The paradigm dispute in medicine - Conclusion

- The paradigm dispute in medicine (H. L. Coulter)

We have tried to show that medical differences taking the form of paradigm disputes are not conducted according to scientific rules. Scientific, social and even legal norms are trampled underfoot in order to preserve the paradigm and neutralize any perceived threat.
 When inordinate power is exercised in this way by a professional body (i.e. , physicians), the outcome is a surrealistic scenario which conflicts with people's ordinary expectations and perceptions of reality.
 Item: homoeopathy, numbering hundreds of thousands of practitioners worldwide and tens of millions of patients, not to mention the scores of homoeopathic veterinarians, is still today, after 200 years, treated by the majority paradigm as placebo therapy. "Official" recognition of the homoeopathic doctrine would undermine the socio-economic and psychological position of the majority paradigm, which cannot be permitted to happen.
 Item: Andrew Ivy's documented cases, ultimately rising to the level of 5000, with supporting testimony from hundreds of cooperating physicians, were simply dismissed by the AMA Committee which produced the "Status Report," and by other committees, without interviewing, or even meeting, the patients themselves. Purely hypothetical explanations for Ivy's apparent successes ("spontaneous remission," "previous treatment," etc.) were accepted as if they had been scientifically proven. But it is ludicrous to think that 5000 cancer patients could be treated successfully for a decade or more with an ineffective medicine. That kind of fable runs against ordinary common sense. Of course Krebiozen was an effective remedy in cancer-just how effective we will never know.
 Today, in fact, some grudging lip-service is paid to Krebiozen. William Regelson, MD, professor at the Medical College of Virginia, stated that it was "perhaps ...a non-specific stimulator to host resistance." Louis Lasagna, MD., stated at a 1989 meeting of the President's Cancer Committee that Ivy presented several hundred regressions of "hopeless tumors" under Krebiozen where no other explanation could be found.
 Item: At a time when half of all deaths in the United States will soon be from cancer, and the medical establishment has a continuing record of failure in treating this condition, Burzynski's documented 3000 cases are dismissed just as Ivy's were, without any systematic investigation. The Government brings him to trial for trivial offenses, and the Government lawyers dismiss as "irrelevant" any consideration of the therapeutic efficacy of Antineoplastons. He is threatened with a life sentence in jail because, years earlier, some of his employees gave Antineoplastons to members of the families of out-of state cancer patients, knowing that they would transport this medicine back home to other states, and all this at a time when Burzynski had already obtained FDA approval to conduct clinical trials, i.e. , to ship Antineoplastons across state lines.
 No wonder jury members looked incredulous when the prosecution laboriously developed this testimony. The jury could recognize this scenario as surreal even if the government could not.
 Burzynski's enemies in the FDA mutter, "no one is above the law." The real question, however, is whether the FDA itself is above the law and is abusing its powers in a vindictive persecution of Burzynski.
 No wonder Congress thinks this agency is out of control.
 In 1995 former FDA General Counsel Peter Barton Hutt stated in an interview: "If you beat the FDA in court, you have an angry FDA that is willing to slit your throat. When the FDA loses a case, it has a mind like an elephant. It's just something you've got to understand about the FDA. Once the agency makes a collective decision, trying to make it let go is almost impossible. These are FDA crusades-in a real sense they are vendettas."
 The FDA's persecution of Burzynski certainly falls within this definition.
 Other instances of surrealistic-even obscene-behavior by agents of governmental and private authority against representatives of minority paradigms could be mentioned. But, rather than expressing astonishment or indignation, we should attempt to understand the reasons.
 First it must be recognized that, in a paradigm conflict, the aim is to win at any cost-to suppress or marginalize the opponent-not to solve a scientific problem by scientific means. Abandoning even the pretense of scientific objectivity, the majority conducts the struggle as an exercise in naked power and an effort to influence public opinion. The dominant paradigm ceases communicating with the minority and directs its efforts at influencing the public.
 Here the "site visit" or "inspection" seems to play a major role. Blackstein and Bergsagel flew all the way from Toronto to Houston merely to examine nine files and did not interview a single patient!! Why could these files not have been mailed from Houston to Toronto and perused at leisure by these gentlemen? Because the purpose of the "site visit" from the beginning was a public attack on Burzynski, not a scientific evaluation of his therapy. The dramatic flight down to Houston, like the dramatic visit of the Nature triad to Benveniste's laboratory, and in both cases the issuance of reports within days, were designed to influence public opinion. The AMA "Status Report on Krebiozen" played the same role. While the "site visit" element was absent, the aim was identical.
 A seeming exception to this rule was the 1991 site visit to the Burzynski Clinic by six experts from the National Cancer Institute. After reviewing the records of 7 terminal brain cancer cases treated with Antineoplastons they concluded that in 5 cases the tumor had disappeared completely, while 2 manifested a partial response. Their report stated: "anti-tumor activity was demonstrated in this best-case series." NCI official Michael Friedman, MD (at this writing, the acting FDA Commissioner) wrote in an internal memorandum: "It turns out that antineoplastons are well-defined pure chemical moieties ...The human brain tumor responses are real."
 But when the leader of this team, Nicholas Patronas, MD, the NCI Chief of Neuroradiology, testified at a 1993 hearing before the Texas State Board of Medical Examiners (on whether or not to withdraw Burzynski's medical license) that antineoplastons were the most effective treatment for brain tumors he had ever seen, he was severely reprimanded by the NCI higher echelons for giving support to Burzynski. And these positive NCI findings did not prevent the Government from bringing suit against Burzynski two years later-more surrealistic elements in an already bizarre scenario.
 Ordinary people not caught up in the majority paradigm are amazed, above all, by the extraordinary lack of curiosity of "scientific medicine" when presented with a potential cure for cancer, as with Krebiozen and the Antineoplastons, or with potential cures for all diseases, as with homoeopathy. But ordinary people do not understand the power of the paradigm.
 The refusal to contact live patients, and the insistence on judging results only from files and records, is a striking feature of paradigm conflict in medicine. The whole body of nineteenth-century allopathic literature probably does not contain a single allopathic interview of a patient treated with good results by a homoeopath. And the allopathic authorities never agreed to a supervised trial of the homoeopathic medicines and procedures, even though this was proposed on several occasions by homoeopaths.
 While the medical establishment's concern lest a trial turn out too favorably for the "quack" cannot be discounted as a motive, an equally powerful one is fear of ritual contamination from contact with "quack" procedures. When the paradigm has a quasi-religious significance, the opponent is seen as a heretic-"unclean"-or worse. Thus the homoeopathic physicians were demonized by the allopaths as frauds with whom any intercourse would be demeaning, even sinful. A New Hampshire physician wrote in 1856: "What should be the treatment of homoeopathy? It should be that of abomination, loathing, and hate. It should be considered the unclean thing-foul to the touch, wicked and treacherous to the soul..."
 But at some level this is recognized as unrealistic, even surrealistic, and the resulting psychological conflict is expressed in revealing ways. A medical school professor stated in front of witnesses: "Even if Krebiozen proved to be the absolute answer to cancer, the final cure, still Dr. Ivy would be wrong." A British colleague of Benveniste stated: "I would prefer you to be wrong, even if you are right, since otherwise you are opening the doors to numerology, astrology, acupuncture, and the like." Statements such as these go way beyond the limits of rationality.
 This organized opposition by representatives of the majority paradigm is, of course, a "conspiracy" in any normal sense of the word: "an agreement by two or more persons to commit a crime, fraud, or other wrongful act." Such actions are fraudulent or wrongful because, while claiming to be dictated by purely scientific considerations, they are actually designed to protect a given socio-economic position. That those engaged in such conspiracies are unwilling to admit it is of minimal significance.
 To this writer the determining factor in the Krebiozen story was the adamant refusal of Josiah J. Moore, Henry Szujewski, and their associates in the conspiracy against Ivy to testify under oath at Illinois legislative hearings convoked expressly to get to the bottom of the whole sordid story. In the Burzynski story the backing and filling by the National Cancer Institute and the FDA clearly point to a different agenda than the mere pursuit of scientific truth.
 This raises an interesting point, however, which was touched upon by an AMA publication in 1959 when that body was first accused of conspiring against Krebiozen: ";Members of doctors' family circles, just like anybody else, fall prey to one of the leading causes of pain, suffering, and death-cancer. Yet ...advocates of the socalled cancer drug Krebiozen would have the public believe that a 'medical conspiracy' led by the AMA has suppressed the drug."
 The implication here is that all those involved in the medical establishment's attack on Krebiozen knew that it was an effective medicine and were nonetheless attempting to destroy it. In responding to this one must distinguish between the leaders of the profession and the rank-and-file. With respect to the leaders, the interpretation issued by Krebiozen's supporters is thoroughly plausible-that J. J. Moore (treasurer of the American Medical Association) and his associates conspired to weaken Ivy's and Durovic's position in order to purchase the rights to Krebiozen at fire sale prices, but that the issue blew up in their faces because of Ivy's immense prestige. Thereafter, as the public and the profession became polarized, Moore and his associates had to stick by their initial position that Krebiozen was quackery. The outcome was the loss of a potentially valuable medicine against cancer.
 How, then, to explain Moore himself, who at one point commented that a person who conspired to block the use of an effective medicine against cancer, should be "hung, drawn, and quartered." Maybe he was blurting out his real opinion of himself? Unfortunately Moore died in 1964, and his views on this point cannot now be ascertained. Dealing with the rank-and-file was easy. The AMA was more monolithic then than it is today, and it was only needful that a small group possess the inside knowledge. The typical physician does not think much about these matters, and most echoed the American Cancer Society official who stated in 1964 that he had never used Krebiozen himself but knew it was a fraud: "I believe firmly in the scientific journals. That's how we run our business."
 Economic and business considerations are at all times involved in paradigm conflicts and, of course, influence the views of participants. Michael Prados, MD, head of oncology at the University of California San Francisco, interviewed by Julian Whitaker in 1996 about Antineoplastons, stated that he had a "terrible bias against Antineoplastons," that he "can't be objective in discussing it," that he knew nothing about Burzynski's therapy, was not interesting in investigating it himself, did not want even to make a telephone call to Burzynski, did not know the formula of Antineoplastons, did not know how Burzynski uses them to treat patients, did not know these drugs' mechanism of action, and was not interested in finding out.
 From this one would not have known that this same Michael Prados, MD, was at the time the Principal Investigator in a trial of phenylacetate (an ingredient of antineoplastons) in cancer, working for an Irish company, Elan Pharmaceuticals, which had earlier sought collaboration with Burzynski himself. In other words, Prados was in direct economic competition with Burzynski, employing a product which Burzynski himself had been the first to use against cancer. Some of Prados' own patients had been treated with Antineoplastons, and the files of the Burzynski Institute contain letters from him recognizing that they were making excellent progress.
 Physicians who might not agree with the official position are whipped into submission by administrative measures. Allopaths in the 19th century were expelled from their medical societies for contact with a homoeopath. In the 20th century they were warned that prescribing Krebiozen was "unethical," meaning that it could lead to loss of license. A newspaperman studying the controversy observed: "physicians who damned Krebiozen did not particularly object to being quoted on their positions, but doctors who felt it might be effective refused to discuss the matter before they received assurances that their identities would not be disclosed." When Dr. Patronas spoke out in favor of Burzynski, he was castigated and silenced by his NCI superiors.
 Being a technical area in which the average layperson does not feel competent to render a judgment, medicine is the classic case where society confronts the possessors of specialized knowledge and tries to keep them from serving their own interests at society's expense? This issue emerges in an acute form during a paradigm conflict.
 In the late 20th century the conflict of interest between the physician and society is largely ignored. The physician is assumed to be guided by "science," and there cannot, by definition, be a conflict between "science" and the interests of society.
 But this is mere self-delusion, albeit actively propagated by organized medicine. While physicians are, on the whole, desirous of helping their patients, the modalities of this help are determined by the existing paradigm. Technical ("scientific") elements are incorporated into the physician's practice only to the extent that they fit into the overall socio-economic paradigm.
 While medical practice contains "scientific" (i.e. , technical) elements, it is not itself a science, and physicians should not be allowed virtual monopoly control over this area of public activity which consumes, in the United States, close to $1 trillion per year. Medicine is too important to be left to the physicians, just as war is too important to be left to the generals. Especially at times of paradigm changes the backwardness and inertia of the medical profession becomes an actual threat to society's interest in effective medicines against serious diseases.
 To minimize the likelihood that valuable but unpopular medical ideas will continue to be suppressed, the medical establishment should come under the rules that govern the activities of other interest groups in society.
 Recognition that medicine has no claim to special consideration by virtue of its "scientific" status, but is just another economic interest-group pursuing its own selfish aims, will go far to restoring the balance. Recognition that the views, judgments, and opinions of physicians do not possess some higher legitimacy but are subject to the same criticism and correction (by journalists and other social watchdogs) as generals, industrialists, and politicians, will be very beneficial.
 Today, despite honorable exceptions, journalists tend to follow the official line in medicine. Newspaper articles on "alternative medicine," as well as radio and television programs, often seem to demand the presence of an "establishment" physician to provide "balance." But articles and programs presenting establishment views on medicine never seek "balance" from "alternative" practitioners. Providing this sort of "balance" would be a good place for journalists to start.
 In the Krebiozen case only a few of the Chicago newspapers were willing to scrutinize the outrageous statements and actions of the medical establishment. Other newspapers avoided the issue out of fear of giving undue publicity to what seemed a suspicious drug. In this they were not fulfilling their social responsibility.
 Medical stories should be treated like other news stories, with pro and con positions. For instance, whenever the American Cancer Society makes its obligatory promise of a "breakthrough" in the treatment of cancer, it would be helpful if journalists could point to the many broken promises of this nature in the past. It would be equally helpful if they could present to the public the social and economic costs of vaccination programs as forthrightly as the supposed benefits.
 They were not afraid to contradict the Pentagon over Vietnam, but they often become fawningly obsequious when facing a self-confident physician in a white gown.
 Since the medical regulatory agencies are part of the problem, they also should come under tighter judicial and legislative control. Today civil liberties lawyers note that the Bill of Rights is largely suspended in matters relating to illicit drugs ("the drugs exception to the Bill of Rights"). It is also suspended to a large degree in the regulation of licit drugs. Even though Burzynski has not been convicted of any crime, the FDA has yet to return 200,000 documents seized from him 12 years ago in 1985. When the KGB acted this way against Andrei Sakharov, the whole world was indignant, but the same measure against Dr. Burzynski passes almost without comment (he must sometimes imagine himself back in 1960s Poland).
 The system functions by inertia, seizing more and more power by default-because there is no countervailing power in society-and the attempt to reform it from within make about as much sense as the attempts in the 1980s to reform the Soviet Communist Party (and the KGB) from within. No member of an interest group in society will willingly act against the judgment of the group. But society creates a mess when it endows such a professional group with a monopoly of power, preventing competing voices from being heard.
 The cure, as is usually true in the United States, is a return to the Constitution. The founding fathers viewed mankind is inherently sinful. To curb that propensity they were guided by the principle of the "separation of powers," setting up one political body to watch and control another. But this rule is not being applied sufficiently to the medical establishment, seemingly on the grounds that physicians pursue an arcane discipline which is governed by "science."
 But, as we have shown, the "scientific" component of medicine is quite insufficient to ensure an adequate hearing for those who would change or challenge the paradigm. And those in positions of medical power are just as prone to sin and error as the political authorities governed by the Constitution. They can harass innovators and block their progress today just as they have in the past. And if the advocates of the minority paradigm are particularly pertinacious (as with Krebiozen), the piling of report upon report and hearing upon hearing, thus burdening and obfuscating the record, make the story so difficult to follow that the public loses interest, and the Establishment again wins by default.
 The powers of physicians should be curtailed by revising the Medical Practice Acts, and those of the FDA by revising the food and drug laws.
 At a time when half of all Americans alive today are destined to die of cancer, it is collective suicide to leave the solution to this overwhelming medical challenge in the hands of those whose attachment to an outmoded and ineffective paradigm inhibits them from recognizing an effective one and whose institutional interests are thus directly opposed to those of society. 

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