Spontaneous Regressions

One of my clients wrote to me in desperate search of a treatment for his wife. Her doctors, using all the methods known to them, held out little hope. He therefore sought my advice. "Over the years I have heard of spontaneous remissions," he wrote, "but have never met anyone who personally experienced one (including our doctors). Is there any truth to them? If so, was there any common denominator in them?"

Serendipitously, his letter came just as I was planning to write a newsletter on this very topic. My immediate inspiration was an article that appeared earlier this year in the journal Medical Hypotheses with the provocative title, "Spontaneous regression: a hidden treasure buried in time." However, the topic of spontaneous regressions, or remissions, has galvanized me since I first learned about them almost 30 years ago.

A spontaneous remission is the disappearance of cancer without any immediate medical cause. As my former employer, Memorial Sloan-Kettering President Lewis Thomas, MD, once said: "The rare but spectacular phenomenon of spontaneous remission of cancer persists in the annals of medicine, totally inexplicable but real, a hypothetical straw to clutch in the search for cure. . . .No one doubts the validity of the observation."

For centuries, such observations astonished attentive doctors and gave heart to desperate patients. Cancer is called a "progressive" disease, but (unlike in politics) the adjective is not meant as a compliment. If not successfully treated, cancer "progresses" to its seemingly inevitable endpoint: death. The fact that cancer sometimes just disappears on its own is an amazing fact. The number of patients who experience a spontaneous remission has always been small, and (according to the authors of the aforementioned article) is growing smaller. But it is a fact, and seeing it, or even reading about it, alters one's view of reality. It is like suddenly seeing a UFO appear in the night sky. It shakes your ordinary convictions and demands a profound change in worldview. After all, if Nature can do this, why can't we mortals learn the trick and start to do it ourselves? Shouldn't medicine imitate Nature and its ingenious cures rather than trying to devise artificial cures that are inimical to what the body does best?

The classic work on the topic in English is Spontaneous Remission, by Brendan O'Regan and Caryle Hirshberg. This 713-page "annotated bibliography" was published by the Institute of Noetic Sciences in 1993. The scientific advisory board included Drs. Michael Lerner, Rachel Naomi Remen and Lucy Waletzky, all experts on the mind-body connection in cancer. This large book considered 1,574 citations, and discussed in detail hundreds of cases of malignant tumors that partially or completely disappeared with no curative medical intervention. Brendan O'Regan died tragically of melanoma while the book was in progress, but Caryle Hirshberg still lectures on its conclusions.

Perusing this scholarly book, you find that while there is no single cause for all the spontaneous cures of cancer, the majority of such patients experienced an acute infection just prior to the regression of their tumor. This is a striking fact. These infections were usually accompanied by fevers. This microbial attack stimulated some powerful immune responses. The riled-up immune system then turned on and destroyed a different kind of enemy, the tumor. It was as if an army had mobilized to fight one adversary but continued marching to defeat a second, even more dangerous, foe.

Our own ingenious solutions to the cancer problem seem puny compared to the perfectly natural way that the body sometimes gets rid of it. Why not learn from, and harness, this tremendous natural force? For hundreds of years, the phenomenon of spontaneous remission has fascinated the greatest minds in cancer, seeming to point the way out of a hopeless morass. In 1976, Warren Cole, MD, wrote in a celebrated paper:

"After years of thought concerning the cause of this phenomenon [spontaneous regression], this author is convinced that most of the cases are examples of development of an immunologic process, and if we knew the explanation of the regression, we would be able to develop a method for regression of many types of human cancer."

However, lately, there has been a disturbing trend: spontaneous remissions are becoming rarer. I myself have seen but a few examples (and sometimes it is hard to distinguish those from "alternative cures"). I knew a young woman who had such a fear of doctors that she left her breast cancer entirely untreated. By the time she sought help, the tumor had ulcerated and spread. At one point, the tumor became infected. What happened next was amazing. One day, while she was in the shower, the tumor simply fell out of her chest, leaving a smooth scar.

Sadly, the tumor had already metastasized and, despite subsequent chemotherapy, she died of metastatic disease. Nonetheless, it was a fascinating example of what might be the natural course of some cases of this disease. I have seen a few other cases of partial spontaneous remission, such as the disappearance of lung metastases when an affected kidney was removed.

In the article "Spontaneous regression," the authors attribute the decline in spontaneous remissions to the modern "anti's": antiseptics and antibiotics and, I would add, antifever medications. These ubiquitous drugs have certainly reduced the incidence of postoperative infections, much to the relief of doctors and patients. Fevers and chills are soothed away by acetaminophen. An uncontrolled fever in a cancer patient would be seen as a profound failure by the medical staff.

At the same time, modern treatments, especially radiation and chemotherapy, have decreased the body's ability to mount a rip-roaring immune response if and when an infection does occur. So much so that a recent review of the topic ended with the conclusion, "Immunotherapy applied to patients with established tumors rarely leads to an objective response" (Forni 2000). This wasn't the opinion fifty or one hundred years ago.

Some of the mysteries of medical history can be explained by the untutored activation of the immune system, or the "vis medicatrix naturae," as the ancients called it. In 1742, for instance, the French doctor H. F. Le Dran reported on a young patient who had an inoperable cancer of her left breast. The tumor ulcerated and a gangrene infection developed. Within two days, the entire tumor sloughed off with profuse bleeding and pus (suppuration). The wound healed in five weeks. Unfortunately, the disease recurred, causing death eight months later.

In 1783, a Dr. V. Trnka described another patient with breast cancer who came down with malaria (associated with chills, fever and sweating). The patient's tumor went into permanent remission within a few weeks. A physician of the time stated: "This mortification could have been advantageous to the patient, for it could, as we have seen sometimes, destroy the whole tumor, procuring a salutary amputation [of the tumor] without pain."

Wonderful Toads

Because of these accidental infections, eighteenth-century physicians started to experiment with deliberately induced infections and fevers. In 1768, G. White discussed in a letter "the wonderful method of curing cancers by means of toads." A woman in Hungerford, England, he said, was treating patients with breast cancer by applying a toad to the lesion until its death. (In many cultures, animals such as guinea pigs or pigeons are applied to diseased parts of the body.) Some might consider this "toad cure" the height of quackery. On the other hand, it is possible that the skin of the toad contains some poisonous substances that might adversely affect cancer cells. Since the dead toad was affixed to the breast lesion for several weeks by means of a poultice, it also provided an excellent breeding ground for local infections.

One patient treated by this unorthodox method had been reduced to a "meer skeleton," we are told, but had a regression of her metastatic lesions and was able to swallow once again with ease following the "toad cure."

Other doctors in the eighteenth century deliberately applied dressings from wounds. Some surgeons even encouraged the formation of infections in their incisions. Doctors of the time called this "laudable pus." Today, this practice is ridiculed as a relic of bizarre and outlandish medical customs. But one doctor of the time said, "I was often struck by the slowness with which [cancer] recurrence developed in such cases. . .I asked myself if suppuration, in eliminating the traces of cancer which had escaped the knife, did not play a role in delaying recurrence, and if therein lay the secret of success" (cited in Hoption Cann 2002).

By the mid-nineteenth century it was widely accepted that leaving an infection in the surgical wound after a cancer operation could actually benefit the patient. Stanislas Tanchou (the same doctor who formulated the doctrine that cancer was a "disease of civilization") commented: "It is remarkable that. . .gangrene [has] caused the largest number of cures. Gangrene may be considered as a therapeutic agent, whether it occurs spontaneously or is induced medically."

When Sir Joseph Lister's methods of aseptic surgery gained ascendancy in the late nineteenth century, however, these profound observations were forgotten. In addition, a fear of lawsuits made it all but impossible to deliberately infect a patient with live bacteria. By the start of the twentieth century, this crude sort of immunotherapy with live (and admittedly dangerous) bacteria was rejected as a relic of pre-scientific medicine.

No one is suggesting that cancer patients today be deliberately infected with gangrene. However, there is another option. Over one hundred years ago, a brave surgeon in New York City named William B. Coley, MD, began a clinical experiment in the use of bacterial byproducts that still offers hope to desperate cancer patients. Next week I will tell the story of what happened to that most promising treatment.

(Next Week: The Story of Coley's Toxins)

--Ralph W. Moss, Ph.D.

References:

Cole WH. Relationship of causative factors in spontaneous regression of cancer to immunologic factors possibly effective in cancer. J Surg Oncol 1976;8:391-411.

Forni G et al. Immunoprevention of cancer: is the time ripe? Cancer Res 2000;60:2571-5.

Hoption Cann SA et al. Spontaneous regression: a hidden treasure buried in time. Med Hypotheses 2002;58:115-9.

Le Dran F. Traité des opérations de chirurgie. Paris: C. Osmont, 1742.

Trnka V. History of remittent fevers. Vienna: Vidnobonae, 1783.

White G. Letter XVIII to Thomas Pennant, 27 July 1768. In: The Natural History of Selborne. London: G. Routeledge and Sons, 1890:56.

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