http://scienceblogs.com/insolence/2017/08/01/no-alternative-medicine-ever-disappears-when-shown-to-be-ineffective-the-case-of-laetrile/

No alternative medicine ever disappears when shown to be ineffective: The case of Laetrile

Posted by Orac on 

Everything old is new again, or so it always seems with alternative medicine.

Before I explain what I’m talking about a bit more, let me just preface my remarks with an explanation for why there was no post tomorrow. I realize that most people probably don’t care that much if I miss a day or two, but I care. Basically, I was in Chicago from Thursday through Sunday taking a rather grueling review course in general surgery offered by the American College of Surgeons. The reason is that I have to take my board recertification examination in general surgery in December. It was an amazing course, and I was stunned at how much outside of my specialty had changed in the decade since I last had to recertify, just as, I’m sure, those who don’t specialize in breast surgery were shocked at how much has changed in how the surgical care of breast cancer has changed in the last decade. (I might have more to say about this in a later post.) The primary reason I’m mentioning now (other than because it explains why I didn’t manage to get a new post for this blog) is because this change in the standard of care in response to new scientific evidence is one of the greatest features of science-based medicine. It’s also one of the biggest contrasts between science-based medicine and alternative medicine; i.e., what I like to call quackery, mainly because it is.

I was reminded of this contrast by an article I came across on Buzzfeed yesterday, These People Are Making Money Off A Bogus Cancer Cure That Doctors Say Could Poison You. Of course, I knew right away what the article was about just from the title, without even having to note that the blurb for the article mentioned apricot seeds. Yes, we’re talking laetrile here, and apparently there are still quacks who are partying like it’s 1979, which was laetrile’s heyday as an alternative cancer cure:

It turns out that Richardson’s son is continuing the family business, so to speak:

See what I mean? In the early 1980s, clinical trials showed that laetrile had no appreciable anticancer effect in humans and that it was also toxic. (The reason, of course, is the cyanide.) In science-based medicine, that would have been that. The treatment would have abandoned. But that’s not how alternative medicine works. True, laetrile did fade in popularity for a couple of decades after that, but of late it appears to be undergoing somewhat of a resurgence and “renaissance” (if you can call the revival of dangerous quackery a “renaissance”). I first noticed it three years ago when Eric Merola, the man behind two propaganda films promoting Stanislaw Burzynski’s cancer quackery, decided to shift topics to—you guessed it—laetrile. He directed a documentary entitled Second Opinion: Laetrile at Sloan-Kettering, which, like his films on Burzynski were full of misinformation, obvious bias and spin, and just plain quackery and pseudoscience. Basically, as I discussed in my deconstruction of his film, the central idea being that Ralph Moss, who was a science writer of some sort at Memorial Sloan-Kettering Cancer Center and is now laetrile’s foremost popularizer, along with other MSKCC employees, “leaked” documents “proving” that laetrile/amygdalin had incredible anticancer activity. It was the same old thing. According to Merola, the negative clinical trials were “rigged not to work.” According to Merola, Laetrile “tested positively” in preclinical studies but that those results were “covered up” (of course). Other works supposedly showing the efficacy of laetrile was “suppressed.”\

You get the idea.

It turns out that Richardson is a bit more canny in that he states very,.”We don’t mention the C-word in our company,” the “C-word” being cancer. The Buzzfeed article also notes:

Holy quack Miranda warning, Batman! I’ve never seen a company actually respond to any mention of cancer on its social media pages with a pre-emptive quack Miranda before!

And, thanks to that same social media, everything old is new yet again:

I’ve discussed this before, of course, but I’ll briefly cover it again, mainly because there are likely to be newbies reading this. Basically, according to this article, the idea behind laetrile is that the body is lacking in a nutrient that proponents call “vitamin B17.” That’s sort of true, but only the latest iteration in the ever-morphing scientific “explanations” for how laetrile/amygdalin/vitamin B17 “works.” Basically, “Laetrile” is the trade name for laevo-mandelonitrile-beta-glucuronoside, a substance allegedly synthesized by Ernst T. Krebs, Jr. in the 1920s. It’s chemically related to amygdalin, a substance found naturally in the pits of apricots and some other fruits. Again, most proponents of Laetrile for the treatment of cancer use the terms “Laetrile” and amygdalin interchangeably, and I generally do as well. Historically, amygdalin was tried as an anticancer agent as early as 1892, but was abandoned because it was ineffective and toxic, its toxicity deriving from how it can break down in the body into glucose, benzaldehyde, and hydrogen cyanide.

Like the rationale for many forms of quackery, the rationale for Laetrile has shifted over the decades. In the 1950s, Ernst T. Krebs, Jr. claimed that cancer tissues are rich in an enzyme that causes amygdalin to release cyanide, which would destroy the cancer cells. Supposedly noncancerous tissues are protected by another enzyme. Later, Krebs claimed that Laetrile/amygdalin is a vitamin (B17) and, of course, cancer is due to a deficiency in that particular vitamin. Other claims have shifted, from Laetrile being a cancer cure to being able to “control” cancer to being a cancer “preventative.” Then, like so many alternative medicines, the indications for its use went what the military might call “mission creep” in that it was advocated for more and more conditions. These days, amygdalin/vitamin B17/laetrile is advocated for almost anything that ails you, just like the snake oil peddled by wandering salesmen 150 years ago.

So how did Richardson’s father get involved with selling amygdalin? He met up with Krebs, of course:

Also, presaging how the antivaccine movement and other supporters of quackery have become more associated with anti-government conservative/libertarian movements, here’s what happened when the elder Richardson was arrested in 1972 for selling laetrile:

Laetrile isn’t being called laetrile much any more, but rather vitamin B17 or amygdalin, or it’s being sold in the form of apricot seeds. It’s a rather obvious “rebranding” to avoid the FDA and FTC’s ban on advertising laetrile for cancer. Avoid the “C-word,” throw in the liberal use of the quack Miranda warning, and start marketing laetrile as a dietary supplement, the better to avoid having to demonstrate efficacy and safety.

Another feature of this sort of marketing is that the companies selling supplements like amygdalin don’t actually have to make health claims. They can outsource it to the internet communities of believers who trade alternative cancer cure testimonials, to believers who have written books, made videos and movies, and write blogs. Of course, as I’ve said so many times before, dead patients don’t give testimonials; so of course only the patients who are still alive and doing relatively well are the ones promoting amygdalin with their stories. People you don’t hear about are cancer patients like this:

In quackery, be it cancer quackery or quackery used for other diseases, no treatment, no matter how ineffective and even toxic, ever disappears. No treatment ever disappears after being shown by science to be ineffective. The story of laetrile shows us that. The difference between quackery and science-based medicine could not be clearer.

By any measure, John (“the elder”) Richardson made a huge amount of money off laetrile. From the Quackwatch article about the rise and fall of laetrile (the fall part seems to have been premature):

“In 1974, he reported that his medical practice had grossed $783,000, with a net income of $172,981. By charging patients $2,000 for a course of Laetrile, Richardson managed to increase his net income 17-fold in just two years. According to his income tax returns, Richardson grossed $2.8 million dollars from his Laetrile practice between January 1973 and March 1976. The actual amount of money he received may have even been higher. In Laetrile Case Histories, he claimed to have treated 4,000 patients, with an average charge of $2,500 per patient. Culbert states that by 1976 Richardson had treated 6,000 patients. If these figures are correct, Richardson would have grossed between $10 and $15 million dollars during this time.”

https://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/laetrile.html

"After peaking in the late 1970s, the "Laetrile Movement" ran out of steam in the wake of the Supreme Court decision, the NCI study, the death of Steve McQueen, and other unfavorable publicity. But as the Laetrile fantasy faded, its prime movers added many other "miracle cures" to their arsenal and added AIDS, arthritis, cardiovascular disease, and multiple sclerosis to the list of diseases they claim to treat. Although they appear to speak with sincerity, they still fail to sponsor the type of research which could persuade the scientific world that anything they offer is effective."

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