No alternative medicine ever disappears when shown to be ineffective: The case of laetrile [Respectful Insolence]

Everything old is new again, or so it always seems with alternative medicine.

Before I explain what I’m talking about a bit more, let me just preface my remarks with an explanation for why there was no post tomorrow. I realize that most people probably don’t care that much if I miss a day or two, but I care. Basically, I was in Chicago from Thursday through Sunday taking a rather grueling review course in general surgery offered by the American College of Surgeons. The reason is that I have to take my board recertification examination in general surgery in December. It was an amazing course, and I was stunned at how much outside of my specialty had changed in the decade since I last had to recertify, just as, I’m sure, those who don’t specialize in breast surgery were shocked at how much has changed in how the surgical care of breast cancer has changed in the last decade. (I might have more to say about this in a later post.) The primary reason I’m mentioning now (other than because it explains why I didn’t manage to get a new post for this blog) is because this change in the standard of care in response to new scientific evidence is one of the greatest features of science-based medicine. It’s also one of the biggest contrasts between science-based medicine and alternative medicine; i.e., what I like to call quackery, mainly because it is.

I was reminded of this contrast by an article I came across on Buzzfeed yesterday, These People Are Making Money Off A Bogus Cancer Cure That Doctors Say Could Poison You. Of course, I knew right away what the article was about just from the title, without even having to note that the blurb for the article mentioned apricot seeds. Yes, we’re talking laetrile here, and apparently there are still quacks who are partying like it’s 1979, which was laetrile’s heyday as an alternative cancer cure:

The San Francisco Bay Area doctor had been giving patients a therapy that is essentially a chemical compound found in apricot kernels and known by several names — laetrile, amygdalin, vitamin B17. Richardson had been told it could attack tumors, naturally and precisely. It can also convert into potentially poisonous amounts of cyanide when eaten. But Richardson was a true believer.

“Yes, the evidence that Vitamin B17 is nature’s control for cancer is quite overwhelming,” he wrote in his book. “So the next time you hear an official spokesman for orthodox medicine proclaim that there is none, you might tell him that such a statement is a ‘self-evident absurdity’ and suggest that he do his homework before posing as an expert.”

Less convinced were the police who, on June 2, 1972, barged into Richardson’s clinic and jailed him on charges of medical quackery. He eventually lost his medical license and was charged with smuggling laetrile, an illegal drug, into the country.

It turns out that Richardson’s son is continuing the family business, so to speak:

Now, three decades after Richardson’s death, his son, John Richardson Jr., is no stranger to apricot seeds. Through Apricot Power, his thriving e-commerce store, he sells bitter seeds ($32.99 for 1,500), seed extract-based tablets (up to $97.99 a bottle), and B17-infused anti-aging cream ($49.99). Recipes for apricot-seed pesto, egg nog, and marzipan offer a “delicious and easy” way to work the supposed superfood into your diet, and videos explain why the site’s mission is to “get B17 into every body!” Though Richardson Jr. won’t reveal revenue numbers, he says his family operation of around 10 employees has served “thousands” of customers all over the world since it launched in 1999.

See what I mean? In the early 1980s, clinical trials showed that laetrile had no appreciable anticancer effect in humans and that it was also toxic. (The reason, of course, is the cyanide.) In science-based medicine, that would have been that. The treatment would have abandoned. But that’s not how alternative medicine works. True, laetrile did fade in popularity for a couple of decades after that, but of late it appears to be undergoing somewhat of a resurgence and “renaissance” (if you can call the revival of dangerous quackery a “renaissance”). I first noticed it three years ago when Eric Merola, the man behind two propaganda films promoting Stanislaw Burzynski’s cancer quackery, decided to shift topics to—you guessed it—laetrile. He directed a documentary entitled Second Opinion: Laetrile at Sloan-Kettering, which, like his films on Burzynski were full of misinformation, obvious bias and spin, and just plain quackery and pseudoscience. Basically, as I discussed in my deconstruction of his film, the central idea being that Ralph Moss, who was a science writer of some sort at Memorial Sloan-Kettering Cancer Center and is now laetrile’s foremost popularizer, along with other MSKCC employees, “leaked” documents “proving” that laetrile/amygdalin had incredible anticancer activity. It was the same old thing. According to Merola, the negative clinical trials were “rigged not to work.” According to Merola, Laetrile “tested positively” in preclinical studies but that those results were “covered up” (of course). Other works supposedly showing the efficacy of laetrile was “suppressed.”

You get the idea.

It turns out that Richardson is a bit more canny in that he states very,.”We don’t mention the C-word in our company,” the “C-word” being cancer. The Buzzfeed article also notes:

If a customer review on Apricot Power’s website even mentions the term, the company leaves a comment pointing out that it doesn’t make any disease or illness-related claims about its products. Legally, it can’t: The FDA prohibits companies from selling laetrile, under any name, as a cancer treatment, because studies have found it to be at best ineffective, and at worst toxic.

Holy quack Miranda warning, Batman! I’ve never seen a company actually respond to any mention of cancer on its social media pages with a pre-emptive quack Miranda before!

And, thanks to that same social media, everything old is new yet again:

In laetrile’s heyday in 1981, a doctor called it “the slickest, most sophisticated, and certainly the most remunerative cancer quack promotion in medical history.” Three decades later, the internet has only spread the gospel, creating an unstoppable, hydra-headed ecosystem of buyers and sellers.

I’ve discussed this before, of course, but I’ll briefly cover it again, mainly because there are likely to be newbies reading this. Basically, according to this article, the idea behind laetrile is that the body is lacking in a nutrient that proponents call “vitamin B17.” That’s sort of true, but only the latest iteration in the ever-morphing scientific “explanations” for how laetrile/amygdalin/vitamin B17 “works.” Basically, “Laetrile” is the trade name for laevo-mandelonitrile-beta-glucuronoside, a substance allegedly synthesized by Ernst T. Krebs, Jr. in the 1920s. It’s chemically related to amygdalin, a substance found naturally in the pits of apricots and some other fruits. Again, most proponents of Laetrile for the treatment of cancer use the terms “Laetrile” and amygdalin interchangeably, and I generally do as well. Historically, amygdalin was tried as an anticancer agent as early as 1892, but was abandoned because it was ineffective and toxic, its toxicity deriving from how it can break down in the body into glucose, benzaldehyde, and hydrogen cyanide.

Like the rationale for many forms of quackery, the rationale for Laetrile has shifted over the decades. In the 1950s, Ernst T. Krebs, Jr. claimed that cancer tissues are rich in an enzyme that causes amygdalin to release cyanide, which would destroy the cancer cells. Supposedly noncancerous tissues are protected by another enzyme. Later, Krebs claimed that Laetrile/amygdalin is a vitamin (B17) and, of course, cancer is due to a deficiency in that particular vitamin. Other claims have shifted, from Laetrile being a cancer cure to being able to “control” cancer to being a cancer “preventative.” Then, like so many alternative medicines, the indications for its use went what the military might call “mission creep” in that it was advocated for more and more conditions. These days, amygdalin/vitamin B17/laetrile is advocated for almost anything that ails you, just like the snake oil peddled by wandering salesmen 150 years ago.

So how did Richardson’s father get involved with selling amygdalin? He met up with Krebs, of course:

A successful salesperson must buy into what they’re selling, and Richardson Jr. is all in. Growing up in the Bay Area suburb of Orinda, he and his seven siblings weren’t fed sugar or processed wheat, an abstention he keeps up to this day. He says he started eating apricot seeds for his health at age 5. Now 52, he’s up to 40 a day.

The seeds contain amygdalin, a compound also found in apple seeds and almonds. In the 1950s, Ernst T. Krebs Jr., a self-described doctor and biochemist with no medical degree, patented a purified form of amygdalin that he called “laetrile.” He also promoted it as “vitamin B17,” although it’s not an officially recognized vitamin.

In 1971, Krebs Jr. shared with the elder Richardson his theory of how this nutrient could stop cancer growth. As Richardson later summarized: “[N]ature’s mechanism will not work if one fails to eat the foods that contain this necessary vitamin, which is exactly what has happened to modern man, whose food supply has become further and further removed from the natural state.”

Also, presaging how the antivaccine movement and other supporters of quackery have become more associated with anti-government conservative/libertarian movements, here’s what happened when the elder Richardson was arrested in 1972 for selling laetrile:

When the elder Richardson was arrested in 1972 (on charges that were dropped), it prompted his fellow members of the John Birch Society, the far-right conspiracist group of the era, to start a lobbying group to legalize laetrile. Later, Richardson was fined $20,000 and placed on probation on charges of conspiracy to smuggle laetrile from Mexico to the US. Indictments against him and 18 other accused promoters noted that he had deposited $2.5 million in his bank account over two years.

Laetrile isn’t being called laetrile much any more, but rather vitamin B17 or amygdalin, or it’s being sold in the form of apricot seeds. It’s a rather obvious “rebranding” to avoid the FDA and FTC’s ban on advertising laetrile for cancer. Avoid the “C-word,” throw in the liberal use of the quack Miranda warning, and start marketing laetrile as a dietary supplement, the better to avoid having to demonstrate efficacy and safety.

Another feature of this sort of marketing is that the companies selling supplements like amygdalin don’t actually have to make health claims. They can outsource it to the internet communities of believers who trade alternative cancer cure testimonials, to believers who have written books, made videos and movies, and write blogs. Of course, as I’ve said so many times before, dead patients don’t give testimonials; so of course only the patients who are still alive and doing relatively well are the ones promoting amygdalin with their stories. People you don’t hear about are cancer patients like this:

Campbell had a daughter who, not long after she was born, developed a rare, aggressive brain cancer and died. More than five years later, Campbell developed cancer, too, in her breast. Having watched her daughter undergo chemotherapy and radiation, she was determined to avoid them herself. So she started juicing, eating an all-vegetarian diet, and ordering cannabis oil and apricot seeds online. “She said, ‘This is my journey, it’s my body, I have to do it on my own,’” recalled Beggs, who lives in Northern Ireland. “‘You’re either with me or against me.’”

Beggs understood why Campbell distrusted conventional therapies, but “at the same time, we were so fearful,” she said. Campbell’s tumor kept growing until she finally agreed to have a mastectomy. Then new tumors sprouted in her liver and spine.

Campbell died in October 2015, soon after her 33rd birthday. By the end, she was up to 40 apricot kernels a day, her aunt said.

In quackery, be it cancer quackery or quackery used for other diseases, no treatment, no matter how ineffective and even toxic, ever disappears. No treatment ever disappears after being shown by science to be ineffective. The story of laetrile shows us that. The difference between quackery and science-based medicine could not be clearer.