The Promise of William B. Coley

Last week I spoke about the promise represented by the phenomenon of "spontaneous remissions." These are cures of cancer that occur without medical intervention. While rare, they are well documented. For centuries, doctors have dreamed of harnessing this phenomenon to create a natural cure for cancer.

In the 1890s, a young New York surgeon, fresh out of Yale University and Harvard Medical School, made a fascinating discovery. Desperate to find a cure for bone cancer, he searched the records of New York Hospital to see if anyone had ever been cured of the advanced form of that disease. He discovered that one man with advanced sarcoma had contracted an infectious skin disease called erysipelas in the hospital. He not only survived the infection but his cancer went into a "spontaneous" remission.

Most doctors would have shrugged their shoulders and moved on to the next case. But William B. Coley was no ordinary doctor. He was the Sherlock Holmes of cancer. He went to the address listed on the man's records, but the man had moved. And so he tracked him from tenement to tenement until finally in 1888 he found the man alive, well, and cancer-free seven years after the spontaneous cure.

This was an event that changed the course of Coley's life. In 1891, he began treating patients with the same organism that caused erysipelas, a germ called Streptococcus pyogenes. His first patient developed a raging fever, and then the "miracle" occurred: the tumors of his tonsils and neck completely disappeared, and only a scar remained. This man, who could only swallow liquids and whisper when Coley started the treatment, made a complete recovery. (Ten years later he was still free of cancer.) Coley inoculated nine more patients with live erysipelas microbes and discovered that physicians in Germany, such as Dr. Busch, were doing the same thing independently of his own discovery. In 1893, he tabulated the first results and published his first article on the method. Out of seventeen cases of advanced cancer, four were permanently cured, ten showed improvement, while three showed no improvement at all.

While some people saw their cancers regress with the use of live bacteria, others died. In addition to its risks for the patient being treated, using live bacteria was dangerous to other patients and to the staff. So Coley conceived the idea of using killed bacterial byproducts. He added a nonpathogenic organism called Serratia marcescens to the "soup" and started treating patients with this mixture.

The world quickly dubbed this combination "Coley's toxins," since they represented the toxic byproducts of the bacteria without the bacteria themselves. However, the word "toxins" was an unfortunate choice. (A more acceptable name for the treatment is "mixed bacterial vaccine.") The bacteria deliberately caused side effects, such as fever and malaise. But they were not toxic in the sense that radiation or chemotherapy is toxic. They did not destroy the immune system but put it through a rigorous drill that often resulted in the shrinkage or disappearance of the tumor.

Over the years Coley published dozens of articles in the best medical journals. These recorded his success (and sometimes his failure) in applying the mixed bacterial vaccine to people with advanced cancer. In sarcomas, he claimed 41 percent complete cures. In other kinds of cancer there were many astounding remissions.

There were drawbacks to the treatment, however. Having frequent fevers is trying on the patient. The preparations (mostly made for Coley by Parke-Davis) were variable in their potency. This led to much confusion and disappointment. Some doctors, initially enthusiastic about the treatment, became disillusioned when they used less effective preparations. Oftentimes, doctors did not use the toxins aggressively enough. It took a tremendous belief to persevere with this treatment. Nevertheless, despite the difficulties and drawbacks, there is no doubt in my mind that Coley's toxins represented one practical application of the idea of spontaneous remission to treatment.

The subsequent history of Coley's toxins is rather sad. Coley died in 1936. He never wrote a book about his amazing life experience, and his journal articles began to gather dust in medical libraries. His son, Bradley Coley, MD, continued to use the vaccine at Memorial Sloan-Kettering into the 1950s, but in an increasingly hostile environment. First radiation and then chemotherapy became directly competitive with this more natural approach. Coley's daughter, Helen Coley Nauts, founded the Cancer Research Institute of New York to save and promote his work. She was an amazing presence in the cancer field for many decades. But although she got her father removed from the American Cancer Society "quack list" in the mid-1970s, she was never able to get his treatment used widely.

I first heard of Coley from his Memorial colleague, Kanematsu Sugiura, DSc, who compared his own problems with laetrile to those experienced by Coley in the 1920s and 1930s. Through Lloyd Old, MD, then vice president of Sloan-Kettering Institute, I interviewed Mrs. Nauts at her home on Park Avenue in 1975. This was an eye-opener, to say the least. Mrs. Nauts remained a good friend for many years. She had a vast influence on cancer, befriending and supporting many young researchers. She died on January 2, 2001, at the age of 93.

Helen Coley Nauts, DSc (Hon.)

At the present time, there are few clinics that use Coley's toxins as part of a comprehensive treatment protocol. One that interests me very much is an inpatient program in Tijuana, Mexico, that combines Coley's toxins with the Gerson diet and other forms of immunotherapy. As indicated, readers can find out more about this program by calling Gar Hildenbrand of the Issels Treatment Center at 858-759-2966.

Soft-Core Quackbuster?

I received a very interesting e-mail from a client, who wrote:

"It seems like you are skeptical of most alternative treatments due to the lack of publishing in scientific journals. Your responses to questions about ozone and cesium are vague. It is my understanding that nothing gets condoned by mainstream medicine unless it is profitable for someone. When it comes to cancer, people want to do anything that could help them get well whether it is mainstream or not. They also don't have time to wait 10 years for a double blind clinical peer reviewed blah blah blah. Do you really believe in alternative approaches, or are you just a politically correct soft-core quackbuster?"

I was amused at his characterization of me as a "soft-core quackbuster." I'm sure the folks at "Quackwatch" would be equally amused at my inclusion in their ranks. Nonetheless, I admit that I do not "believe" in alternative approaches to cancer, if "belief" means the blind acceptance of their validity in the absence of proof.

I do believe that all sane and sentient adults should have the freedom to choose any treatment they want, and that the government should ease the restriction on relatively nontoxic treatments. I consider myself a follower of John Stuart Mill and his work, "On Liberty." At the same time I think that proponents of any cancer treatment have a responsibility to provide scientific proof of the safety and efficacy of their treatments. This requirement extends to conventional, as well as alternative, treatments. I have routinely criticized the medical profession for failing to provide such proof for surgery, radiation and chemotherapy.

But this doesn't give alternative practitioners a free ride. Whether my interlocutor knows it or not, there are a lot of frauds out there. Waste your time and money on a fraudulent treatment and you will not get another chance to avail yourself of a useful one. Patients have an urgent need to know the difference between real and phony "alternatives." Coley's toxins, for instance, are supported by a body of reputable data stretching back over 100 years. Some other treatments are based on almost nothing but wishful thinking.

I also emphatically disagree that peer-reviewed clinical studies are "blah blah blah." There is tremendous merit in the scientific method. The struggle lies in getting the money allocated to studies of the most promising alternative treatments. It is funny to be lectured on the economic dimensions of the cancer problem since some people think I literally "wrote the book" on the topic (The Cancer Industry, first published in 1980). The difficulty of getting new treatments across doesn't absolve proponents of alternative therapies of the responsibilities to prove the worth of their treatment.

I intend to continue criticizing shoddy presentations, regardless of whether they come from conventional or alternative medicine. If that makes me a "politically correct soft-core quackbuster," so be it.

--Ralph W. Moss, Ph.D.

References:

Coley WB. The treatment of malignant tumors by repeated inoculations of erysipelas with a report of ten original cases. Am J Med Sci 1893;105:487-511.

Hall SS. A Commotion in the Blood. New York: Holt, 1997. An excellent report on immunotherapy.

Moss RW. The Cancer Industry. Brooklyn: Equinox, 1996. Chapter 7 concerns Coley's toxins.

Nauts HC. The beneficial effects of bacterial infections on host resistance to cancer. End results in 449 cases. 2nd ed. Monograph No. 8. New York: Cancer Research Institute.

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