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The Effectiveness of the National Cancer Institute YY %

In Cancer Research and Development 4 Meats
Linus Pauling opr D
Linus Pauling Institute of Science and Medicine ua)
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2700 Sand Hill Road, Menlo Park, California 94025

26 April 1977

During the past quarter century the National Cancer Institute has

spent several billion dollars in the effort to obtain an increased control of

cancer, its budget this year being more than 800 million dollars. Thousands
of investigations have been carried out, and these investigations have provided
additional insight into the problem of controlling cancer. There has, however,
been only a small change in the age-corrected incidence of faottality from

cancer as a whole, although)some gettgame improvement in the treatment of

  

some kinds of cancer, he He;

a ae
(Av) Several years ago,I formed the opinion that the most promising way

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of achieving a large decrease in the age-corrected incidence of and mortality
from cancer was through the use of substances normally present in the human
body, such as the vitamins pe in particular vitamin C (ascorbic acid,
sodium ascorbate, calcium ascorbate) in amounts hundreds of times larger
than those usually ingested, A similar opinion was expressed also by
Irwin Stone (1972), on the basis of published reports. The use of these
substances might be considered to lie in the field of nutrition in relation to

cancer, for’which Congress in recent years has appropriated funds.
In 1971 Dr. Ewan Cameron, Chief Consulting Surgeon of
Vale of Leven Hospital, Loch Lomondside, Scotland, began treating patients
with advanced cancer by giving them sodium ascorbate, usually in the amount
10 grams per day. The apparent improvement in health of the patient! ho
received MA sodium ascorbate was so striking that in the spring of 1973 I
went to the National Cancer Institute with case histories of the first forty
patients to have been treated in this way, and asked the officials of the
Institute to carry out a controlled trial. I was told that the National Cancer
Institute would not carry out a controlled trial until animal studies had been
made, and was invited to submit an application for Support of such studies.
I submitted the application, and three similar applications, during later years.
These grant applications were turned down. I now have another application
pending - an application for support not only of animal studies, but also of
basic scientific studies of the action of ascorbic acid, especially in relation to
the immune process, and clinical studies in several hospitals. The developm ents
in the field of ascorbic acid in relation to cancer during the past four years,
especially teesgrvall Eivan Cameron and his associates, have been so striking
as, in my opinion, to justify, of a significant fraction of the total budget of the
National Cancer Institute to the investigation of vitamin C and other vitamins
in relation to the prevention and treatment of cancer.

I have received from Roger H. Halterman, Chief, Diagnosis and
Treatment Branch, Division of Cancer Research Resources and Centers,

National Cancer Institute, a copy of the Summary Statement about the review
ty ta Earp call Prva poi Why Sood,

Ac my grant proposal (reference 1 ROL CA 21970-01; letter from Dr. Halterman
\ 14 April 1977). The first sentence of the Summary Statement is 'Based
on evaluation of scientific merit of this application, disapproval must be
recommended.'' Dr. Halterman in his letter writes that ''The grant application
and recommendation of the Experimental Therapeutics Study Section will be
reviewed by the National Cancer Advisory Board at its meeting on May 23-24.”
I have for some time been observing the actions of the National Cancer
Institute and thinking about its lack of success. The efforts of the National
Cancer Institute to achieve a decrease in incidence of and mortality from
cancer are of two kinds: research, the discovery and study of new methods
of prophylaxis and therapy, and development, the refinement of existing
methods. It is my opinion that the National Cancer Institute has been doing
an excellent job in the field of development. For example, hundreds of
therapeutic trials of chemotherapeutic agents in which the effects of different
amounts of the agents or of different combinations of them with respect to

cancers of one or another type have been carried out, in the effort to achieve

f some increase in the effectiveness of these substances. On the other hand,

it is my opinion that the National Cancer as coss not know how to carry —
2 ox research nor how to recognize a new idea. Ip

   
 

The criteria for assessing the value or promise of a grant application
for research should be quite different from those for a grant application for
development. There is as a rule nothing novel about a grant application for

development. The existing knowledge permits the detailed formulation of the
 
  
  

plan for the entire project, and the decision about the grant application may
and should depend on the assessment of the plan and of the experience that the
investigators have had in carrying out similar studies. On the other hand,
the most important aspect of a grant application for research is the idea_ on
which it is based. The idea must be a new one, or, if itis not new, one that
has been overlooked and has remained uninvestigated. Each new idea should
be studied to the extent justified by the evidence about its possible importance,
and, in the case of the National Cancer Institute, the investigation of the new
idea should be continued until its value with respect to the prevention and
treatment of cancer has been determined. I believe that it would have been
proper for the National Cancer Institute to have made a grant of $50,000 or
$100, 000 to me four years ago, when _ there was Andication that vitamin C
in amounts one cares usually ingested might have significant
value in preventing and treating cancer, and that it would be quite proper now
for a grant several million dollars to be made for the same purpose, because
the evidence y& the importance of vitamin C has become so much stronger,

through the work of Ewan Cameron. It ope have been proper for the

National Cancer Institute to have setamp clinical trials four years ago; it is

imperative that it be done now, ithe National Conean inettnare rapes

The report of the Experimental Therapeutics Study Section of the

 

; . contai
National Cancer Institute on my pending application ? Beveral pages of

statements to the effect that the application is not sufficiently detailed and
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precise in the description of the studies of vitamin C in relation to cancer,

A
OrahetiLSt Carrigg¢zziee- The application is treated as though it werea

proposal to carry out developmental work. It is not such a proposal;

instead, it is a proposal to make various studies about a new idea. There

is a tremendous amount of work that will have to be done, in case that

vitamin C turns out to have the value in controlling cancer that I believe

it to have. The studies that are mentioned in the grant application are

only examples of those that would be carried outg if the grant application gov lede
a successful. For example, a couple of studies with mice are described,

and we have in fact embarked upon one of them. The mouse, however, is

not a good animal to use in studies of ascorbic acid, because the mouse

manufactures ascorbic acid in its own cells, at a rate corresponding to an

intake of about 20,000 milligrams per day by a man, } oer 4 haye bf eancer™ y

that have been studied in mice, and the effect of ascorbic acid might be

checked for any one of them. The guinea pig, which requires exogenous

vitamin C, would be a better experimental animal, but there is not so much

known about cancer in guinea pigs as in mice or rats (rats also manufacture

ascorbic acid). We have recently begun some preliminary studies on a way

of inhibiting the synthesis of ascorbic acid by mice. This work is not mentioned

in the application. If it should turn out that the synthesis of ascorbic acid by

mice could be inhibited without large physiological effects of other sorts, the

mouse might well tags the best,animal to use in the study of intake of

ascorbic acid in relation to the control of cancer.
When a decision is made about a grant application for research,
it should be on the basis of an assessment not only of the originality and
promise of the idea basic to the proposed study, but also of the ability of
the investigator to carry on research. It is not necessary that his experience
in research be in exactly the same field as that of the project, and if the idea
is sufficiently novel it may well be that neither the investigator nor any one
else has had experience in the field. When in 1935 I had the idea that it would
be worth while to study the magnetic properties of hemoglobin and its
derivatives, to see if some questions about the structure of the molecules and
the nature of the binding of the iron atom to the globin and to the attached
oxygen molecule or carbon monoxide molecule could be answered, I applied
to Fhe Rockefeller Foundation, and was given a grant. I had had essentially no
experience in measuring magnetic susceptibilities, and the apparatus that I had
built, with the help of a student, E. Bright Wilson, Jr., was very Simple,
involving a borrowed electromagnet and an analytical balance. Charles D.
Coryell was able to increase the sensitivity to the extent necessary for
success in the vwestpaten #. detailed procedure used in the magnetic
studies could not have been described in my application to the Rockefeller
Foundation, because it was wenked=ewt nee the studies were carried out,
after the grant was received. The officers of the Rockefeller Foundation
apparently decided that my success in experimental studies of the structure
of crystals by the x-ray diffraction method and of the study of gas molecules

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by the electron-diffraction method indicated that I could also jmeke Measurements

of the magnetic susceptibility of blood, ane COU temex-on Workiw iniunochemites,
No serious harm would have been done in 1935 if The Rockefeller Foundation
had delayed for a year in making its grant for the work on the magnetic properties
of hemoglobin. Delay in supporting research on cancer is, however, far more
serious. Some of the work that my enya and I propose to carry out if
our present application is approved cewke have been carried out four years ato
if the first application had been approved. If, as I believe, a great decrease in
the age-corrected incidence of and mortality from cancer can be achieved through
the optimum use of vitamin C and other vitamins, each year of delay in the
program of research and development in this field means unnecessary suffering
for tens of thousands or hundreds of thousands of people.

In 1971 I published my opinion that a decrease of 10% in the age-specific

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incidence of and mortality from cancer could be achieved by use of vitamin C.
There is far more information now than was available in 1971, and my present
estimate is that a decrease of 75% can be achieved by use of vitamin C alone,

and a further decrease by the use of other nutritional measures. In 1966

 

 

Ewan Cameron presented the thesis that potentiation of the natural protective

 

mechanisms of the body would permit a considerable control over cancer to be

achieved. Several studies have shown that an increased intake of vitamin C
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potentiates these natural protective mechanisms. Epidemiological studies
Tapers pecsihnomn
have shown tim kemxromeas ah imbaive wmf thi sori Ine rremeantia sreidenmen
the prophylactic value of vitamin C against cancer, and the clinical studies
by Ewan Cameron have shown its therapeutic value. It is imperative that this

important discovery b& thoroughly investigated. The National Cancer Institute

should not continue its present policy of preventing progress toward the control

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of concert how Jexng asl ‘