substantial fund s t o conservativ e thin k tank s tha t hav e produce d studie s i n favor o f simplifying th e proces s an d makin g i t les s costl y (Drinkar d 1996) . T h e situatio n i s eve n mor e difficul t fo r man y o f th e alternativ e cance r therapies tha t rel y o n vitamins , herbs , bacteria l vaccines , o r othe r natura l and/or nonpatentabl e products . Product s tha t canno t b e patente d ar e poo r candidates fo r privat e research , becaus e th e fund s necessar y t o inves t fo r

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approval o f thei r us e a s drug s canno t b e recuperate d late r i n futur e profits . T h e FD A approva l proces s ha s becom e a classi c cas e o f a barrier t o entr y i n an oligopolisti c market . T h e researc h tha t woul d allo w natura l o r nonpat entable product s t o pas s throug h th e FD A drug-approva l proces s i s no t getting don e becaus e ther e i s n o profi t incentive . If , fo r example , on e company wer e t o inves t severa l hundre d millio n dollar s t o ge t a natura l substance approve d a s a cance r drug , al l othe r companie s woul d benefi t a s free riders . Several suggestion s hav e bee n mad e t o remed y thi s glarin g proble m in th e drug-and-devic e approva l process . Wherea s som e reformer s hav e advocated abolishin g th e efficac y requiremen t completely , other s sugges t reducing i t dramatically . I n testimon y befor e th e Subcommitte e o n Govern ment Oversigh t o f th e Hous e Commerc e Committee , attorne y Richar d Jaffe suggeste d tha t "th e leve l o f amoun t o f proo f neede d t o establis h th e efficacy o f th e dru g o r devic e shoul d b e directl y relate d t o th e produc t s safety" (Jaff e 1995 : 16) . I n othe r words , product s wit h lo w demonstrate d side effect s an d hig h safet y shoul d no t hav e t o pas s th e sam e efficac y requirements a s drug s an d device s tha t hav e hig h risk s an d sid e effects . Additional criteri a fo r lowerin g th e barrie r t o entr y coul d includ e muc h lower efficac y standard s i f th e substanc e i s bein g use d fo r chroni c disease s and i f there ar e n o prove n cure s fo r th e diseas e (a s in th e cas e o f cancer). 7 A reasonable lo w efficac y standar d i n thi s situatio n woul d b e a saf e produc t that demonstrate s apparen t efficac y i n relate d disease s o r anima l experi ments. B y thi s standard , a competen t physicia n coul d introduc e a saf e therapy int o a treatmen t progra m fo r a patien t wit h cance r o r anothe r chronic disease . O n e ste p i n th e righ t directio n i s tha t i n 199 6 th e FD A shortened approva l period s fo r cance r drugs . However , althoug h th e changes ma y b e helpfu l fo r th e pharmaceutica l industry , the y d o no t mee t the proble m o f regulatory barrier s agains t nonpatentabl e products . Medical write r R o b e r t Housto n ha s propose d additiona l polic y change s for th e regulator y process . H e ha s argue d tha t th e FDA' s recor d o n uncon ventional cance r therapie s reveal s s o muc h negativis m an d obstructio n tha t it ma y b e necessar y t o establis h " a separat e agency , wit h authorit y t o overrule th e FDA , t o asses s th e safet y an d efficac y potentia l o f alternativ e therapies, orpha n drugs , an d unpatentabl e natura l agent s outsid e o f th e expensive I N D / N D A procedure s o f th e FDA " (1989 : 51) . Althoug h thi s proposal ma y no t b e ver y welcom e i n a budgetary climat e tha t ha s focuse d on eHminatin g agencies , i t i s feasibl e an d relativel y inexpensiv e t o hav e some sor t o f externa l appea l proces s fo r FD A rulings , suc h a s a jur y o f

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relatively neutra l peer s (wit h selectio n procedure s simila r t o thos e o f othe r juries tha t allo w bot h side s t o exclud e apparentl y biase d jurors) . Further more, Houston' s secon d proposa l woul d als o b e relativel y inexpensive : "automatic demotio n an d possibl e crimina l penaltie s ma y b e impose d o n government personne l w h o knowingl y o r prejudiciall y misrepresen t o r mistreat alternativ e therapie s o r thei r proponents " (1989 : 51) . Finally, acces s issue s ar e severel y restricte d b y privat e insuranc e compa nies a s wel l a s government-sponsore d healt h insurance . Al l ar e concerne d with cuttin g skyrocketin g medica l costs . Yet, privat e companie s hav e histor ically provide d littl e insuranc e suppor t fo r alternativ e therapie s tha t ar e les s costly an d potentiall y efficacious . Ther e i s enoug h evidenc e o f efficac y fo r some alternativ e cance r treatment s t o warran t preliminar y suppor t fro m insurance companies , pendin g outcome s analyses . A standard , three-wee k treatment i n mos t o f th e Tijuan a cance r clinic s i n 199 5 ra n abou t fiv e thousand dollar s pe r week ; thi s i s les s expensiv e tha n a standar d cours e o f chemotherapy an d radiatio n fo r man y patients . M u c h les s controversia l ar e the variou s exercise , diet , an d stres s reductio n plan s fo r hear t disease . I n a few case s som e privat e insuranc e companie s hav e alread y realize d th e bene fits o f allowin g patient s t o us e som e alternativ e therapie s tha t mee t profi t criteria o f lowe r cost s an d som e efficacy . Thes e criteri a ar e usuall y me t i n cases o f chroni c diseas e wher e patient s an d companie s ar e no t happ y wit h success rate s an d cost s o f standar d treatment s (Cowle y 1995) . By th e mid-1990 s competitiv e force s wer e drivin g som e healt h mainte nance organization s int o offerin g plan s that provid e variou s type s o f alterna tive medica l coverage , an d i t i s likel y tha t marke t force s wil l continu e t o force th e expansio n o f coverag e o f alternativ e therapies . Legislator s coul d speed thi s proces s alon g an d simultaneousl y lowe r healt h car e cost s b y building i n a n optio n fo r patient s o n government-sponsore d healt h insur ance t o pursu e a t leas t som e alternativ e therapie s tha t ar e safe , o f equivalen t or lowe r cost , an d potentiall y efficacious . B y leadin g th e way , government sponsored plan s an d outcome s analyse s woul d provid e a mode l fo r privat e insurance companie s t o follow , and , i n th e process , cost s o f th e federa l an d state programs coul d b e slashe d considerabl y withou t encounterin g taxpaye r anger. Clearly , thes e change s wil l no t involv e blanke t acceptanc e o f al l alternative therapies . Specifi c decision s woul d hav e t o b e mad e pendin g cost-benefit analyse s tha t tak e int o accoun t safety , cost , an d outcom e i n comparison wit h standar d therapie s fo r th e particula r disease . However , there i s evidenc e tha t a t leas t som e o f th e alternativ e cancer-therap y proto -

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cols hav e equivalen t mea n surviva l tim e an d lowe r cos t tha n conventiona l therapies (e.g. , Hildenbran d e t al . 1995) . I t i s likel y tha t thes e pattern s would exten d t o othe r chroni c diseases , particularl y arthritis , hear t disease , and AIDS .

Rights to Research Information A mor e complicate d are a o f polic y interventio n involve s medica l researc h priorities. I n additio n t o providin g th e publi c wit h greate r acces s to a wide r range o f medical-treatmen t options , a reforme d medica l polic y als o need s to provid e th e publi c wit h bette r guidanc e o n efficacy . Statistic s fo r 199 0 indicate tha t th e America n peopl e spen t ove r te n billio n dollar s fo r alterna tive medica l care , roughl y equivalen t t o thei r out-of-pocke t expens e fo r hospital bill s (Eisenber g e t al . 1993) . I t i s reasonabl e t o assum e tha t the y would shif t mor e financia l resource s t o alternativ e medica l car e i f the y ha d more informatio n an d mor e insuranc e support . I f the y ha d mor e informa tion, the y woul d probabl y als o spen d th e mone y mor e wisel y b y makin g better decision s abou t relativ e efficac y amon g alternativ e therapies . Give n the fac t tha t th e America n peopl e ar e spendin g mone y o n alternativ e medical care , an d lot s o f i t — w i t h o r withou t insuranc e support , an d wit h or withou t th e sanctio n o f th e medica l professio n o r governmen t agen cies—the ke y questio n seem s t o b e h o w t o provid e u s with informatio n s o that w e ca n mak e decision s wisely . O n e proble m i n gettin g th e accurat e informatio n t o th e publi c i s th e revolving doo r o f funding amon g th e N C I , th e ACS , an d th e majo r cance r research an d treatmen t centers . Economist s Jame s Bennet t an d Thoma s DiLorenzo hav e show n ho w th e researc h institution s represente d b y th e American Cance r Society' s boar d o f director s als o receiv e a large portio n o f the grant s give n b y th e organization. 8 Followin g alternative-cancer-therap y researcher Ralp h Mos s (1989) , the y poin t t o th e interloc k o f ACS an d N C I personnel o n man y committees . Bennet t an d DiLorenz o als o not e tha t even thoug h th e AC S budge t i s muc h smalle r tha n tha t o f th e N C I , "th e ACS tai l is wagging th e N C I dog. " (1994 : 170) . I n general , th e peer-revie w system tend s t o preclud e innovator s an d t o maintai n th e circulatio n o f grants an d researc h achievement s amon g a relatively smal l grou p o f people . Bennett an d DiLorenz o advocat e sunshin e law s fo r larg e charitie s a s a ste p toward openin g u p th e entir e proces s o f researc h an d educatio n t o publi c

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accountability. Thei r proposa l i s a n importan t piec e o f th e puzzl e becaus e the publi c need s t o hav e mor e acces s t o informatio n o n h o w researc h an d funding agenda s ar e bein g set . However , mor e reform s ar e als o necessary . A mor e direc t for m o f interventio n i n agenda-settin g wa s th e Congres sionally mandate d creatio n o f th e Offic e o f Alternativ e Medicin e withi n the Offic e o f th e Directo r o f th e Nationa l Institute s o f Health . N o t w i t h standing th e goo d intention s behin d thi s move , th e budge t fo r 199 6 wa s se t at unde r te n millio n dollar s ou t o f a quarte r o f a billio n dollar s fo r th e Office o f th e Directo r an d twelv e billio n dollar s fo r th e N I H a s a whole . T h e publi c i s goin g t o continu e t o us e alternativ e therapie s n o matte r wha t the N I H does . However , withou t guidanc e i n th e for m o f a large quantit y of well-designe d research , th e publi c i s force d t o mak e it s decision s base d on anecdota l information , patien t referrals , an d bes t cas e reviews . W h e n I toured th e alternative-cancer-therap y clinic s an d hospital s i n Tijuana , I wa s impressed b y th e lac k o f statistica l informatio n o n outcomes . Som e ha d a track recor d o f thousand s o f patients , bu t the y wer e unwillin g o r unabl e t o provide potentia l patients/consumer s wit h clea r statistics . O f th e clinic s an d hospitals tha t I visited , onl y th e on e affiliate d wit h th e Gerso n Researc h Organization ha d a published , peer-reviewed , quantitativ e analysi s o f out comes, an d th e Contrera s hospita l wa s th e onl y othe r institutio n I visite d that offere d a writte n evaluatio n o f outcomes . T h e publi c badl y need s controlled, clinica l trial s tha t ar e designe d t o provid e a fai r tes t o f th e strengths an d weaknesse s o f alternativ e cance r therapies . I n addition , ther e needs t o b e a n immediat e analysi s o f th e outcome s o f alternativ e cance r treatment b y th e retrospectiv e analysi s o f existin g collection s o f patien t records. In orde r t o achiev e thi s leve l o f evaluation , th e nationa l cance r polic y would hav e t o g o wel l beyon d th e drop-in-the-bucke t fundin g leve l fo r th e Office o f Alternativ e Medicine . A drasti c overhau l i s neede d b y whic h Congress mandate s muc h mor e mone y fo r cance r preventio n an d fo r th e evaluation o f alternativ e therapies . Give n th e fac t tha t th e curren t spendin g of ove r tw o billio n dollar s a year ha s bee n correlate d wit h increasin g cance r rates an d fe w improvement s i n surviva l rates , i t i s tim e t o overhau l th e budget completel y an d dedicat e th e bul k o f i t (sa y one-thir d each ) t o prevention an d testin g o f alternativ e therapie s (wit h th e othe r thir d re maining t o suppor t ongoin g conventiona l projects) . O n e migh t argu e tha t approximately one-thir d o f the N C I budge t i s already dedicate d t o "preven tion," bu t a s historia n R o b e r t Procto r demonstrate s muc h o f th e spendin g takes th e for m o f "chemoprevention, " tha t is , trial s o f th e effectivenes s o f

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chemotherapy a s a preventiv e measur e (1995 : 267) . Thus , legislatio n need s to redefin e preventio n t o includ e publi c educatio n programs . Furthermore , legislation i s als o neede d t o reorien t researc h prioritie s awa y fro m basi c research towar d clinica l studies . A ste p i n thi s directio n i s Senato r Mar k Hatfield's propose d Clinica l Researc h Enhancemen t Act , whic h woul d modify th e focu s o f th e N I H towar d clinica l researc h proposal s an d poten tially ope n door s towar d testin g alternativ e therapies . Thi s kin d o f proposa l needs t o b e mad e mor e specifi c fo r th e N C I , s o tha t a t leas t a thir d o f th e budget i s devote d t o testin g th e majo r nutritiona l an d metaboli c therapie s that th e publi c i s alread y using , wit h o r withou t guidanc e fro m th e cance r establishment. Reallocation o f a substantia l par t o f th e budge t o f th e N C I fo r primar y prevention an d testin g alternativ e therapie s woul d b e a n importan t ste p toward endin g th e wa r o n cancer , bu t anothe r proble m woul d hav e t o b e solved i n orde r fo r th e fundin g t o b e successful . T h e grea t proble m wit h controlled, clinica l studie s o f alternativ e cance r therapie s i s tha t ther e i s a history o f mistrus t base d o n suspicion s o f bias . Fo r example , w h e n publi c pressure finall y le d t o clinica l trial s o f laetril e i n 1980 , cance r activist s became mistrustfu l becaus e thei r offe r t o provid e laetril e wa s no t accepted . To thi s da y man y believ e tha t rea l laetril e wa s neve r tested. 9 Likewise , wit h the Vitami n C trial s Linu s Paulin g foun d a numbe r o f majo r desig n flaw s in bot h th e first an d secon d May o Clini c studies . T h e flaw s include d discontinuation o f th e vitami n a t an y sig n o f worsenin g (thu s provokin g a rebound effect) , a departure fro m th e origina l protoco l b y reducin g media n time o f Vitamin C administratio n t o te n weeks , an d evidenc e tha t member s of th e contro l grou p wer e surreptitiousl y takin g Vitami n C. 1 0 Simila r problems an d mistrus t hav e surrounde d th e hydrazine-sulfat e trial s o f th e early 1990s. 11 A ke y issu e i s the choic e o f institutions a s hosts fo r controlle d trials. Regardin g th e subsequent , simila r controvers y ove r th e antineoplas ton trials , Mos s commented : The NC I an d OA M bot h faile d t o recogniz e tha t thes e institution s repre sented th e enemie s o f alternativ e medicine . . . . We sa w thi s wit h laetril e a t Sloan Kettering, we saw this again with hydrazin e sulfate , an d we sa w it wit h the May o Clini c i n thei r flawed test s o f Vitamin C . I a m no t surprise d tha t Memorial didn' t follo w th e Burzynski protocol. I t was predictable. 12 In th e clinica l trial s o f alternative cance r therapies , testin g passe s t o majo r research centers , wher e desig n decision s ar e mad e withou t consultatio n with th e origina l advocates . Change s i n desig n ar e made , an d the n late r i t

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is announce d tha t th e trial s fail . W h e n th e desig n change s becom e known , questions ar e raise d abou t th e intentio n behin d th e desig n changes . Give n the lon g histor y o f suppression , o f whic h I hav e outline d onl y a smal l portion i n thi s book , th e question s o f inten t an d charge s o f cover-u p ar e not necessaril y paranoi d o r misguided . T h e en d resul t i s tha t alternativ e medicine advocate s rejec t th e faile d trial s a s biased , an d th e hug e publi c expenditures fo r clinica l trial s onl y fue l th e controvers y rathe r tha n resolv e it. Th e trial s resul t i n n o meaningfu l separatio n o f effectiv e fro m ineffectiv e therapies, bu t onl y a greate r ga p o f mistrus t betwee n bot h sides . I n short , there i s polarization rathe r tha n approximation . Can anythin g b e don e t o avoi d thi s problem ? O n e possibilit y i s t o mov e public fundin g o f multicente r trial s int o institutiona l location s wher e ther e is n o eviden t bia s agains t alternativ e medicine . Som e o f th e OAM-funde d projects represen t a move i n thi s direction . However , multicente r studie s o f alternative cance r therapie s don e outsid e th e cance r establishmen t woul d probably provok e mistrus t fro m tha t establishment . Thus , multicente r trial s of alternativ e cance r therapie s ma y nee d t o includ e som e establishe d medi cal center s a s well , althoug h mayb e no t som e o f th e mor e mistruste d institutions. T h e differenc e o f whethe r a n establishmen t o r a nonestablish ment sit e i s use d migh t eve n b e analyze d statisticall y a s on e variabl e i n th e experimental design . More important , alternative-cancer-therap y activist s hav e suggeste d a n additional wa y t o remed y th e proble m o f bias i n gold-standar d tests : legisla tive mandate s woul d stipulat e tha t qualifie d advocate s o f alternativ e thera pies pla y a key rol e a s coprincipal investigator s a t th e desig n stag e o f clinica l trials. I f the advocate s hav e th e powe r t o approv e th e desig n protoco l prio r to it s initiation , the y woul d b e i n a wea k positio n t o cr y fou l b y makin g post ho c analyse s o f desig n flaws i n th e even t o f a failed trial . Conversely , i f an individua l sit e change d th e protoco l withou t th e advic e an d consen t o f the coprincipa l investigator , i t woul d b e muc h mor e eviden t an d reprehen sible. Involvemen t a t th e desig n stag e coul d als o preven t th e intentiona l o r unintentional introductio n o f artifacts . I n short , bot h side s woul d benefit . Furthermore, th e taxpayer s woul d no t wast e thei r mone y o n hug e clinica l studies tha t en d u p bein g mistruste d becaus e o f potential flaws i n th e desig n that onl y com e t o ligh t afte r th e protocol s ar e reveale d an d th e studie s ar e completed. To tur n thi s ide a int o practice , Congres s need s t o mandat e tha t multicenter universit y trial s o f alternativ e cance r therapie s includ e i ) som e sites wher e th e institution s ar e know n t o b e friendl y t o alternativ e medi -

Policy Cures | 16 7 cine; an d 2 ) coprincipal-investigato r statu s fo r th e majo r advocat e o f th e alternative therap y tha t i s bein g tested . T h e coprincipa l investigato r woul d have th e righ t t o approv e protocol s an d protoco l changes . I n addition , i t may b e necessar y t o se t u p a protoco l revie w boar d t o provid e fo r a mechanism o f adjudicatio n shoul d dispute s aris e amon g coprincipa l investi gators. Thi s boar d coul d b e a separat e entit y o r a functio n o f th e O A M advisory board . T h e policymakin g proces s coul d b e furthe r democratize d b y backin g u p any board s tha t overse e alternativ e medicin e researc h wit h a secon d for m of publi c inpu t int o th e researc h process . A s discusse d b y ST S analys t Richard Sclov e (1995 , 1996 ) o f th e Lok a Institute , severa l Europea n coun tries ar e no w followin g th e Danis h mode l o f citizen-revie w panel s fo r policy decision s i n area s involvin g scientifi c an d technica l controversies . This proposa l goe s beyon d th e ide a o f a "reasonabl e center " o f expert s o n an advisor y boar d t o a la y revie w boar d compose d o f ordinar y citizens . These citizens—perhap s i n thi s cas e cance r patient s w h o hav e use d alterna tive therapies—mee t a t governmen t expens e i n a forum simila r t o tha t o f a jury. Ove r a perio d o f severa l month s the y revie w researc h an d fundin g decisions o n a particula r therapy , an d the y issu e a repor t wit h polic y recommendations. W h a t kind s o f alternativ e therapie s shoul d b e teste d i n a reformed worl d in whic h ther e i s a vastl y expande d O A M budge t wit h a clea r legislativ e mandate t o evaluat e alternativ e cance r therapies ? Conside r fo r a m o m e n t why I hav e examine d i n thi s boo k th e bacterial-etiolog y theory . Prio r t o this stud y I hav e spen t year s studyin g alternativ e science s an d medicine s i n Brazil an d th e Unite d States . Mos t o f wha t I sa w I conside r ver y unscien tific. I would no t cal l i t quacker y o r frau d because , fo r example , th e healer s I studie d i n Brazi l wer e generall y religiou s peopl e w h o sincerel y believe d in wha t the y wer e doing . However , I remai n doubtfu l o f claim s o f efficac y for ailment s othe r tha n mil d psychologica l disorder s tha t wer e ofte n inter preted a s spiritua l ailment s an d fo r whic h th e spiritua l idio m sometime s served a s a successful translatio n o f psychological problems . In contrast , th e bacterial-etiolog y t h e o r y — a t leas t i n th e modifie d for m that I presente d i n th e previou s chapter—ha s t o it s credi t a bod y o f scientific an d medica l publications , man y i n peer-reviewe d journals . T o repeat, th e theor y a s I hav e modifie d i t doe s no t clai m tha t bacteri a caus e cancer, bu t onl y tha t bacteri a pla y a n overlooke d etiologica l rol e i n som e human cancer s an d tha t recognizin g thi s rol e migh t hel p researcher s t o make bette r decision s fo r th e testin g o f bacterial vaccines , choriogonadotro -

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pin (CG ) vaccines , an d antibiotic s i n cance r therapy . A s discusse d i n th e previous chapter , th e rapi d change s o f medica l consensu s o n ulcers—an d more recently , a possibl e chang e o n arthritis—sugges t tha t bacteri a ma y have been too quickl y rejected a s etiological agents in chronic, degenerativ e disease (Marshal l e t al . 1988 , 1994) . I t seem s appropriat e t o dedicat e mor e of th e taxpayers ' mone y t o researc h o n bacteri a an d chroni c diseas e i n general a s wel l a s th e possibl e lin k wit h cance r i n particular . Certainl y experiments t o tes t Koch' s postulate s wit h CG-like-producin g bacteri a would b e i n order , an d additiona l evaluatio n o f the Glove r serum , Living ston vaccines , Coley' s toxins , an d othe r bacteria l vaccine s see m wort h th e public investment. By additional evaluation I mean both attempts to analyze how thes e therapie s migh t work—either guide d by the bacterial theor y o r by othe r theorie s suc h a s the cascad e o f cytokines theory—an d to . test th e extent t o which the y d o i n fact wor k i n human populations . Furthermore , any researc h o n CG , eithe r guide d b y th e bacteria l theor y o r not , shoul d be supported . I hav e used th e cas e of bacteria an d cance r merel y a s an exempla r an d a case study . I t shoul d b e clea r tha t althoug h I thin k th e bacteria l theor y warrants some limited taxpayer funding from th e twelve-billion-dollar NI H budget (on e percen t migh t b e a goo d startin g point) , thi s dedicatio n o f public funds shoul d happen alongside a larger allocation of funds t o evaluat e a numbe r o f othe r alternativ e cance r therapies . Th e grea t proble m i n budgeting is that ther e ar e many alternativ e therapie s an d alternativ e medi cal theorie s i n circulation , an d i t woul d b e a ridiculou s wast e o f taxpaye r dollars t o tes t the m all . Som e criteri a ar e neede d t o separat e th e mor e credible fro m th e les s credibl e alternativ e therapies . I n thi s boo k I hav e suggested a combinatio n o f consistency , accuracy , pragmati c /efficacy, an d low-social-bias criteri a a s a means fo r evaluatin g a n alternativ e theor y an d therapy. To mak e th e firs t cu t i n a huge worl d o f alternative therapies , I sugges t that a good wa y t o distinguis h therapie s tha t ar e wort h investigatin g from those tha t ar e not i s a general accurac y an d consistenc y criterio n tha t I call the "credibl e biological mechanism" test , provided tha t it is combined wit h a pragmatic criterio n o f some clinical evidence for efficac y an d nontoxicity . If advocates o f a therapy for cance r ca n provide a rationale an d a modicum of evidenc e t o suppor t a theor y tha t a credibl e biologica l mechanis m i s involved, an d i f the y ca n poin t t o som e clinica l evidenc e tha t th e therap y has som e efficac y an d safet y i n huma n populations , the n th e therap y i s worth investigating . Th e mechanis m doe s not hav e to be proven t o be tru e

Policy Cures | 16 9 (as in th e bacterial-etiolog y theor y an d th e propose d C G mechanism) , an d the efficac y doe s no t hav e t o b e demonstrate d i n mor e tha n cas e histories , because th e goa l i s t o provid e researc h mone y t o evaluat e th e therapy . However, th e propose d mechanis m o f actio n shoul d b e withi n th e real m o f possibility give n curren t biomedica l knowledge , an d ther e shoul d b e a t leas t some soli d cas e historie s t o indicat e som e promis e fo r clinica l efficacy . T h e theorie s an d therapie s that , i n m y opinion , woul d mee t a sufficientl y credible biological-mechanis m tes t an d preliminar y clinical-efficac y tes t generally fal l int o th e overlappin g categorie s o f immunological, nutritional , herbal, an d metabolic . I n th e are a o f alternativ e cance r therapies , a partia l list include s bacteria l vaccines , som e alternativ e pharmacologi c substance s used i n immunotherap y (e.g. , antineoplaston s an d immunoaugmentativ e therapy), large-dos e dietar y supplement s (vitamins , minerals , amygdalin , enzymes, an d fatt y acids) , adjuvan t psychotherapie s wit h measurabl e psy choneuroimmunological markers , th e Gerso n die t an d relate d diet s tha t ca n propose a credibl e biochemica l rational e (suc h a s therapeuti c potassium sodium balances) , an d som e herb s tha t contai n know n antitumo r factor s and hav e a lon g clinica l record . Advocate s o f thes e categorie s o f therapie s generally ca n provide a sufficiently specifi c an d credibl e biologica l rationale , and the y provid e som e cas e studie s tha t poin t t o potentia l clinica l efficacy . (Some hav e gon e eve n furthe r t o quantitativ e cas e review s an d outcome s analyses, a s in th e cas e o f Coley s toxin s an d th e Gerso n therapy. ) Therefore , in m y opinion , thes e therapie s warran t dedicatio n o f sufficient publi c fund s for testin g an d evaluation , an d th e testin g need s t o b e conducte d accordin g to th e guideline s o f fairness describe d abov e (suc h a s coprincipal-investiga tor status , sit e selectio n t o reduc e bias , etc.) . T h e propose d biologica l mechanisms o f thes e therapie s ar e no t necessaril y wha t th e nex t century' s scientists an d patient s wil l accep t a s true, bu t th e advocate s o f these therapie s can propos e a rationale tha t i s sufficiently credibl e t o b e withi n th e real m o f possibility. T o bolste r thi s point , i t i s wort h notin g tha t cance r researcher s are alread y movin g i n thi s direction . Som e o f th e nutritiona l therapie s ar e likely t o becom e integrate d int o conventiona l cance r treatmen t a s valuabl e adjuvant therapies. 13 However , evaluatio n need s t o conside r thei r claim s t o efficacy a s primary therapie s a s well. According t o thi s perspective , som e alternativ e therapie s woul d no t warrant investigatio n a t th e presen t time , a t leas t a s preliminar y candidate s for funding . I woul d classif y i n thi s grou p thos e therapie s fo r whic h a credible biologica l mechanis m i s absent . Example s includ e praye r an d psy chic healing , homeopathy , dietary/nutritional/metaboli c approache s with -

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out a credible biologica l rational e o r a record o f good cas e studies demon strating clinica l efficacy, an d therapies for whic h th e rational e i s a theory o f subtle energie s no t i n agreemen t wit h curren t physica l knowledg e (ofte n non-Western i n origin , suc h a s Reik i therapy). 14 I woul d no t labe l thi s group quac k therapies; many of the advocates have noble intentions, do no t make unwarrante d claims , an d hav e produce d som e case s o f anecdotal , anomalous recoverie s t o suppor t thei r claims . However , taxpaye r dollar s should no t b e expende d base d o n vagu e promise s whe n ther e ar e man y other orphane d therapie s tha t hav e a muc h stronge r basi s o f scientifi c support. Th e therapie s tha t lac k suc h suppor t shoul d b e relegate d t o th e domain o f privat e fundin g unti l the y amas s a larg e bod y o f evidenc e fo r efficacy o r the y ca n propos e a sufficientl y credibl e biologica l mechanism . Given limite d resources , taxpaye r dollar s shoul d g o t o th e categorie s o f alternative therapie s tha t ca n mee t th e standar d o f the credibl e biological mechanism test and show some potential for clinica l efficacy. Thi s standard , like al l legal standards , canno t b e reduce d t o a n algorithm . I t will hav e t o be articulated in general terms and elaborated ove r the course of time across specific case s that clarif y th e criteri a via precedents (a s in cas e law). Legislative mandat e need s t o encod e thi s standar d b y specifi c referenc e t o th e types of therapies described above, in order to prevent government agencie s from reinterpretin g the test in such a way as to continue to exclude research on alternativ e cance r therapies. Skeptics ma y oppos e thes e proposal s a s a tremendous wast e o f taxpaye r dollars, but this economic argumen t is misleading. If skeptics turn ou t t o b e right, an d i f th e majo r alternativ e therapie s mentione d abov e a s passing a minimal pre-evaluatio n tes t al l tur n ou t t o b e inefficacious , the n cance r victims an d thei r friend s wil l hav e bette r informatio n tha t wil l hel p the m to avoi d makin g ba d financia l an d health-car e decisions . A s a result , a potential drai n o n th e econom y muc h large r tha n th e cos t o f testin g th e therapies wil l b e ende d wit h a relativel y modes t investmen t o f taxpaye r dollars.

Conclusions By proposin g a majo r legislativ e interventio n int o th e cance r researc h agenda, I am assuming that research agendas have become to o important t o be lef t t o th e scientist s an d doctors . Althoug h a degre e o f autonom y i s always necessar y an d eve n desirable , an d certainl y th e inpu t o f the expert s

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is necessary , medica l researc h i s als o abou t patient s an d thei r right s a s citizens. Furthermore , biomedica l researc h an d it s regulator y apparat i ar e far fro m autonomous ; rather , muc h o f it i s shape d b y professional , pharma ceutical, an d othe r financia l interests . Thus , ther e i s a legitimat e publi c interest i n democratizin g th e proces s fo r establishin g genera l researc h agendas i n man y area s o f science , technology , an d medicine . Thi s interes t i s especially pressin g give n th e epidemi c o f cance r an d th e failur e o f curren t research agenda s t o sto p th e dying . O n e wa y o f shiftin g mor e contro l o f th e agenda-settin g proces s t o th e public i s by legislativel y mandatin g specifi c researc h program s o r agendas . A meager star t occurre d wit h th e creatio n o f th e ver y poorl y funde d O A M . However, tha t proces s need s t o b e carrie d forwar d b y a numbe r o f addi tional reforms : provide sunshin e law s for larg e public healt h charitie s (wit h large define d so tha t th e law s themselve s d o no t constitut e a barrie r t o entr y fo r th e smaller, alternativ e nonprofi t organization s suc h a s the Cance r Contro l So ciety); mandate a majo r chang e i n publi c fundin g o f cance r researc h s o tha t a large portio n o f th e budge t i s dedicate d t o th e evaluatio n o f nontoxi c an d alternative therapie s an d t o meaningfu l preventio n (no t trial s o f preventiv e chemotherapy); provide a mechanism suc h a s coprincipal-investigator statu s s o tha t advo cates o f alternativ e medicin e ca n participat e i n th e desig n o f large trial s an d be able to overrul e change s in design that introduce negativ e bias; mandate multicente r trial s o f alternativ e therapie s tha t includ e organiza tions known t o be nonhostile t o alternativ e therapies ; provide fo r a protoco l revie w boar d (o r a bindin g arbitratio n powe r for th e advisor y board ) fo r dispute s amon g coprincipa l investigator s ove r protocol; mandate occasiona l citizen-revie w panel s t o serv e a s lay public juries tha t evaluate fundin g decision s o n alternativ e medicin e research , protoco l revie w board decisions , and appointments t o the review board(s); specify criteri a tha t prioritiz e alternativ e therapie s tha t warran t taxpaye r support versu s thos e tha t d o no t (suc h a s my propose d credibl e biological mechanism tes t and clinical efficacy tes t based on cas e studies). T h e change s tha t I a m proposin g ca n b e achieve d wit h littl e o r n o cos t to taxpayers , becaus e I a m suggestin g a way o f reallocatin g existin g medica l research budget s rathe r tha n spendin g mor e money . Furthermore , i t i s likely that a significant reorientatio n i n budgetar y prioritie s fo r researc h o n cance r (and perhap s othe r chroni c disease s suc h a s hear t diseas e an d arthritis )

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could resul t i n significan t long-ter m saving s t o th e nationa l econom y an d government health-car e budget . Give n th e impendin g demographi c explo sion o f bab y boomer s w h o wil l becom e senio r citizens , an d th e continue d increase i n cance r rates , suc h a low-cos t investmen t strateg y coul d hav e a huge an d beneficia l payof f i n futur e Medicar e costs . In additio n t o th e specifi c se t o f recommendation s fo r th e researc h process, stat e an d federa l legislator s nee d t o debat e a number o f other majo r proposals tha t coul d significantl y alte r th e shap e o f healt h car e an d right s t o medical acces s i n thi s country . Amon g th e proposal s tha t shoul d b e debate d are th e following : allow al l qualifie d healt h car e practitioner s t o us e so-calle d unconven tional therapies provided that the conditio n is life-threatening o r chronic, th e treatment o r procedur e i s not dangerou s t o th e patient , an d th e practitione r discusses all options with th e patient ( a proposal now unde r consideration) ; end the ability of federal regulatory agencie s to raid the businesses, homes, and clinic s o f peopl e wh o prescribe , use , manufacture , o r sel l medica l o r nutritional product s associate d wit h th e holisti c healt h movement , an d re strict th e regulator y power s t o recall s o f specifi c product s tha t pos e a clea r and present dange r to th e public; provide fo r th e federa l paymen t o f cour t cost s o f the defendant s o f FD A raids if the cost s exceed a set amount ; continue th e classificatio n o f vitamins, minerals , herbs , amin o acids , en zymes, an d othe r foo d supplement s a s food rathe r tha n drugs , bu t allo w th e producers t o mak e tru e healt h claim s with substantiatio n fro m th e scientifi c literature an d requir e tha t producer s underg o periodi c audit s fro m privat e companies t o ensur e tha t th e nutritiona l agent s claime d t o b e i n th e supple ments ar e actually there in the proper quantity ; lower drug-and-devic e approva l regulator y barrier s accordin g t o th e Jaffe principle tha t relates level of proof needed t o establis h efficac y o f the dru g o r device t o th e product' s safety , bu t tha t als o lower s th e leve l o f evidenc e fo r efficacy require d for chroni c disease s with n o known cur e such as cancer an d arthritis; provide a fai r appea l proces s fo r advocate s o f unconventiona l drug s an d devices wh o believ e the y ar e facin g obstructio n i n th e FD A regulator y approval process; provide penaltie s fo r regulator y official s wh o knowingl y o r prejudiciall y misrepresent advocate s o f alternative therapie s o r th e therapie s themselve s o r obstruct fair applicatio n o f regulatory procedures ; reorient Medicar e an d Medicai d fundin g t o allo w reimbursemen t fo r alternative therapie s judged t o b e o f equivalen t o r bette r efficacy , safety , o r cost to standar d therapies.

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The propose d change s would resul t in minimal o r no increase d cost s to th e government, an d som e o f th e proposal s coul d resul t i n significan t cos t savings. In general, however, ther e is an overall savings to the economy tha t is incurred b y allowing consumer s t o hav e acces s to mor e informatio n an d more resources so that they ca n make better decisions . The wa r o n cance r ha s earned th e nicknam e o f the "medica l Vietnam. " Scientists hav e becom e los t an d defeate d i n th e jungles o f basi c research , and patients listen onl y to th e hollow an d receding promise tha t a cure is at hand. I t i s tim e t o declar e a n en d t o th e wa r o n cance r (an d t o th e masculine metaphors) , t o brin g hom e th e me n an d wome n fro m th e research front s tha t hav e led nowhere , an d t o pu t the m t o wor k o n mean ingful preventio n an d o n testin g th e alternativ e therapie s tha t th e publi c i s already using.

6 Appendix The New Science Studies

In th e pas t i t ha s bee n c o m m o n fo r socia l scientist s t o adop t a neutral stanc e towar d competin g claim s i n scientifi c controversies . T h e social scientis t s role wa s t o examin e th e socia l dynamic s o f controversie s i n a wa y tha t scrupulousl y avoide d takin g sides . T h e polic y implication s o f such studies , t o th e exten t tha t ther e wer e any , wer e largel y limite d t o suggesting way s o f improvin g processe s o f disput e resolutio n i n scienc e o r in th e government . T h e positio n o f th e neutral , observin g socia l scientis t w h o analyze s controversies certainl y ha s it s place; however , I fin d th e positio n inadequat e in th e worl d today . O n e reaso n i s tha t th e mor e marginalize d grou p wil l tend t o captur e a n apparentl y neutra l social-scienc e study ; i n othe r words , it wil l clai m tha t th e neutra l stud y support s it s claim s (Scott , Richards , an d Martin 1990 ; Marti n 1996) . Likewise , th e mor e establishe d grou p wil l ten d to rejec t th e sam e stud y a s covertl y favorin g th e mor e marginalize d group . In short , apparentl y neutra l socia l studies , lik e thos e o f th e natura l sciences , are ofte n unpacke d an d translate d a s sociall y interested . N o matte r ho w rigorously socia l scientist s attemp t t o adop t an d maintai n a neutral position , their account s en d u p gettin g repositione d a s favoring on e sid e o r th e other . Moreover, durin g recen t decade s th e rol e o f th e citize n i n scienc e an d technology controversies , especiall y thos e involvin g biomedica l research , has becom e muc h mor e sophisticated . A s scientifi c controversie s hav e b e come increasingl y publi c affairs , citizen s hav e grow n confiden t enoug h t o question exper t opinion . Nowaday s public-interes t group s routinel y ques tion th e exper t opinions , eithe r directl y o r throug h othe r expert s w h o m they enrol l a s allies . Socia l scientist s occup y a uniqu e positio n share d b y only a fe w othe r occupation s (suc h a s journalists, librarians , som e electe d and appointe d publi c officials , an d nongovernmenta l leaders ) becaus e the y are citizen s wit h relativel y unusua l resources : th e researc h skill s an d tim e that mak e i t possibl e t o understan d th e technica l detail s o f controversies ,

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the freedo m no t t o worr y abou t losin g thei r medica l license s o r NI H grants, an d th e researc h expertis e tha t allow s the m t o fin d relationships between apparentl y neutral technical positions an d interested socia l ones. The changin g role of the social scientist with respect to technical contro versies i s more tha n a product o f the failur e o f the neutra l observe r mode l and th e increasingl y publi c natur e o f scientifi c controversies . I t i s als o a product o f the changin g political econom y an d demography o f universities. As governments cu t back funding fo r higher education and as employmentconscious students move toward technological and pragmatic fields, the role of the socia l sciences a s part o f a general liberal-art s educatio n ha s increasingly become a luxury that many universities canno t afford . Socia l scientists find themselve s i n interdisciplinar y research-and-teachin g team s tha t study , for example, new information technologies , the environment, biomedicine , and engineering. As the technical experts make decisions that have political and socia l implications, an d a s they mak e claim s abou t th e socia l o r polic y aspects of science and technology, social scientists are drawn into controver sies as active participants rather than a s disinterested observers . For thes e an d othe r reasons , th e positio n o f impartialit y i n th e socia l studies o f scienc e i s n o longe r adequate . Socia l scientist s ca n an d shoul d play a rol e i n th e evaluatio n o f whic h researc h program s warran t publi c support an d exper t attention . Althoug h th e detail s o f specifi c knowledg e claims an d researc h choice s withi n a research progra m ma y requir e exper t knowledge beyon d th e leve l o f competenc e o f outside r evaluators , th e choice amon g genera l researc h program s themselve s i s a matte r o f grea t public interest . Socia l scientists , lik e othe r citizens , hav e a legitimate righ t to becom e involved ; indeed , w e hav e a n obligatio n t o exer t a leadershi p role.

STS after the Strong Program Readers familia r wit h scienc e an d technolog y studie s (STS ) will undoubt edly recogniz e tha t th e framewor k I advocat e her e depart s substantiall y from th e basi c principle s o f th e stron g program . Introduce d i n th e 1970s , the stron g progra m i s largel y recognized , fo r bette r o r fo r worse , a s a watershed i n the socia l studies of science. Prior t o th e 1970s , most sociolo gists focused o n institutiona l aspect s o f science suc h a s its reward syste m o r its networks of invisible colleges. During the 1970 s some sociologists turne d back t o a n olde r researc h traditio n know n a s the sociolog y o f knowledge .

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Their wor k le d t o a ne w emphasi s o n socia l studie s o f th e conten t o f science, i n othe r words , it s theories, methods , an d knowledg e claims . Th e term "constructivism " ha s different meaning s for differen t users , but here it will b e interprete d a s a range o f frameworks tha t emerge d i n th e wak e o f the stron g program (se e Hess 1996 , 1997) . These framework s includ e labo ratory studie s o f th e socia l constructio n o f knowledg e an d actor-networ k theories o f scientific entrepreneurs . The stron g program represents a concise an d widely cited early formula tion o f th e sociolog y o f scientifi c knowledg e (SSK) . Th e basi c principle s were: 1 ) causality: social studies of science would explai n beliefs o r states of knowledge; 2 ) impartiality: th e sociolog y o f scientific knowledg e would b e impartial wit h respec t t o trut h o r falsity , rationalit y o r irrationality , o r success o r failur e o f knowledge (and , presumably , technology) ; 3 ) symme try: th e sam e type s o f caus e woul d explai n tru e an d fals e beliefs , etc . (i n other words, one would not explai n "true " science by referring i t to natur e and "false " scienc e b y referrin g i t t o socia l interest s o r cultura l values) ; 4) reflexivity: th e sam e explanation s tha t appl y to scienc e would als o apply t o the sociological studies of science (Bloo r 1991) . For a number o f reasons the strong program and its siblings and offsprin g in th e sociolog y o f scientifi c knowledg e becam e exhausted . On e proble m was that SS K researchers tende d t o dismis s othe r current s o f STS research : the institutiona l sociolog y o f science, ofte n calle d th e "Mertonian " sociol ogy o f science , fo r it s lac k o f interest i n explainin g content ; critica l socia l studies o f scienc e an d technolog y fo r thei r lac k o f impartiality , an d th e traditional philosophy of science (an d the view of many practicing scientists) because i t ofte n explaine d th e outcom e o f scientifi c dispute s b y referenc e to th e natural world instead o f to th e socia l world, a move that violated th e symmetry principle . B y far , th e thir d proble m wa s th e mos t severe , an d philosophers wer e soo n levellin g charge s o f relativis m an d incoherenc e against the strong program and constructivist account s o f science. The mai n philosophical objection s hav e been epistemologica l an d mora l relativism. Th e argumen t o n epistemologica l relativis m goe s roughl y a s follows: th e impartialit y an d symmetr y principle s impl y tha t account s o f how knowledge cam e to be widely accepte d in science should rely only o n sociocultural factors , rathe r tha n o n representationa l (evidentiary ) factors . In othe r words , a s a variabl e i n explainin g ho w knowledg e cam e t o b e accepted o r constructed , suc h a s afte r th e closur e o f controversies, SS K ignores th e accurac y o r consistenc y o f truth claims . Som e SS K researcher s argued tha t th e real , materia l world—an d observation s draw n from it —

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plays littl e o r n o rol e i n th e resolutio n o f controversies . Philosopher s pointed ou t tha t social scientists who analyze d natural-science controversie s went abou t resolvin g thei r ow n sociologica l controversie s b y usin g th e evidence o f social facts. I n othe r words , in practice socia l scientists grante d themselves a rationality tha t the y were unwillin g t o gran t scientist s i n thei r sociological account s o f how knowledge cam e to be widely accepted . A secon d charg e agains t SS K wa s tha t th e extrem e epistemologica l relativism lead s t o mora l relativism . Thi s charg e tende d t o emerg e mor e from th e critica l o r engage d win g o f STS . Clearly , anyon e wh o want s t o change th e world , o r a t leas t t o chang e aspect s o f scienc e an d technology , could not rel y on a framework tha t endorse d epistemologica l relativism. To change th e world on e must firs t b e abl e to justify one' s diagnosis o f what is wrong with i t and to justify proposal s for alternatives . ST S researchers wh o were associate d wit h th e scientist s fo r social-responsibilit y movement , th e feminist movement , o r th e radical-scienc e movemen t als o tende d t o b e skeptical of the epistemologica l relativis m o f the SS K school. At firs t th e relativis m controvers y remaine d withi n th e ST S field an d i t had a largely disciplinar y an d nationa l flavor: philosopher s versu s sociolo gists, sociall y concerne d scientist s versu s philosophicall y concerne d socia l scientists, an d America n sociologist s versu s thei r Britis h counterparts . However, b y th e 1990 s th e controvers y ha d expande d int o th e so-calle d "science wars," when som e scientists began to take the few radical relativists of the SS K school a s representative o f STS in orde r t o discredi t th e field as a whole. This misrepresentation i s unfortunate an d highly polemical. As has already bee n indicated , th e ST S field i s quit e divers e an d characterize d b y fundamental philosophica l disagreements . The entir e relativis m controvers y i s largel y a dea d hors e tha t som e philosophers an d STS-basher s manage d t o kee p aliv e into th e 1990s . The y often propos e a n alternativ e o f naive scientifi c realism , whic h o n thi s issu e would hol d tha t i n mos t historica l case s mer e researc h alon e (suc h a s experimental dat a fro m a crucia l experiment ) ha s resolve d a scientifi c o r medical controversy . Thi s alternativ e i s untenabl e a s an empirica l descrip tion o f scienc e becaus e i t simpl y doe s no t matc h th e historica l record . Nevertheless, th e philosophers an d othe r critic s o f SSK relativism ar e righ t in rejecting th e position o f extreme epistemologica l relativism . I am amon g a large number o f STS analysts who suppor t neithe r th e extrem e relativis m advocated b y som e SS K researchers no r th e naiv e realis m o f some o f thei r detractors. Rather , ther e i s a reasonabl e middl e ground . Fro m thi s view point socia l contingenc y an d cultura l value s shap e th e proces s o f knowl -

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edge-making i n tande m wit h th e restraint s o f evidence , tha t is , th e struc tures an d limitation s o f th e real , materia l world . Som e philosopher s hav e developed version s o f thi s positio n unde r th e rubri c o f "constructiv e real ism" o r "realisti c constructivism " (e.g. , Gier e 1993 , 1995 ; Fuller 1993 : 5). The questio n o f ho w muc h th e social/cultura l shape s th e outcome s o f controversies, versu s ho w muc h consideration s o f evidenc e do , canno t b e answered i n genera l terms : eac h cas e i s different . Certainly , i n th e cas e o f cancer research—a scienc e that is applied, industrialized , an d supporte d b y a larg e syste m o f privat e an d publi c grants—social/cultura l factor s wil l loom large . However , consideration s o f evidence—including point s i n th e history o f cancer research where th e evidenc e was ambiguous—are crucia l for th e accoun t a s well. The point i s to develo p a sophisticated analysi s that falls prey to neither a naive relativism nor a naive realism. I also part with the strong program and constructivist account s of science by movin g fro m a descriptiv e accoun t o f a controvers y t o a prescriptiv e account. I ask , fo r example , wha t criteri a shoul d b e used t o evaluat e th e bacterial-etiology theor y an d researc h program ? I s i t credibl e science ? Should taxpaye r dollar s b e spen t t o investigat e alternativ e cance r theorie s and therapies ? I f so , ho w shoul d governmen t institution s b e reforme d i n order t o mak e suc h investigatio n mor e viable ? Th e question s abou t th e value o f competin g researc h program s ar e fundamenta l t o an y scientifi c field, an d socia l scientist s nee d t o as k those question s i f their wor k i s to b e relevant t o publi c debat e an d no t a n exercis e i n academi c parochialism . Once on e begin s askin g tha t typ e o f question , relativis m i s impossible . Likewise, a naive faith tha t evidenc e an d research wil l solv e al l problems is a recipe for policy failure . This boo k i s based o n a set o f principles tha t provide s a n alternativ e t o the stron g program an d relativist versions o f constructivism. Th e principle s provide on e translatio n o f a constructiv e realis t positio n int o a concrete , interdisciplinary researc h program fo r STS . Growin g number s o f STS ana lysts alread y us e som e o r al l o f thes e principle s a s par t o f thei r researc h frameworks. I n effect , thes e principle s coul d b e interprete d a s a distillatio n of the majo r line s o f postconstructivist STS . The principle s ar e a s follows : 1) power : th e analysi s focuse s o n ho w scientist s i n position s o f powe r shape th e constitutio n o f orthodox y an d heterodoxy , o f consensu s an d controversy, i n field s o f science an d technology ; 2 ) culture : th e interpreta tion o f th e histor y o f powe r i n scienc e an d technolog y mus t g o beyon d instrumental reaso n to include an analysis of the cultures in which research ers ar e working, includin g th e rol e o f evidence i n controversies ; 3 ) evalua -

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tion: th e ST S analys t shoul d analyz e th e credibilit y o f competing scientifi c claims of alternative position s by using the best availabl e knowledge an d by taking int o accoun t th e possibl e biase s i n tha t knowledg e uncovere d b y previous step s o f th e analysis ; 4 ) positioning : th e genera l politica l an d specific polic y implication s o f the researc h shoul d b e examine d an d evalu ated. Thi s approac h t o ST S researc h involve s a significan t shif t fro m th e neutral, unengage d positio n tha t characterizes man y studie s i n th e field, and i t i s sympatheti c t o th e alternativ e ST S tradition s associate d wit h some versions o f feminism an d th e variou s science-for-social-responsibilit y movements. To put int o practic e thi s framework, i t ha s been necessar y t o dra w o n a wide rang e o f STS disciplines . Unlik e th e SS K researchers, wh o tende d t o exclude significant branche s of STS research as irrelevant or wrong-headed , I dra w eclecticall y o n variou s method s an d concept s i n a more transdisci plinary spirit. As a theoretical contribution t o the STS field, this framework provides on e way of moving beyond th e disciplinar y ghetto s to a transdisciplinary analysi s i n whic h history , sociology , anthropology , cultura l studies , philosophy, an d policy studies all have a role to play in a synthetic analysis.

Power and Culture The first principl e i s tha t th e analysi s i s politica l i n th e sens e tha t i t pay s attention t o th e operatio n o f powe r i n th e histor y o f wha t come s t o b e accepted as scientific knowledg e and what comes to be rejected a s unorthodox or heterodox. Th e ter m "power " ha s many meanings, among them th e Marxist sense of the arrangemen t o f society so that on e clas s dominates an d benefits, th e Weberia n sens e o f on e grou p bein g abl e t o ge t it s wa y eve n when othe r group s wan t somethin g els e (playe d ou t her e i n th e for m o f professional power) , the Foucauldia n sens e of power embedde d i n practices that rationaliz e an d disciplin e socia l life, an d th e feminist sens e o f power as the differentia l effect s o f socia l arrangement s o n gender s an d othe r socia l categories. Th e first leve l o f analysi s o f power addresse d i n thi s boo k i s a very basic form o f power: th e suppressio n o f dissident tradition s i n scienc e and medicine . However , beyon d th e sometime s graphi c an d bruta l mean s that thos e i n powe r us e t o maintai n thei r hegemony , m y concer n i s als o with mor e comple x form s o f power tha t requir e embeddin g a n analysi s o f power in an analysis of culture. The questio n o f heterodox y i s a good empirica l topi c fo r developin g a

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cultural approac h t o th e analysi s o f power . Wherea s man y SS K account s focus o n ho w successfu l scienc e an d technologie s achieve d success , I focu s on ho w a research progra m cam e t o b e forgotte n an d excluded . Althoug h some SS K framework s examin e th e failur e o f scientifi c networks , th e accounts focu s o n strategi c error s an d technica l bottlenecks . Fro m my perspective, thi s approac h i s to o narrow . Th e questio n i s no t merel y wh y some scientist s di d no t becam e th e Pasteur s o f thei r field ; rather , i t i s als o why the field di d not allo w them to achiev e success. The existenc e o f heterodoxie s provide s on e reaso n wh y a n analysi s o f power need s t o b e accompanie d b y a more genera l analysi s o f culture. I t is helpful t o begin by returning to one of the first research programs associated with th e stron g program: Edinburgh-school interest s theory. Although I do not suppor t a simplisti c retur n t o thi s framework , I a m intereste d i n th e history o f that originar y momen t i n SS K when certai n theoretica l assump tions were excluded , muc h a s in th e originar y moment s o f cancer researc h in th e earl y twentiet h centur y whe n microbia l theorie s o f cance r wer e foreclosed. Th e cas e studies of the "Edinburg h school " contribute d t o ST S a model of how to analyze scientific controversie s in terms o f interests (e.g. , Barnes an d Shapi n 1979 ; MacKenzi e 1983) . A variet y o f interest s wer e considered, bu t clas s interests were th e mos t controversial , an d criticisms o f the Edinburg h schoo l tende d t o focu s o n it s attempt s t o dra w line s o f causality from clas s interests to technical positions in a scientific controversy . As various critic s argued , th e interest s studie s suffere d fro m th e proble m o f transforming macrosociologica l clas s interest s int o th e microsociologica l accounts o f the motivations tha t shape the actio n o f individuals. I n general , interest-based analyse s riske d turnin g scientist s an d othe r technica l actor s into "interes t dopes. " Th e framewor k reduce d analyse s o f scientists t o flat, cartoonlike character s who wer e guide d b y exogenous interest s rathe r tha n a comple x se t o f contingencie s an d motivations , includin g a concern wit h evidence an d consistency . Give n th e genera l overdeterminatio n o f socia l action, unicausa l theories o f any sort, including some sort of determinatio n by clas s interests , ar e no w highl y suspec t t o man y ST S analyst s (Barne s 1981; MacKenzie 1981 , 1984; Woolgar 1981a , 1981b ; and Yearley 1982) . This versio n o f interes t theory , whic h I discus s i n chapte r thre e a s Version I , run s int o exactl y th e sam e problem s whe n I attemp t t o appl y i t to th e cas e o f cance r research . I n othe r words , i t i s ver y difficul t t o dra w any causal lines of influence fro m th e capitalist class to the content o f cancer research. The problem emerges even though medical research in the Unite d States shoul d provid e goo d case-stud y materia l becaus e o f th e potentia l

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vector o f transmission provide d by the capitalis t foundation s tha t supporte d the transformatio n o f medicin e durin g th e earl y twentiet h century . Th e basic imputatio n proble m remains , an d a s I examine d th e historica l recor d closely, the lines of causality dissolved into ambiguitie s o f interpretation. Why, then , brin g bac k th e dea d hors e o f Edinburgh-schoo l interes t theory? Whe n interes t theor y wa s rejected , mos t form s o f macrostructura l sociological and anthropological analysi s were also rejected in the SSK wing of STS . Ther e i s stil l a prominent rol e fo r interest s analysis , a t leas t i n th e case o f cance r research , a s i s ampl y demonstrate d b y th e hug e financia l interests that are at stake in the conservative consensus of the cancer research community. Thus , professiona l an d financia l interest s pla y a majo r rol e i n the constitution o f this research tradition, but not in the form o f determination b y capitalis t clas s interests . Rather , th e interest s ar e mor e local : the y involve th e emergin g cance r industry . I n fact , i t i s difficul t t o provid e a good explanatio n o f the histor y o f cancer research without referrin g t o th e substantial institutiona l an d financia l interest s o f wha t som e estimat e ha s become a one-hundred-billion-dollar-a-year industr y i n th e Unite d State s alone. An analysis that is restricted to professional interest s still represents a very limited form o f power, similar to what Marshall Sahlins (1976) calls practical reason. Practica l reaso n continue d t o infor m man y SS K accounts o f scien tists eve n afte r th e Edinburgh-schoo l progra m wa s rejecte d (e.g. , Latou r 1987, 1988) . Actor-network theor y alternative s to interest theory portraye d scientists a s actin g ou t o f a sens e o f strategi c gai n rathe r tha n a desir e t o defend professiona l o r othe r interests . Th e primar y metapho r tha t emerge s from thes e studie s is military: scientist s ar e like general s o n a field o f battle where credit , credibility , fame , an d glor y ar e th e stake s o f victory . Th e warfare metapho r sometime s overlap s wit h th e economi c metapho r tha t also appear s i n som e SS K accounts : bot h ar e storie s o f actor s wh o ar e attempting t o maximiz e gain . Scientist s become mer e strategists ; instead o f being driven by interests, they attemp t t o produce interest s an d enrol l allies in a n effor t t o furthe r thei r scheme s o f self-aggrandizemen t o r enhanc e their credibility . Just as it is inadequate to explain the history of repression and suppression as the result o f a coalition o f interested doctors , researchers, and institution s that ac t i n a strategic wa y t o protec t thei r interests , i t i s also inadequate t o explain tha t histor y a s motivated merel y b y a masculine, militar y ques t fo r power an d credit . Additiona l analytica l resource s ar e necessar y t o explai n why consensu s knowledg e develope d a s i t did . Thos e resource s nee d t o

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incorporate anothe r leve l o f analysi s tha n th e instrumenta l reaso n tha t underlies a variety o f SS K frameworks , includin g bot h Edinburgh-schoo l analyses and actor-network analyses . The rubric o f "culture" flags this other level that takes a sociology of science beyond instrumental reason. Scientist s act insid e researc h cultures , whic h ar e i n tur n neste d i n mor e genera l societal an d tempora l cultures . Th e analysi s need s t o examin e th e genera l parameters o f these research cultures—thei r ke y assumptions an d polaritie s of orthodox y an d heterodoxy—an d thei r relationshi p t o th e genera l soci etal and temporal cultures . Bringing cultur e int o th e analysi s o f powe r make s i t possibl e t o mov e beyond th e instrumentalis m o f som e SS K account s withou t losin g th e original insigh t o f th e Edinburgh-schoo l studies : tha t scienc e i s mad e i n societies an d no t merel y i n networks . A s chapte r thre e demonstrates , th e failure o f filtrationis m a s a schoo l o f bacteriolog y an d th e hegemon y o f cytotoxic therapie s canno t be explaine d merel y a s the failur e o f the micro bial researchers t o build stron g networks o r make sur e that powerful finan cial interest s wer e appeased . Th e analys t als o need s t o ente r int o th e culture o f medicine an d scienc e t o understan d wh y som e possibilities wer e marginalized an d wh y other s wer e eas y t o incorporate , i n short , wh y th e playing field wa s not even . Describing th e cultur e o f researc h program s bypasse s th e simplifyin g accounts o f scientists that reduce the m to entrepreneurs , military strategists, interest dopes , o r othe r figure s o f practica l reason . Instea d o f th e two dimensional flatland o f practical reason , cultura l analysi s delineate s th e ke y theoretical and evidentiary claims of the research cultures in which scientist s worked. Thus , th e analysi s restore s som e o f th e rationalit y o f scienc e tha t many scientist s fin d missin g whe n the y rea d SS K account s o f thei r fields . At th e sam e time , thi s framewor k doe s no t retur n t o a merel y internalis t account that focuses onl y on theories, evidence, and other so-called rational factors i n th e resolutio n o f controversie s an d th e makin g o f consensus . Although th e rationalit y o f scienc e i s restore d b y examinin g th e scientifi c world an d assumption s o f th e scientists , th e cultur e o f researc h program s itself becomes th e objec t o f social scientific inquiry . As i n th e cas e o f th e relationshi p betwee n cultur e an d ecolog y i n th e anthropological analysi s o f small-scal e societies , th e relationshi p betwee n the specifi c researc h cultur e an d th e ecolog y o f th e broade r societ y i s th e focal poin t o f social inquiry. Fo r example , in th e cas e of twentieth-centur y cancer researc h i n th e Unite d States , a modernist cultur e tha t emphasize d standardization, a masculinist cultur e tha t emphasize d heroi c medicine , an d

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a relativel y insulate d nationa l cultur e tha t preclude d widesprea d interna tional trave l an d communicatio n ar e amon g th e additiona l factor s tha t helped structur e cance r researc h s o tha t th e genera l microbia l theorie s fel l off th e playin g field . Conversely , th e postmoder n cultur e o f flexibility, the emergence o f feminis m an d it s linkag e t o breast-cance r activism , an d th e globalization o f communication an d concomitan t d e facto deregulatio n ar e among th e factor s tha t ar e spurring th e growt h o f alternative cance r thera pies today , includin g a re-examinatio n o f th e los t bacteria-and-cance r re search program. Although macrosociologica l interest s an d broader cultura l values d o play a rol e (alon g wit h evidentiar y an d consistenc y concerns ) i n shapin g th e research program s culture , thei r shapin g rol e i s mediate d throug h tha t culture, whic h als o mediate s th e changin g force s o f ne w empirica l evi dence. Lik e a prism , researc h culture s d o no t alway s reflec t th e externa l factors i n a simpl e way . A s Marshal l Sahlin s (1976 ) argue d fo r small-scal e societies, cultures develop thei r ow n interna l logic tha t change s in respons e to outsid e shapin g interest s an d historica l contingencies , bu t thes e change s tend t o occu r alon g lines tha t ar e consisten t wit h th e cultura l logic . Like wise, scientifi c researc h program s chang e ove r tim e (i n respons e t o ne w research findings , th e growt h o f ne w industries , changin g professiona l configurations, etc.) , but the y do s o in ways that ten d t o be consisten t wit h cultural logics that have a momentum o f their own . I n this way, power, lik e knowledge, is mediated through culture , and the framework make s possible a more comple x understanding o f power an d culture in science.

Evaluation An analysi s tha t move s beyon d instrumenta l reaso n t o a cultura l leve l nevertheless remain s withi n th e parameter s o f descriptiv e an d explanator y social science. On e coul d finis h readin g suc h a study an d stil l have n o ide a whether, fo r example , th e microbia l theorie s o f cance r hav e an y scientifi c value. "S o what? " on e migh t legitimatel y ask . Remember, th e questio n o f credibility is not a theoretical exercis e for people with cancer . Another ste p of analysis is required: t o examin e th e comparativ e validit y of the knowledge claims of the consensus and alternative research traditions. In othe r words , full y interdisciplinar y ST S analysi s mus t ste p ou t o f th e traditional plan e o f socia l scientifi c analysi s (her e formulate d aroun d th e two strand s of culture an d power) t o a prescriptive level. This level involves

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two steps : th e evaluatio n o f knowledg e claim s an d th e evaluatio n o f pro posed polic y o r politica l changes . The evaluatio n o f knowledge claim s i s based o n th e standard s o f th e bes t available scientifi c knowledg e a t th e tim e o f th e evaluato r s analysis , bu t i t also assume s tha t thos e standard s ma y themselve s b e biase d agains t th e research unde r analysi s du e t o th e sam e political/cultura l processe s alread y analyzed. Fa r fro m providin g a n impartia l o r symmetrica l analysis , I g o o n to evaluat e th e researc h claims . Yet , I d o thi s b y takin g int o accoun t th e possibilities o f bia s introduce d b y th e cultura l politic s analyze d i n th e previous stages . T h e evaluatio n o f researc h program s generall y canno t b e reduce d t o a formal metho d (suc h a s a crucia l experiment) ; rather , i t i s mor e lik e th e processes o f disput e resolutio n i n th e lega l professio n an d th e qualitativ e social sciences . Evidenc e ca n be establishe d bu t alway s within a context tha t recognizes th e powe r o f cross-examinatio n an d interpretation . T o establis h criteria fo r evaluatin g th e alternativ e researc h program , I dra w o n a wid e range o f source s i n th e philosoph y o f science . Rathe r tha n viewin g th e philosophy o f scienc e a s a stra w person , a s ofte n occur s i n th e SS K litera ture, I vie w i t a s providing a basic se t o f resource s tha t ar e fundamenta l fo r the evaluatio n problem . A s philosophe r Stev e Fulle r (1988 ) ha s argued , philosophy o f scienc e ca n b e relevan t fo r a wid e rang e o f publi c debate s w h e n i t i s geare d towar d helpin g peopl e clarif y thei r position s o n prescrip tive issues . I focu s o n on e specifi c prescriptiv e problem , theor y choic e an d evaluation. Thomas K u h n s lis t o f prescriptiv e theory-choic e criteri a i s a goo d starting poin t becaus e i t bring s togethe r th e finding s o f a numbe r o f philosophical traditions . Althoug h Kuh n ha s sometime s bee n accuse d o f radical relativism, hi s essay s subsequent t o th e Structure of Scientific Revolutions reveal tha t th e accusatio n i s unfounded . I n on e o f hi s subsequen t essays , Kuhn outline d th e majo r criteri a tha t shoul d guid e soun d theor y choice : First, a theory shoul d b e accurate : withi n it s domain , tha t is , consequence s deducible fro m a theor y shoul d b e i n demonstrate d agreemen t wit h th e results o f existing experiment s an d observations . Second , a theory shoul d b e consistent, no t onl y internall y o r wit h itself , bu t als o wit h othe r currentl y accepted theories applicable to related aspects of nature. Third, it should have broad scope : in particular, a theory's consequence s shoul d exten d fa r beyon d the particula r observations , laws , o r su b theories i t wa s initiall y designe d t o explain. Fourth , an d closel y related , i t shoul d b e simple , bringin g orde r t o phenomena tha t i n it s absenc e woul d b e individuall y isolate d and , a s a set ,

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confused. Fifth— a somewha t les s standar d item , bu t on e o f specia l impor tance t o actua l scientifi c decisions— a theor y shoul d b e fruitfu l o f ne w research findings : i t should , tha t is , disclos e ne w phenomen a o r previousl y unnoted relationship s amon g those already known. (Kuh n 1977 : 321-22) Kuhn s decisio n t o begi n wit h th e accurac y an d consistenc y criteri a i s well-founded. T h e accurac y criterio n coul d b e reconcile d wit h som e typ e of verificationis m o r falsificationism . Likewise , th e consistenc y criterio n i s similar t o th e theor y choic e criterio n favore d b y th e conventionalis t Pierr e D u h e m (1982) . W h en on e examine s philosopher s o n th e practica l questio n of theory-choic e criteria , ther e i s littl e disagreemen t ove r th e fundamenta l importance o f accurac y an d consistenc y a s theory-choic e criteria . O f course, a s som e philosopher s hav e warned , consistenc y ca n hav e conserva tive implications , an d therefor e a highly inconsisten t theor y wil l hav e t o d o very wel l o n othe r grounds . Most o f Kuh n s othe r criteri a ca n b e interprete d a s corollarie s o f accu racy an d consistency . Simplicit y wa s als o advocate d b y bot h th e positivis t Rudolf Carna p (1995 ) an d th e falsificationis t Kar l Popper (1963) . Simplicity , however, mus t b e judge d agains t a backgroun d o f othe r theories , an d therefore ultimatel y I vie w i t i s a subcriterio n o f consistency . Fo r simila r reasons I d o no t includ e scop e a s a majo r criterion ; i t to o mus t b e judge d against th e background o f other theorie s an d ma y be considere d a subcriter ion o f consistenc y o r accuracy . Finally , I interpre t Kuh n s fruitfulness crite rion a s a corollary o f accurac y tha t i s oriente d towar d futur e research . Feminist philosopher s hav e introduced a number o f criticisms o f standar d theory-choice evaluatio n criteria , an d Hele n Longin o (1994 ) distille d a n alternative lis t o f si x criteri a fo r theor y (o r researc h program ) choic e tha t are implici t i n feminis t ST S analyst s suc h a s Sandr a Hardin g (1986 , 1992 ) and Donn a Harawa y (1991) . Longin o s criteri a ar e empirica l adequacy , novelty, ontologica l heterogeneity , complexit y o f relationship , applicabilit y to curren t huma n needs , an d diffusio n o f power . Clearly , empirica l ade quacy i s mor e o r les s th e sam e a s th e fundamenta l accurac y criterio n fo r which ther e i s a grea t dea l o f consensus . Novelt y i s a reminde r o f th e conservative implication s o f over-relianc e o n consistency . Applicabilit y t o current huma n need s i s a n importan t developmen t o f th e pragmatis t tradi tion, an d i t deserve s t o b e adde d a s a n additiona l criterion . I n th e cas e o f alternative cance r therapies , thi s i s a criterio n o f overwhelmin g importanc e for decidin g whic h researc h program s shoul d b e funded . T h e operation alized versio n o f th e criterio n woul d impl y answerin g th e questio n o f h o w

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likely th e theor y i s t o lea d t o progres s towar d safe r an d mor e efficaciou s treatments. Longino's othe r criteri a introduc e unnecessar y ambiguitie s (Hes s 1997) . In thei r place I have opte d fo r lowe r socia l bias such a s gender o r race bia s as a significant theory-choic e criterio n tha t represent s th e genera l feminis t contribution t o philosophical discussions . For example, if one o f the candi date theorie s appear s t o b e mor e aligne d with masculinis t value s an d practices (suc h as a cancer theor y that is aligned with th e practice o f what man y view t o b e unnecessaril y aggressiv e breas t surgery) , the n thi s negativ e criterion shoul d be relevan t to theory choice . Alone, the criterio n ma y no t lead to rejection o f a theory, but it can serve as a warning flag to re-examin e a theory o n othe r grounds . In sum, I suggest accuracy, consistency , pragmatic value, and lower social bias a s the fou r group s o f major criteri a fo r evaluatin g majo r theorie s an d research programs . Clearly , i t i s possibl e tha t contradiction s ma y emerg e among th e differen t criteria . I n thi s case , on e mus t us e th e criteri a t o triangulate (o r quandragulate ) one' s way throug h wha t i s obviously a com plex decisio n tha t canno t b e reduce d t o a n algorithm . However , i n my opinion accurac y should remai n th e most important criterion .

Positioning The fourth guidin g principle is that the analysis is positioned; it provides an evaluation o f alternativ e polic y an d politica l goal s tha t coul d resul t i n beneficial institutiona l an d researc h program changes . As a social scientist I therefore assum e tha t I wil l b e positione d insid e th e controversy , a s th e capturing literatur e demonstrate s i s inescapable , an d tha t I a m bette r of f positioning mysel f rathe r tha n havin g someon e els e d o i t fo r me . I n th e terminology o f th e ST S field, thi s leve l o f analysi s ca n b e describe d a s a typ e o f reflexivity , bu t on e tha t i s mor e profoundl y sociologica l o r anthropological tha n previously discusse d forms . Elsewhere I argue d agains t th e mer e epistemologica l reflexivit y o f th e strong program an d suggested a culturally oriente d reflexivit y tha t operate d at the level of the relation s between th e researcher s academic communitie s and th e group s researche d (Hes s 1993) . Th e final chapte r i n th e presen t book develop s thi s transitio n furthe r towar d wha t migh t b e bes t terme d positioned intervention . Th e topi c ha s receive d increasin g attentio n i n anthropological studie s o f scienc e an d technolog y (e.g. , Downey , Dumit ,

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and Traweek 1997) . I develop th e discussio n o f positioning by viewing it as intervention i n a controvers y b y evaluatin g agenda s fo r potentiall y benefi cial institutional change s and investments for futur e research . Although th e fina l chapte r examine s polic y issues , i t als o represent s a n attempt t o discus s polic y i n a differen t vein . Informe d b y th e SS K lesso n that draw s attentio n t o content , I examin e th e issu e o f researc h policy . I n other words , a crucia l polic y issu e fo r nationa l healt h i s makin g a soun d choice amon g competin g researc h programs. I t is not a question merel y o f developing more efficien t way s to spend money o n research, o r of spending more mone y fo r researc h o n a particula r disease . Rather , i t i s a questio n of reorientin g th e researc h agend a towar d preventio n an d environmenta l carcinogenesis, a s Samue l Epstei n an d colleague s (1992 ) argue , a s wel l a s toward th e evaluatio n o f alternative therapies . In suggesting policy reforms , one has to tak e into accoun t tha t ther e is a recalcitrant cance r establishmen t that ha s a documented recor d o f draggin g it s feet an d suppressin g researc h on alternatives . Thus , polic y need s t o b e rethough t i n term s o f ho w t o make sur e tha t legislate d intention s ar e carrie d out . On e need s t o thin k through th e landscap e o f th e researc h cultures t o deriv e policie s tha t wil l carry ou t th e intention s o f the legislators. I n thi s way, the policy discussio n draws o n th e insight s o f th e previou s stage s o f th e analysis . Rathe r tha n view scienc e studie s a s a serie s o f disciplinar y ghettoes—history , socia l studies, philosophy , an d policy— I brin g thes e field s togethe r t o provid e a transdisciplinary approac h t o a pressin g socia l an d medica l problem . Th e final stage , then, i s a clarification o f policy option s tha t rest s o n transdisci plinary empirica l research and philosophical analysis.

Notes

NOTES T O CHAPTE R I

i. O n cance r incidence an d mortality rat e increases, see Davis and Hoel (1992) ; Davis, Dinse , an d Hoe l (1994a : 431 ) citin g Ries , Hankey , an d Edward s (1990) ; Epstein (1993) ; an d Wing , Tong , an d Bolde n (1995 : 12-16) . Rate s ar e als o pub lished b y th e America n Cance r Societ y (1992 ) an d Nationa l Cance r Institut e (1991). Onl y a few cancer s (suc h a s stomach cancer ) sho w a decline. Th e explana tions fo r th e growt h i n cance r incidenc e ar e th e subjec t o f heated debat e (Procto r 1995: chs. 3-6; Wright 1991) . 2. McGinnes s (1991 ) review s th e differen t estimate s o f user s o f alternativ e cancer therapies , an d Eisenber g e t al . (1993 ) provid e th e estimat e o f th e large r population o f alternative medicine users . For an overvie w of legislative changes , see Sale (1995) . Fo r review s o f major alternativ e cance r therapies , se e Falcon e (1994) ; Moss (1992) ; Pelton an d Overholse r (1994) ; and Walters (1993) . 3. Fo r sources o n th e controvers y ove r survival rates, see Epstein (1993 : 18-19) ; Proctor (1995 : 4, 252); Lerner (1994 : 51-54) ; Moss (1992 , 1995) ; and Wing, Tong , and Bolden (1995) . 4. See , fo r example , Lakato s (1978 ) an d Lauda n (1977) , wh o i n tur n wer e developing a more specifi c alternativ e to Kuhn's (1970 ) concept o f paradigms. NOTES T O CHAPTE R 2

i. Persona l correspondence , Naut s to Hess , December 20 , 1995. 2. Persona l correspondence , Naut s to Hess , December 20 , 1995 , and March 29, 1996. 3. Persona l correspondence , Naut s t o Hess , December 20 , 1995. 4. Th e firs t versio n (Park e Davis IX , 1899—1906 ) wa s "ver y weak" ; th e secon d (Parke Davis XII, 1906-15 ) wa s "a little more effective" ; an d the thir d (Park e Davis XIII, 1915-51) , wa s "bette r tha n XII. " Persona l correspondence , Naut s t o Hess , December 20 , 1995 . On Liste r Institut e products , persona l correspondence , Naut s to Hess , March 29 , 1996. 5. Low y (1993 : 340-41) . Th e studie s include d Shwartzma n an d Michailovsk y (1932) an d Duran-Reynals (1933) , followed b y Shear et al. (1943). 6. I n 194 3 Murra y J. Shear , a t th e Nationa l Cance r Institute , isolate d wha t h e

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believed t o b e th e activ e substanc e i n th e Cole y toxins , a lipopolysaccarid e i n Serratia marcenscens. Thi s discover y wa s "importan t t o th e late r discover y o f tumo r necrosis factor " (Ol d 1988 : 60) . Ol d (1988 ) review s subsequen t researc h o n TN F and immunotherapies , an d Roo k (1992 ) an d Starne s (1992 ) discus s th e revive d interest i n Coley' s toxins . O n th e cascad e o f cytokines , se e Wieman n an d Starne s (1994). Research o n TN F an d bacterial vaccines is also mentioned i n th e Offic e o f Technology Assessmen t repor t o n BC G b y historia n Patrici a Spai n War d (1996) . According t o Mos s (1989 : 128 ) an d Hildenbran d i n hi s foreword t o Haugh t (1991 : ix-xi), th e OT A staf f refuse d t o circulat e Ward' s papers , includin g he r histor y o f BCG whic h mention s th e TN F research . Thes e paper s becam e par t o f a bitte r controversy an d charge s tha t OT A staf f wa s manipulatin g contrac t report s fo r th e final report (Offic e o f Technology Assessment 1990 ; Moss 1996) . 7. Persona l correspondence, Naut s to Hess , December 20 , 1995. 8. Persona l correspondence , Naut s to Hess , December 20 , 1995. 9. Fo r example , New York Post, April 17 , 1936 ; New York Times, April 1 6 an d 17, 1936 . 10. Naut s (1995 : 25) , amende d b y persona l correspondence , Naut s t o Hess , March 29 , 1996. 11. Lette r from Rhoad s t o John D. Rockefeller, Jr., December 29 , 1941, Friends and Services , Doctors , Willia m B . Coley , I I 2 H , 26 , 198 , 23 1 C71 , Rockefelle r Archives. 12. Fo r example, Havas, Groesbeck, an d Donnelly (1958) ; Havas, Donnelly, an d Levine (i960) ; and Johnston (1962) . 13. Persona l correspondence, Naut s to Hess , March 29 , 1996. 14. Persona l correspondence , Naut s t o Hess , Marc h 29 , 1996 . Simila r issue s plagued othe r trial s o f so-calle d unprove n therapies . Se e Markl e an d Peterso n (1980, 1987) ; Mos s (1989) ; Paulin g (1993) ; Peterso n an d Markl e (1979a , 1979b) ; and Richards (1981) . 15. Persona l correspondence , Naut s t o Hess , March 29 , 1996 . On clinica l trials, see Hava s e t al . (1993 ) an d Tan g e t al . (1991) , an d th e revie w b y Wieman n an d Starnes (1994) . 16. Naut s commented o n this sentence as follows: "Ther e is nothing mild abou t the intellectua l repressio n Cole y endured. " Persona l correspondence , Naut s t o Hess, March 29 , 1996. 17. See Journal of the American Medical Association, letter s of January 1 , p. 52; Feb. 5, p. 396; and March 26 , p. 885. 18. McArthu r t o Coley , Novembe r 22 , 1920 , Institut e fo r Cance r Research . The letter s cite d i n thi s section wer e mad e availabl e thank s t o Hele n Cole y Nauts . In som e case s I received hand copie s o f the letters because they were to o frai l t o b e copied mechanically . 19. Dougla s t o Coley , March 21 , 1923, Institute for Cance r Research .

Notes to Chapter 2 \

19 1

20. Glove r to Coley , June 15 , 1924 , and Nerry ( ? illegible) t o Coley , March 23, 1923, Institute for Cance r Research . 21. May o t o Coley , July 3 , 1926 , Institute for Cance r Research . 22. Glove r to Coley , March 25 , 1931 , Institute for Cance r Research . 23. Cole y to Glover , March 26 , 1931 , Institute fo r Cance r Research . 24. Cole y to Glover , Februar y 2 , 1932 , Institute for Cance r Research. Berg also wrote Cole y t o confir m tha t h e ha d independently culture d th e organism : Berg t o Coley, March 16 , 1932 , Institute for Cance r Research. Se e Berg and Cole y (1932) . 25. Cole y to Mayo, April 5 , 1932 , Institute for Cance r Research . 26. Gy e to Coley , March 17 , 1936, Institute fo r Cance r Research . 27. Naut s to Hess , January 18 , 1996. 28. "Dr . Netterber g spen t man y month s trackin g dow n tw o cance r patient s whom Dr . Scot t had cure d o f advanced cance r and whose case s were written u p i n the Irish Journal of Cancer in 1926 . After bein g declare d terminall y il l with cancer , both ha d live d int o ol d ag e an d wer e completel y fre e o f cance r decade s later " (Netterberg an d Taylor 1981 : 10). Scott als o published i n Northwest Medicine during this period. I n 197 7 Netterberg trie d to ge t copie s o f Glover's NIH record s directl y from th e NIH , an d h e wa s tol d tha t the y wer e los t (Netterber g an d Taylo r 1981 : 38). RLI N searche s o n Scot t an d Glove r di d no t resul t i n success , s o I hav e relie d on the book by Scott's friend Mar k Boesch (i960) . 29. Deake n t o Murdock, June 24 , 1926 , Institute for Cance r Research . 30. Probabl y wit h th e ai d o f Nikol a Tesla , Lakhovsk y develope d a frequenc y machine simila r t o th e on e tha t Rif e develope d (Lakhovsk y 1988) . Wor k o n electronic frequenc y machine s i n Franc e continue d afte r Lakhovsk y wit h th e controversial research o f Antoine Prior e (Graill e 1984) . 31. Unfortunately , Lyne s does not documen t thes e final event s surroundin g th e demise o f the Rif e machines ; suc h documentatio n woul d b e a n importan t contri bution t o the historical record, an d until they are fully documente d the y are subjec t to warrante d skepticism . I attempte d t o ge t i n touc h wit h Rife' s partne r Joh n Crane, bu t h e di d no t respon d t o m y inquiries . I later learne d tha t h e die d durin g the winter o f 1996. 32. Thei r therap y shoul d therefor e b e classifie d a s a genera l immunotherap y rather tha n a seru m o r vaccin e fo r a propose d cancer-causin g microorganism . Because th e formul a fo r Krebioze n wa s secret , i t i s difficul t t o asses s the claim s o r the propose d biologica l mechanism . Se e Iv y (1956 ) fo r th e research , th e Counci l on Pharmacy and Chemistry (1951 ) and Stoddard (1955 ) for critiques , Bailey (1958 ) on th e politic s an d repressio n o f th e therapy , an d War d (1984 ) fo r a professiona l history o f the incident . 33. Th e biographica l material s ar e from Livingsto n (1972 , 1984) . 34. Bisse t (1969 , 1970) . A ver y shor t notic e als o appeare d i n th e July 8 , 1969 , issue of the Journal of the American Medical Association.

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35. Se e Crofto n (1936) ; Youn g (1925a , 1925b) ; an d Boesc h (i960 ) fo r a n overview o f the battles faced b y Young in th e United Kingdom . Als o not discusse d here i s the microbia l researc h o n cance r i n Italy , suc h a s the wor k o f Fonti (1958) , and th e vira l theories propounde d i n Spai n by Duran-Reynals (1950 ) an d in Japan by Hasum i (1980) . Furthermore , whil e I wa s i n Brazi l i n 199 5 I foun d som e evidence o f a historica l interes t i n bacteri a an d cance r ther e a s well , includin g among well-known medica l figures suc h as Miguel Couto . Another prominen t Germa n cas e i s tha t o f Wilhel m Reich , wh o ha d t o fle e Germany becaus e o f his criticism s o f fascism, an d the n late r ende d u p i n prison i n the United State s because o f his unusual scientific experiments . Reich believed tha t pleomorphic organisms , whic h h e terme d "bions, " playe d a role i n cancer . Give n the problemati c relationship s betwee n th e microbia l cance r researcher s an d fascis m in Germany , i t would be interesting to explor e the Reich sag a in more detail . 36. Bowke r an d Latou r (1987 : 739-40 ) argu e tha t th e ide a tha t th e Frenc h educational syste m is highly centralized is a myth, but the y agree that most researc h is funde d b y th e governmen t an d i s centralize d throug h th e nationa l researc h organization CNRS . Freudentha l (1990 ) argue s tha t th e centralize d fundin g o f the researc h i n Franc e ca n explai n th e uneve n succes s an d disperse d institution alization o f scienc e an d technolog y studie s i n Franc e i n contras t wit h th e Anglo phone world . Thus , thes e studie s confir m bu t als o qualif y Villequez' s us e o f the well-known clai m that Frenc h science s ca n be conservativ e du e t o institutiona l reasons suc h a s centralize d fundin g an d th e wa y Frenc h societ y i s centere d o n Paris. 37. Accordin g t o Villeque z (1955) , thi s i s reported i n th e Semaine des Hopitaux (Supplement d'informations , June 1 4 and 26, 1965) . Another o f Naessens's antican cer drug s wa s GN-24 , whic h wa s base d o n th e theor y tha t cance r cell s coul d b e stopped by a drug that blocked anaerobic respiration . NOTES T O CHAPTE R 3

i. Barne s (1977 , 1981) ; MacKenzie (1981 , 1984) ; Woolgar (1981a , 1981b) ; an d Yearley (1982) . See Martin (1993 ) for th e social context tha t might hel p explai n th e abandonment o f interests theory . 2. Se e Procto r (1995 : ch. 2 ) o n th e histor y o f th e environmentalis t thesis . Th e work o f Mau d Sly e a t th e Universit y o f Chicag o o n hereditar y factor s i n cance r was recognize d a t th e Lak e Mohon k conferenc e (Cole y 1926) . Seiber t (1968 ) mentions th e influenc e o f Slye' s work, an d Blumentha l (1991 : 263 ) als o mention s as important th e related research o f Clara Lynch o f the Rockefeller Institute . 3. Ellerma n an d Bang (1908) ; Fujinami an d Inamoto (1914) ; and Rous (1910) . 4. Coulte r (1987 : 449) , citin g Journal of the American Institute of Homeopathy, V (1912-1913),^ 509 . 5. Blumentha l (1991 : 257); Fleming (1987 : 208); and Flexner (1987) .

Notes to Chapter 3 \

19 3

6. Archiva l source s als o indicat e tha t Joh n D . Rockefeller , Jr. , an d Willia m Coley were friends, an d a note indicates tha t Rockefeller, Sr. , and a nurse respecte d Coley (Rockefelle r Archives , Friends an d Services , Doctors, William B. Coley, 231 C71, I I 2 H, 26 , 187) . Laurence Rockefeller als o gave a keynote addres s at the 197 5 meeting of the Cance r Research Institut e founde d b y Helen Cole y Nauts . 7. Berline r (1985 : 139-75); Corner (1964 : 158-59) ; and Brown (1979 : 166-67) . 8. Se e Borkin (1978) . Claims o f the rol e o f the carte l in th e Naz i ris e to powe r have probably been overstate d (Stoke s 1988 : 22). 9. Rhoad s papers , Rockefelle r Archives , R G 608 , Serie s 1 , Box 2 , Folde r 18 , and Serie s 4 , Box 8 , Folder 97 ; RG 1.1 , Serie s 200 , Box 98 , Folder 1189 . Also se e Corner (1964 : 271, 593). 10. Rockefelle r Archives , RG 1.1 , Series 200, Box 98, Folder 1189 . 11. Rockefelle r Archives , RG 1.1 , Series 200, Box 98, Folder 1192 . 12. "Mr . Charle s Ketterin g an d th e Sloan-Ketterin g Institute, " Rhoad s papers , Rockefeller Archives , RG 608 , Series 1 , Box 4, Folder 32. 13. I n the 1920 s a technician who administere d radium at the Memorial Hospi tal die d fro m leukemi a (Hayes-Marti n Collection , Rockefelle r Archives , R G 500 , Box 6 , Folde r 106) . Likewise , durin g Worl d Wa r I industria l worker s luminize d watches with radium , an d they eventually fell sick from th e exposure . 14. Mos s (1989 : 65) , followin g Considin e (1959) , state s tha t th e gif t wa s a hundred thousan d dollars . Radiotherap y historia n De l Regat o state s tha t th e offe r was fo r a thir d o f a millio n dollar s an d severa l gram s o f radiu m (1993 : 69) . According to Del Regato, the offer include d dedicatin g the hospital to the exclusiv e care o f cance r patients , establishin g a n affiliatio n wit h Cornel l (wher e Ewin g ha d been a professor) , an d makin g Ewin g "actin g hea d a s wel l a s pathologis t o f th e institution" (1993 : 69). Original source s in th e Hayes-Martin collectio n d o not ad d much ne w informatio n o n thi s questio n (Hayes-Marti n Collection , Rockefelle r Archives, RG 500 , Box 3 , Folder 48). 15. O n Dougla s an d hi s daughter , se e Hayes-Marti n Collection , Rockefelle r Archives, RG 500 , Box 3 , Folder 48 . Del Regato (1993 : 236) report s tha t Dougla s supported th e us e of radium t o trea t his daughter, an d he aske d to reserv e some fo r his family's personal use. Moss (1989 : 66) suggests that Douglas s death from anemi a might hav e bee n du e t o radiu m poisoning . Th e U.S . governmen t wa s apparentl y interested i n th e projec t becaus e a large par t o f th e ore s bein g mine d wer e bein g exported t o Europ e (De l Regat o 1993 : 69). O n th e radiu m deal , se e Mos s (1989 : 65) an d De l Regat o (1993 : 69) . A lette r fro m th e directo r o f th e Burea u o f Mines confirme d tha t hal f the radiu m mine d woul d g o t o th e Memoria l Hospital , presumably vi a Douglas ; se e Hayes-Marti n Collection , Rockefelle r Archives , R G 500, Box 6, Folder 107 , letter of June 27, 1917. On th e sobriquet "radiu m hospital," see Rusch (1985 : 393). I t i s likely that Ewin g an d Dougla s purchase d radiu m fro m Curie o n thei r tri p t o Europ e i n 1913 . O n Curie , se e Hayes-Marti n Collection , Rockefeller Archives , RG 500 , Box 3 , Folder 48, and Box 6, Folder 101.

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16. Se e Martin (1944 ) an d Hayes-Martin Collection , Rockefelle r Archives , R G 500, Box 6, Folder 106 . 17. Stude r an d Chubi n (1980 : 21), citing Marshino (1944 : 432), say that hal f of the $400,00 0 appropriatio n wa s designate d fo r radium . Accordin g t o record s o f a House debate , th e amoun t ma y hav e bee n tw o hundre d thousan d dollar s ove r a five-year perio d (Yaremchu k 1977 : 97). The hous e debate s collected by Yaremchuk suggest tha t th e representatives ' an d senators ' mai n sourc e o f information wa s th e medical communit y 18. "Industria l Scienc e an d Cance r Research, " Rhoad s papers , Rockefelle r Archives, RG 608 , Series 1 , Box 4A, Folder 40C. 19. "Mr . Charle s Ketterin g an d th e Sloan-Ketterin g Institute, " Rhoad s papers , Rockefeller Archives , RG 608 , Series 1 , Box 4, Folder 32. 20. "Fronta l Attack," Time, July 27, 1949 , pp. 66-75. 21."The Nex t Hal f Century i n Cance r Research, " Rhoad s papers , Rockefelle r Archives, RG 608 , Series 1 , Box 2, Folder 13. 22. Rhoad s papers, Rockefeller Archives , RG 608 , Series 1 , Box 3 , Folder 23. 23. "Th e Nex t Hal f Century in Cance r Research," Rhoads papers, Rockefelle r Archives, RG 608 , Series 1 , Box 2, Folder 13. 24. Mine r (1952 : 872—73); "Virus Conference Report, " Rhoads papers, Rockefeller Archives, RG 608 , Series 1 , Box 4, Folder 40. 25. "Viruse s i n Tumo r Therapy " (pape r presente d a t th e Secon d Nationa l Cancer Conference , America n Cance r Society , 1953) , Rhoads papers , Rockefelle r Archives, RG 608 , Series 1 , Box 2, Folders 1 7 and 20. 26. "Industria l Scienc e an d Cance r Research, " Rhoad s papers , Rockefelle r Archives, RG 608 , Series 1 , Box 4A, Folder 40C. 27. "Th e Pharmaceutica l Industr y an d Cance r Research, " Rhoad s papers , Rockefeller Archives , RG 608 , Series 1 , Box 4A, Folder 40C. 28. "Mr . Charle s Ketterin g an d th e Sloan-Ketterin g Institute, " Rhoad s papers , Rockefeller Archives , RG 608 , Series 1 , Box 4, Folder 32. 29. Rhoad s papers , Rockefelle r Archives , R G 608 , Serie s 1 , Bo x 4A , Folde r 40C, No. 30. 30. "Mr . Charle s Ketterin g an d th e Sloan-Ketterin g Institute, " Rhoad s papers , Rockefeller Archives , RG 608 , Series 1 , Box 4, Folder 32. 31. Fo r example , Dille r was able to d o he r immunological researc h a s a cytologist in the Department o f Chemotherapy o f the Institut e fo r Cance r Research , an d Rusch (1985 : 394 ) mention s tha t Rhoad s supporte d a t leas t som e researc h i n virology an d immunology . Vira l researc h di d no t receiv e muc h attentio n unti l th e 1950s an d 1960s , afte r th e successe s o f th e poli o vaccinatio n an d th e growt h o f a body o f research o n anima l oncoviruses (Shimki n 1977 : 596). 32. Mullin s (1972 ) an d other studies reviewed in Hess (1997). 33. Se e also the recent work o n ecologie s o f knowledge (Sta r 1995).

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19 5

34. Fo r example s o f Becham p i n th e alternativ e medicin e literatur e today , se e Bird (1990) ; Cantwel l (1990) ; Cournoye r (1991) ; Enb y (1990) ; an d Lyne s (1987) . See also the biography by Nonclerq (1982) . 35. Brau n (1947) ; Klieneberger-Nobe l (1949 , 1951) ; an d Diene s an d Weinb erger (1951) . 36. Frobishe r (1928) . I a m followin g Amsterdamska' s selectio n o f passages her e (1991: 213) . After consultin g th e origina l literature , I agree tha t thes e wer e tw o o f the strongest statements against the filtrationist/cyclogenist position . 37. Wolbac h (1947 : 336-39 ) o n Zinsser' s research . Typhoi d i s cause d b y a member o f the salmonella group, and typhus by a rickettsia; both ar e gram-negativ e bacteria, althoug h rickettsia s share characteristics with viruses. 38. Bernhei m (1948 ) an d Corne r (1964 : 216). Zinsser ha d criticize d th e Welc h protege Flexner ; however , fro m othe r sources , Welc h an d Zinsse r appeare d t o b e on goo d term s (Flexne r and Flexne r 1941 : 169; Fleming 1987 : 133). 39. Lohni s worke d a t th e U.S . Departmen t o f Agriculture , an d Hadle y ha d worked a t the Rhod e Islan d Agricultural Experimen t Statio n before movin g o n t o the University o f Michigan Medica l Schoo l (Amsterdamsk a 1991 : 197, 204). How ever, i n Michiga n th e agricultura l universit y i s Michigan Stat e University , no t th e University o f Michigan. Ralph Mellon, anothe r cyclogenist , ha d a medical positio n but wa s a t th e nonelit e Highlan d Hospita l i n Rochester , Ne w York . Th e Cornel l group o f cyclogenist s wa s a t th e Departmen t o f Publi c Healt h an d Preventiv e Medicine a t th e medica l schoo l i n Ne w Yor k City . Kendal l wa s a t Northwester n and Rosenow, a supporter o f the old focal-infection theory , was at the Mayo Clinic, Thus, th e agricultura l dimensio n tha t Harwoo d suggest s ma y exis t fo r geneticist s may no t appl y t o th e cas e of bacteriologists, bu t ther e ma y be a division alon g th e lines of elite/nonelite background an d position. Harwoo d stresse s the exception s t o this pattern , th e preliminar y natur e o f hi s observatio n fo r th e Unite d States , an d the nee d fo r futur e research . An eve n greate r cautio n woul d appl y t o thi s tentativ e suggestion tha t I a m developin g fro m Amsterdamska' s research , an d mor e researc h would be necessary . 40. I hav e no t mad e an y attemp t t o answe r th e questio n o f th e accuracy o f Mattman's perception . Thi s woul d requir e comparin g gende r ratio s i n CW D research and mainstream bacteriology (whic h also had substantial participation fro m women) fo r th e post-World War II years. 41. Ther e i s als o a sexualit y angl e t o th e cultura l meanin g o f thes e quee r bacteria. This linkage is implicit in the autobiographical narrativ e o f Alan Cantwell , a dermatologis t wh o becam e a frien d o f Livingston, a supporte r o f th e microbia l theory o f cancer , an d late r th e advocat e o f a controversia l theor y abou t th e ori gin o f AIDS . Hi s narrativ e openl y discusse s hi s sexualit y a s a ga y ma n i n th e ag e of AIDS , an d a t on e poin t h e notes , " I wa s forty-fiv e an d I wa s begin ning t o understan d m y purpos e i n life , an d wh y I wa s 'different ' fro m th e rest . I

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knew I ha d t o join Virgini a i n showin g th e cance r microb e t o th e world " (1990 : 100).

42. Fo r example , Livingsto n e t al . (1950) ; Livingston , Alexander-Jackson , an d Smith (1953) ; Livingsto n (1949 , 1955) ; an d Livingsto n an d Alexander-Jackso n (1965a, 1965b) . 43. However , see the very related discussion of killer T-cells and martial imagery in Martin (1994 ) that has influenced m y discussion here. Moss (1995 : 22) also points to th e "macho " nature o f the military language o f cancer therapy . 44. Th e relationshi p betwee n th e Calvinis t religiou s heritag e an d th e scientifi c and medica l refor m movemen t o f th e earl y twentiet h centur y remain s t o b e explored i n detail . Th e backgroun d o f Rockefeller an d Carnegie , no t t o mentio n Rockefeller philanthrop y organize r Gate s an d Welch , suggest s tha t th e connectio n might indee d b e a rich one . O n Welch' s Ne w Englan d religiou s backgroun d se e Fleming (1987 ) an d Flexner an d Flexner (1941) . 45. Th e controvers y involve s hi s us e o f slav e wome n t o lear n a gynecologica l technique an d hi s quarrels , muc h late r i n hi s career , wit h th e trustee s o f th e Women's Hospita l in Ne w York . Compare , fo r example , Mos s (1989 : 47) wit h th e more sympatheti c portrait b y McGregor (1989) . 46. Associate d Pres s report, Albany Times-Union, Apri l 24, 1996 , p. 5. 47. Interview , July 1995 . Koc h di d no t us e hydroge n peroxid e excep t a t on e point durin g hi s research , an d h e expresse d concer n ove r th e danger s o f ozone . "Instead," accordin g t o Treiger , "h e though t tha t th e wa y h e handle d fre e radical s was no t dangerou s becaus e hi s product s wer e use d i n minidoses , leadin g t o th e catalysis o f intracellular reaction s i n which fre e radical s were forme d t o ac t physiologically, imitatin g nature , i n orde r t o neutraliz e pathogens . H e recognize d th e necessity o f neutralizin g intracellula r fre e radicals—i n whic h h e woul d late r b e supported b y nutritional an d orthomolecula r therapies. " (Persona l correspondence , Dr. Jayme Treiger, January 1 5 and February 4 , 1996) . 48. Intervie w with Willia m Fr y an d Geronim o Rubio , Septembe r 3 , 1995 , and visit t o thei r clinic , Septembe r 6 , 1995 . Fry ha d studie d unde r Rife' s partne r John Crane. 49. Housto n (1989 : 24) ; Offic e o f Technolog y Assessmen t (1990 : ch . 6) , Mos s (1989: 260-61) . NOTES T O CHAPTE R 4

i. Gregor y (1952 ) defende d th e vira l theory ; however , h e use d antibiotic s i n treatment an d hi s description s o f th e viru s include d a cel l wall , nucleus , an d cytoplasm, s o i t i s likely tha t h e wa s observin g bacteri a or , i f he reall y observe d a nucleus, the prokaryotic fungi . Clar k (1993 ) argue s for a parasitic theor y o f cancer , but the scientific suppor t is weak. Wyburn-Mason (1964 ) argued that the protozoa n Entamoeba Umax sets up precursor condition s tha t lead to cance r and that antiproto -

Notes to Chapter 4 |

19 7

zoal drug s ar e effectiv e i n th e treatmen t o f cancer. Subsequen t studie s sugges t tha t he ha d wrongl y identifie d cell-wal l deficient bacteri a a s protozo a (Chapdelain e 1996). Pric e an d Bulme r (1972 ) foun d tha t th e yeas t Cryptococcus neqformans pro duced tumor s whe n inoculate d int o mice , an d Whit e (1965 ) als o supporte d a connection between yeast and malignancy . 2. Cole y an d Rif e ar e no t include d becaus e Cole y di d no t publis h muc h o n bacterial pathogen s a s etiologica l agent s o f cancer , an d Rif e di d no t leav e behin d adequate an d accessibl e documentatio n o f hi s research . Cole y s therap y i s als o a general bacterial therapy, not on e specifically linke d to a purported cance r microbe. As for th e Europeans, th e Frenc h an d Germa n researcher s tended no t t o publish i n peer-reviewed journals, an d I also faced a problem o f access. 3. Mattma n (1993 : 111—12 ) and Domingue, ed . (1982) . See also Livingston an d Livingston (1972) . 4. Se e Brau n (1947) ; Diene s an d Weinberge r (1951) ; an d Klieneberger-Nobe l (1949, 1951) . 5. Persona l correspondence , Novembe r 22 , 1995 . Fo r th e relevan t studies , se e Green, Heidger , an d Domingu e (1974a , 1974b) ; Domingu e (1995 , 1996) ; an d Domingue e t al. (1995). 6. Fo r a popular revie w o f Brown' s work , se e Scammel l (1993) . Medica l cita tions an d th e importanc e o f Brown i n th e bacteria l etiolog y theor y o f arthritis ar e provided b y Clar k (1995) . For th e trial s see Kloppenburg e t al . (1995 ) an d Tilley e t al. (1995) , an d fo r example s o f th e controvers y se e Clar k (1995) ; Gallan d (1995) ; McKendry (1995) ; and Paulus (1995) . 7. Se e Procto r (1995 : 225-35); Varmu s an d Weinber g (1993 : 106) ; an d Wein berg (1994 : 167-70) fo r a review of this research. 8. Nuzum (1921 , 1925) ; Crofton (1936) ; Inoue, Singer , an d Hutchinson (1965) ; and Inoue an d Singe r (1970) . 9. Green , Heidger , an d Domingu e (1974a , 1974b) . Se e als o th e ope n cycl e proposed b y Domingu e (1995 , 1996 ) an d th e limite d cyclica l mode l o f Bisse t (1970). 10. Livingsto n an d Allen (1948) ; Livingston (1949) ; and L'Esperance (1931) . 11. Cohe n an d Stramp p (1976) ; Aceved o e t al . (1978) . Se e als o Affront i e t al . (1976) an d Maruo e t al. (1979). 12. Aceved o e t al . (1981 ) an d Backu s an d Affront i (1981) . The latte r rule s ou t one possible artifact an d reviews the crow n gall/plasmi d transfe r theory . 13. Acevedo , Campbell-Acevedo , an d Kloo s (1985) . Thi s pape r show s th e absence o f C G productio n i n som e bacteri a fro m cance r patient s an d it s presenc e in some bacteria from noncance r patients . Backus and Affronti (1981 ) found C G i n twelve o f fourteen sample s cultivate d fro m malignan t tissue , and non e o r very little in controls. 14. See , for example , Naughton e t al. (1975); McManus, Naughton, an d Martinez-Hernandez (1976) ; and later the Regelson editoria l (1995) .

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Notes to Chapter 4

15. Domingu e e t al. (1986: 97). The beta subunit requires at least six of a cluster of seven genes on chromosom e ninetee n (Krichevsk y e t al. 1995 : 1034). 16. Grover , Woodward , an d Odel l (1995 : 77). Se e als o Carrell , Hammon , an d Odell (1993 ) an d Huth e t al. (1994). 17. Probabl y th e mos t cite d o f the researcher s o n mycoplasm a an d leukemi a i s Hayflick (Hayflic k an d Korpowsk i 1965 ; Hayflic k 1969) . Th e othe r 1960 s studie s on mycoplasm a ar e cite d i n Gilbe y an d Pollar d (1967) , wh o presen t thei r largel y negative results with germ-fre e leukemi c mice . 18. Researc h reviewe d b y Mattma n (1993 : 312) : Buntin g (1914) ; D e Negr i and Miereme t (1913) ; Fraenke l (1912) ; an d Fraenke l an d Muc h (1910) . Othe r contemporary wor k o n Hodgkin' s an d bacteri a include s Bloomfiel d (1915 ) an d Torrey (1916) . Cantwel l (1981 , 1990 : 72-73 ) review s th e literatur e fro m th e 1920 s and 1930s . 19. Fleishe r (1952) ; Carpente r e t al . (1955) ; an d Chang , Appleby , an d Bennet t (1974). 20. Cantwel l (1981) , Cantwel l an d Kelso (1984) , and Alexander-Jackson (1954 ) and Seiber t e t al. (1970) . A study o f bovine lymphom a foun d evidenc e fo r bacteri a in five o f six specimens (McKa y et al. 1967). 21. Diller , Donnelly , an d Fishe r (1967 : 1402-3) . Th e deat h fro m othe r infec tious diseases suggests a possible variable infectious outcom e simila r to what Duran Reynals (1950 ) claime d an d t o wha t Livingsto n propose d i n he r argumen t tha t cancer was related to th e collage n diseases. 22. Gregory' s book (1952 : 19—20 ) summarizes hi s research presented i n medica l publications, e.g. , Gregor y (1948 , 1949 , 1950a , 1950b , 1950c , 1951) . I f h e i n fac t was observin g nucle i rathe r tha n som e othe r interio r body , th e organis m migh t b e classified a s a fungus . Anothe r apparentl y independen t researc h repor t wa s Wein man e t al. (1968). 23. Se e Nauts (1975 , 1976 , 1980) ; Zheren an d Nauts (1991) ; Havas, Groesbeck , and Donnelly (1958) ; Havas, Donnelly, an d Levine (i960) ; Havas e t al . (1993) ; and Johnston (1962) . 24. America n Cance r Societ y (1992) , citin g Nationa l Cance r Institute , Cance r Statistics Branch . Th e 1983-9 0 statistic s ar e fro m Wing , Tong , an d Bolde n (1995 : 27).

25. "Cassileth , Claimin g 'Goofs, ' Refuse s t o Resign, " Cancer Chronicles, Sep tember 1993 , p. 4. See also Falcone (1994 : 81-83). 26. "Cure s o r 'Quackery'? " U.S. News and World Report, July 17 , 1995, p. 49. 27. I d o no t inten d t o questio n th e competenc e o f th e researchers. Rather , I intend t o poin t t o certai n aspect s o f the interpretation , measurement , o r desig n o f the stud y tha t coul d hav e been improve d o r changed , an d tha t would mak e a more convincing compariso n i n a future study . 28. Thes e question s hav e emerge d elsewher e (e.g. , Lerner 1994 : 330 ) an d fro m the Livingston Clini c (intervie w with Patrici a Huntley, Septembe r 1995) .

Notes to Chapter 5 |

19 9

29. Seiber t e t al . (1973 ) an d Seiber t an d Davi s (1977) . Thes e ma y b e tw o different studies , but th e desig n is almost identical so I am led to conclud e tha t the y may be two reports o f the same study. 30. Se e m y discussio n i n Hes s (1995 : 27-32) , whic h review s wor k b y Gilber t and colleague s (Biolog y an d Gende r Stud y Grou p 1989) ; Hubbar d (1990) ; Marti n (1991); and others. 31. Kelle r (1985 ) an d Manning (1983) , extended i n Hess (1995 : 27-32).

NOTES T O CHAPTE R 5

i. Fo r a n accoun t o f the controversy , se e Procto r (1995 : chs. 3—6 ) an d Wrigh t (1991). Sample articles in the controvers y includ e Coggo n an d Inski p (1994) ; Davis et al . (1990) ; Davis, Dinse , an d Hoe l (1994a , 1994b) ; Davis an d Hoe l (1992) ; Dol l and Peto (1987 : 4.94-123); Epstein (1993) ; and Muir, Fraumeni , an d Doll (1994) . 2. Eisenber g e t al . (1993) . The patter n o f use o f alternative medicin e ma y b e a long-term phenomenon . Fo r example , Beal e (1939 : 210 ) report s o n a surve y o f YWCA member s tha t found tha t 77 2 went t o osteopaths , 12 0 to chiropractors , 18 7 to Christia n Scientists , an d 12 5 t o medica l doctors . Likewise , ther e ar e parallel s between th e Thompsonia n movemen t o f th e nineteent h centur y an d aspect s o f alternative medicin e today . 3. O n user s demographic s an d patterns , se e Cassilet h e t al . (1984) ; Furnha m and Forey (1994) ; and Sharma (1992) . 4. Th e phras e "medical Vietnam" a s a sobriquet fo r th e war on cance r has been attributed t o Stanfor d Universit y Presiden t Donal d Kenned y (Procto r 1995 : 4). I t refers t o th e quagmir e o f researc h an d treatmen t spending , an d th e hug e tol l i n human lives . I n a previou s boo k (Hes s 1993 ) I suggeste d tha t th e Ne w Ag e movement i n th e Unite d State s was linked t o th e bab y boomer generation ; i t no w seems clear that as the boomers ag e they have shown increasing interest in nutritio n and alternative medicine . 5. I have been unable t o documen t th e primary sourc e for thi s commonly mad e attribution. Accordin g t o attorne y Clinto n Miller , wh o attempte d t o locat e th e primary sourc e bu t faile d t o d o so , th e tas k o f findin g Rush' s origina l statemen t may not be an easy one. 6. Committe e fo r Freedo m o f Choic e i n Medicin e (1995 : 640) ; als o Housto n (1989: 51). 7. Anothe r typ e o f chang e i s t o eas e restriction s o n th e importatio n o f drug s and device s from othe r countries . Fo r example , i n respons e t o activis m from AID S patients, i n 198 8 th e FD A ease d restriction s s o tha t patient s coul d impor t drug s from foreig n countrie s for personal use. 8. The y wer e abl e t o demonstrat e fro m availabl e statistic s i n th e 1980 s tha t about a third of the grants go to these organizations, but a 1976 ACS report suggest s

200 |

Notes

to Chapter 5

that th e figur e ma y b e a s high a s 8 9 percent (Bennet t an d DiLorenz o 1994 : 162 63). 9. Markl e an d Peterso n (1980 , 1987) ; Mos s (1989 : 150-51) ; an d Peterso n an d Markle (1979a , 1979b) . 10. Se e Paulin g (1993) ; Richard s (1981 ) fo r a mor e historica l account , an d Riordan e t al. (1994) for subsequen t research . 11. Kame n (1993 ) suggeste d tha t th e clinica l trial s ma y no t hav e exclude d th e incompatibles o f alcohol , sleepin g pills , an d tranquilizers , an d tha t patient s ma y have received prior chemotherapy i n conflict wit h the protocol. The clinica l studies were publishe d i n th e June , 1994 , issu e o f Journal of Clinical Oncology. Fo r a subsequent respons e t o th e charg e that incompatible s wer e no t excluded , se e Kosty et al. (i995). 12. Th e suppressio n o f Burzynski's work is chronicled in the newsletter Options: Revolutionary Ideas in the War on Cancer (People Against Cancer , P.O . Box 10 , Otho, Iowa 50569) . For the purposes here the most relevant articl e is the on e where Mos s is quoted : "Burzynsk i Charge s Nationa l Cance r Institut e wit h Misconduct : NC I Sponsored Trial s Halted!" (October , 1995 , p. 4). 13. Fo r example, I am thinking of the apparentl y rapidly changin g consensus i n cancer treatmen t tha t i s increasingl y openin g th e doo r t o adjuvan t nutritiona l therapies, a s i n th e nationa l symposiu m sponsore d b y th e America n Colleg e o f Nutrition an d the Cance r Treatmen t Research Foundatio n i n September , 1995 . 14. Wester n psychotherapie s occup y a n ambiguou s middl e ground . Ther e i s a consensus tha t patients with a better attitud e an d social support generall y d o better , so a t thi s leve l the y ar e no t reall y alternativ e therapies , bu t standar d adjuvan t therapies. However , othe r claims , suc h a s th e occasiona l claim s tha t hypnosi s o r suggestion ca n reliev e chronic , physica l diseases , ar e complicate d an d beyon d th e scope o f the genera l issue that I am discussing here.

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Index

Acevedo, H e r n a n , 133-3 7 AIDS, 4 1 , 46, 99 , 101 , 15 7 Alexander-Jackson, Eleanor , 3 0 - 3 8 , n o , 127, 130-3 3 Alternative cance r therapies : anthropolog y of, 95-104 ; estimate d n u m b e r o f users , 1 2, 157 ; polic y and , 156-73 ; suppressio n patterns of , 4 7 - 4 8 . See also N u t r i t i on an d cancer; Vaccine s American C a n c e r Society , 15-16 , 24 , 3 1 , 37-39, 51-52 , 57 , 70 , 92 , 16 3 American Medica l Association , 17 , 20—21 , 25, 28 , 34 , 51 , 6 1 - 6 4 Amsterdamska, Olga , 78-8 3 Antibiotics, 67 , 7 0 - 7 1 , 114-15 , 122-23 , : 5 5 Arthritis, 3 1 , 115-16 , 16 8 Bacteria: cell-wal l deficient , 88-90 , 112-16 ; L-forms, 22 , 35 , 37 , 88-89 , 113-16 ; m y cobacteria, 30 , 89 , 130-32 ; mycoplasma , 35, 37 , 89 , 139 ; pleomorphis m and , 18 , 22, 25 , 39 , 4 4 - 4 5 , 7 8 - 8 1 ; staphylococcus , 112, 131 , 133 , 136 , 149 ; streptococcus , 10, 18 , 83 , 133 , 136 ; typhoi d and , 25 , 7 9 80, 83 , 84 , 19 5 n . 37 . See also Bacteria l theories o f cancer ; Cyclogeny ; Filtra tionism; Vaccines . Bacterial theorie s o f cancer : an d cascad e o f cytokines theory , 13 , 116 , 149-50 , 168 ; continental tradition , 40 , i n ; modifica tions m a d e necessar y b y recen t research , 121, 138 , 153—55 ; reasons fo r los s o f sup port, 13-14 , 2 3 - 2 4 , 36 , 43 , 5 1 - 5 8 , 7 4 - 7 5 , 85, 9 5 - 9 7 ; secondar y infectio n theory , 105, 124 , 149 , 155 . See also Enderlein ; Glover; Livingston ; Naessens ; Rife ; Vil lequez Bechamp, Antoine , 7 6 - 7 8 , 111-1 2 Bergey's Manual, 83 , 13 4

Cancer: cance r industry , 51 ; policy, 158-73 ; research history , 50—58 ; statistics, 1-2 , 156-57. See also Alternative cance r thera pies; Bacteria l theorie s o f cancer ; Carcin ogens; Vaccine s Cancer therapies . See Alternativ e cance r therapies; Chemotherapy ; Hyperthermia ; N u t r i t i o n an d cancer ; Radiotherapy ; Sur gery; Vaccine s Cancer types : breast , 20 , 26 , 68 , 142-45 ; l e u kemias, 8 , 139—40 ; Hodgkin's disease , 33 , 87, 125 , 139 ; sarcomas , 8 , 132 , 13 9 Carcinogens, 1 , 119 ; chemical , 52-54 , 60 , 119—21, 151 ; environmental, 35 , 53 , 60 , 156; fungal , 8 , 118-19 ; radiation-induced , 19, 54 , 68 . See also Bacteria; R a d i o t h e r apy; Viruse s Chemotherapy, 14 , 16 , 34 , 4 1 , 53 , 58 , 6 4 74, 9 4 - 9 6 , 1 3 2 Coley, William , 9 - 1 9 , 52 , 56-57 , 6 1 . See also Vaccines, Coley' s toxin s Coulter, Harris , 48 , 5 9 Credible biologica l mechanis m test , 168 — 70 Culture o f cance r research , 5 0 - 5 8 , 72 , 85 , 92—104 Cyclogeny, 22 , 40 , 81-87 , 112-14 , I 2 9 Diet. See Gerso n therapy ; N u t r i t i o n an d cancer D o m i n g u e , Gerald , 112—15 , 129 , 133-37 , 154 Douglas, James, 6 8 - 6 9 Enderlein, Glinther , 3 9 - 4 1 , 81-82 , i n , 129-30 Evaluation, 1—3 , 105-11 , 183-86 ; outcome s analysis, 148-4 9 E w i n g , James, 7 , 8 , 13 , 33 , 5 0 - 5 1 , 57 , 6 8

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Filtrationism, 2 1 - 2 2 , 25 , 55 , 8 1 - 8 7 , 113 , 129 Fishbein, Morris , 2 1 , 2 7 Flexner report , 61-6 3 Food an d D r u g Administration , 15-16 , 28 , 52, 100 ; deregulation , 99-104 , 158-6 1 Fujimura, Joan , 53 , 11 6 Fungi versu s bacteria , 8 , 26 , 30 , 39-40 , 129-30, 19 6 n . 1 . See also Bacteria; V i ruses G e n d e r an d science , 87-97 , I 5 0 - 5 3 Genetics, 5 4 - 5 5 . See also Molecular theor y of cance r Gerson therapy , 42 , 95 , 148 , 16 9 Globalization, 9 9 - 1 0 4 Glover, T h o m a s , 16-24 , 27 , 4 7 - 4 8 , 76 , 86 , 120-21, 126-30 , 132-3 3 Heredity, 52-55 , 6 1 H u m a n choriogonadotropi n (hCG) , 38 , 118, 135-38 , 152-55 , 16 8 Hyperthermia, 13 , 2 6 Immunotherapies, 8-10 , 13 , 53 , 9 5 - 9 6 , 169 , 190 n . 6 . See also Vaccines Insurance, 38 , 162-6 3 Interest theory , 4 9 - 5 0 , 1 8 0 - 8 1 ; cance r indus try, 6 7 - 7 5 ; industria l interests , 58-6 7 Issels, Josef, 35 , 4 1 - 4 2 Johns H o p k i n s Medica l School , 39 , 6 0 - 6 3 , 69, 83 , 85 ; an d Willia m Halsted , 95 ; an d H o w a r d Kelly , 69 ; an d Willia m Osier , 60 ; and Willia m Welch , 61-6 3 Kendall, Arthur , 2 5 - 2 8 , 76 , 82-8 7 Klieneberger-Nobel, Emmy , 35 , 8 8 Koch, Willia m Frederick , 10 0 Koch's postulates , 20 , 26 , 3 1 , 33 , 56 , 78 , 127-29, 16 8 Krebiozen, 29 , 19 1 n . 3 2 K u h n , T h o m a s , 106-7 , 184-85 ; i n c o m m e n surability, 77 , 117-1 8 Livingston, Virginia , 22 , 2 9 - 3 9 , 48 , 56 , 9 1 96, n o , 13 5 Longino, Helen , 107-109 , 151 , 153 , 185— 86 Lowy, liana , n - 1 3

Martin, Emily , 85 , 87 , 134 , 15 0 Mattman, Lida , 37 , 88-89 , 112-18 , 124-2 5 Mayo Clinic , 18 , 25 , 16 5 Medical pluralism , 9 9 - 1 0 0 M e m o r i a l Sloan-Ketterin g Cance r C e n t e r (Memorial Hospital) , 7 , 13-15 , 18 , 3 4 36, 50 , 68—73 , 95 , 165 . See also C h e m o therapy; E w i n g , James; Radiotherapy ; R h o a d s , Corneliu s M i x e d Bacteria l Vaccin e (MBV) , 10-16 , 53, 85 , 100 , 116 , 139 , 141 , 145 , 16 9 M o d e r n i s m an d scientifi c researc h cultures , 75-87 Molecular theor y o f cancer , 53-54 , 116-19 , 133-35, 151-5 2 Moss, R a l p h , 51 , 64, 6 7 - 7 3 , l 6 5 Naessens, Gaston, 44-47,82,100,111,129-3 0 National Institute s o f Health , 23 , 115 , 126 ; National C a n c e r Institute , 5 1 - 5 3 , 69 , 156, 163-73 ; Offic e o f Alternativ e M e d i cine, 163-7 3 Nauts, H e l e n Coley , 10-16 , 8 5 N u t r i t i o n an d cancer , 57 , 6 1 , 78, 9 3 - 9 6 , 123-24, 158-60 , 16 9 Pasteur, Louis , 57 , 76 , 78 , 103 , 11 2 Pleomorphism. See Bacteri a Radiotherapy, 13-14 , 26 , 36 , 51-54 , 6 1 , 6 8 70, 85 , 92 , 95 ; radium , 6 8 - 7 0 R a n d o m i z e d controlle d trials , 148-49 , 1 6 5 66; outcome s analysis , 148-4 9 R e i c h , Wilhelm , 19 2 n . 3 5 Research culture , 50 , 7 2 - 7 3 , 87-88 , 179-83 ; ecology of , 7 4 - 7 5 ; orthodox y an d h e t e r o doxy, 7 4 Research progra m an d tradition : bacterial , 9; cultur e of , 182 ; defined , 2 ; evaluatio n criteria for , 1 0 6 - n ; flexibilit y an d routin ization of , 73-74 ; har d core , 53 , 8 4 R h o a d s , Cornelius , 14 , 3 3 - 3 5 , 50 , 66, 7 0 73, 92 , 9 6 Fife, Roya l R a y m o n d , 2 4 - 2 9 , 4 7 - 4 8 , 87 , 100, 11 9 Rockefeller foundations , 58-6 7 Rosenow, Edward , 18 , 2 5 R o u s , Peyton , 7 , 19 , 3 2 - 3 3 , 51 , 55-56 , 6 1 , 84, 1 2 0 - 2 1 . See also Viruses, R o u s sar coma viru s

Index | Science studies : actor-network theory , 50 , 57, 74, 103 , 123, 181; culture-and-power theory, 74-76 , 87-104 , 178-87 ; feminis t theory, 107-9 , I 5°~"53; incommensurabil ity, 77, 117-18 ; interest theory , 49-50 , 180-81; neutrality fallacy , 174-75 ; philosophy o f science, 106-11 , 183-86 ; scienc e wars, 177 ; strong program, 175-7 8 Scleroderma, 30-3 1 Sera: Doyen, 42 ; Glover, 16-24 , 47, 137-38 , 142-45; Naessens, 46 Standardization o f therapies, 12 , 62, 72, 85 Starr, Paul , 60, 63 Suppression, 47-5 0 Surgery, 53 , 68, 93-96, 15 0 Trophoblastic theory , 13 5 Tuberculosis, 30-31 , 33 , 37, 40-41, 87 , 115, 131, 139 . See also Vaccines, BC G TyndaUization, 9 8

23 3

Ulcers (gastric) , 3 , 8, 115-16 , 16 8 Vaccines: BCG, 8-9 , 53 , 116, 141 ; cascade of cytokines theory , 13 , 116, 149-50 , 168 ; Coley's toxins , 10-16 , 53 , 85, 100 , 116, 139, 141 , 145, 169 ; hCG, 137 ; Livingston, 35 , 138 , 145-50 ; policy, 16 9 Villequez, Ernest, 42-47 , i n , 13 1 Viruses: compared wit h bacteria , 22 , 25-26, 31—33, 55, 76-87; confusion durin g 1930s, 81 ; history, 8 , 34, 51-56, 61, 71 ; and National Cance r Institute , 51-53 ; Rous sarcom a virus, 21, 31-32, 132-33 ; virologists versus bacteriologists, 19 , 5556 Von Brehmer, Wilhelm , 41,44 , i n , 13 1 Wood, Francis , 18 , 50, 56 X-ray therapy . See Radiotherapy

About th e Autho r

David J. Hes s i s an anthropologis t an d tenure d professo r i n th e Science an d Technolog y Studie s Departmen t a t Rensselae r Polytechni c Institute. Hi s previou s researc h o n alternativ e medicin e involve d ethno graphic fieldwor k wit h th e Spiritis t movemen t o f Brazil, wher e h e exam ined beliefs , practices , an d scientifi c controversie s associate d wit h spirits , mediums, an d healing . Tha t researc h le d t o Samba in the Night, Spirits and Scientists, The Brazilian Puzzle ( a boo k coedite d wit h Robert o DaMatta) , and Science in the New Age, a comparativ e boo k o n simila r issue s i n th e United States . Hess ha s also written tw o genera l book s o n scienc e studies : Science and Technology in a Multicultural World and Science Studies: An Advanced

Introduction. H e i s the recipien t o f various grant s an d awards, including tw o Fulbrights an d a Nationa l Scienc e Foundatio n gran t fo r researc h o n th e public understandin g o f science , an d h e i s chai r o f th e Committe e o f th e Anthropology o f Science , Technology , an d Computin g o f th e America n Anthropological Association . Can Bacteria Cause Cancer? i s th e first i n a planned series of books on alternative cancer therapies, cultural and political issues relate d t o thei r controversia l status , an d th e proble m o f ho w t o evaluate them .

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