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Gerson therapy is the name given to a regimen that claims to be able to cure even severe cases of cancer. The regimen consists of a special diet, coffee enemas, and various supplements. The regimen is named after Max Gerson (1881-1959), a German physician who emigrated to the United States in 1936 and practiced medicine in New York.
In 1977, Gerson's daughter, Charlotte, co-founded the Gerson Institute, which oversees The Baja Nutri Care Clinic in Tijuana, Mexico. The clinic's website has a very strange message on its front page for such a cheery, optimistic site: BNC reserves the right to refuse service to anyone, at anytime without notice for any reason. It is still illegal for a clinic to offer the Gerson treatment as a cancer cure in the U.S. Charlotte is not a medical doctor but she was given on-the-job training in her father's clinic. She trains physicians in the Gerson method, lectures widely on the benefits of the therapy and the evil forces trying to suppress it, and has written a number of pamphlets centering on testimonials from various people who claim to have been cured of their cancer. She's co-authored a book on the Gerson way and is joined in her endeavor by her son Howard Strauss. Howard has a degree in physics and has written a biography of his grandfather called Dr. Max Gerson: Healing the Hopeless. Mother and son believe that Howard's wife was cured of cancer by Gerson therapy.*
Gerson says he started on the road to his regimen when his migraines went away after going on a vegetarian and salt-free diet. The diet in the regimen eventually came to include lots of juice from organic fruits and vegetables, and to exclude coffee, berries, nuts, dairy products, tap water; bottled, canned or processed foods; and cooking in aluminum pots and pans. The supplements came to include linseed oil, acidophilus-pepsin capsules, potassium solution, laetrile, Lugol's solution (iodine/potassium iodine), thyroid tablets, niacin, pancreatic enzymes, royal-jelly capsules, castor oil, ozone enemas, vaccines, and vitamin B12 mixed with liver.* The liver injections were removed from the regimen after it became clear that it was making some people sick.*
Who was Max Gerson and why would anyone with cancer follow his advice of massive quantities of vegetable juice and daily coffee enemas? The second question is easy to answer. The therapy appeals to those who believe a "natural" cure exists for cancer and most other diseases but special interests (known in some circles as "they") have suppressed these cures. It appeals to cancer patients who are extremely fearful of or violently opposed to surgery, radiation, or chemotherapy. It appeals to cancer patients who have been told that science-based medicine has no treatment for them and who are desperate to continue living. The first question requires a longer answer.
According to Croft Woodruff, "Max Gerson was the personal physician and friend of Albert Einstein and the philanthropist and missionary, Albert Schweitzer....Albert Schatz was also a friend of Dr. Gerson, Dr. Einstein, and the Schweitzers." (Many consider Schatz to be the true discoverer of streptomycin.)* Schweitzer believed that Gerson's diet therapy cured him of adult onset diabetes and cured his wife of tuberculosis. Schweitzer said of Gerson:
...I see in him one of the most eminent geniuses in the history of medicine. Many of his basic ideas have been adopted without having his name connected with them. Yet, he has achieved more than seemed possible under adverse conditions. He leaves a legacy which commands attention and which will assure him his due place. Those whom he has cured will now attest to the truth of his ideas.
Apparently Schweitzer was referring to Gerson's cure for migraines, which he then went on to use to treat a variety of other disorders, including skin tuberculosis (lupus vulgaris), asthma, pulmonary tuberculosis, and arthritis. Gerson, however, never used a control group and did not keep records to show that his patients received Gerson therapy only and not other, conventional treatment as well. Thus, he was never justified in concluding that the effects he observed were due to his regimen. He also did not report the failures or those who quit the treatment for whatever reasons. He reported only the apparent successes. Selection bias is a major flaw in the evidence for so-called alternative treatments. They rely on the subjective validation and personal reporting of the one doing the treating, rather than controlled experiments and detailed record keeping. Cancer quacks are greatly helped by the fact that dead patients can't talk. Even so, as noted below in the case of famous comedian Pat Paulsen, the ones left behind may have no problem rationalizing failure.
Although medical science has not been able to provide support for Gerson's regimen or his beliefs about the nature of cancer and disease, he had his reasons:
Gerson described cancer as a "degenerative disease," fundamentally similar to many other disease states; he believed that an "impaired metabolism" was the underlying problem in degenerative disease and that proper liver function was critical to maintaining metabolic order. He believed that several physiologic functions were impaired in cancer patients, including the metabolism of fats, proteins, carbohydrates, vitamins, and minerals; the activity of oxidative enzymes; and the activity of intestinal bacteria. Gerson believed that the impairment in these functions created an internal climate favorable to the growth of malignant cells.
Gerson believed that his treatment regimen reversed the conditions he thought necessary to sustain the growth of malignant cells. He attached great importance to the elimination of "toxins" from the body and to the role of a healthy liver in recovery. Gerson noted that if the liver were damaged, e.g. by cancer or cirrhosis, the patient had little chance of recovery on his treatment regimen. He observed that patients who died showed a marked degeneration of the liver, which he presumed was due to unspecified toxic factors released into the bloodstream by the process of tumor regression. He believed that these toxic tumor breakdown products poisoned the liver and other vital organs.*
Gerson's prescription of coffee enemas was his solution to the detoxification problem.
He maintained that the coffee enemas helped to stimulate the flow of bile, thereby increasing the rate of excretion of toxic products from the body.
Gerson believed that the need to detoxify resulted not only from the internal generation of poisonous substances but also from the external supply of toxins created by the use of insecticides and herbicides in commercial agriculture. Accordingly, his dietary regimen emphasized the use of food grown organically. He reasoned that treatment for cancer must replenish and detoxify the entire body to allow its innate healing mechanisms to be restored.*
Enemas have been used in body purification and cleansing rites for thousands of years by many cultures. "The coffee enema appeared at least as early as 1917 and was found in the prestigious Merck Manual until 1972. In the 1920s, German scientists found that a caffeine solution could open the bile ducts and stimulate the production of bile in the liver of experimental animals. "* Gerson believed that caffeine would act as a detoxifier by stimulating the liver. He first used coffee enemas to treat tuberculosis, a bacterial infection. In the 1930s he began treating cancer patients with coffee enemas.
The appeal to detoxification resonates with many people for some reason, although there is no scientific evidence to back up the claims that we need detoxification, that commercial agriculture is especially poisonous compared to organic food, or that coffee enemas do anything more than cause electrolyte imbalance and dehydration. Furthermore, none of the proponents of detoxification by enema identify any specific toxins removed by the process. You'd think at least one advocate would analyze at least one specimen and identify at least one toxin found.
The conventional view of cancer does not find any evidence for the view that removing "toxins" is effective for treating cancer. Antioxidant supplements may actually increase mortality.* Those who say that Gerson therapy is scientific tend to focus on such evidence as "substances found in coffee—kahweol and cafestol palmitate—promote the activity of a key enzyme system, glutathione S-transferase, above the norm."* They note the evidence, accepted by the medical establishment, that certain substances in fruits and vegetables can neutralize free radicals and that this might be beneficial in preventing cancer. However, the notion is unsubstantiated that once cancer has been established, detoxification by diet and enemas is effective in fighting the disease. Whatever benefit Gerson therapy might have for preventing disease does not translate into effective treatment for those who have cancer.
Another central component of Gerson's approach concerned the balance of potassium and sodium in the body. An imbalance in the concentration of these substances contributes to the internal environment supporting the growth of tumors, Gerson believed. He sought to eliminate sodium in patients' diets and to supplement with potassium (in the forms of potassium gluconate, potassium phosphate, and potassium acetate)....
The role of oxidation in the treatment of cancer was another central element of Gerson's theory. He believed that tumor cells thrive in an environment depleted of oxygen and can be destroyed when oxidative reactions occur. He believed it was essential to supply intact oxidative enzymes in the diet, in the form of vegetable and fruit juices prepared by a stainless steel grinder and press (rather than by centrifugal juicers or liquefiers, which he believed destroyed the foods' oxidative enzymes). He also recommended avoiding food that had been canned, processed, bottled, powdered, frozen, or cooked in aluminum pots. The combined effect of these treatment components was intended to "normalize the biological function of damaged cells." Gerson wrote:
. . . the end result is to return the body to its physiologic functions as they existed before the development of malignancies. In this state of the normal metabolism, abnormal cells are suppressed and harmless again.*
Unfortunately, there is no compelling evidence that his regimen returns a cancerous body to the state of "normal" metabolism. What there are, though, are numerous stories told by people who think they have had their cancer, or some other disease, cured by the Gerson regimen. There are many satisfied customers. The dead ones, like Sacramento TV newswoman Pat Davis, aren't here to give their testimonials. Not that it much matters to those desperate for a cure. Comedian Pat Paulsen was another who sought a cure for his cancer at a clinic in Tijuana. When he died at the clinic, his daughter did not criticize the treatment. Paulsen had had some good days while on the "alternative" treatments, which would have been expected by natural fluctuation. His daughter claimed that the treatment worked, but had failed in her father's case because they had sought the treatment too late. When he was diagnosed with brain and colon cancer, his wife Noma was quoted in press reports as saying that the doctor in Tijuana "is confident it can be cured. The doctors here say it can't. We like the ones over there a lot better." An official press release on his death claimed he died from pneumonia, not cancer. A family spokesman was quoted as saying: "His cancer was under control after undergoing alternative treatment in Mexico. He succumbed at 2 pm on Thursday after complications brought on by pneumonia and kidney failure after recent non-cancer related surgery." His wife did not think the alternative therapy was worthless. She said: "We want to thank our team of doctors in Mexico who treated my husband humanely and with respect, and who were with him 24 hours a day trying to save his life." I would just add that they didn't do it for free or simply out of the goodness of their hearts.
Still, celebrities like Prince Charles think the testimonials from satisfied customers are evidence enough to warrant further scientific investigation. Maybe. It is important to know why the customers are satisfied. Are they satisfied because they have objective, unbiased evidence that the therapy is effective? Good. Then it may be worth testing. Are they satisfied because they feel better or because they think the therapy cured them of a deadly disease? Sorry, such subjective evidence isn't sufficient to warrant an investigation. Actor Steve McQueen said he felt much better after his Laetrile treatments right before he died. Many people think they've been cured of deadly diseases when they didn't have a deadly disease in the first place.
Although the Gerson regimen has been around for 60 years, the empirical evidence in its support is astoundingly thin. The evidence consists mostly of testimonials and subjective reports from Gerson himself or other Gerson practitioners. There has yet to be a study that meets the basic criteria set forth by the National Cancer Institute (NCI) for evaluating clinical benefit:
The patient must have histologic verification of the presence of a malignant neoplasm, and the diagnostic sections must be available for independent review to verify the diagnosis.
If the patient had surgical resection or other previous treatment for a proven malignant neoplasm, the presence of a recurrence or metastasis also must be verified histologically and the sections made available for review.
If the patient had been previously treated, he must be completely reevaluated and observed for a long enough period of time to verify that this treatment was ineffective, and that the neoplasm is indeed advancing.*
The above criteria are given in chapter 3 of the 1990 publication Office of Technology Assessment: Unconventional Cancer Treatments. A study published in 1995 by the Gerson folks, "Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review," did not meet these criteria. An evaluation of the study on the Sloan-Kettering Cancer Center site notes:
A serious flaw in this study is its failure to control for additional variable therapies used by patients, and failure to specify any prior or concurrent conventional treatments used. Because this study only follows 61% of the patients treated at the clinic, there remains the possibility that this is not a comprehensive representation of the therapy's outcomes. The authors claim that the NCI's prior best-case review of the Gerson therapy was flawed in its focus on the outcome of tumor regression, which is not adequately documented at most alternative medical clinics. Though its questionable data are interesting, this study illustrates the need for more comprehensive record keeping at alternative medical clinics. If proponents of such therapies wish them to be evaluated scientifically and considered valid adjuvant treatments, they must provide extensive records (more than simple survival rates) and conduct controlled, prospective studies as evidence.*
The complaint of the Gerson people that it is unfair to require them to keep data on tumor regression in the patients they claim to cure of cancer is absurd on its face. If they can't prove that a patient had a tumor, received nothing but the Gerson treatment, and then the tumor went away, then they can't prove they cured a cancer.
In 1947, Gerson himself submitted ten case histories of cancer patients treated with his regimen to the NCI for review. The NCI "found no convincing evidence of effectiveness, particularly since the patients were also receiving other anticancer treatments."* Gerson was invited to submit additional data but he didn't. In 1959, NCI reviewed the 50 case histories presented in Gerson's book A Cancer Therapy: Results of Fifty Cases and concluded that overall Gerson's data provided no demonstration of benefit.
Even so, the testimonials remain powerful persuaders for many people and are inspiring to some who have been told that there is nothing modern medical science can do for them. The peddlers of hope are assisted by the fact that we can't cure cancer yet, even though treatment in many areas has significantly increased longevity and quality of life. Also, every once in a while an advocate of a quack therapy will come along who is eloquent and persuasive. His claims that the quack has been denied his rightful place at the table because of a conspiracy by Big Pharma and the "medical establishment" will resonate with those who see surgery, radiation, and chemotherapy as assaults on the body foisted on an unsuspecting public to line the pockets of doctors and drug companies. Such a one is Steve Kroschel, whose feature film in defense of the Gerson regimen is called "The Beautiful Truth." It began playing in theaters on November 14, 2008. The point of the film is an ugly lie, but it seems to be told by someone who honestly believes Gerson discovered the cure for cancer and many other diseases sixty years ago and the proof is in the stories of the people who believe it's so. Fortunately, even a well-made movie by someone with talent and good intentions can get bad reviews. Tim Grierson of the Village Voice had this to say about "The Beautiful Truth":
....you might expect The Beautiful Truth to be a David-versus-Goliath exposé on how corporations stand in the way of individual health in pursuit of the almighty dollar, but that’s merely scratching the surface of this condescending, manipulative film. Kroschel organizes his argument around Garrett [Kroschel's real-life son], a home-schooled 15-year-old whose studies about the Gerson Therapy provoke him to investigate its validity. Actually, it’s Kroschel who seems to be provoking the investigation, using Garrett as a passive prop to push Gerson’s agenda—the nearly mute kid spends most of the film getting talked at by cancer survivors and scientists who tell him how evil the mainstream medical community is. Kroschel positions The Beautiful Truth as a sort of instructional video for young people on the merits of eating healthy, but its creepy messianic vibe is far more toxic than all the pollutants in all the processed food you could ever consume.
See also communal reinforcement, confirmation bias, control study,the Gonzalez protocol, Occam's razor, the placebo effect, the post hoc fallacy, the regressive fallacy, selective thinking, self-deception, subjective validation, testimonials, and wishful thinking.
Gerson regimen (Sloan-Kettering Cancer Center)
Questionable Cancer Therapies by Stephen Barrett, M.D. Victor Herbert, M.D., J.D.
"Why Bogus Therapies Often Seem to Work" by Barry L. Beyerstein, Ph.D.
Dr. Max by Giuliano Dego by Ralph Moss (Skeptics will especially like the part about Gerson's son-in-law and EVP. Dego claims Gerson spoke to him from the dead via radio and told him that he didn't die of pneumonia (as his death certificate stated) but that he was poisoned with arsenic. Gerson's widow is said to have verified the claim that high levels of arsenic were found in Gerson's body and that he was in perfect health when he died. Hmmm. Arsenic-laced coffee?) Ralph Moss, Ph.D. (in classical languages) is a story in himself. He claims to be some sort of expert on a variety of medical treatments.