Commentary
Refer to: Gunn AE: Laetrile: Riding on something else's coattails (Commentary). West J Med 129:80-81, Jul 1978
Laetrile: Riding on Something Else's Coattails ALBERT E. GUNN, MD, Houston
AT TIMES it seems that the most unimportant element in the debate over Laetrile, America's most controversial cancer nostrum, is whether it is effective against cancer or, for that matter, whether it is harmful. The argument over Laetrile is not an argument over a drug or a vitamin or a food or whatever it ultimately ends up being called. It is, rather, part of something much more profound. Laetrile is gaining approval not on what it is or does but rather because of what it represents to many people. If I were asked who has made the greatest contribution to Laetrile's legislative success in a number of states, I would have to answer that the medical and scientific communities deserve the most credit. Laetrile's success is part of the antiestablishment mood of the country, and the establishment has had some of its legal machinery turned upon itself. Discussions of the curative powers of Laetrile often shift gradually into complaints about bureaucrats and big-shot doctors. People are sending a message to what is loosely termed the establishment by pressuring their legislators to pass laws giving Laetrile the unique status among all drugs, vitamins and foods of being specifically legislated into legitimacy. Penicillin, L-dopa, streptomycin and polio vaccine never received such preferential treatment. This was because people were satisfied in the past to leave the medicines to the "docs." After all, physicians went to medical Dr. Gunn is an Assistant Director (Hospitals), University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute in Houston. Reprint requests to: Albert E. Gunn, MD, Assistant Director (Hospitals), M. D. Anderson Rehabilitation Center, 2015 Thomas Street, Houston, TX 77009.
80
JULY 1978 * 129 *
1
school to learn about these things, so people trusted their judgment. But times are changing. Now books are written about deprofessionalising medical care and people no longer believe physicians have all the answers on sickness and health. This situation has been building for some time. It is in part a result of the increasing complexity of medical knowledge, which is mushrooming at such an incredible rate that even physicians are having a hard time keeping up. If the profession has difficulty keeping abreast, then what of the public? Rapid changes in medical care concepts must seem like irrational flip-flops to many people. What was accepted in the past-such as treating acne with x-rays-is regarded as harmful today. If physicians keep changing their minds, some may ask, how can people put any faith in them? Well, it was not always so. In the old days physicians were consistent. They had tonics and explanations for diseases that most people could understand. Physicians spent more time talking with people over a cup of coffee in the kitchen after seeing the patient in the bed upstairs. There was not much else they could do. They watched children die of pneumonia and prescribed bed rest and whatever other remedy was available at the time and waited for the will of the Almighty. But though they were less able to help, physicians were liked better because people knew them better. The modern physician-scientist concentrates on the disease-which he knows more about than his predecessors-and regards the body as a depersonalized system. Patients notice the difference and interpret the new attitude as
COMMENTARY
indifference to them as persons. The physician is not a complete villain here. In extenuation, he can plead that he is misunderstood and point out that patients are better off under the new system than they were under the old. But, unfortunately, the increasing complexity of medical care does not completely get physicians off the hook. They still have a number of charges to answer, many of which have helped precipitate the public's ambivalent feelings toward them: * Physicians at times appear snobbish, even supercilious. Nothing makes me wince more than listening to some big shot wearing a white coat talk down to the great unwashed on network television. * Many physicians and scientists involve themselves in issues, particularly politics, where their say is no better than that of the man in the street. This attempt to pretend that scientific training gives one more authority to pronounce on the topics of the day makes people less likely to listen to them even when they speak about subjects in their own field. Psychiatry is still reeling from the 1,000 physicians who pronounced Barry Goldwater a nut in Fact magazine before the 1964 Presidential election without even examining him. They could have just told their friends that they were not going to vote for him and left the "MD" off their names. What do Goldwater's supporters-all 20 million of them-think about psychiatry now? * Scientific studies have been overdone. Every night we hear of a new study from the medical or academic world which contradicts conventional judgments or morality. Some restraints are needed on press releases about scientific discoveries. No wonder people are leery of controlled studies. * Doctors and scientists have been self-serving in their demands for financial support and special privileges. Science magazine once achieved the
ultimate in this type of prattle by demanding special treatment for Andrei Sakharov because he had applied the "scientific ethos to human affairs"-whatever that means. Where was Science magazine when 17,000 Lithuanians imperiled their safety by protesting denial of their liberties to the United Nations. I am sure Sakharov himself does not think he is any better than they are. * Anyone who has gone to medical school knows that a large part of the knowledge imparted is terminology: changing common English names for things to technical terms. As important as scientific terminology is in lending precision to technical journals, physicians should drop all this high-flown talk when they are explaining things to -the public. I still think knee cap is better than patella. * Scientists and others of the great washed should avoid being identified as scientists when they become involved in bizarre fads. Animal rights seems to be the latest. The neo-Malthusian scare stories about overpopulation are on the back burner now. And the supersonic Concorde has not destroyed the ozone layer yet. Anyway, you get the point. When people write letters to their state legislators demanding that Laetrile be legalized they have something else in mind and physicians had better get the message. There still is hope because, as many times as I have heard physicians in general condemned, people still like and respect their personal physicians. The medical profession will have to build on this basic, personality-oriented faith. The tragedy is that all this should have somehow gotten intermingled with the controversy over Laetrile as a cancer cure. Laetrile is riding this wave as a passenger. It has not made it on its own merits but is coming in on the coattails of the bigger dispute. We can only hope that not many people get hurt by it.
THE WESTERN JOURNAL OF MEDICINE
81
Refer to: Gunn AE: Laetrile: Riding on something else's coattails (Commentary). West J Med 129:80-81, Jul 1978
Laetrile: Riding on Something Else's Coattails ALBERT E. GUNN, MD, Houston
AT TIMES it seems that the most unimportant element in the debate over Laetrile, America's most controversial cancer nostrum, is whether it is effective against cancer or, for that matter, whether it is harmful. The argument over Laetrile is not an argument over a drug or a vitamin or a food or whatever it ultimately ends up being called. It is, rather, part of something much more profound. Laetrile is gaining approval not on what it is or does but rather because of what it represents to many people. If I were asked who has made the greatest contribution to Laetrile's legislative success in a number of states, I would have to answer that the medical and scientific communities deserve the most credit. Laetrile's success is part of the antiestablishment mood of the country, and the establishment has had some of its legal machinery turned upon itself. Discussions of the curative powers of Laetrile often shift gradually into complaints about bureaucrats and big-shot doctors. People are sending a message to what is loosely termed the establishment by pressuring their legislators to pass laws giving Laetrile the unique status among all drugs, vitamins and foods of being specifically legislated into legitimacy. Penicillin, L-dopa, streptomycin and polio vaccine never received such preferential treatment. This was because people were satisfied in the past to leave the medicines to the "docs." After all, physicians went to medical Dr. Gunn is an Assistant Director (Hospitals), University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute in Houston. Reprint requests to: Albert E. Gunn, MD, Assistant Director (Hospitals), M. D. Anderson Rehabilitation Center, 2015 Thomas Street, Houston, TX 77009.
80
JULY 1978 * 129 *
1
school to learn about these things, so people trusted their judgment. But times are changing. Now books are written about deprofessionalising medical care and people no longer believe physicians have all the answers on sickness and health. This situation has been building for some time. It is in part a result of the increasing complexity of medical knowledge, which is mushrooming at such an incredible rate that even physicians are having a hard time keeping up. If the profession has difficulty keeping abreast, then what of the public? Rapid changes in medical care concepts must seem like irrational flip-flops to many people. What was accepted in the past-such as treating acne with x-rays-is regarded as harmful today. If physicians keep changing their minds, some may ask, how can people put any faith in them? Well, it was not always so. In the old days physicians were consistent. They had tonics and explanations for diseases that most people could understand. Physicians spent more time talking with people over a cup of coffee in the kitchen after seeing the patient in the bed upstairs. There was not much else they could do. They watched children die of pneumonia and prescribed bed rest and whatever other remedy was available at the time and waited for the will of the Almighty. But though they were less able to help, physicians were liked better because people knew them better. The modern physician-scientist concentrates on the disease-which he knows more about than his predecessors-and regards the body as a depersonalized system. Patients notice the difference and interpret the new attitude as
COMMENTARY
indifference to them as persons. The physician is not a complete villain here. In extenuation, he can plead that he is misunderstood and point out that patients are better off under the new system than they were under the old. But, unfortunately, the increasing complexity of medical care does not completely get physicians off the hook. They still have a number of charges to answer, many of which have helped precipitate the public's ambivalent feelings toward them: * Physicians at times appear snobbish, even supercilious. Nothing makes me wince more than listening to some big shot wearing a white coat talk down to the great unwashed on network television. * Many physicians and scientists involve themselves in issues, particularly politics, where their say is no better than that of the man in the street. This attempt to pretend that scientific training gives one more authority to pronounce on the topics of the day makes people less likely to listen to them even when they speak about subjects in their own field. Psychiatry is still reeling from the 1,000 physicians who pronounced Barry Goldwater a nut in Fact magazine before the 1964 Presidential election without even examining him. They could have just told their friends that they were not going to vote for him and left the "MD" off their names. What do Goldwater's supporters-all 20 million of them-think about psychiatry now? * Scientific studies have been overdone. Every night we hear of a new study from the medical or academic world which contradicts conventional judgments or morality. Some restraints are needed on press releases about scientific discoveries. No wonder people are leery of controlled studies. * Doctors and scientists have been self-serving in their demands for financial support and special privileges. Science magazine once achieved the
ultimate in this type of prattle by demanding special treatment for Andrei Sakharov because he had applied the "scientific ethos to human affairs"-whatever that means. Where was Science magazine when 17,000 Lithuanians imperiled their safety by protesting denial of their liberties to the United Nations. I am sure Sakharov himself does not think he is any better than they are. * Anyone who has gone to medical school knows that a large part of the knowledge imparted is terminology: changing common English names for things to technical terms. As important as scientific terminology is in lending precision to technical journals, physicians should drop all this high-flown talk when they are explaining things to -the public. I still think knee cap is better than patella. * Scientists and others of the great washed should avoid being identified as scientists when they become involved in bizarre fads. Animal rights seems to be the latest. The neo-Malthusian scare stories about overpopulation are on the back burner now. And the supersonic Concorde has not destroyed the ozone layer yet. Anyway, you get the point. When people write letters to their state legislators demanding that Laetrile be legalized they have something else in mind and physicians had better get the message. There still is hope because, as many times as I have heard physicians in general condemned, people still like and respect their personal physicians. The medical profession will have to build on this basic, personality-oriented faith. The tragedy is that all this should have somehow gotten intermingled with the controversy over Laetrile as a cancer cure. Laetrile is riding this wave as a passenger. It has not made it on its own merits but is coming in on the coattails of the bigger dispute. We can only hope that not many people get hurt by it.
THE WESTERN JOURNAL OF MEDICINE
81
