Thank you very much for inviting me to address your Congress. Like many, I have long admired the work of German pioneers of complementary medicine, such as Hans Nieper, Wolfgang Scheef and Manfred von Ardenne. They were well known in America even 25 years ago. Today, there is increasing respect for the work of a new generation of German integrative physicians, who are admired and emulated by many in America. I salute all of you, and especially my friends Drs. Gyorgyi Irmey, Josef Beuth, and K. F. Klippel, for taking such giant steps in fostering the development of a new Integrative Oncology.

However, today, I want to speak about the darker side of the pictureÑthe deficiencies in the way that the cancer problem is presented to the public.

What you are told in the media about cancer does not accurately reflect what is really happening. We, the public, are subjected to a sustained barrage of biased information.

For instance, it is difficult to turn on the television and not hear about some exciting new "cancer breakthrough." Individually and collectively, these stories convey an exaggerated picture of progress in the battle against this disease.

This falsification serve multiple interests, including those of the government and the medical centers, of drug and equipment manufacturers, and of the media itself. Together these form a complex of self-interested parties, which I call the "Cancer Industry."

In this talk I hope to open your eyes to the strategies and tactics used by the cancer industry to convince you that all is going well with the War on Cancer. I hope that after hearing my speech, you will be better prepared to decipher some of the deceptions that pass for truth in the field of cancer.

First, let us establish the scope of the problem. Cancer takes an enormous toll. In the US, each year 1.2 million people develop life-threatening cancers and 550,000 die. In Germany, there are 236,000 deaths, about equally divided between men and women.. In industrialized countries, cancer now strikes one in three women and one in two men. I defy anyone to say this is not an epidemic.

Since 1971, the US has waged an expensive "War on Cancer." For the year 2000, President Clinton has proposed a cancer budget of $2.7 billion. Not to be outdone, Vice President Gore has promised a $4.7 billion increase if he is elected. This is only a fraction of the total that is spent. The American Cancer Society raises an additional $550 million each year. The annual treatment costs for cancer are conservatively estimated at $100 billion. Cancer is truly big business!

To sell such costly programs, the public and its representatives have to be convinced and re-convinced that steady progress is being madeÑthat cancer rates are declining, effective new treatments emerging, and a cure for cancer just around the corner.

SLIDE #1: "Chemoradiation Reduces Colon Cancer Mets, But Results in No Increased Survival." From: Oncology Times (Feb. 2000)

A lot of that alleged progress is predicated on the ability of cancer drugs to shrink tumors. "Responses," "activity," "remissions"Ñthese are the measures of success that oncologists use. Yet, as Ulrich Abel, PhD, of the University of Heidelberg, showed so brilliantly, tumor shrinkages (responses) do not necessarily lead to prolonged survival.

Here is one headline from a professional magazineÑa behind-the-scenes perspective patients rarely see. It demonstrates that conventional radiation and chemotherapy often do shrink or eliminate tumors or metastases (colloquially called "mets"). But such shrinkages only address the size of the tumor. They do not address its causes or its virulence. And, all too often, they do not increase the overall survival of patients.

The message is this: be very cautious whenever anyone speaks of "responses" as indicating the effectiveness of a cancer treatment!

SLIDE #2: THE EVER-IMPENDING CURE FOR CANCER

Each year, we are subjected to a barrage of publicity to convince us that the cure for cancer is around the corner. The public awaits final word of a cure that never comes. Here are a few of the famous cancer "breakthroughs" of yesteryear. Interferon, interleukin, taxolÉWho now remembers the tremendous hopes that were engendered by these stories, or the bitter disillusionment that followed for millions of patients and their families?

SLIDE #3: NEW YORK MAGAZINE

Typical of the current crop is this New York magazine article, "The Dawn of a New Era in Medicine." Here is an astounding quote from a Memorial Sloan-Kettering Cancer Center scientist: "We are going to see a global conquering of cancer in five to ten years." Allegedly, the global conquest will come from gene therapy. We are now assured that unraveling the human genome will inevitably lead to a cure. Dennis Slamon, MD of the University of California (UCLA) proclaims that gene therapy "could mean the end of disease as we know it. " We shall return to Dr. SlamonÕs treatment in a moment.

SLIDE #4: HBO SPECIAL

Here is an advertisement for a recent two-and-a-half hour television special, "Cancer: From Evolution to Revolution." I found the program profoundly disappointing. The only patients who survived were those who had curable leukemiasÑno surprise. There was not a whisper about complementary medicine, although we know that up to half of all cancer patients are using such treatments. Every five minutes the program was interrupted to give the phone number of the National Cancer Institute or its affiliated institutions. The program was one long advertisement for NCI.

SLIDE #5: HERCEPTIN RESULTS

LetÕs now talk about gene therapy. According to Dr. Slamon, a genetically engineered drug that he pioneered, Herceptin, "heralds a new age in how we treat cancer." Dr. Larry Norton of Memorial Sloan-Kettering agrees: "This is the biggest difference I have ever seen in advanced breast cancerÉa big effect, not a small, minor effectÉ.[It] is not like anything we have ever seen before."

But what does the record show? In the first clinical trial, 37 patients were considered evaluable. Nine (24.3 percent) had major tumor shrinkages when they were given Herceptin as well as the drug cisplatin. "The median time to progression among the responders was 8.4 months." {Semin Oncol 1999 Aug;26(4 Suppl 12):89-95}.

Memorial Sloan-Kettering found 5 out of 43 major shrinkages, for an overall response rate of 11.6 percent. The minor responses lasted 5.1 months {Semin Oncol 1999;26S:78-83}.

There was one complete responders in each of these trials. These two lucky women were repeatedly interviewed on television and held up before the eyes of the public as proof of the "new age" miracle. When alternative doctors do the same thing they are attacked for peddling "mere anecdotes."

The results with gene therapy for cancer, so far, are not impressive. It is mainly the power of public relations that has created the excitement around Herceptin.

SLIDE #6: THE LANCET, Jan. 15, 2000

The only scientific publication combating this trend is the British medical weekly, the Lancet. No wonder many consider it the finest medical journal in the world.

In this January 15, 2000 editorial, they states, "Even for single-gene disorders, such as cystic fibrosis and muscular dystrophy, the optimism generated for gene therapy about a decade ago has become muted. The population effect of targeting therapy at people with genetic pre-dispositions to cancer is still to be proven.ÉMost patients who have cancer still die with it. The end of cancer cannot be said to be in sight."

Gene therapy has been advertised as a non-toxic treatment. But it is not always safe. In 1999, an 18-year-old boy volunteered for a gene therapy trial at the University of Pennsylvania. A few weeks later, he was dead from an immune reaction to synthetic genes. His world-famous doctors hid 95 percent of the treatmentÕs side effects, even from NIH officials.

As the Lancet said, public confidence "will be shattered when the public starts to see the gap between what is being said and what is being achieved."

Meetings such as this one reflect the growing disillusionment with the conventional approach to cancer. Millions more people are waking up to the deceptions that have been practiced over the years in order to sell a toxic and often ineffective approach to cancer.

PART TWO: IS CANCER IN DECLINE?

The cancer establishment claims that cancer rates are declining. In 1996, the NCI claimed that the overall cancer death rate in the US fell by almost 3 percent between 1991 and 1995.

The Director of the NCI said that this "marks a turning point from the steady increase we have seen throughout much of the century. The 1990s will be remembered as the decade when we measurably turned the tide against cancer." He added, "This is the news we've been waiting forÉ. Now our NationÕs investment is paying off by saving lives. We are immensely gratified."

But let me suggest two reasons that such "progress" may be less substantial than it appears.

Slide #7: REMBRANDT, THE ANATOMY OF DR. TULP

The first question has to do with autopsies, which as you know are postmortem examinations. Autopsies are a time-tested way to accurately determine cause of death. But in the US and Germany autopsies are rarely performed: in the US, the rate has plummeted from 50 percent in the 1960s to 5 percent today. In Germany, the current rate is 8 percent. Cost-cutting has eliminated most autopsies.

How does this alter cancer statistics? A landmark 1998 article in the Journal of the American Medical Association shows that in many cases, cancer is either misdiagnosed or missed entirely as the cause of death of patients.

SLIDE #8: BURTONÕS JAMA PAPER

Pathologist Elizabeth Burton, MD, studied this problem for ten years. She and her colleagues performed over 1,000 autopsies. One hundred and eleven malignant cancers were discovered in 100 of these bodies, which had either been misdiagnosed or entirely undiagnosed while they were alive. In 57 of these patients, the immediate cause of death was attributed to the undiscovered cancers. "The discordance between clinical and autopsy diagnoses of malignant neoplasms in this study is 44 percentÉ" she wrote.

Dr. George Lundberg, then editor-in-chief of the Journal of the American Medical Association, explained that this startling data called into question all cause-of-death data in the United States. Upon re-evaluation, he said, cancer might turn out to be the nationÕs number one killer. Dr. Lundberg lost his job soon after these comments. According to ABC News, he was fired in part for criticizing "doctors for having moved away from performing large numbers of autopsies."

It is also striking that the country with the highest rate of cancer, Hungary, also has the highest rate of autopsies in Europe.

In other words, there are probably many more cancer cases in our societies than meet the eye. The "decline" in cancer may be due in part to a failure to look for it.

SLIDE #9: AGE DISTRIBUTION IN US

How much cancer occurs in a society depends on the age distribution of the population. Make sure that any statistics you are given that are carefully adjusted for the various age groups. Otherwise, such statistics can be highly deceptive.

For instance, consider the "baby boom" phenomenon. In the 1930s, there were only 2.3 million births per year in the US. This rose sharply in 1946 and peaked at 4.2 million per year (nearly double) in 1959, before sharply declining again. There are currently 82 million "baby boomers" in the US.

How does this affect cancer statistics? These "baby boomers" are now passing into late middle age. Eighty percent of cancers are diagnosed after the age of 55 and people over the age of 65 are ten times more likely to get cancer than are younger people. The average age of a cancer patient is 62 years.

The first baby boomers will arrive at age 62 in 2008. By 2015, there will be a huge number of people 62 and older in the population, who will be more prone to develop cancer. We can predict that the number of cancer cases and deaths will probably rise in a few years due to these population dynamics. Celebrating the demise of cancer is premature.

PART THREE: DANGEROUS TREATMENT

SLIDE #12: THE NEW YORK TIMES

Dangerous experimental chemotherapy is often given to patients with no proof of its safety or effectiveness. And the Food and Drug Administration, which frequently harasses alternative practitioners, says nothing about this truly dangerous situation.

The most extreme example is high-dose chemotherapy with bone marrow transplantation. This brutal treatment was never been shown to extend the lives of adults with advanced solid tumors. Protests against its use fell on deaf ears, as desperate patients converged on greedy doctors.

In October, 1999, the New York Times published a front-page exposŽ of this scandal, calling it an "unproven" method (a term formerly reserved for alternative practitioners). This exposŽ showed that bone marrow transplantation "entered the medical marketplace in the 1980s before studies to test its effectiveness had even begun. By the time testing was underway, the business had taken on a life of its own."

And what a business it is! Each procedure cost over $100,000, and by 1998, at least 15,000 of these had been performed.

When five clinical trials were finally performed, in four of these there was no difference in survival between women who got transplantation and those who had conventional chemotherapy. Only one flawed South African study showed benefit. In early 2000, it was revealed that this study was fraudulent. The researcher in question was fired.

A leading breast cancer researcher summed up this fiasco: in overselling bone marrow transplantation, he said, "we deceived ourselves and we deceived our patients."

SLIDE #13: US NEWS

Nor are clinical trials without peril. There is an enormous drive to get cancer patients to enroll in clinical trials. Since 1996, the US government has mandated that such trials be paid for by Medicare insurance. In 1999, individual states similarly instructed insurance companies pay for such trails. Thousands of websites, magazines, books and even billboards urge patients to enroll in clinical trials.

In my view, many cancer clinical trials are unethical and impractical. As a general rule, they mainly benefit the drug companies. Doctors are frequently paid by these companies for every patient they recruit into a trial. There are many cases in which patients have been hustled into trials that had only a remote possibility of helping them.

In Phase III trials, patients are assigned to receive either the experimental treatment in question or the conventional "state-of-the-art" treatment for the same disease. But letÕs face it: for advanced cancer, there is usually no effective conventional treatment. Thus, a Phase III trial consigns half the patients to a useless and generally toxic therapy. No wonder less than 5 percent of patients will consent to take part in these trials and that it takes an enormous propaganda campaign to convince them otherwise.

In my experience, wealthy or influential patients never enter randomized clinical trials. They will not run the risk of getting an ineffective conventional treatment. Clinical trials are predicated on (a) an ignorance of alternative treatments and (b) an absence of freedom of choice.

Slide #14: WHATÕS BEHIND THIS? THE DRUG INDUSTRY

One unspoken factor in the nature of cancer treatment is the influence of the pharmaceutical industry. This profoundly influences every aspect of cancer research and treatment. Thousands of oncologists are in the pay of the drug companies, and this fact compromises their independence and certainly warps their attitude toward alternative approaches. There is almost no research into non-toxic treatments done at major cancer centers.

Oncologists are not only employed by drug companies, but own stock and stock options, receive grants and research funding, serve as paid advisors, receive honoraria, travel expenses, and gifts, and in many ways are the beneficiaries of company largesse. Top professors are hired to teach other doctors how to extend the use of patented drugs. Their advertisements sustain many a cancer journal, newsletter and website. There is a notorious "revolving door" between the NCI, the Food and Drug Administration, and the drug industry.

In the 1980s, there were 80 major pharmaceutical companies. Today, there are just 35. In a few years there will probably be only a dozen major firms left. Wall Street demands that drug companies maintain their current astronomical profit rates. They can do this only by further consolidating and producing "blockbuster drugs," which earn $1 billion or more per year. The number of companies in the oncology sector is already very smallÑBristol-Myers Squibb, Pfizer, Boehringer Ingelheim, and a few others dominate the field.

Profits are huge. A respected independent research firm estimated 1999 sales of anti-cancer drugs at nearly $14 billion, up from just $3 billion ten years before.

Directors and executives of pharmaceutical companies routinely serve on the boards of cancer hospitals.

Once upon a time, pharmacy served medicine. Today it is largely the other way around. In any field, the growth of monopoly is a grave sign: it means higher prices for the consumers. Historically, it has also meant a tendency to suppress innovation and invention.

CONCLUSIONS

There is no simple solution to such profound problems. Oncology needs to be thoroughly reformed if we expect to see real progress in the War on Cancer. Leaders need to be frank and honest in their approach to patients and the public in general. They should expose problems that exist. Above all, they should admit that the "slash-burn-and-poison" approach is fundamentally flawed.

Alternative approaches, focused on boosting the healing powers of the body, must move from the periphery to center stage.

A good start has been made in this direction at the National Institutes of Health, but it needs to go further and faster. Some alternative treatments are starting to be evaluated and the Internet (PDQ) statements are more honest than they were in the past. But we have a long, long way to go.

These changes did not happen spontaneously. They are the result of the effort of numerous doctors, scientists legislators, and activists. I am proud that you have invited me to address your meeting and to be here among some of the outstanding representatives of this trend.

It will take a determined and united movement to create the climate for profound changes. People in America look to Germany for inspiration in how to foster the scientific evaluation of alternative medicine. I look forward to joining with you in the days and the years to come, helping to make oncology an effective and, yes, an ethical path towards the conquest of cancer.

THE END