Unproven Methods of Cancer Management Gerson Method “After study ofthe literature and other aval able information, the American Cancer So ciety has found no evidence thatthe Gerson ‘Method results in objective benefit in the treatment of cancer in human beings. Lack- ing such evidence, the American Cancer Society strongly urges individuals with ‘cancer not 10 seek treatment with the Ger- son Method. The following isa review and summary ‘of material on the Gerson Method in the ‘American Cancer Society files as of May 31, 1989, Reference to that material by the Society does not imply agreement with its contents Method ‘The Gerson treatment for cancer. devel oped in the 1920s by Max Gerson, MD (1881-1985. is the original “metabolic therapy, of which there are now about 20 different types." Metabolic therapies gen- erally claim to cure various diseases by “detoxifying” the body and, in recent years by “boosting the immune system."* Gerson wrote in 1958 that “cancer is nota single cellular problem: it is an accumula- tion of numerous damaging factors com- bined in deteriorating the whole metabo- lism, after the liver has been progressively impaired in its functions." He developed 2 radical nurtitional program combined with, vigorous purging that he. believed would ce cancer and all degenerative dis- cases, This therapy is sil availabe through ose the Gerson Institute at a Mexican clinic. Gerson believed thatthe cancer rate is increasing because the use of chemical fer- tilizers in agriculture lowers the potassium content and raises the sodium content of fruits and vegetables. According to Ger- son, food processing and cooking add more sodium, with resultant changes in the min- eral metabolism of human body cells." ""It is at this point that (Gerson] assumes that the weaker ‘abnormal’ cells that exist in every organism are first hurt and, in their anxiety 10 survive, change their metabo- lism from oxidative to fermentative. Thus they leave the harmony of the normal cells, and sustain themselves by destroying neighboring tissue with their toxic meta- bolic products, eventually killing the host body itself." The Gerson treatment seeks to cleate a “near normal condition of the ‘oxidizing system in the body, to which ma- lignant celis with the fermentation system ‘cannot adapt. Promotional materials from the Gerson Institue state that the treatment “is able 10 achieve almost routine recovery —90 per- cent or better—from early to intermediate cancer." When cancer involves the liver or pancreas or has metastasized, the claim is that “about 50 percent recoveries can be achieved by the Gerson method. Results are less certain if the patent has been poi soned by chemotherapy.""* No supporting evidence for these statements is provided inany Gerson Institute literature. Before admission to the Gerson facil- (CAAACANCER JOURNAL FORCLINICIANSity, patients are advised to study the regi- ‘men in Gerson’s book, A Cancer Therapy: Results of Fifty Cases, and to make a com ‘mitment to follow the program for atleast 1S months, An information sheet states that patients should arrange for someone to a: ‘company them to learn the techniques of therapy and to assist them, both at the clinic, which has no nursing care, and at hhome, forthe next several years.” “The daily schedule forthe fist three to four weeks of the Gerson regimen calls for 13 hourly eightounce glasses of juice— ‘one of orange, four of “green leaf,” five ‘of applefcartot, and three of pressed raw calf liver, all selected and prepared in a highly specific way. Meals are restricted 10 ‘oatmeal, salad, baked potatoes, and cooked and raw vegelables and fruit, two table spoons of linseed oil daily are also in- cluded. All dairy products. fish, and meat “are forbidden until further not Among the items forbidden indefinitely are salt, oil, coffee, berries, nuts, drinking ‘water, and all botled, canned, refined, pre served, or frozen foods. No aluminum ‘utensils are to be used: a special grinder a [ress are required to make the juices.” Gerson devised a fast and far reaching detoxication [sic] of the whole body" that he believed was essential to the success of his therapy. To stimulate the liver and in- crease the production of bile, the daily Schedule calls for five coffee enemas (2 dilute one-quart solution), four hours apart. “In case of pain or discomfort, a coffee ‘enema should be given immediately, the every two hours, or more frequently.” Every other day, an oral dose of castor oil is given, followed by acastor oil enema, in addition to the coffee enemas. “Green Teaf” enemas are used in colon disease chamomile tea enemas are used periodi- cally. After six weeks, the enemas can be gradually reduced and resumed as neces- sary." ‘Daily medications include the follow- ing: thyroid (Five grains). Lugol's solution (Godine/potassium iodide), acidophilus pepsin (six capsules), pancreatin (15 tab lets), royal jelly, niacin (300 mg), and an intramuscular injection of vitamin By (100 meg), combined with crude liver ex: YOU. 40,NO.& JULVAUGUST 1990, tract (three cc). Potassium is added to each of the 10 frun and vegetable juices, All previous medications are discontinued, ex- fept for one aspirin a day if needed for pain.” ‘Within three to 10 days she patient can be expected to experience what Gerson termed “‘an allergic inflammation reac tion™ period that will recur every two ‘weeks ‘and. later every month. Flalike symptoms of nausea, Vomiting, intestinal spasms, and headaches, and an inability to continue the therapy are experienced over 4 period of one 10 three days. Increased numbers of coffee enemas are said to pro- Vide relief. These “flare-ups” are t0 be ‘managed by the patient alone after return- ‘ng home." One patient reported having "a five-to-six week healing reaction where | couldn't walk due tothe pain." ‘The clinic offers other therapies along with Gerson’s original program. Lactrie is used in some patients for "short-term re- sponse relief from pain, emission ofr Tignaney.""”- “Polarizing treatments’ — intravenous administration of GKI (glue cose, potassium, insulin) solution —were added in 1982." “Staphage lysate, a vac cine formeriy known as the Lincoln bacte- Fiophage, is now being used to enhance healing." tn 1983, Gerson therapy physi cians began using medical ozone and hy~ drogen peroxide to “destroy snfections and promote normal healing." Mast commonly Used isthe “ozone enema,” whereby upto 1,000" ce of ‘saone/oxygen (130 mg. of ozone) is administered rectally. "Among the metabolic therapies, the Gerson Method is considered the mos if ficult to undertake. Cancer eure ae said 0 be achieved only by strict adherence 10 every aspect ofthe diet and is techniques. ‘An Institute official estimates that 40 to 50 hours a week are required for shopping preparing the food, and cleaning the equip- ment as instructed," Juices eanmot be pre- pared ahead of time and stored, and the “organically grown" liver eannot be fro- en before use Although patients are instructed to tele phone the Gerson Institute for advice and instructions every month or two after they leave, only about 25 percent do so, The 259Institute assumes thatthe rest are not fol- lowing the program." “The Gerson Institute suggests a stay of three to eight weeks a the Mexican facility ‘The weekly cost is $2,000, plus $30 a day for a companion." In 1986, the total staff was estimated at 60 and the number of patients treated per year at 600."" Patients are told to bring all their medical records with them, particularly biopsy reports, acrays, and the results of laboratory tests. ‘According to the following notice in the Institute's journal, the laboratory facilities are limited: “Better and more complete ‘methods of testing and monitoring patients need to be used and developed. The testing methods currently available in many re- spects do not equal those used by Gerson half a century ago on his tuberculosis pa- tients in Germany," Proponents Max Gerson, MD, was bom and educated in Germany and began the practice of med- icine in 1904, His theories derived from clinical observations beginning with what he believed to be the cute of his own mi- sgraine headaches through diet. One of his patients who used the diet for migraine re- ported that his lupus vulgaris (skin tuber- éulosis) was cured as well. Gerson subse- {quently used his dietary method to treat all forms of tuberculosis and other conditions, such as arthritis and arteriosclerosis. He reportedly used the same treatment for ean- cer beginning in 1928." In 1936, Gerson emigrated 10 the United States. He received a medical li- cense in New York in 1938 and resumed the use of his treatment in private practice. From 194610 1950, he also treated patients atthe Gotham Hospital in New York City. He operated in-patient treatment facilities from 1948 to 1959 in New York State. In 1945, Gerson published a prelimi- nary report of his results in treating can- cer.!? He appeared with five of his patients before a US Senate Subcommittee in 1946, Raymond Gram Swing. a national radio broadcaster, publicized Gerson’s testi- mony, adding to a growing controversy about the treatments efficacy."* Gerson’s 288 ‘malpractice insurance was discontinued in 1953. After an investigation, he was sus- pended from membership in the New York County Medical Society by a membership vote on January 27, 1958.” He died in 1959, and his book, A Cancer Therapy,? ‘was published shorlly thereafter. Now in its third edition, the book has been in print continuously and is distributed. by his Alaughters and the Gerson Institute. ‘The Gerson Institute was founded in 1977 by Charlotte Gerson Straus and Nor- rman Fritz as a nonprofit educational or- ganization supported by memberships, contributions, and teaching. Mrs. Straus lectures nationally and serves as a consul tant teacher to the Mexican clinic physi cians. She lectures to patients atthe clinic Several days a week. Although she has no formal medical traning, she sates that she leamed enough about medicine from her father to teach the Mexican physicians who staff the therapy centers to cure virtelly anything." The Institute publishes the bi- ‘monthly Healing Newsleter and distributes ‘books, audiotapes, and videotapes on the Gerson Method. Hospital de Baja California, the medi- cal group that operates the for-profit clinic in Tijuana, Mexico, includes general prac- titioners Vietor Ortuno, MD, and Dan Rogers, MD." The clinic accommodates 27 patients in double rooms. A larger faci: ity With modem laboratories was scheduled tocpen in the summer of 1989. Published Information (On March 10, 1988, the American Cancer Society wrote to the Gerson Institute re- {questing documentation on their clinical experience using the Gerson Method. No reply has been received to date Published information on the Gerson Method was identified through computer searches of 11 databases for biomedicine, science, law, and the press from 1966 10 1989. Gerson’s publications conceming the treatment of cancer date from 1946 10 1978.*'4588 “The experimental evi dence presented in these works, however, is restricted to selected patient case histo ries. Lacking criteria for case selection or ‘CAACANCER JOURNAL FOR CLINICIANSdoailed and consistent treatment interven ti 3s, selected case histories cannot pro- ide information that is useful in determin- ing the activity of this approach in patients with cancer.2” No supporting clinical evi- dence of efficacy from other sources as appeared in the literature. Several writers have considered biochemical aspects of Gerson’s theories. and observations and suggested that further study is needed.”""* Others, however, have reported serious side effects of Gerson therapies.***” Evaluation In 1946, scientists at the National Cancer Institute reviewed 10 cases submited by Gerson. They found the data inconclusive, since the patients were also receiving other anticancer treatments. Gerson was invited to submit additional data but did not do so. ‘The National Cancer Institute does notcon- sider the Gerson Method to be an effective ‘means of cancer treatment.” ‘A special subcommitice of the New York County Medical Society was ap- pointed in 1957 to review Gerson’s method for treating cancer. "The nine cases that Were offically reported were found to in- dicate that Dr. Gerson demonstrated a lack ‘of understanding of the natural history of neoplastic disease. His presentation of ‘cases left much to be desired in the way of either proof that some patients actually had malignant disease at the time they were treated or that actual cure or atest of the ‘malignant process, if present, had resulted from his treatment. He showed no case in i could be demonstrated that a cure ignant disease had been obtained by his treatment.""" ‘There are conflicting reports on the amount and quality of clinical data gathered by the Gerson Institue since 1977. Institute officials stated in 1986 that several factors have led to limited data—the failure of clinic physicians to gather data initially, a 1986 fire that destroyed clinic records, and the failure of patents and their families to report back to the Institute.’ Fritz has stated that survival statistics are based on a combination ofthe doctor's es- timate that the departing patient has area VOL.40,NO.4. JULVALGUST 1990 sonable chance of surviving" and feelings that the Institute staff have about the status ‘of people who call in."' In 1987, the Inst tute’s newsletter announced, however, that a study of 10 years of clinical experience ‘with approximately ‘been undertaken.” not yet appeared. Serious illnesses and deaths have re- sulted from practices associated with Ger- son therapy. Between January 1979 and March 1981, 10 patients were admitted to ‘San Diego County-area hospitals for treat- ‘ment of sepsis caused by Campylobacter _fetus, subsp. fetus. The only exposure com- ‘mon to these patients was the use of the Gerson regimen of raw fruit, vegetable juices, raw calf’ iver, and coffee enemas. Nine of the patients had cancer; eight had been teated ata Tijuana clinic, and another hhad treated himself at home with the same regimen. The raw cal’s liver was consid- ered by health officials tobe the most likely source of infection. Physicians atthe University of Califor- nia, San Diego, Cancer Center reported the admission of three cancer patents in 1984 to 1985 who had been receiving coffee ene- ‘mas in Tijuana. One had sepsis (postive blood cultures for salmonella), very low blood pressure, and a serum sodium level ‘of 114 mmol/l. Another was severely de- hydrated and had renal failure and Camp) obacter and cryptosporidium in hs stool. ‘The third patient was a 28-year-old man ‘with metastatic seminoma not previously treated with chemotherapy who was found tg have a salmonella brain abscess.”* Two deaths due to coffee enemas were reported in 1980 by the Office of the Medical Ex- miner in Kings County, Washington. In ‘one case, a 46-year-old woman received as many as'10 or 12 enemas for pain associ- ated with gallstones the night before she died. An autopsy attributed her death to bronchopneumonia and cerebral hypoxia ‘with hypokalemia as the proximate cause. ‘The second case was a 37-year-old woman with breast cancer, who discomtinued con- ventional therapy to receive weatment at the Gerson clinic. On her return to Seattle, she continued the therapy, with weekly tele- phone consultations but without seeing a 255Jocal physician. Her death was attributed 10 fluid and electrolyte imbalance caused by the coffee enemas. Insummary, there isno convincing evi dence that any aspect of the Gerson regi- men is effective in the treatment of cancer. Reterences 1. Miller J, Howard-Rulben J: Unproven meth ods of eancet management, Part I: Background tnd historical perspectives. Oncology Nursing Forum 10:46-82, 1983, 2, Michelmore P: Beware the health huckstes. Reader's Digest, January 1989, pp 114-118 3, Gervon M:A Cancer Therapy Results of Fifty Cases, ed 3. Ashland, Oregon, World Wide Publishing Corpration, 1977 4. Straus M: Gerson therapy. in Hulke M (ed) ‘The Encyclopedia of Altemative Medicine and Self Help, New York, Schocken Books, 1979 '. Gerson Therapy Center opens. Undated Ger- son Insitute Ayer, reprint fom Cancer News Journal 16. case history: At five years, Healing News lene, No 4, July/August 1986, pp 5-8 7. Wiscombe I: The promise of ¢ eure: How far will peape go? Coping, Sunsmer 1988, pp 5-8. 5. Hidenbrand G: A new rationale for he ant rooplastic effects of polarizing weatments. Healing Newsleter, No I, June 1984, pp 1-3 9, Gerson Institut: Update yer. Spring 1983. 10, Fri N: Gerson Institute Progress Report. August 1983, TI" Lowell 5: The Gerson Clinic. Nutrition Forum 3:9-12,1986. 12" Hust J Hope sold at clinics of Tijuana, Los ‘Angeles Times. October 22 and 23, 1987, pp 1S. 15, Research programs. Healing: Joural ofthe Gerson Insitute nd the Gerson Therapy 1:7, Fall 1981, 14, Gerson M: The cute of advanced cance by dict therapy: A summary of 30 years of clinica ‘experimentation lecture given in 1956). Physiol ‘Chem Phys 1049-468, 1978, 15, Gerson M: Dietary considerations in malig- nant neoplastic diseases: Preliminary report. Rev Gasttoenterol 12:419-425,1945 (conection printed in 1351, 1946, 16. Gerson’s ‘cancer eatment (editorial). JAMA 132-645-646, 1946. 17. Letter to Profesional Education Division, American Cancer Society, fom General Coun Frequent coffee enemas have been shown, in fact, to have dangerous sie effects, in- cluding death. The American Cancer Soci ‘ety Wars against the use of the Gerson Method for any medical condition. se, New York County Medical Society, March 27, 1988. 18 Gerson M:No cance in normal metabolism, Undated: pamphlet, translated from Medizi- rische Klinik, No 26, June 25, 1954. 19, Gerson M: Effects of combined diewry re imen on patens with malignant tumors. Exper Med and Surg 7299-317 1949. 20. Moses LE: The series of consecutive cases asa device for assessing outcomes of interven tion, N Engl} Med 311:705-710, 1984 21: Cope F: A mecical application ofthe Ling association-induction hypothesis: The high po- sium, low sodium diet ofthe Gerson cancer therapy. Physiol Chern Phys 10-465-468, 1978. 122. Regelson W: The "grand. conspiracy” fgainse the ‘cancer cure. JAMA. 283337~ 339,1980, 23, MeCany MF: Aldosterone and the Gerson dice. A speculation. Med” Hypotheses 7'591-$97.1981 24, Richards BA: The enzyme knife: A renewed ‘rection for cancer therapy? JR Soc Med B1-285-285,1988, 25, Shils ME, Hermann MG: Unproved dietary lam inthe weatment of patients with cancer. Bull NY Acad Med 58:323-340, 1982 26, Herbert V: The nuttionally and metabol cally destructive “nutriional and metabolic an Tineoplstic det of late proponents. Am J Clin Nat 32:96-98,1999. 27. Ginsberg MM, Thompson MA, Peter CR: Campylobacter sepsis associated with nut ‘onal therapy": Calforia. MMWR 30:204— 295,198. 28. Markinan M: Medical complications of“: temative™ cancer therapy (eter). Engl} Med 312: 1640-1641, 1985. 29. Eisele IW, Reay DT- Deaths related to cof {ee enemas, JAMA 2441 608-1609, 1980. 40. NCI Staement: Gerson Therapy. Bethesda ‘Maryland, May T1, 1988. 31, Hildenbrand G: A unique opportunity to bnelp. Healing Newsleter, Nos 20-21, JulyiOc- tober 1987. (CAVACANGER JOURNAL FOR CLINICIANS,detailed and consistent treatment interven- tions, selected ease histories cannot pro- vide information that is useful in determin- ing the activity ofthis approach in patients with cancer.2° No supporting clinical evi- dence of efficacy from other sources has appeared in the literature. Several writers hhave considered biochemical aspects of Gerson's theories and. observations. and suggested that further study is needed." Others, however, have reported serious side effects of Gerson therapies.">” Evaluation In 1946, scientists at the National Cancer Institute reviewed 10 cases submitted by Gerson. They found the data inconclusive, since the patients were also receiving other anticancer treatments. Gerson was invited to submit additional data but didnot do so. ‘The National Cancer Institute does not con- sider the Gerson Method to be an effective ‘means of cancer treatment.”® ‘A special subcommittee of the New York County Medical Society was. 9 pointed in 1957 to review Gerson’s method for treating cancer. "The nine cases that ‘were officially reported were found to in- dicate that Dr. Gerson demonstrated a lack of understanding of the natural history of neoplastic disease. His presentation of ceases let much tobe desired in the way of either proof that some patients actually had ‘malignant disease at the time they were treated or that actual cure or arrest of the ‘malignant process, if present, had resulted from his treatment, He showed no case in ‘which it could be demonstrated that a cure cof malignant disease had been obtained by his weatment.""” ‘There are conflicting reports on the amount and quslty of clinical data gathered bby the Gerson Insitute since 1977. Institute officials stated in 1986 that several factors hhave led to limited data—the failure of clinic physicians to gather data initially, a 1986 fire that destroyed clinic records, and the failure of patients and their families to report back to the Institue.” Norman Fritz has stated that survival statistics are ‘based on a combination ofthe doctor's es- timate that the departing patient has area VOL 49.0.4 JULVAUGUST 1990 sonable chance of surviving" and feelings thatthe Institute staff have about the status ‘of people who call in."* In 1987. the Insti- tute’s newsletter announced, however, that a study of 10 years of clinical experience with approximately 4,000 patients had been undertaken." This information has ‘not yet appeared. Serious illnesses and deaths have re- sulted from practices associated with Ger- son therapy: Between January 1979 and March 1981, 10 patients were admitted to San Diego County-area hospitals for trea ment of sepsis caused by Campylobacter fetus, subsp. fetus. The only exposure com- ‘mon to these patients was the use of the Gerson regimen of raw fruit, vegetable juices, raw calf’ liver, and coffee enemas. Nine of the patients had cancer; eight had ‘been treated ata Tijuana clinic, and another had treated himself at home with the same regimen. The raw calf's liver was consid- ‘ered by health officials tobe the most ikely source of infection.” Physicians atthe University of Califor- San Diego, Cancer Center reported the admission of three cancer patients in 1984 to 1985 who had been receiving coffee ene- ‘mas in Tijuana. One had sepsis (positive blood cultures for salmonella), very low blood pressure, and a serum sodium level ‘of 114 mmoll, Another was severely de- hydrated and had renal failure and Campy- lobacter and cryptosporidium in his stool ‘The third patient was a 28-year-old man with metastatic seminoma not previously ‘ueated with chemotherapy who was found to have a salmonella brain abscess.” Two deaths de to coffee enemas were reported in 1980 by the Office of the Medical Ex- aminer in Kings County, Washington. In ‘one case, a 46-year-old woman received as ‘many as 10 oF 12 enemas for pain associ- ated with gallstones the night before she died. An autopsy attributed her death to bronchopneumonia and cerebral hypoxia with hypokalemia as the proximate cause. ‘The second case was a 37-year-old woman with breast cancer, sho discontinued con- ventional therapy to receive treatment at the Gerson clini. On her return to Seattle, she continued the therapy, with weekly tele ‘phone consultations but without seeing a 288