Freedom of Choice and Apricot Pits

By Frederic Golden

In one of his chronic outbursts against doctors, Mark Twain once complained that the "insane," monopolistic American medical system was "an infamous thing, a crime against a free man's right to choose his own assassin." Twain's fulmination is now being echoed by contemporary opponents of the medical establishment. Championing Laetrile, their painless apricot-pit panacea, they are insisting that Americans should be allowed a "freedom of choice" to pick their own cancer therapy.

It is a clever--indeed beguiling--battle cry. It again evokes nostalgic memories of a simpler, more ruggedly individualistic and freer America, where citizens relied less on Government and were in turn less encumbered by it--paying fewer taxes, able to build on their property without restriction, allowed to bear whatever firearms they wished. The crusade also has a basically humanistic ring. For all the progress in the war against cancer, medicine's advances have seemed agonizingly slow to many people, especially to this killer disease's victims and their desperate families. Finally, the Government's fervent opposition to Laetrile, barring it even to the terminally ill, seems not only cruel but fundamentally contradictory. The nimblest Washington lawyers find it difficult to rationalize a ban on a substance that, in reasonable quantities, apparently can do no direct harm, while at the same time the Government permits the sale of a known carcinogen (cigarettes) and may soon revoke its ban on a suspected carcinogen (saccharin). Says the Food and Drug Administration's chief counsel, Richard Merrill: "It is hard to provide an appealing rebuttal in this case."

In fact. Laetrilemania seems to be only one facet of a broader rebellion. The signs of revolt are everywhere--from the refusal of motorists to buckle their seat belts to the fascination with occult healing. Some feminists insist on teaching themselves how to perform their own gynecological examinations in order to regain control, as they put it, of their own bodies from the male-dominated medical profession. Vastly different ideologies may be at play, but these grievances express a common discontent with officially proclaimed wisdom about public health. Though he himself is suffering from cancer (and refuses to take Laetrile), Dr. Franz Ingelfinger, the witty editor of the New England Journal of Medicine, has said it well: "Forbidden fruits are mighty tasty, and especially to those who hope that a bite will be life-giving."

So why not throw in the sponge on Laetrile? The FDA could run a few tests on the alleged wonder drug to assure itself of its basic innocuousness, slap a Surgeon General-type warning on it ("The Government has determined that Laetrile, alias vitamin B17, can do nothing for your health"), and let it loose in the marketplace, along with such other pharmaceutical miracles as cold tablets, skin creams and vaginal deodorants. Under the Government's nodding supervision, the purity of the product might then be assured, the flourishing black market in Laetrile--which has netted some of its pushers millions of dollars--would finally be broken, and the nostrum could be given despairing patients beyond all hope of conventional medicine.

Unfortunately, as innocent as such a solution may seem, it is filled with as many perils as, well, a 19th century medicine man's wagon. In the case of cancer, quack remedies involve more than bustled ladies sipping alcohol-laced Lydia Pinkham's compound or husky baldpates rubbing themselves with hair-growth oil. They are a cruel hoax that distracts cancer patients from possibly effective therapy. Even if it were accompanied by a caveat, an FDA stamp of approval for Laetrile would draw still more cancer patients away from conventional treatment--with disastrous consequences. Says Dr. Vincent DeVita, director of cancer treatment at the National Cancer Institute (NCI): "Hardly a day goes by now that I don't hear of a case of a patient dying after leaving accepted treatment and taking Laetrile."

Of course, it is conceivable that the medical establishment may be wrong about Laetrile. History is filled with examples of medical shortsightedness. In the early 1 8th century, the Rev. Cot ton Mather, of all people, was accused by Boston doctors of in terfering with the "all-wise providence of God almighty" by rec ommending inoculation against smallpox. Louis Pasteur evoked the fury of medical savants with his germ theory of disease.

Even in our own day, medical ideas change as often as skirt lengths. Until recently, U.S. doctors almost always insisted on re moving the breast when cancer occurred there. Now, under pres sure from women horrified by the prospect of such mutilation, they are finally beginning to restrain their scalpels and try al ternatives, notably radiation therapy, that have long been fa vored by European doctors. Similarly, many doctors are now having second thoughts about the value of hysterectomies, which are about as common as tonsillectomies.

Still, the growing grass-roots movement may soon force the Government's hand. NCI'S acting director. Dr. Guy Newell, has already indicated that his agency may, in spite of the absence of any positive animal data -- a prerequisite in the case of all other purported anticancer drugs -- undertake a clinical test of Lae trile on humans, something it has steadfastly refused to do.

Though he still considers Laetrile "an out-and-out fraud," De-Vita allows that "testing it may be more ethical, more beneficial and less harmful to the public than what is happening now."

Possibly, as Ingelfinger suggests, a public trial supervised by a collaboration of doctors and laymen might do more to bury Laetrile than all the official debunking. It would perhaps help repair the badly strained bond between medicine and the American people. Yet a too easy acquiescence by the FDA could, like any strong medication, produce unwanted and even dangerous side effects. By letting individuals use Laetrile, regardless of its value, the Government would be abrogating its traditional responsibilities to protect the national wellbeing. It could also fan the already widespread public suspicion of contemporary medicine and indeed of scientific expertise generally. However justified such suspicions may occasionally be, the notion of setting lay judgment and emotions against the best advice of science raises disturbing questions. Above all, the benefits of a public test must be weighed against the dangers of false hopes raised and sound treatments ignored.

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