Sal beat the odds, and I’ll never know why
Just when I think I can predict a disease’s deadly outcome, along comes someone to remind me how little we truly know about cancer. Sometimes, a patient survives against all probability, and I am left not knowing why.
“Sal Wittgen” (not his real name) was a poet. When I first saw him in my examination room, I noticed his shock of white hair and the wild look in his eye. Back in 1994, I discovered his liver tests were elevated then found he had hepatitis C, using the new blood test that had just become available.
His ultrasound showed that his liver had the beginnings of cirrhosis. A liver specialist prescribed the anti-viral treatment alpha interferon, but it made him fatigued and he quickly stopped it.
In 1997, when Sal was feeling fairly well, I sent him for a routine ultrasound of his abdomen that showed a mass in the liver. A liver biopsy revealed hepatocellular carcinoma, a vicious type of cancer that is very difficult to cure. Its five-year survival rate with conventional chemotherapy was only 4%. I suggested a liver transplant.
I won’t survive it, Sal insisted.
Instead, he chose what was then a new kind of treatment: chemoembolization, in which chemotherapy is administered through the artery that feeds the tumor and then the artery is destroyed. Since 1997, this treatment has been used effectively for more than 1 million patients in more than 30 countries. But back in 1997, no one knew how well it would work.
His tumor shrank in response to the treatment, and though I kept waiting for the cancer to regrow and spread, his follow-up CT scans continued to be negative. But the hepatitis C virus continued to eat away at his liver.
Enough of poisons, Sal said. Instead, he turned to a heretical alternative medicine physician, Emanuel Revici, who was 100 years old and still practicing medicine.
Revici was born in Romania in 1896. He received a medical degree from the University of Bucharest in 1920. He moved to Paris, then Mexico City, where he began experimenting with drugs to treat cancer, then to New York in 1947, where he started the Institute of Applied Biology and conducted experimental cancer research. Professional cancer societies soon began to consider him anything but a scientist.
In the 1980s, he received more than a dozen patents for chemical formulations to use on cancer patients. But New York state soon challenged and restricted his medical license, and found him guilty of professional misconduct in 1988.
Sal was very impressed with Revici’s philosophy of healing and his belief that cancer was due to an imbalance of fat in the body. Rather than crediting the lasting effects of that single chemoembolization, Sal began to credit the Revici purges and enemas and mystery combo chemicals for prolonging his life.
As time went on, I began to wonder if Sal really was in remission. Looking at his bloated belly on the examining table and smelling the ammonia-laced breath from his liver failure, it was difficult to believe he was doing better. But CT and MRI scans continued to show that he was clear of cancer.
I feel better than I look, Sal said.
Revici’s “guided chemotherapy” was based on a urine analysis followed by a secret formula made of some combination of alcohols, caffeine, zinc, lithium, iron, selenium, magnesium, sulfur and fatty acids. A study published in the Journal of the American Medical Assn. in 1965 found that of 33 patients who were referred to Revici after they failed conventional treatment, 22 died, eight showed no improvement and the remaining three showed progression of disease.
But Sal had faith. He believed it was difficult to scientifically study Revici’s methods because each patient was different. And certainly, it is true that response to a particular cancer treatment is often unpredictable, even with standard chemotherapy.
Genetics clearly play a role in this variability in response: Tumors may look the same from outside, but they can arise from variations in many different genes, making them more or less responsive to drug A, drug B or drug C. For example, a study from the Broad Institute of MIT and Harvard, published this month in the New England Journal of Medicine, reported a genetic pattern in liver tissue that correlates with survival and lack of recurrence of liver tumors.
As long as I keep writing my poems and see a great healer like Revici, I will stay alive, Sal said to me on several occasions.
There is little scientific evidence to support this idea, though plenty of popular books that espouse it. In 1986, alternative medicine guru Dr. Bernie Siegel (no relation) wrote in his book “Love, Medicine, and Miracles”: “When a human being suffers an emotional loss that is not properly dealt with, the body often responds by developing a new growth.” Siegel saw people’s cancers as challenges that a proper healer could help them vanquish with the help of positive emotions.
But a follow-up study of Siegel’s patients published in the Journal of Clinical Oncology in 1993 found that women with breast cancer who went through his program died at the same rate as those who hadn’t.
Sal’s case would seem to run counter to conventional science. Was this just luck? In all studies of cancer, there are some patients who simply survive no matter how grim the prognosis.
Did that single chemoembolization save him or did he have a genetic predisposition to remission? Patients such as Sal fuel the myths of the Siegels and Revicis of the world without providing any real evidence to support their fringe treatments.
I am intrigued that Sal appeared to respond to the quackery dispensed by that aging huckster and his followers, but in the end, I stop far short of believing in it or recommending it to anyone else.
In late 2005, when Sal was finally admitted to the local Veterans Affairs hospital for a serious infection and out-of-control diabetes, obscured in the unpleasantness of his dying was the miracle of his cancer remission.
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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine and the author of “False Alarm: The Truth About the Epidemic of Fear.” He can be reached at marc@doctor siegel.com.
