Laetrile - An Overview James H. Price, PhD, MPH Joy A. Price, MA, SpA

ABSTRACT The original theory in the 1920s on the mode of action of Laetrile is described along with the research that followed in light of this theory. For over 40 years, studies were conducted, using test animals, in an attempt to substantiate the theory. AN of these studies have shown Laetrile does not preferentially kill cancer cells. In spite of these studies, the misconceptionpersists that Laetrile prevents and cures cancer. The legal and socioeconomic implications of Laetrile are examined and the role of health education in combating this problem is explored. INTRODUCTION Cancer is an ill-defined and heterogeneous group of diseases characterized by abnormal cell growth. It ranks second only to heart disease as the leading cause of death in the United States. This year almost 700,000 new cases of cancer will be diagnosed and will kill over 385,000 Americans - more than 1,000 people a day! According to present rates, 1 in 4 will eventually have cancer. This means that cancer will ultimately strike two of every three families in America! “Of every six people who get cancer, two will be saved and four will die . . . one might have been saved with earlier diagnosis and prompt treatment. The other three of the four will die of cancer which cannot yet be controlled.”’ Cancer is one of the great equalizers of society. It does not respect race, sex, age, or socioeconomic status. Therefore, when the cures of rational science fail, the path to non-traditional medical care becomes crowded with people from all walks of life. At the end of that path is a wide array of special diets, salves, vaccines and serums, machines and devices, and plant products to help allay the fears of cancer patients. Among the plant products purported to prevent or cure cancer is a substance commonly called Laetrile. Other names for it include amygdalin, Aprikern, Bee 17 Vitamin B-17, and nitriloside. HISTORY AND CHEMISTRY The seed from which Laetrile sprouted as a cancer cure was planted by John Beard in his wordy treatise on the etiology of cancer published in Lancet in 1902.2 His theory stated that cancer is fundamentally “lost germ SEPTEMBER 1978

cells” which later in life can be activated to divide and produce trophoblasts (invasive placenta-like cells) which, when located outside the uterus, are malignant cells. Then in 1948 in Federation Proceedings, Beard published results from biological tests he developed to substantiate the “trophoblastic theory” of malignancy. Beard was convinced that cancer was an enzyme and nutritional deficiency disease! This theory was further refined by E. T. Krebs, Jr. in 1950. He proposed that trophoblasts were present in the various organs of the body as undifferentiated cells which later could become activated, forming cancer cells. The recent scientific rationale for Laetrile fits into the aforementioned theory that maintains that cancer is a result of metabolic and nutritional deficiencies and can be corrected by proper diet. The first use of Laetrile as an anticancer agent was reportedly by the late E. T. Krebs, Sr., M.D. shortly after 1920.5 It was easy to produce Laetrile by extracting amygdalin (a cyanidesugar complex frequently used as Laetrile) using ether and alcohol and partially purifying it from extracts of ground peach pits (or apricot pits).6*’ The actual chemical structure of Laetrile according to the Merck Index 8 is 1-mandelonitrile-beta-glucuronic acid (Figure 1-A), whereas amygdalin is a D-mandelonitrile-beta-Dglucoside-6beta-D-glucoside containing two glucose residues (Figure 1-B). Thus, Laetrile and amygdalin are two closely related but different chemicals. Amygdalin was first isolated from bitter almonds by French chemists in 1830.’ Later work showed that amygdalin is cleaved by an enzyme (beta-glucosidase) which releases the sugars (glucoses) and a cyanide complex (mandelonitrile). Figure 1-C shows how the mandelonitrile decomposes to form benzaldehyde and hydrocyanic acid either spontaneously to a slight degree or by action of a second enzyme. Dr. Krebs’s preparation consisted mainly of amygdalin,9 as did his son’s, E. T. Krebs, Jr., preparation in the late 1940s which he propounded as a “refined” formula. lo We will refer to their preparation as Laetrile since it is the term commonly used in the literature, although it was and still is amygdalin. The elder Krebs stated he had used the drug for 20 years in far-advanced cancer patients” but that it was too toxic for general use until his son had refined it in 1952 for



THE JOURNAL OF SCHOOL HEALTH

409

Figure 1 Chemical Structures COOH

CH 2 OH

H

OH

B. AMYGDALIN (D-Mandelonitrile-Beta-DGlucoside-6-Beta-D-Glucoside)

A. LAETRILE ( 1-Mandelonitrile-Beta-Glucuronic Acid)

Mandelonitrile

CH

Benzaldehyde

C. FORMATION OF BENZALDEHYDE AND CYANIDE

injection into humans (although the preparation was not altered).9 E. T. Krebs, Jr., is given credit for the name Laetrile which he derived from the fact that his apricot kernel preparation was laevorotatory to polarize light (caused it to turn to the left) and because amygdalin was chemically a mandelonitrile. Their reasoning, at that time, in using Laetrile as an anticancer agent was scientifically sophisticated. The theory was that cancer cells were rich in the enzyme betaglucuronidase which was supposed to cleave Laetrile eventually to cyanide, thereupon killing the cancer cells, but normal cells survived since they were low in that enzyme. Normal cells supposedly had more of another enzyme, rhodanase (thiosulphate transfurase), which inactivated free cyanide by forming thiocyanate, a less toxic substance. This theory was supported by Fishman and AnlyanI2 in 1947, who compared the betaglucuronidase activity of normal and tumor tissues and found that elevated beta-glucuronidase was characteristic of malignant cells. Meanwhile David Greenberg et a1 at Berkley in 1952!3-15 studied the biological action of malononitriles in tumors and normal tissue. His findings showed that neither sodium cyanide nor malononitrile showed growth retardation in tumors. Tumors do not have significantly less rhodanase (the “protective enzyme”) than normal tissue, and the beta-glucuronidase enzyme (cyanide “releasing” enzyme) is more scarce in tumors. which is contrary to 410

THE JOURNAL OF SCHOOL HEALTH

Laetrile supporters.’6 Conchie et a1 in 1959, demonstrated only traces of beta-glucosidase in animal tissues and even less in tumors. The liver and kidneys naturally contained the most, and therefore Laetrile consumers should have severe liver and kidney damage if their original theory was correct. REVIEW OF THE RESEARCH In the early 1950s,the use of Laetrile as an anticancer agent was publicized in a number of national magazines of the lay press. This was brought to the attention of the Cancer Commission of the California Medical Association which set up a group appointed from its Committee on Chemotherapeutic Agents to study 30-50 patients treated with Laetrile over a period of six months and to follow up the patients over the next six months. The findings would indicate if long-term studies would be worthwhile!’ Krebs, Jr. refused to give them a supply of his drug since he saw the investigation as an attempt to discredit Laetrile. With a great deal of difficulty, a list of 44 human patients with cancer who were being treated by Laetrile was compiled. Most of these patients died promptly while under Laetrile treatment. Some patients survived with the cancer, but not necessarily because of Laetrile since the patients were also treated simultaneously with radiotherapy and other forms of chemotherapy. Autopsies and histological studies by five different SEPTEMBER 1978

pathologists showed no chemotherapeutic effects attributable to Laetrile. The Cancer Commission also conducted studies on cancer in laboratory mice (which were easily treated by other means of chemotherapy), but the cancer was not affected by Laetrile. This was the first article to appear in the literature using Laetrile in animals.” The Commission recommended Laetrile be banned. In 1959, the California Legislature passed a bill against cancer quackery; and under this statute, Laetrile was made illegal in California.’ The only case reports found in a professional American journal which gave evidence in favor of Laetrile as an anticancer drug was in Experimental Medicine and Surgery in 1962 by M ~ r r o n e !He ~ cites 10 cases of treatment with Laetrile and notes possible regression of metastases since the patients had dramatic relief of pain, discontinuance of narcotics, and improved appetite. The American Cancer Society in their publication “Cancer Quackery”20 defines these types of results as ‘testimonials’ which are emotional responses as a result of the “placebo effect”2land not considered scientific evidence. Other testimonials from Laetrile advocates tend to give miraculous “evidence” of advanced cancer patients who had been given no hope for recovery by orthodox medicine only to be completely “cured” by Both the FDA and established scientific researchers have been highly critical of testimonials and case histories as scientific work. The furor created by these testimonials of Laetrile supporters was so great that in 1972 and 1973, petitions signed by 43,000 people were sent to President Nixon demanding Laetrile be te~ted.2~ The petitions were referred to Benno Schmidt, one of President Nixon’s science advisors, who then had four studies set up: two by the National Cancer Institute (NCI), one at SloanKettering, and one at the Catholic Medical Center in Queens, New York.26 The NCI found no antitumor activity by Laetrile in mice. From August 1973 to February 1975, chemist Kanematsu Sugiura, DSc, a respected cancer researcher for over 40 years, ran animal tests using spontaneously-induced mammary tumor strains, with preliminary tests showing amygdalin had a 20% rate of metastases as compared to 80% for control^.^^-^^ The premature results were unofficially leaked to the lay press and flaunted by Laetrile promoters. In an attempt to reproduce these results, two experiments were begun in 1974 at the Catholic Medical Center and negative results were found. Professor Sugiura also failed to duplicate his results when he repeated the tests with veterinarian Franz Schmid, his son-in-law. But the damage was already done, and the Laetrile supporters believed what they wanted and ignored the negative reports citing only the positive preliminary tests. C. Chester Stock, PhD, Sloan-KetterSEPTEMBER 1978

ing Institute’s vice-president and associated director for administrative affairs, has reported that they are submitting for publication to the Journal of Surgical Oncology the results of approximately 32 experiments on mice and rats which will include Professor Sugiura’s results. It will be the first scientific publication of his work. 29 A number of recent studies have been published, most notably at the Southern Research Institute in Alabama.3Oa3I Altogether, they used six different transplantable rodent tumors and used amygdalin alone and in combination with beta-glucosidase in an attempt to prove the original anticancer theory for Laetrile. They were also testing a recent theory of Dr. Dean Burk, formerly of the National Cancer Institute, who supported the vitamin theory for Laetrile. Burk et al 32.33 reported that a certain type of cancer cell (Ehrlich ascites cells), treated in vitro, was sensitive to combined treatment with amygdalin and beta-glucosidase. Levi et al earlier disproved this, but no in vivo (in animals) studies were done. All their tests were conclusively negative, even after they tested and retested ones that had an inkling of hope. Hil134at Washington University School of Medicine in St. Louis tested and retested amygdalin in varying doses on B16 melanoma and leukemia injected mice, but the amygdalin treated mice died sooner than the controls. When Ovejera, et a13’transplanted human malignancies into mice and treated them with amygdalin he found that amygdalin had no effect on the human tumors. Laetrile advocates claim that the above studies do not accurately represent human tumors. It is their contention that human malignancies are metabolic problems arising from vitamin deficiency, (B-17). To further compound the problem, Laetrile advocates claim that their research has been completed by numerous researchers outside the United States. The following studies have been cited by Laetrile supporters: Navarro,36 a biochemist, published the results of 14 patients treated with Laetrile. There were no controls in the study and no evidence of prolongation of life. Dr. Navarro reported another study of 83 patients he had treated with Laetrile.37 Their survival times were between 7 and 24 months, which falls within the range for persons receiving no treatment. As a side note, Dr. Navarro stressed in his articles that “Laetrile is hydrolyzed by the hydrochloric acid in the stomach; hence, it should never be given by mouth.” In Germany, Nieper reported the results of 35 cancer patients treated with Laetrile.” Approximately 6 of the 35 patients had some objective improvement. However, it is not possible to credit Laetrile with the improvement of these patients since they were also receiving other forms of therapy with the Laetrile. As part of the data submitted to the FDA by the McNaughton Foundation THE JOURNAL OF SCHOOL HEALTH

41 1

for an Investigational New Drug application, animal studies were done by the Scind Research and Development Company, Inc. of San Francis~o.’~ Their report indicated that Laetrile by itself was ineffective in treating several forms of mouse malignancies. To date, no studies have been completed either in animals or humans to warrant the use of Laetrile in humans. Laetrile has been studied extensively, and no significant positive results have been identified and repeated. Since Krebs could not get Laetrile into the U S . as a drug, in 1970, he transformed the cyanogenic glycoside into a vitamin by simply changing its name to antineoplastic vitamin B17. Krebs claimed that beta-cyanogenic glucosides (laetriles) of nitrilosides, are vitamins and that a deficiency of this vitamin is the cause of cancer.’ He claimed that B-17 occurs in many foods but that through modern diets and food processing we have eliminated it from our diets. The current theory for the use of Laetrile is not just as a cure for cancer but for prevention when taken along with special diets. The initial diet consists mainly of fruits and vegetables and other “natural foods” and excludes animal products. 41 Their philosophy begins at the fringes of modern orthodox medicine with ortho-molecular and megavitamin therapy and ends up in “left field” with an orientation towards naturopathic medicine which can produce untold harm. 42 Naturopaths rely on a method of healing which emphasizes “diets based on natural foods, vitamins, fasting, vegetarianism, and a combination of nature’s forces . . . .”43 To further confuse the public, the Laetrile movement mimics the sounds of modern orthodox medicine, emphasizing not only prevention but holistic medicine. Krebs’ change in strategy from having Laetrile seen as only a cancer cure to one of a missing vitamin was a well-planned move for several reasons. First, as a food supplement or vitamin, it would not require the FDA’s permission to sell it for human consumption. Secondly, there was already occuring in the U.S. a growing disenchantment with processed foods, and there was a rising consciousness in nutrition and health foods. Therefore, many “health food” stores began marketing ground apricot kernels and selling Laetrile underground. Yet, “Animal tests have failed to show that any disease develops when Laetrile is removed from the diet, nor does it cure any disease when added to the diet,”29,44 which is a standard test for a vitamin. LEGAL ISSUES In 1961, the FDA brought criminal action against the John Beard Memorial Foundation in San Francisco (the Foundation established by the Krebs and used to distribute their Laetrile preparation). Krebs, Jr. was 412

THE JOURNAL OF SCHOOL HEALTH

fined $3,755 and prohibited from the production, distribution and importation of Laetrile into the U.S. The charges were based on the fact that Laetrile did not meet the requirements of the new drug act, which was the Kefauver-Harris Amendment to the Pure Food, Drug, and Cosmetic Act of 1938. “Previously, the government had been required to prove that a remedy was useless before removing it from the marketplace. Under the new law, the burden of proof was shifted to the supporters of the drug which, in this case, was Krebs.” 43 The Canadian food and drug officials also prohibited the distribution of Laetrile in Canada in 1965:’ The Mexican Department of Health banned Laetrile for cancer treatment in October, 1976. The FDA has won numerous court cases banning the interstate commerce of apricot kernels, Aprikern and Bee-17, which all contain Laetrile. In response to continual enforcements by the FDA, Laetrile supporters have turned their attention to the state level in an attempt to win grassroots support for their cause. Alaska was the first state to legalize Laetrile in 1976. Since that time, 1 1 more states have legalized some form of Laetrile: Arizona, Delaware, Florida, Indiana, Louisiana, Nevada, New Hampshire, Oklahoma, Oregon, Texas, and Washington.” Eight other states have turned down the Laetrile crusade, two of which are the most populous states, New York and California. Most state laws have provisions similar to Alaska’s with the primary intent to protect physicians who decide to use the drug. Therefore, hospitals and state medical boards cannot take disciplinary action against those physicians who choose to use Laetrile. However, John Richardson, MD, from Albany, California, a prominent Laetrile supporter was arrested in 1972 for conspiracy to smuggle Laetrile into the United States. l6 Richardson lost his license to practice medicine, was fined $20,000 and placed on three years probation. Some of the state laws are far more permissive than just the use of Laetrile. Arizona, Delaware, Indiana, Nevada, and Texas also permit the manufacturing, distribution and sale of Laetrile. State legislation has left the public in a precarious situation. Physicians are now “free to prescribe a drug with no proven benefit, under state laws which contain no provision for standardization or quality control. Finally, the state laws contain no scientific specification of the compound involved.” 45 The FDA 44 has found Laetrile tablets, supposedly containing 500 milligrams, vary in amygdalin content from 42 to 450 milligrams.* Solutions for injections have varied from 14% to 87% amygdalin. In addition, there have been indications of “serious microbial contamination.” The state of Oklahoma has been in the forefront of the current news on Laetrile since 1975, when Federal SEPTEMBER 1978

Judge Luther Bohanan in Oklahoma City granted Glen Rutherford an injunction that allowed him to bring Laetrile in from Mexico .for himself. Judge Bohanan ruled that cancer patients can import Laetrile if they have a doctor’s affidavit confirming their need for the medication. In an appeal by the FDA, the Tenth U.S. Circuit Court of Appeals upheld the Bohanan injunction and ordered the FDA to hold public hearings on banning Laetrile. At a public hearing held in May, 1977 in Kansas City, more than 100 pro-Laetrile supporters cheered Laetrile advocates and “booed” their opponents?* A new twist had been added to the Laetrile problem by the recent introduction in Congress of the “Medical Freedom of Choice” bill. Introduced Representative Steven D. Symms of Idaho, this bill has over 100 cosponsor~.~’The bill would repeal the FDA’s authority to rule on the efficacy of drugs, but would require the FDA to judge drugs solely on their safety. Consumer Reports recently summarized the problems the bill would create should it be passed: “The Medical Freedom of Choice” bill. Introduced by Representative Steven D. Symms of Idaho, this bill has over 100 copurveyors of worthless nostrums could prey freely on an unprotected public, exploiting the fears of the sick and the desperation of the dying. The fight against charlatans in medicine has been long and hard and it is far from over.”’6

SOCIOECONOMIC ISSUES The promotion and controlling interests in the Laetrile movement are frequently of questionable character. There are five organizations actively supporting Laetrile.” The Committee for Freedom of Choice in Cancer Therapy is the largest and emphasizes the constitutional right of people to do with their lives what they want. The oldest group of Laetrile advocates is the National Health Federation which often crusades for unorthodox medical treatments and “health food” regimes.49The Cancer Control Society which publishes Cancer Control Journal, a non-professional journal, and the International Association of Cancer Victims and Friends, which publishes Cancer News Journal 53 are also Laetrile advocates. The fifth group to support the Laetrile movement is the McNaughton Foundation, established for the purpose of sponsoring independent research, particularly for scientists whose ideas are unconventional. In April, 1970, E. T. Krebs, Jr., through the McNaughton Foundation, applied to the FDA for an Investigative New Drug Application (IND) which would allow Laetrile to be used for clinical trial^?^ The application was soon rescinded because there were deficiencies in the scientific evidence that the drug was safe and effective in the treatment of cancer. In his SEPTEMBER 1978

application, he cited a number of case histories by Ernest0 Contreras, MD of Tijuana, Mexico. Contreras, a former military pathologist, was introduced to Laetrile in 1963 through a cancer patient in California who wanted treatment with Laetrile but could not travel the distance to Canada. Dr. Contreras has since grown into the number one trafficker in Laetrile in the Western Hemisphere!’ Other leading investors in the Laetrile movement include “ ‘Dr.’ Krebs, Jr. (whose honorary DSc came from American Christian College in Tulsa, Oklahoma)” 55 and a Canadian, Andrew McNaughMany of the supporters of Laetrile are against abortion reform, the Equal Rights Amendment, the welfare system, and government regulation in general.s6 These topics are all packed with emotionalism, and Laetrile has taken its place among them. Laetrile is now a political rather than a medical issue. Congdon Wood of the American Cancer Society lo attributes some of Laetrile’s success to the national interest in the occult, faith healing, astrology, UFOs and so forth.” It provides a nonrational and simplistic remedy for a complex and in most cases incomprehensible illness for cancer patients. Cancer victims repeatedly seek help from the medical and scientific community for answers and are greeted with cold and stark realities which cancer patients reject for a seemingly easier solution, or at least one that offers them “hope.” Leaders of the Laetrile movement have been accused of profiteering at the expense of the critically ill. The drug costs less than one dollar per vial to manufacture, but can cost $50 a day for three injections$ The tablets cost less than two cents per pill to manufacture but cost patients $1.25 per tablet, usually at a dosage of several tablets each day.” It has been alleged that within a two-year period, several of the Laetrile leaders each banked about $2 million.” However, it should be remembered that traditional cancer treatment has a median cost of $19,000 per case.59 Another sad aspect of this whole story is that some individuals, even some professionals, have been suggesting that “Since Laetrile is harmless, why not let cancer patients use it anyway?” On the contrary, Laetrile is a toxic poison. Two hundred milligrams of cyanide is toxic to humans. Three grams of Laetrile contain the equivalent of 180 milligrams of cyanide.60 Some investigators have cited cases of Laetrile poisoning.61s6zDogs fed doses of Laetrile similar to those prescribed for cancer patients died of cyanide poisoning.63 Rapid death from Laetrile has been reported in a 17-year-old girl and an 11-month-old girl who swallowed five of her father’s 500 mg Laetrile tablets?65 Furthermore, it has been purported that Laetrile may be carcinogenic; since “small amounts of cyanide are converted in vivo to thiocyanate, which is THE JOURNAL OF SCHOOL HEALTH

413

goitrogenic; and all goitrogens are known to be carcinogenic.’”* It has also been suggested that Laetrile may be chronically toxic to the nervous system and may have teratogenic effects? The freedom to use a worthless drug may seem harmless at first, but the reasons against it are numerous: too many patients who have a chance to be cured or lengthen their lives with conventional methods may reject them for Laetrile; 59-61 Laetrile could prevent some individuals from obtaining early medical care; the economic burden could be devastating to the patient and the family; and the use of Laetrile without appropriate tests erodes the basis of scientific medicine - the use of controlled experiments.

THE ROLE OF HEALTH EDUCATION It is the responsibility of the medical, educational and scientific community to educate the publica concerning cancer and chemotherapy. Quackery is not something new; but if the medical community ignores it rather than fights it, it will create further hardships for innocent victim^.^^*^^ For example, in dealing with state Laetrile bills, ‘‘in Massachusetts the state chapter of the American Cancer Society failed to testify at a hearing on the proposed legislation and in Arizona only a single person (a dietitian) spoke against the bill.”@ The absence of a continued, coordinated effort on the part of responsible health organizations will continue to permit pro-Laetrile supporters to gain further support. Laws on the Federal level and strict enforcement of them are needed to combat quackery. Both school and public health education on quackery should be increased. In a study to be published by a group of sociologists from Western Michigan University, the social characteristics of those in the Laetrile movement were e~amined.~’ They found the majority of their sample was white, middle-aged females with some college education. The supporters of Laetrile “believed in the efficacy of vitamins in preventing and treating disease, negatively evaluated M.D. s, regularly shopped at health food stores, and disapproved of the fluoridation of public water supplies.’’ This helps to identify those individuals where concentrated educational efforts may be of some value. The health educator needs to have competencies in the following areas to successfully educate others on cancer quackery: (1) knowledge of cancer and its treatments; (2) the role of well-designed research studies, including the random allocation of subjects into treatment groups and the need for a control group; (3) the placebo effect; (4) reasons for patients claiming Laetrile cures: non-professional diagnosis, multiple treatment modalities, misdiagnosis, and spontaneous remission; and (5) the role of naturopathy and megavitamin theories in maintaining health. To help 414

THE JOURNAL OF SCHOOL HEALTH

their students examine the issues of Laetrile, the health teacher could help them explore answers to the following questions: What motivates people to support ideas or behave in certain ways? What motivates Laetrile supporters to support Laetrile? Is there a glamor associated with the illicit? What are the backgrounds of the leaders of the Laetrile movement?” What role does “informed consent’’ play in the use of Laetrile? Should people be allowed to do whatever they wish with their bodies as long as others are not harmed? When, if ever, do personal rights diminish (eg, for the good of society)? Are there times when people need help to protect themselves from quackery? If so, who should provide that help? Does the public support legalization of Laetrile? The actual etiology of cancer quackery is a very complex psychosocioeconomic problem. Emotionalism is very hard to combat, but sound reasoning is one of the best bets. Burkhalter67 has offered several suggestions for helping cancer victims and their families combat cancer quackery which are relevant to all health professionals: take the time to listen; provide correct information; be sympathetic and non-judgmental; report the selling of unproven methods; and offer hope to the cancer patient and his family.

REFERENCES

1. American Cancer Society, 1977 Cancer Facts & Figures. New

York, American Cancer Society, 1976. 2. Beard J: Embryological aspects and etiology of carcinoma. Lancer 1:1758-1761,June 21, 1902. 3. Beard HH: Correlation of the unitarian or trophoblastic thesis with the biological test of malignancy. Fed Proc 7:145, 1947. 4. Unproven methods of cancer treatment. CA 13:120-122,1963. 5 . “Cancer cure” with mafia blessing. Med World News 9:32-34, 37, Nov 15, 1968. 6. Sanders GB:Report from KMA cancer committee - new and unproven methods of cancer treatment - “Laetrile.” J Ky Med Assoc August 1976, p377.

7. Greenberg DM: The vitamin fraud in cancer quackery. Wesr J Med 122:345-348April 1975. 8. Stecher PG fed): The Merck Zndex, ed 8. Rahway NJ, Merck & Co Inc, 1968, Vol 76, p606. 9. Levi L, French WN, Bickis IJ, et al: Laetrile: a study of its physicochemical and biochemical properties. Canud Med Assn ‘J 92:1057-1061,May 15, 1965. 10. Holden C: Laetrile: quack cancer remedy still brings hope to sufferers. Science 193:982-985,Sept 10, 1976. 11. Unproven methods of cancer treatment. CA 12:69-71,1962. 12. Fishman WH,Anlyan AJ: Comparison of the beta-glucuronidase activity of normal, tumor, and lymph node tissues of surgical patients. Science 10656-67,July 18, 1947. 13. Gal EM, Fung F, Greenberg DM: Studies on the biological action of malononitriles I. The effect of substituted malononitriles on the growth of transplanted tumors in mice. Cancer Res 12565-572, 1952.

SEPTEMBER 1978

14. Petrakis NL, Bierman HR, Shimkin MB: Addendem substituted malononitriles in neoplastic diseases in man. Cancer Res 12:573, 1952. 15. Gal EM, Fung F, Greenberg DM: Studies on the biological action of malononitriles 11. Distribution of rhodanese (transulfurase) in the tissues of normal and tumor-bearing animals and the effect of malononitriles thereon. Cancer Res 12574-579, 1952. 16. Laetrile - the political success of a scientific failure. Consumer Rep 42:444-447, August 1977. 17. Conchie J, Findley J, Levvy GA: Mammalian glycosidases distribution in the body. Biochem J 71:318-325, 1959. 18. Report by the Cancer Commission of the California Medical Association. The treatment of cancer with “laetriles.” Calif Med

78:320-326, April 1953. 19. Morrone JA: Chemotherapy of inoperable cancer - preliminary report of 10 cases treated with laetrile. Exp Med Surg 20:299-308, 1962. 20. American Cancer Society, Minnesota Division Inc. Cancer

Quackery “Laetrile. ” (Undated) 21. Bush PJ: The placebo effect. J Amer Pharm Assoc 14:671-674, December 1974. 22. Culbert ML:Vitamin B17 - Forbidden weapon against cancer. The Fight For Laetrile. New Rochelle, NY, 1974. 23. Kittler GD: Control For Career. New York, Warner Books, 1963. 24. Richardson JA, Griffin P: Laetrile Case Hktories. New York, Bantam Books, 1977. 25. Jukes TI-I: Laetrile for cancer. JAMA 236:1284-1286, Sept 13, 1976. 26. Lange WR: The pit and the pendulum: the status of Laetrile. MD State Med J 26:47-50, September 1977. 27. Laetrile flunks new lab tests. Med World News, August 11, 1975, ~ ~ 2 1 - 2 3 . 28. Culliton BJ: Sloan-Kettering: the trials of an apricot pit - 1973. Science 182:100-1003, Dec 7, 1973. 29. Young P: Laetrile: hope for cancer patients, or just a hoax? Nut Observer New York, Dow Jones & Co Inc, May 16, 1977.

30. Stone B: New Sloan-Kettering report shows Laetrile isn’t effective. Amer Med News 1:15-16, April 11, 1977. 31. Wodinsky I, Siniarski JK: Antitumor activity of amygdalin MF (NSC-I 5780) as a single agent and with beta-glucosidase (NSCO1280056) on a spectrum of transplantable rodent tumors. Cancer Chemotherapy Rep 59:939-950, Sept/Oct 1975. 32. Laster WR, Schabel FM: Experimental studies of the anti-tumor activity of amygdalin MF (NSC-15780) alone and in combination with beta-glucosidase (NSC-128056). Cancer Chemotherapy Rep 59:95 1965, Sept/Oct 1975. 33. Burk D: Effects of amygdalin, prunasin, mandelonitrile, and HCN-benzaldehyde on the Pasteur effect, metabolic death, and trypain blue staining of Ehrlich ascites carcinoma cells. In Progress in Antimicrobial and Anticancer Chemotherapy (Proceedings of the 7th International Congress of Chemotherapy 2:133, 1971.) 34. Burk D. McNaughton ARL, Von Ardenne M: Hyperthermy of cancer cells with amygdalin glucosidase, and synergistic action of derived cyanide and benzaldehyde. Panminerve MED 13520, 1971. 35. Hill GJ, Shine TE, Miller C: Failure of amygdalin to arrest B16 melanoma and BW5147 AKR leukemia. Cancer Res 36:2102-2107, June 1976. 36. Ovejera AA, Houchens DP, Barker AD, et al: DL Amygdalin: inactivity in treatment of human tumor xenographs in athymic mice. Unpublished manuscript, 1977. 37. Navarro MD: Laetrile therapy in cancer. Philippine J Cancer

-

1962. 38. Navarro MD: Laetrile in malignancy. Santo Tomas J Med No. 10, 1955 and Why are cancer patents “pregnant?” Santo Tomas J Med No. 26, 1Y71.

SEPTEMBER 1978

39. Nieper HA: Recalcification of bone metastases by calcium diorotate. Aggressologie 11:495-502, 1970. 40. Report to A.R.LL McNaughton, San Francisco, Scind Research and Development Co Inc, Oct 18, 1968. 41. Clark M, Gosnell M, Shapiro D, et al: Laetril - should it be banned? Newsweek: June 27, 1977, pp48-56. 42. Lehmann P: Laetrile: the fatal “cure.” FDA Consumer 11:lO-15, Oct 1977. 43. Cornacchia HJ: Consumer Health. St Louis, C V Mosby Co, 1976, p 43. 44. Jukes TH: Is Laetrile a vitamin? Nutrition Today 12:12-17 Sept/Oct 1977. 45. FDA Report on Enforcement and Compliance. US Dept HEW Washington (Leigh-W02-4861) September 1965, pp5,6. 46. Ross R: When you have nothing to lose, all roads lead to Mexico’s “cancer underground.” True: 24-26, 28-29, 75, 1975. 47. FDA counterattacks on Laetrile. Med World News 18:22, Sept 5 , 1977. 48. Leinert JT: Laetrile. J Iowa Med SOC 68:47-50, February 1978. 49. Murphy-Ferris JTM, Torrey L: The apricot connection. New Sci 74:766-768, June 30, 1977. 50. FDA, HEW label Laetrile unsafe. C & EN 55:6, Aug 15, 1977. 5 1. Knapp ES: Laetrile cancer fraud or free choice? State Gov’t News 20:2-4 July 1977. 52. Laetrile smuggling drama hits the courts. Med World News 17:17-20, June 28, 1976. 53. If your patients ask about Laetrile. Med Times 105:3,7-8 June

-

1977. 54. Unproven methods of cancer management. CA221245-251, 1972.

55. Leff DN: Laetrile: anti-orthodox-medicine clans rally round its banner. Med World News 19:43-51, May 1, 1978. 56. Schultz T, Lineman B: The victimizing of desperate cancer patients. Today’s Health 51-28, 31-33, 59-61, November 1973. 57. Meares A: Regression of cancer after intensive meditation. Med JAust 2:184, July 31, 1976. 58. Laetrile crackdown. Time 107-60, June 7, 1976. 59. Damn the doctors - and Washington. Time 2050, 53, June 1977. 60. Lewis JP: Laetrile. Wes J Med 12755-62, July 1977. 61. Townsend WA, Boni B: Cyanide poisoning from ingestion of apricot kernels-California. Morbid Mortal Wkly Rep 45:427, Sept 13, 1975. 62. Sayre JW, Kaymakcolan S: Cyanide poisoning from apricot seeds among children in central turkey. New Eng J Med 270:11131115, May21, 1964. 63. Schmidt ES,Newton GW, Sanders SM, et al: Laetrile toxicity studies in dogs. JAMA 239-943,947, March 6, 1978. 64. Sadoff L, Fuchs K, Hollander J: Rapid death associated with Laetrile ingestion. JAMA 239:1532, April 14, 1978. 65. Update - Toxicity of Laetrile. US Pharm 3:68-70, March 1978. 66. Moertel CG: A trial of Laetrile now. New Eng J Med 298:218, Jan 26, 1978. 67. Burkhalter PK: Cancer quackery. Amer J Nuts 77:451-453, March 1977.

BIBLIOGRAPHY Greenlaw CW: Laetrile and the profession of pharmacy. Drug Intel Clin Pharm 11:427-428, July, 1977. Crile G : Legalization of Laetrile - a suggestion. New Eng J Med 295: 116, July 8, 1976. Baker JJ, Lokey JL, Price NA, et al: Against legalization of Laetrile. New Ena J Med 295:679, 1976.

THE JOURNAL OF SCHOOL HEALTH

415

Morse DL, Harrington JM, Health CW: Laetrile, apricot pits, and cyanide poisoning. New Eng J Med 295:1264, Nov 25, 1976. Brown H: Cancer quackery what can you do about it? Nursing 5 : 24-26, May 1975. lsler C: The fatal choice - cancer quackery. RN 1974, pSS. Petersen JC, Markle GE: Adjudicution in Science: The Luetrile Controversy. Presented at national meeting of American Sociological Association, 1977. Markle GE, Petersen JC, Wagenfeld MO: Notes from the cancer underground: participation in the Laetrile movement. Soc Sci and Med 12:31-37, January 1978.

-

Davignon JP, Trissel LA, Kleinman LM: Pharmaceutical assessment of amygdalin (laetrile) products. Cuncer Treat Rep 62:99-104, 1978. Smith FP, Butler TP, Cohan S,et al: Laetrile toxicity: a report of two patients. Cuncer Treat Rep 62:169-171, 1978.

Stock CC, Tarnowski GS, Schmid FA, et al: Antitumor tests of amygdalin in transplantable animal tumor systems. J Surg Oncol 10:81-88, 1978.

Stock CC, Martin DS, Sugiura K, et al: Antitumor tests of amygdalin in spontaneous animal tumor systems. J Surg Oncol 10:89-123, 1978.

James H. Price, PhD, MPH, is Associate Professor of Allied Health Sciences, Kent State University, Kent, OH 44242 (Corresponding author). Joy Ann Price, MA, SPA, is a doctoral candidate in the Department of Biochemistry and Molecular Biology, Health Sciences Center, University of Oklahoma, Oklahoma City, OK 73132.

Four Grants Announced to Expand School Nurses’ Roles Funds to assist four states to improve school-based health services by using specially-trained nurses, and to document the program’s impact, were announced August 2 by The Robert Wood Johnson Foundation. Colorado, New York, North Dakota, and Utah, selected from among 30 states that applied for support under the Foundation’s School Health Services Program, are receiving a total of $4.8 million. Thirty-seven thousand children will receive care from school nurse practitioners. In announcing the grants, Foundation President Dr. David E. Rogers said: “A billion dollars is spent each year on school health services in this country. School nurses are employed in most school systems, yet tradition, regulations and lack of training often limit the nurses’ role to first aid, referral notes, and performing clerical duties. This program has been designed to help the participating states capitalize on evidence from a number of communities that school nurses with the expanded clinical skills of nurse practitioners can make impressive gains in caring for the many children who lack adequate access to medical and other health services.” “Ultimately, the information resulting from a careful before and after study of the program will be available to all groups federal, state and local officials, parent groups, and health professionals - interested in school health services in this country.” Children’s lack of adequate access to medical and other health services is a serious problem in low-income neighborhoods where there simply are not enough physicians. Furthermore, large numbers of working mothers frequently have difficulty getting children to needed health services. Evidence

of the dimensions of these problems include the 20 million children that are not immunized against one or more potentially dangerous diseases, and the 11% of children, ages six to eleven, that have uncorrected vision problems. With these grants, the states will broaden and strengthen the clinical skills of school nurses and place them in schools serving children who lack adequate access to care. It is expected that the cost of health and medical services given to children of low-income families will be covered by state and federal programs. School nurses trained as nurse practitioners working under physician supervision can give immunizations, physical examinations and provide periodic screening for health problems. With physician backup in the community, the nurse practitioner can care for minor injuries, manage most common childhood illnesses, and identify potentially more serious conditions that require the attention of physicians or other health professionals. In addition, nurse practitioners are trained to work with parents and physicians in the care of chronically ill and disabled children, and to help children and their families locate needed medical services and then to follow-up to make sure those services are received. Data from a program in Hartford, Connecticut show that school children have fewer illness-related absences when cared for by nurse practitioners backed up by community physicians. The children also made fewer visits for routine medical needs to hospital emergency rooms and outpatient clinics, where the care received is far more costly. In Cambridge, Massachusetts, a similar

program using nurse practitioners in school clinics also provides care to preschool children. In the last decade, the program was responsible for increasing the percentage of children immunized in Cambridge from 55% to nearly 100%. In addition, the Cambridge project has reported that it has: cut in half the inappropriate use by children of emergency services at Cambridge Hospital, while use of these services by a control group went up or remained stable; dropped the prevalence of blood lead levels in preschoolers from 7% to 0.5%; and cut the rate of anemia in the one to two . year olds from 16% to 4%, and in two to three year olds from 22% to 7%. In an effort to produce similar information on the four announced projects, the Foundation has awarded a separate grant to the University of California at Los Angeles to evaluate the impact of the services. This evaluation is intended to document: the extent to which the children’s access to care is improved; the productivity of the nurse practitioner and the ability of the nurse to follow-up on children referred to other sources of care; the nature of the health problems of school age children in the demonstration programs; and the cost of providing this more complete range of health services in schools. The Robert Wood Johnson Foundation, based in Princeton, NJ, is a national philanthropy that devotes its resources to the improvement of health care in the United States. Most of its grants are to institutions and organizations seeking to improve general, out-of-hospital health care.

Laetrile--an overview.

Laetrile - An Overview James H. Price, PhD, MPH Joy A. Price, MA, SpA ABSTRACT The original theory in the 1920s on the mode of action of Laetrile is...
880KB Sizes 0 Downloads 0 Views

Recommend Documents