by Thomas Hager
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Just as he once had a standard stump speech promoting a test ban, Pauling now had a stump speech promoting vitamin C. He would go through Irwin Stone's evolutionary argument for high doses of ascorbic acid, then criticize the U.S. government for its irrational nutritional policy in regard to vitamins. Laboratory monkeys, he would point out, eat a standardized diet that the federal authorities dictated should have ninety times as much vitamin C per day as the equivalent recommended daily allowance for humans. Perhaps the authorities wanted to keep their research monkeys in better health, he would tell the crowd, because, unlike humans, they were expensive to replace.
He would then display a set of large test tubes containing various amounts of powdered vitamin C, illustrating how much the various animal species would produce in a day if they were the size of an average human. A 70-kg goat, he told the crowds, would produce in its body 13 grams of vitamin C per day, about half a test tube full. A similar-size human being produces this much, he said, holding up an empty tube. And the FDA recommends we take this much to make up for it. He would hold up a tiny pinch of powder. "The goat manufactures 330 times as much as the Food and Drug Nutrition Board recommends," he said. "I think that the goat knows more about this matter than the board does."
Then he would tell the crowds that he himself was now taking 10 grams per day, an amount that had risen steadily the more he learned about vitamin C. Why was he taking this much when his books recommended only 2 grams or so? "You can neglect what you read in my books," he said, "because I had to be sort of cautious when I was writing the books—approach the problem gradually and not frighten all the physicians."
Despite all the scientific controversy, the public listened to Pauling. Tens of thousands had discovered, as Pauling had, that taking a gram or more of vitamin C per day made them feel better and helped them fight off infections. Consumption continued to climb, with demand rising so high during the 1970s that the bulk price of ascorbic acid tripled despite an increase in supply. The world's largest producer of vitamin C, Hoffmann-LaRoche, doubled its production capacity over the decade by building new plants—and every year, as a way of saying thank you, donated $100,000 to the Linus Pauling Institute.
Crocodile Dung and Mummy Dust
In March 1979, Pauling and Cameron published an extensive review article on vitamin C and cancer in the journal Cancer Research, summarizing what they had found in a literature search of more than 350 scientific articles and books and concluding with a statement of their current understanding of the role of vitamin C in controlling cancer. "There is evidence from both human and experimental animal studies that the development and progress of cancer evokes an increased requirement for ascorbic acid," they wrote. "Ascorbic acid is essential for the integrity of the intercellular matrix. . . . There is good evidence that high intakes of ascorbate potentiate the immune system in various ways. Ascorbate may also offer some protection against a variety of chemical and physical carcinogens and against oncogenic viruses and is also involved in a number of other biological processes believed to be involved in resistance to cancer."
They concluded that it is "essential that extensive studies of ascorbic acid in cancer be made without delay."
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Six months later, the first such study was published, and the news was not good. Pauling received an advance copy on September 12, 1979, and could tell almost everything he needed to know from the title: "Failure of High-Dose Vitamin C (Ascorbic Acid) Therapy to Benefit Patients with Advanced Cancer."
This was the Charles Moertel/Mayo Clinic study that the NCI had set up, and the results appeared to refute Cameron's work in Scotland. But in reading the paper, Pauling and Cameron could see, if not holes in Moertel's study, certainly ways in which it failed to replicate Cameron's work. The most important difference was that Moertel had included a number of patients who had significant prior chemotherapy, a factor Pauling had warned Moertel would weaken their immune systems. Moertel had given sixty terminal patients 10 grams per day of vitamin C for some time, but only five of the group had received no previous chemotherapy or radiation. Their failure to respond to vitamin C did not indicate that it was ineffective, Pauling wrote Cameron. "I think the conclusion to be drawn from this result, together with your observations, is that cytotoxic chemotherapy destroys the immune system to such an extent as to prevent ascorbate from being effective."
Cameron's patient population was quite different—in Scotland it was not common practice to give terminal patients the kind of aggressive therapy given in the United States—but that difference was not mentioned in Moertel's paper. Moertel stated that half of Cameron's patients had previously received radiation and/or chemotherapy, but that was wrong, Cameron said. The number of patients receiving those treatments at the Vale of Leven came nowhere near 50 percent.
This was a significant point, and Pauling pointed out the error to Moertel, asking that it be corrected before the paper reached print in the New England Journal of Medicine (NEJM). He was told that it was already in production and too late to change.
When published, the Moertel study was taken as proof that Pauling's ideas about vitamin C and cancer were quackery. "No Vitamin C Benefits Found in Cancer Trial," headlined the Medical World News. "Dr. Linus Pauling's much-publicized claim that vitamin C can prolong and improve the lives of terminal cancer patients has collided head-on with the scientific method." The same tone was picked up by newspapers nationwide.
Pauling answered with rebuttals, noting differences in the Moertel and Cameron studies in letters and interviews with the New York Times, the Wall Street Journal, and the Washington Post. Moertel expressed his feelings about the issue in a note to the NEJM correcting his statement about Cameron's use of other therapies. "Any contention that previous chemotherapy prevented our patients from achieving the extraordinary survival increases claimed by Drs. Cameron and Pauling must be considered highly speculative at best. . . . On the basis of available evidence, we do not consider it conscionable to withhold oncologic therapy of known value to give the patients large amounts of vitamin C."
The battle lines were now drawn between Moertel and Pauling, who after this point gave up personal communication in favor of public attacks on each other's work. Pauling referred to Moertel's work as part of the establishment conspiracy against vitamin C and claimed that most physicians were unwilling to try something new for fear of a malpractice suit. Moertel in his public statements would lump vitamin C with quack cancer remedies like laetrile, holy water, crocodile dung, and mummy dust.
It was strangely like Pauling's battle with Dorothy Wrinch over the cyclol theory of proteins forty years before, with Pauling taking Wrinch's role. Pauling was now the outsider in an established field, the intruder whose ideas were dismissed by those in power. He saw his opponents' papers quickly published in respected journals, while his and Cameron's work was often turned down. Pauling now experienced what it felt like to have his ideas and his grant requests rejected outright not because they were fully disproven but because the case was considered closed.
Perhaps he could better understand Wrinch's feelings when she wrote to a friend in 1940 comparing Pauling and his supporters to a "power syndicate just like Hitler's" that only those who were strong and powerful could survive.
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Everyone else might take Moertel's work as the last word, but Pauling did not. His and Cameron's book Cancer and Vitamin C was published a few weeks after Moertel's study appeared. Despite negative reviews like that in the Times Literary Supplement—which noted Pauling's "almost obsessive preoccupation with vitamin C" and concluded that the book was "totally unacceptable, the more so, since it may raise hopes which are unsupported by proper scientific evidence"—sales were brisk, in part because Pauling himself bought fifteen thousand copies to send to physicians and one thousand more for members of Congress and government officials. He pressured NCI director DeVita to fund a second clinical trial that would more accurately dup
licate the Vale of Leven work.
And again he got results. To put the issue to rest again, DeVita s agency would eventually okay a second trial, stipulating that the patients were not to have received prior chemotherapy or radiation. The only problem from Pauling's standpoint was that the second trial was to be conducted again by Charles Moertel.
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The combination of bad publicity from the Moertel trial and the drain of the Robinson suit had put the institute again on shaky financial ground. In 1980 the owner of the institute's leased home notified Pauling that he would have to move by next year. The only affordable space that could be found in the area was a leaky, twenty-year-old warehouse near a busy Palo Alto intersection. A few years earlier, Pauling would never have considered it. "It is an old building, and not very attractive," Pauling wrote a friend. But it was roomy, inexpensive, and available on short notice. With some remodeling, it would do for a short time, Pauling told himself, until fund-raising picked up again.
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It had been five years since Ava Helen's stomach cancer operation, and they had been good years. She had traveled extensively with Pauling, and she had received a few recognitions of her own: an honorary doctorate from San Gabriel College and guest-of-honor invitations to a number of fund-raisers for peace, environmental issues, and women's rights.
Then, as the controversy over ascorbate raged, her health began to flag. In the summer of 1981, during a second trip to China with Pauling, she fell so ill with abdominal pain that they had to alter their travel plans. When they returned to California, her doctors recommended that she undergo exploratory surgery.
The results were not good. She was suffering a recurrence of her stomach cancer, the physicians told them. The disease had spread far enough, surrounding some important arteries, to make surgery impossible.
Standard U.S. oncological therapy at this point dictated chemotherapy, but Ava Helen, after talking with Pauling, Cameron, her children, and her physicians, decided against it. She apparently now qualified as a terminal cancer patient, and she understood quite clearly what her choices were. She decided that her only therapy, aside from pain control, would be to increase her intake of vitamin C.
She then went to the ranch, shooed aside most sympathy, and tried to take care of Pauling. She knew better than anyone how poorly he dealt with emotional distress, and so she encouraged him to work hard and to travel, to keep up his schedule of speaking engagements. While he was on his trips, the children came and stayed with her. On one long weekend, she talked with Linda about things Pauling did not want to hear: the type of memorial service she wanted, the music to play, her wish to be cremated. As she weakened through the fall, Ava Helen was the calmest one in the household. Linda, who tended to cry now every time she saw her mother, only saw Ava Helen weep once, when she read a letter written by Linda's son Sasha, a simple, loving letter expressing how much she meant to him.
Finally, Ava Helen arranged one last public appearance. She was pleased to learn that she had been named winner of the Ralph Atkinson Award for Civil Liberties, which was to be presented by the Monterey chapter of the American Civil Liberties Union on November 1, and she decided that regardless of how weak she felt, she would attend. She made certain that her children and friends knew about it as well. "She knew she was dying, and she wanted us there," her son Crellin remembered. "She knew this was her last hurrah."
The award ceremony went well. But nine days later, while Pauling was off on his way to England, Ava Helen began vomiting blood. She was hemorrhaging internally, the doctors at the Stanford University Hospital intensive care unit told the family; the cancer was eating away at her tissues, causing the bleeding into her gastrointestinal tract. Pauling returned immediately. Ava Helen's bleeding was stopped, and she went back to the Portola Valley house and began making plans to celebrate Thanksgiving with the entire family down at Big Sur. But on November 23, there was another hemorrhage. She couldn't be moved. Thanksgiving was held at the Portola Valley house.
Pauling hung on to the hope that Ava Helen would live, that massive doses of vitamin C would perform a miracle, as it had with a few of Cameron's patients, that somehow the cancer would simply disappear.
He had added to her diet raw fruits and vegetables, carrot and celery and tomato juices freshly squeezed at home, everything he could think of to restore her to health. "Daddy was convinced that he was going to save her," said Linda. "And that was, I think, the only reason he was able to survive. ... He said to me after she died that until five days before, he thought he was going to be able to save her."
Ava Helen knew better. The hemorrhages were getting worse and more frequent. Finally, she had enough. She had been receiving transfusions to replace the blood she had lost. Now, at the beginning of December, in bed in her house at Portola Valley, she said to stop the transfusions.
Pauling stayed with her as much as he was able, holding her hand. The children were nearby.
On December 7, Ava Helen died.
The Sea
Pauling spent a good deal of time now out on the deck at the house in Big Sur, looking down at the kelp-rich sea and then out to where it turned a pure and simple blue before meeting the sky. It was a good place to sit quietly and think.
Thought was his savior now, pure thought, pure theory, the application of his mind to difficult, abstract problems. The atomic nucleus had caught his attention again, the attempt to build a reasonable picture of the core of matter through ideas about building blocks of subunits, the spheron theory, structural thinking. He published three papers on the nucleus of the atom in 1982.
Most of her things were still inside, the pieces of folk art on the walls and bookshelves, the grand piano, now engulfed by stacks of journals and papers. He still talked to her, holding phantom conversations as he spooned his vitamin C powder into his juice in the morning. He still looked for her, expecting to see her in the doorway, asking him to stop and take a walk, to come to lunch. He would cry and look out to sea. Then he would get back to work.
He was lost for a while after her death. His children guided him through the memorial service, then watched him anxiously, wondering what to do next. They hired him a full-time housekeeper, figuring that he would want someone to cook and clean for him. Pauling fired her. They hired a gardener to take care of the plantings Ava Helen had tended. Pauling fired him.
They took the hint, let Pauling determine his own actions, and watched. He started cooking for himself, making a big pot of spaghetti and eating it for three days, then cooking something else that would last. He tried to keep his schedule as normal as possible through the spring of 1982, making appearances at the institute, traveling and giving speeches, going through the motions. He seemed to be doing all right.
But he wasn't. Ava Helen's death seemed to have split him in two, bifurcating him into the rational and the emotional, the scientist and the little boy. The first half observed the second half with some interest. Sitting in an airplane on his way to a meeting, he was surprised to note that he was moaning aloud. The same thing happened at home, he noticed, unexpected, unbidden periods of moaning. When someone asked about Ava Helen, he would begin to cry.
It was as though it were another person doing these things, but Pauling understood, also, who it was. He had never really known how to react emotionally, so he was doing the only thing possible, responding unconsciously, subconsciously, in ways that surprised him. He wrote his children a letter to let them know how he grieved.
And with enough time, he began to heal. By June, he felt well enough to attend his sixtieth class reunion at Oregon State University, and this, too, became part of the healing process. Almost without thinking, he set off alone in his car days before the reunion, driving fast, ending up in Dayton, Washington, a little town where he had worked with the paving crew and where he and Ava Helen had spent a month in a rented room just after being married. He looked for the places where they had walked. He remembered how she had surprised him that summ
er by outscoring him on an intelligence test. The smartest girl he had ever met.
He rewound his life, driving from there to Condon and Lonerock, where he found the grave of Linus Wilson Darling, then over to the Oregon coast, where he had spent time as a boy. There was nothing there that he remembered. He finally made it to Corvallis, where he spent a few days, seeing his old classmates at the reunion and walking the campus. He visited the lecture room in the science building where he had first seen Ava Helen; it was still very much as it had been that day. He walked to the front of the room where the lectern had been, stood and looked out over the empty seats. He saw a class of young women dressed in the styles of the 1920s. And he said aloud, "Tell me what you know about ammonium hydroxide, Miss Miller."
He went to Salem and looked for the house where he and Ava Helen had been married, then to Portland, where he participated in the presentation of Linus Wilson Darling's diaries to the Oregon Historical Society. He visited places on the way south where he had helped pave roads to work his way through college. Then he returned home. He had driven twenty-four hundred miles. And he had laid Ava Helen to rest.
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He made changes after he got back. He rented an apartment close to Stanford University, just a short way from the institute, and told his son Crellin that he could live in the Portola Valley house. He decorated the apartment with pictures of Ava Helen and himself, framed awards, and pieces of furniture from their travels. It was small and comfortable. He spent half his time there and half at the ranch at Big Sur.
