A Dull Weapon:
Chemotherapy Almost Useless in
Treating Advanced Organic Cancer—
Provocative Theses at the Hamburg Cancer Congress
Article from Der Spiegel, 33/1990, 174-176
(Translation provided by
Against Cancer, Otho, Iowa)
For ten years Ulrich Abel, 38, has
served the West German cancer doctors as a “number cruncher” (his
own expression). This graduate mathematician and PhD in epidemiology
has been helping clinicians carry out their cancer investigations.
His knowledge of method was in demand and his relations with cancer
experts were excellent.
This past spring, however, the Heidelberg
biostatistician himself took up pen and brought out a smart book
with the title: Cytostatic Therapy of Advanced Epithelial Tumors — A
Critique (Hippocrates Verlag, Stuttgart. 112 pages. 28 marks). Since
that time Abel has become a Cain for many West German cancer
specialists. Abel admits that in some cases he is “no longer invited
to participate” in new research.
For a year this researcher, working in the
Heidelberg/Maanheim Tumor Center looked through essentially “a11 the
literature” that deals with chemotherapy (“several thousand
The findings of foreign chemotherapy researchers
were perused by Abel as pertinaciously as those of West German
oncologists. In addition, he sent self-addressed envelopes to 350
cancer experts and cancer centers everywhere in the world in order
to track down additional anti-tumor medication research which had
not yet appeared in the cancer (oncology) journals.
Abel expresses in a single word the outcome of his
In the light of his year-long investigation, Abel
concludes that “faith in the efficacy of chemotherapy” in the brains
of many physicians is clearly a “fixed dogma” which cannot withstand
the acid test of strict science.
What for this employee of the Heidelberg Tumor
Center was “initially just a suspicion” became a “certainty” when be
had finally put the puzzle together: the weapon of chemotherapy has
remained dull in the hands of cancer fighters; even after decades of
clinical application and therapeutic research the cellular poisons (cytostatics)
of cancer therapy “in broad areas” of cancer therapy have
The scientist’s findings show that most kinds of
cancer treatment, which are so productive of side effects, are
disappointing for the patient, and for two reasons:
- Chemotherapy is incapable of extending in any
appreciable way the lives of patients suffering from the most
common organic cancers.
- Even the palliative effect of these
medications, supposedly improving the quality of life of the
patient, rests on shaky scientific ground.
The Heidelberg renegade could have been described
as frivolous if his exposure of chemotherapy had not turned out to
be appropriately differentiated. For nothing is harder for
physicians in daily clinical practice than to dispel the inevitable
fears of patients about chemotherapy. Hence the tumor researcher
shrugs off reproaches made against his book by some West German
cancer bigwigs, even before it had seen the light.
- Abel’s verdict against the medicinal
treatment of cancer is emphatically untrue for various kinds of
lymph cancer, Hodgkin’s disease, leukemias, sarcomas, and
testicular cancers in the male. These kinds of malignancies can
be cured by chemotherapy with a high degree of probability,
especially in children — an undisputed success. But these are,
in any case, only a very small part of the new cases of cancer
diagnosed every year.
- Abel’s doubts are not directed against
chemotherapy when it is used in support of a curative operation,
in order to shrink the tumor beforehand; nor do they apply to
chemotherapy used prophylactically after an operation, to
prevent a relapse (as an adjuvant).
“A scientific wasteland” is how Abel describes the
chemotherapy of advanced epithelial malignancies.” This group
includes almost all organic cancer in which a potentially curative
operation is no lodger possible, because the tumor has already
metastasized, or has recurred after a course of treatment (relapse).
These kinds of tumors constitute at least 80% of all deaths from
cancer every year.
In advanced small-cell lung cancer it is possible
that cellular poisons may extend life somewhat. But the benefit is
very slight — several months on the average.
And neither in breast cancer nor in stomach
cancer, neither in intestinal, bladder, or pancreatic cancer is this
true when the case is advanced and metastasized. The low efficacy of
medicinal antitumor therapy, in the view of the Heidelberg
researcher, “is something of which neither the public nor the
greater’ part of practicing physicians are particularly aware.”
According to Abel, chemotherapy is recognizably
not in a position to appreciably prolong the lives of patients. At
least, there is no conclusive scientific evidence for it. Such
evidence will become available when the survival rates of patients
under chemotherapy can be systematically compared with those of
untreated cancer patients within the framework of controlled
But such a procedure has no chance of acceptance
by ethics commissions made up of physicians. “One cannot leave
untreated a patient whose cancer is treatable with chemotherapy,”
state the West German experts, Dieter Karl Hossfeld and Albrecht
Pfleiderer, “just to find out if he might not survive just as long
without therapy. The benefits of chemotherapy are assumed
axiomatically but not proven.
Also the fact that under chemotherapy the tumor
mass shrinks or temporarily disappears completely) partial or
complete remission) is, in Abel’s view not a good sign. For the
remaining tumor cells which resist the effect of the medication
sometimes grow much faster afterwards.
A connection between “response,” meaning shrinking
of the tumor tissue, and improved survival, which many physicians
see as the justification for chemotherapy, cannot be documented in
the literature. “Surprisingly often” the Heidelberg biostatistician
finds the opposite occurs: patients in whom the medicine had no
effect on the tumor survive longer.
According to Abel’s findings, the second axiom of
chemotherapy, the palliative effects of cytostatic medicines, also
rests on scientifically shaky ground.
Reliable studies, which might substantiate this
belief for the majority of patients (exceptions are possible),
according to Abel “are not yet to be found.” The least one can say
is that older research in the 1970s reached the opposite conclusion:
highly aggressive chemotherapy undertaken prematurely (in, for
examples patients with lung cancer) shortened the survival time as
compared with patients in whom chemotherapy was first instituted
only with the onset of pain and which was conducted less
The is FDA has yet to license a cancer remedy on
the basis of improved quality of life, since no evidence in support
of such a claim has yet been demonstrated.
Despite this, according to the observations of the
Heidelberg scientist, tumor patients are often bombarded with
cellular poisons at a time when the tumor in the body is still
Some of the reasons for the “routine” use of toxic
assaults on the body, Abel maintains, have to do with a diffuse
“belief” of physicians in the efficacy of their therapy. Above all,
badly informed physicians start with the attitude, often urged on by
their desperate patients that they should commence with an
“aggressive therapy causing many side effects” “at an early stage”
and without the patient himself complaining “substantial pain.”
Behind this willingness of clinicians to fire away
there is often a compulsion to conduct research. Patients who are
not suffering any pain are dragged at an early stage into
chemotherapy because their treatment can be conducted as part of a
clinical trial; but here, in Abel’s view, it is hardly possible to
give the patient an “individualized therapy, oriented toward his own
Aggressive doses of cytostatics, moreover meet the
physician’s need for legitimation. The higher the dose, the better
the prospect that the tumor will shrink under the effect of the
cellular poison; hence maximal therapies often have the desired
outcome. A victory over the tumor seems to have been reached when it
remits partially or completely — even though ultimately this is no
victory for the patient it all. States Abel, “There is not yet any
perceptible tendency in medicine to refrain from trials with high
The chemotherapy of advanced organic cancer is
stuck in a blind alley out of which “an exit will be achieved only
in small steps and not without some painful insights.” Oncology, as
the researcher puts it, has “up until now failed to provide an
unobjectionable scientific basis for cytostatic therapy in its
presently dominant form.
The thesis of the efficacy of cellular poisons,
and the “overwhelming dominance of chemotherapeutic researched”
which it has spawned, may, in Abel’s judgment, be seen in the future
as “one of the greatest missteps ever taken in oncology and the one
with the most tragic consequences.
The change of direction which is “urgently needed”
in the patient’s interests runs smack up against the various
structures which have been erected in the meantime. About 90% of
research capacity, in Abel’s view, is tied in with ongoing
chemotherapeutic investigations. The earnings of the pharmaceutical
industry from anti-tumor medications amount to half a billion marks
every year. Many cancer researchers get up to 1000 marks from the
suppliers for each documented case they treat.
Alternative methods of treatment, such as possibly
immune therapy, scarcely make it into the running; since many
physicians lack knowledge of them. “Research proposals along these
lines,” as Able ascertained over and over again during his years of
consulting work, hardly get a hearing in new research plans.
So the other side has a hard time getting to the
table. The advocates of immunotherapeutic approaches, or of certain
other unconventional anticancer methods, are generally reluctant to
let their therapies be tested in comparison with chemotherapy in
controlled clinical trials.
Thus certain questions whose answers would be very
important for the patients remain in a scientifically gray area:
- Do chemotherapeutic techniques promise
greater success in the treatment of advanced organic cancer than
the less toxic immune therapies which also have fewer side
- Do patients who are not treated at all come
out better in the end?
- Is it sufficient if cytostatic medicines are
first prescribed only when the patient’s pain becomes severe?
- Can low doses of chemotherapeutic agents not
basically improve the patient’s outcome?
Only a “lack of scientific imagination” as Abel
thinks, has hindered the clarification of these questions up to now.
One of his proposed models might serve to lift the veil of secrecy:
patients with advanced organic cancer who are not yet in pain from
their tumor could be tested in two groups. One group would receive
cytostatic agents, the other immunotherapeutic remedies. The ethical
dilemma could be resolved by giving the patients in the second group
chemotherapeutic agents if the onset or symptoms demands it.
Biostatistician Abel stands too close to the
rational ideal of his mathematical discipline for his criticism of
chemotherapy to be characterized as “advocacy of dubious therapies.”
He was forced into this reckoning by the dogmatic rigidity of the
chemotherapists and their “excessive optimism.” Says Abel: “they are
painting themselves into a corner.”
Those who have been scolded by him have up to now
given the erstwhile number cruncher short shrift. More recently, as
Abel’s cynicism has been more and more perceptible between the
lines, oncologist Hossfeld and Pfleiderer have “ended all readiness
for dialog with the author.
Perhaps there is more openness to dialog on the
part of foreign tumor experts. At the Fifteenth International Cancer
Congress, which opens Thursday of this week in Hamburg with about
8,000 specialists from all over the world, the book of Cain will be
available in an English translation.