Can Bacteria Cause Cancer?
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Can Bacteria Cause Cancer?

Alternative Medicine Confronts Big Science

David J. Hess

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eBook - ePub

Can Bacteria Cause Cancer?

Alternative Medicine Confronts Big Science

David J. Hess

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About This Book

Growing numbers of cancer patients are exploring diet, food supplements, herbs, and nontoxic immunotherapies like bacterial vaccines as a means of therapy. Yet most cancer research organizations refuse to even evaluate these alternatives. Can Bacteria Cause Cancer? argues convincingly that unless this neglected world of alternative therapies is properly scrutinized, the medical Vietnam of the twentieth century may well affect one in two people by the twenty-first century.

David J. Hess investigates one of the great medical mysteries of the twentieth century—the relationship between bacteria and chronic disease. Recently scientists have overturned long-held beliefs by demonstrating that bacterial infections cause many ulcers; they are now reconsidering the role of bacterial infections in other chronic diseases, such as arthritis. Is it possible, Hess asks, that bacteria can contribute to the many other known causes of cancer?

To answer this intriguing question, Hess takes us into the world of alternative cancer researchers. Maintaining that their work has been actively suppressed rather than simply dismissed, he examines their claims-—that bacterial vaccines have led to some dramatic cases of long-term cancer remission—and the scientific potential of their theories. Economic interests and cultural values, he demonstrates, have influenced the rush toward radiation and chemotherapy and the current cul-de-sac of toxic treatments.

More than a medical mystery story, Can Bacteria Cause Cancer? is a dramatic case study of the failure of the war on cancer.

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Information

Publisher
NYU Press
Year
1997
ISBN
9780814773222

1
Introduction

The carcinogen is the germ of our time. Most of the world’s population lives in a sea of carcinogens: cigarette smoke, pollution, pesticides, asbestos, radiation, radon, excess sunlight, food additives, hazardous waste, poor nutrition, hormones, viruses . . . the list continues to grow. Because there is so much complexity and uncertainty regarding the risk factors and treatment, cancer is more than a disease. It is a political and social problem. Cancer is a symptom of a global civilization that is out of balance with its biology and ecology. It is a medical crisis that affects millions of individuals and their families, but it is also a political and scientific crisis.
Rates of cancer incidence in the United States have risen consistently at about i percent per year. In the late 1950s one in four persons was likely to contract cancer and one in five would die from the disease, but by the 1990s the incidence had climbed to over one in three with over one in four mortalities. Shockingly, current estimates indicate that in the United States 45 percent of males and 39 percent of females will be diagnosed with cancer in their lifetimes. Over one and a quarter million Americans are diagnosed with cancer each year, and over a half million die from the disease each year. It is possible that by the second or third decade of the twenty-first century half of all Americans will be diagnosed with cancer at some point during their lifetimes.1
Of the millions of Americans who have cancer at any one time, many have turned to alternative cancer therapies to complement their conventional treatments, to replace officially recommended therapies, or to use as a last resort when their doctors have given them up as terminal. When the hundreds of thousands of cancer patients who choose alternative therapies are recognized not as a single phenomenon but as a subgroup of the millions of other Americans who use alternative therapies for other diseases and conditions, the dimensions of a grassroots health care revolution become visible. This sea change is spurred by competition among health-maintenance organizations, which are driven by market forces to fund an increasing variety of alternative therapies. Likewise, constituent demands for better access to alternative therapies have led to legislative reforms in many states and at the federal level.2
This rapidly changing situation has given rise to a widespread need for evaluation: legislators, insurers, health-care professionals, and above all patients need more information about which alternative therapies work and which ones do not. Clearly, one way to answer this question is through massive public funding of randomized, controlled trials of specific alternative therapies that patients are now using. Constituent demands for this type of evaluation will grow as the use of alternative therapies grows. However, in addition to testing specific therapies, the broader theoretical frameworks also need to be evaluated. There is growing public dissatisfaction with cancer research and its annual expenditures of billions of taxpayer dollars. The emphasis on basic research and on toxic chemotherapy has led to few real success stories for conventional cancer treatment. Advances have centered on the early childhood cancers and some of the less common cancers; however, the advances associated with chemotherapy occurred decades ago and they probably cannot be extended to the more common cancers (Moss 1995). Overall five-year survival rates of about 50 percent increased only marginally from 1974 to 1987, and even those marginal gains may be due largely to earlier diagnosis.3 Given this dismal picture for cancer treatment, advocates of alternative therapies often seek more than testing of specific therapies. They seek a reevaluation of current research programs and they demand funding for alternative ones.
This book contributes to the evaluation issue by providing a framework for examining not a specific therapy but a broader alternative research program in which therapies are embedded. The terms “research program” and “research tradition,” which have been used in specific ways in the philosophy of science, will be used here loosely to refer to an interconnected network of empirical studies, research practices, applications (e.g., therapies), and guiding theories.4 The fundamental question for this book is, “What is the best way to evaluate alternative medical research programs in order to improve the ones that are currently in place?” To develop an answer for this level of the evaluation problem, I focus on one alternative research tradition for cancer: work guided by the unorthodox theory that bacteria play an overlooked role in the etiology of cancer.
By assessing one alternative theory of cancer, I provide a general method for analyzing the politics and possibilities of alternative research programs. A key assumption is that in order for a criticism of existing research programs to be useful, it should assess the feasibility of an alternative. It does no good merely to criticize the failures of existing research programs; the more difficult and necessary task is to evaluate alternatives that may contribute to reconstructing the existing programs. For the complex field of cancer research, one possibility among many is research on the role of bacteria in tumor genesis and promotion.
Medical researchers have already changed their thinking on one major chronic disease, the gastric ulcer, which is now recognized to have a largely bacterial etiology. They have also shown an increasing interest in the role of bacteria in arthritis. Viruses are now widely recognized as the agents of a number of cancers, rare ones for humans and more common ones for animals. However, the standard explanations for reports of bacterial colonization of human cancer tissues are that bacteria represent either an artifact (contamination) or an opportunistic, secondary infection that plays little or no role in tumor genesis and/or progression. These explanations face a number of anomalous findings that will be described and evaluated. In effect, two theories will be compared: the theory that bacteria may play an unrecognized role in tumor genesis and promotion, and the null theory that bacteria found in cancer tissues are merely opportunistic, secondary infections that have little impact on the multistage process of carcinogenesis.
The comparison of theories should not be done naively. The much heralded “war on cancer”—which President Nixon declared when the Cold War was moving toward detente—has left behind a battlefield bloodied with the bodies of advocates of alternative therapies who have been victims of intellectual suppression. The history of research on the bacterial-etiology theory is no exception. In some cases the suppression may appear to be legitimate, because some of the research was so poorly described or executed that most people with some college-level science background would probably reject it as bad science. However, during the decades following World War II a large amount of legitimate scientific research has appeared in standard, peer-reviewed journals. These publications reveal some evidence that bacteria do play a role in tumor genesis or progression. Yet, the significance and importance of that role remain, in my opinion, unanswered. There are some reports of sera and vaccines based on bacterial cultures that show striking success. These therapies pose relatively low risk to the patient and relatively low cost for society to develop and produce them. Consequently, the bacteria and cancer research program appears to be one example of the many alternative cancer research programs that warrants legislative mandate from Congress, approval for testing by theFDA, funding from public agencies, attention from cancer researchers, and evaluation by open-minded clinicians. Like other alternative cancer research programs, the bacterial program may turn out to be a dead end. However, additional evaluation can be obtained at relatively little cost to a citizenry that is already paying two billion dollars per year for cancer research and much more for toxic treatments.
More generally, the cancer research agenda needs to be rethought in light of the stalled progress in cancer treatment and the gap between research at the level of molecular biology and useful new therapies. The public needs to reevaluate existing cancer research funding with the prospect of diverting a substantial percentage toward projects of relatively low cost that demonstrate reasonable preliminary scientific evidence and a possibly high benefit to patients. Such a strategy has already been adapted, with some success, in the area of specific immunotherapies. In the conclusion, I will advocate extending the research and testing of immunotherapies to those based on the bacterial etiology theory. More generally, I will argue in favor of extended funding for evaluation of those alternative cancer theories and therapies that pass what I will describe as a credible biological mechanism test, provided that they can muster some clinical evidence for efficacy and safety.
Because anyone who dares to question the standard wisdom of cancer research may face severe and deliberate distortion through attacks by a well-funded network of debunkers, it is worth pausing for a moment to underscore the specific claims made in this book. I ask four basic questions in this book: what is the history of this field of research, what are the reasons for its rejection, how sound is the research, and what policy changes would make it easier for a more measured consideration of alternative research programs. My claims are very specific, and they correspond to the chapter organization of the book:
1. There is a history of research on bacteria as etiological agents in cancer, and this research tradition has not been merely forgotten or disregarded, but actively suppressed. This proposition is demonstrated in chapter two, which reviews the relevant historical record.
2. The explanation for the suppression needs to take into account factors beyond those of evidence. Chapter three demonstrates that financial and professional interests as well as more general cultural factors are necessary to explain the history of suppression.
3. When one reviews the evidence in support of the bacterial etiology theory against todays best available scientific knowledge, it appears that bacterial infections may play some contributing role in the genesis or promotion of some human cancers. Furthermore, the occasional efficacy of bacterial vaccines—a clinical finding that has long been recognized in cancer research—may be due partly to their effect on bacterial infections, not merely because they provide general stimulation to the immune system. However, the fourth chapter also considers counterevidence and counterarguments, and some of the earlier claims—for example, that there is a single “cancer microbe”—are rejected as probably erroneous.
4. Several other alternative cancer therapies show some preliminary evidence in support of claims of safety and efficacy, and they have a credible possible biological mechanism. Those therapies should be provided with additional public funding for evaluation. The fifth chapter argues that in the United States (and perhaps other countries), the funding, evaluation, and regulatory apparatus for cancer research needs to be reformed substantially so that reasonable alternative therapies are evaluated promptly and fairly.
It is likely that some readers will misunderstand the point of the book as an argument that bacteria cause cancer. The scientific-medical argument that I make is much narrower. In order for the question posed in the title of this book to make sense, it is necessary to view the role of bacteria as contributing agents to cancer causality, perhaps even as promoters rather than initiators. In other words, a more scientific way of asking the question would be: “In human bodies that are immunologically compromised by poor diet, exposure to carcinogens, and other risk factors, can the emergence of latent bacterial infections contribute to tumor genesis and/or promotion?” I argue that bacterial infections may play an overlooked role in the etiology of cancer, and understanding that role could be important for developing more effective therapies.
The case of the bacterial theory is merely one among several very promising approaches that warrant extensive public funding for further investigation as adjunctive treatments or in some cases replacements for conventional therapies. The other alternative therapies include some of the dietary, herbal, metabolic, and immunological approaches. It is very possible that the bacterial theory is not even the most promising of the many alternative research programs in cancer research. Rather, the case study of the bacterial theory provides a method for a holistic analysis—sociological/anthropological, biomedical, and policy-oriented—of theories and their affiliated research programs in the alternative medicine field.
This case study also provides an empirical example of an alternative type of analysis for those involved in the interdisciplinary field of science and technology studies—the philosophy, sociology, history, anthropology, cultural studies, and policy analysis of science and technology For those who are interested in the science-studies theory that informs my analysis, the key arguments are developed in the appendix. I advocate moving beyond the assumptions of the neutral observer in science studies to the scientific evaluation of research programs as policy choices, and of public institutions as candidates for reform. Thus, the voices sounded here are not merely those of descriptive science and social science, but that of a citizen who is concerned with policy reforms of great public concern.

2
Germ Warfare
The Case for Bacteria as Carcinogen

If anyone were to claim today that there is a causal relationship between bacteria and cancer, most cancer researchers would quickly dismiss the idea. Such skepticism is the product of a history in which some researchers claimed that bacteria and/or viruses were the sole etiological agents of cancer. Against such unicausal theories for a disease—or variety of diseases—as complex as cancer, skepticism was warranted. However, the skepticism may have overcompensated for the more extreme claims. A review of the history of claims of bacteria as carcinogenic agents may lead to an intermediate position between extreme skepticism—there is no relationship between bacteria and cancer—and extreme advocacy—cancer is an infectious disease like tuberculosis, caused by a single bacterial species. The first step in this exercise is to demonstrate that some of the advocates of a bacterial theory of cancer had a less than fair hearing.
One of the classic expressions of extreme skepticism was the first edition of James Ewings Neoplastic Diseases (1919). In that book the influential director of what was then known as the Memorial Hospital (now Memorial Sloan-Kettering Cancer Center) pronounced his diagnosis: “The parasitic theory . . . appealed to the ancients, was tacitly accepted throughout the Middle Ages, was definitely argued by modern observers, and reached the height of its popularity as a scientific theory about 1895, but during the last fifteen years it has rapidly lost ground, and today few competent observers consider it as a possible explanation of the unknown element in blasto-matosis” (1919: 114). Ewings position on microbes was an extreme one. He rejected a contemporary study of a bacterium that brought about tumorlike growths in plants (Agrobacterium tumefaciens), and he also rejected the work of Rockefeller Institute researcher Peyton Rous on chicken sarcoma viruses (117, 121). At most, he argued, studies of the microbial origin of cancer suggest that a microorganism “may have a special capacity to excite inflammatory processes which tend to go on to tumor growth, but they offer no support to the theory of a specific cancer parasite living in symbiosis with the cancer-cell and constantly stimulating its growth” (125).
Although Ewing reported that interest in the microbial theory of cancer had been dying out after the mid-1890s, viral oncologists today view the first decade of the twentieth century as the originary moment of their field. As Ewing’s comments suggest, recognition for their field was slow. It grew gradually over the decades as studies mounted to show evidence for viral etiology in a number of cancers. Rous was not honored with the Nobel Prize until 1966; as a field, tumor virology did not become an important part of mainstream cancer research until the 1960s, when successes with the polio vaccine sparked a renewed interest in viruses and cancer. Nevertheless, although virology is now an accepted part of cancer research, viruses today remain relegated to the rarer human cancers, such as cervical and skin carcinomas, Kaposi’s sarcoma, and some kinds of leukemias, lymphomas, and liver cancers.
Another of Ewings mistakes involves Agrobacterium tumefaciens. The bacterium is now recognized as producing tumorlike growths in plants. Furthermore, microorganisms today are known to be involved in carcinogenesis through mechanisms other than inflammation, as in the case of the fungal carcinogen aflatoxin. However, these examples are regarded as relatively limited causal linkages between cancer and nonviral microorganisms.
Thus, in general terms Ewings view of the importance of microorganisms to the understanding of cancer remains the consensus, especially for bacteria and fungi. The consensus today is that bacteria isolated from cancer tissues represent secondary infections that have little if any role in the promotion of tumor growth. Bacteria are opportunistic, not etiological, agents. Where they are recognized today as playing a role in the etiology of human cancer, such as the case of the ulcer bacterium Helicobacter pylori, it is assumed to be through chronic tissue irritation that may set the stage for tumor genesis. Likewise, although there is a tradition of immunotherapies that use bacteria and bacterial products to stimulate the immune system to attack cancer cells, the efficacy of these therapies is believed to rest on general immune system stimulation rather than a specific attack on purported oncobacteria. Leading tumor immunologists such as Steven Rosenberg therefore are suspicious of the apparently “blunt and empirical approach” of bacterial vaccines such as the tuberculosis vaccine BCG, which has sometimes been used in the treatment of cancer. In his words, “[T]he immune system is highly specific; a response to one stimulus, the BCG, should not stimulate a response to another stimulus, cancer” (Rosenberg and Barry 1992: 59). When used for cancer, the old bacterial vaccines such as BCG are considered nonspecific because they work by stimulating the immune system in general. In contrast, specific immunotherapies such as interleukin-2 are considered superior because they attack cancer cells through recognition of specific immunological markers. Unfortunately, the new, specific immunotherapies suffer from problems of toxicity and only moderate efficacy.
Bacterial vaccines have sometimes been associated with the theory that bacteria, and sometimes fungi, are etiological agents in cancer. This theory was supported by a rich alternative research tradition that involved at least fifty scientists and clinicians in a number of countries. Popular during the nineteenth century, the theory received continued support during the twentieth century as a minority tradition. Although the quality of the research is very uneven, some of the best of the research has been published in recognized, peer-reviewed scientific journals. This alternative research tradition presents several anomalies in the received wisdom on bacteria and cancer. By no means do the anomalies require adopting a unicausal bacterial theory of cancer, as some of the researchers wanted. However, a broadened cancer research program that addresses some of the anomalies and some of the experiments of the bacterial research program could provide new and crucial insights into the etiology and treatment of cancer.
This chapter will demonstrate that many of the researchers suffered instances of intellectual suppression, particularly when they developed clinical applications. To accomplish a complete analysis, it is necessary to separate the “is” and “ought” questions. First, the demonstration that there was a systematic pattern of suppression needs to be answered before the question of whether such suppression should have occurred. Some readers may willingly grant the argument that such theories were suppressed, but they may then argue, “So what? The theories were so crazy that any reasonable person with a scientific background would also have ad...

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