CHEMO’S “BERLIN WALL” CRUMBLES
From The Cancer Chronicles #7
© Dec. 1990 by Ralph W. Moss, Ph.D.
THIS WAS THE ARTICLE THAT EVENTUALLY LED
(FIVE YEARS LATER) TO MY BOOK, QUESTIONING
CHEMOTHERAPY. SEE THE COMPANION PIECE ON
CHEMO’S SIDE EFFECTS.–ED.
This past year will certainly go down in history as the year of
German surprises. The Berlin Wall came down. The two
Germanys united. And now in Germany another wall is beginning
to crumble: the myth of chemotherapy’s invincibility. A
Heidelberg cancer biostatistician, Dr. Ulrich Abel, has issued a
groundbreaking monograph, “Chemotherapy of Advanced
Epithelial Cancer” in which he puts the biggest hole yet in
orthodoxy’s solid front (SADLY, THE BOOK IS NOW OUT OF
“Ten years of activity as a statistician in clinical oncology,” he
explains, led to his increasing uneasiness. “A sober and
unprejudiced analysis of the literature,” he discovered, “has
rarely revealed any therapeutic success by the regimens in
question” in treating advanced epithelial cancer. This is an
astounding charge coming from a member of the cancer
establishment. In Germany they earned Abel a big, largely
favorable, article in Der Spiegel, the German equivalent of Time.
Here, the powerful chemotherapy establishment has maintained
By “epithelial” Abel means the most common forms of
adenocarcinoma– lung, breast, prostate, colon, etc. These
account for at least 80 percent of cancer deaths in advanced
More and more, toxic chemotherapy is being used against
advanced cases of such diseases. More than a million people die
worldwide of these forms of cancer every year and the majority of
them now “receive some form of systemic cytotoxic therapy
In 92 tightly-reasoned pages, however, Abel shows that “there is
no evidence for the vast majority of cancers that treatment with
these drugs exerts any positive influence on survival or quality of
life in patients with advanced disease.” The “almost dogmatic
belief in the efficacy of chemotherapy” is “usually based on false
conclusions from inappropriate data.” Abel also polled hundreds of
cancer doctors while writing his paper. “The personal views of
many oncologists,” he reports, “seem to be in striking contrast to
communications intended for the public.” Indeed, studies cited by
Abel have shown that many oncologists would not take
chemotherapy themselves if they had cancer.
The establishment ascribes the alleged historical increase in 5 –
year survival rates over the last few decades to the beneficial
effects of chemotherapy.
But as Abel demonstrates this is erroneous thinking. “Equating
cure with 5-year-survival is misleading,” because it combines data
for both local and disseminated cancers. And comparisons with
historical controls are highly biased. “Modern methodologists
agree that reliable information on the relative value of two
therapies can only be obtained by means of randomized
comparisons.” It is astounding that such comparisons almost
never take place for orthodox therapies. Some of the reasons five –
year survival rates might be better today than years ago include:
- improvement in early detection
- stage migration (better diagnosis leads to improved prognosis)
- better supportive care
In one astounding chart Abel summarizes all the available direct
evidence from randomized studies as to whether chemotherapy
extends survival. Small-cell lung cancer “is the only carcinoma
for which good direct evidence of a survival improvement by
chemotherapy exists.” But this improvement amounted to a
matter of three months! For non-small cell lung cancer there is
also some “weak indications” of small benefit.
For other kinds of chemotherapy, the news is far less promising:
- Colorectal: no evidence survival is improved by chemotherapy.
- Gastric: no clear evidence.
- Pancreatic: largest study “completely negative.” Longer survival in the control group.
- Bladder: no clinical trial done.
- Breast: no direct evidence that chemotherapy prolongs survival. Use is “ethically questionable.”
- Ovarian: no direct evidence, but probably a small advantage from cis-platinum regimens. But non-randomized comparisons “almost worthless for assessment of therapy.”
- Cervix and corpus uteri: no improved survival.
- Head and neck: no survival benefit, but occasional “positive effect” from shrinkage of tumors.
Given these almost uniformly bad results, where did the idea
originate that chemotherapy is of such benefit in these cancers?
One reason is because toxic drugs often do effect a response. i.e., a
partial or complete shrinkage of the tumor. But contrary to
popular opinion, this “reduction of tumor mass does not prolong
expected survival.” Sometimes, in fact, the cancer returns more
aggressively than before because killing off 99 percent of a mass
fosters the growth of resistant cell lines.
But doesn’t chemotherapy at least improve the patient’s quality of
life (QL)? In the sense that it offers a dying patient some choice,
it probably brings a modicum of psychological relief. (This is often
based on the misconception that it will be curative, however.) If it
palliates symptoms, as in head/neck cancer, that is a plus. But as
Abel points out, “to date there have been no randomized studies
yielding clear evidence for an improvement of QL by means of
chemotherapy.” In fact, most of these drugs are so toxic [see next
article] that they can lead to a horrendous loss of QL in many
patients pushed to what one oncologist calls “the vital frontier”
(i.e., the brink of death).
But what about that rare and lucky individual whose advanced
carcinoma seems to be cured by drug treatment? A few people may
indeed respond in this “miraculous” way. But one must measure
this one person’s gain against the total cost to all those recipients
who do not benefit. It is the totality of risk vs. benefit that must be
weighed, otherwise the argument takes on “the same structure as
a recommendation for gambling” based on “the profit of the
In short, “oncology has been unable to provide a solid scientific
foundation for cytotoxic therapy in its present form.” Yet the
“thesis of the efficacy of chemotherapy” has now assumed “the
character of a dogma.” In fact, in Germany as in the US, it has
become “unethical” not to give these toxic treatments to a
widening circle of patients. Thus, clinical oncology has become “a
prisoner of its own tenets.”
There is more to this brilliant book than we can possible fit in a
short review. Let us just say that in this annus mirabilis, Abel’s
book is one of the most remarkable wonders.
Doctors sometimes brush off chemotherapy’s side effects as a
small price to pay for increased survival. But chemotherapy came
out of World War II mustard gas experiments and it remains