Force of Nature- The Life of Linus Pauling
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He became involved once again in the institute and made some changes here as well. In early 1983 the Robinson suit was entering its fifth year, the complaints ranging from tenure violation to mental distress, slander, libel—"everything but the kitchen sink," as Robinson said. Legal costs on each side had reached somewhere in the neighborhood of $1 million. It was finally nearing a court date.
But the suit never reached a trial. In February, the institute board, weary of the cost in both dollars and negative publicity, decided to settle out of court. On the advice of his lawyers, Robinson accepted something between $500,000 and $600,000—just enough to clear his remaining legal debts and buy a new car, he later said—and walked away. He ended up trying unsuccessfully to start his own health institute at a ranch outside of Cave Junction, Oregon, where he continued to carry on some scientific work, home-schooled his children, and researched and published articles about the benefits of bomb shelters.
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Pauling's life took on a rhythm. He rose early, often around 4:00 a.m., built a fire in the fireplace if he was at the ranch, had some breakfast, and put in a full day's reading and theoretical work. At about four in the afternoon he would knock off for cocktail hour and watch a little television, the news mostly or The People's Court, which he enjoyed. He would fix himself dinner, oxtail soup or some pasta dish, and go to bed at about seven, where he would read until he fell asleep. He no longer enjoyed science fiction—he felt that he knew all of the plots and per
mutations by now and did not enjoy the new emphasis on extraterrestrial sex—but would occasionally read a Louis L'Amour western or a mystery. He enjoyed the British humor magazines Peter would sometimes send. He drank a little more vodka than before and took less care of his appearance; his outfits, topped always now with his black beret, were often poorly matched combinations of fraying sport coats, well-worn sweaters, and stained pants. He did not exercise beyond an occasional walk or a nude dip in the pool at the ranch. But his health—in part, he was certain, because of the megadoses of vitamins he took—was excellent.
He traveled incessantly, delivering a steady stream of speeches about peace and world affairs, endorsing the nuclear-freeze campaign, decrying Reagan's "senseless militarism" and the folly of the Star Wars program, traveling to Russia—where he was unable, despite his repeated attempts, to meet with Andrei Sakharov—and to Nicaragua, where he arrived on a peace ship loaded with medicine and food from Norway and Sweden and rode in a Land Cruiser to Managua with President Daniel Ortega.
He found that if he did not enjoy living alone, at least he could become accustomed to it. Ava Helen's death had thrown his life off balance, and he missed her desperately. But he righted himself and went on.
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The institute never recovered the momentum it had achieved in 1978. Any money that might have gone into an endowment to provide stable funding had been siphoned off by the Robinson suit. Richard Hicks began focusing his energy on cultivating a few wealthy donors, such as Armand Hammer, the Japanese philanthropist Ryoichi Sasakawa, and Danny Kaye, who had helped entertain the crowd at Pauling's eightieth birthday party. The institute began giving a "Linus Pauling Medal for Humanitarianism" to one or another wealthy potential donor at a black-tie dinner every year. Some of the efforts worked. After he received a medal from Pauling's institute, Hammer donated a significant sum of money. But it was never enough to move out of the warehouse.
Pauling did not help to promulgate an air of scientific integrity when he continued to tout vitamin C in the pages of supermarket tabloids and on television talk shows. An appearance on Donahue became especially embarrassing when Pauling was paired with fellow guest Jack La Lanne, an aging fitness advocate with a line of nutritional products to hawk.
Pauling seemed unconcerned. He had no trouble dealing directly with the public, even if many of his scientific colleagues thought it was inappropriate. His institute depended on the public now. If his ideas were adequately funded by the science establishment, he wouldn't have to take to the airwaves to promote them.
A low point in his professional image came in the spring of 1983, when Pauling took the stand at a San Francisco hearing held by a postal judge to investigate the alleged false and misleading claims of one Oscar R. Falconi, a mail-order vitamin dealer. Falconi, operating as the "Wholesale Nutrition Club," had advertised that vitamin C could protect against bladder cancer, stop urinary tract infections, help users kick tobacco and alcohol addictions, and cleanse the system of the ill effects of caffeine. His hearing would have drawn no attention but for the appearance of Pauling, whose testimony was tracked by the San Francisco papers and was then picked up in the news section of the science journal Nature, which brought it to his colleagues around the world. According to the Nature story, Pauling "appeared willing to defend even the most extreme of Falconi's claims," especially concerning vitamin C's effects in preventing cancer. The reporter also noted the testimony of Irwin Stone, described as "a retired brewing chemist" who testified that "all clinical diseases have as their cause a lack of vitamin C."
Dubious of Pauling's fixation on vitamin C, most scientists chose to ignore it in favor of remembering his earlier achievements. His career was now being rewarded with a string of tributes and honors, capped in 1984 by the award of the most prestigious honor given by the American Chemical Society, the Priestley Medal. On the day of the award, USA Today noted, "For years a pariah, Linus Pauling tonight gets the scientific equivalent of the Good Housekeeping Seal of Approval." This sign of Pauling's "returning respectability," as the Washington Post put it, was welcome. But to Pauling respectability was less important than his effort to make the world realize that cheap, safe vitamin C could greatly reduce human suffering.
The Main Kook
Then Moertel released his second study. Pauling had heard nothing about it until he was called by reporters in January 1985. They had received a news release, they told Pauling, saying that the second study had again shown that vitamin C had no effect on cancer patients.
Pauling had not even received the courtesy of a prepublication copy. When he finally read the paper, he was outraged. Yes, Moertel had answered Pauling's earlier criticism by using only patients who had received no previous anticancer drugs or radiation—in this case a hundred advanced colorectal cancer patients for whom no other known therapy was effective. The randomized, double-blind test adhered to all the rules of standard clinical testing. But Moertel had made a major error in Pauling's estimation. When the investigators saw no indication of an effect (defined as a decrease in tumor size) they immediately took the patients off vitamin C and in some cases put them on chemotherapy. Stopping the administration of a new test drug when it was shown ineffective was standard procedure—a lack of quick effect coupled with potentially severe side effects was good reason to revert to proven techniques—but it was wrong in the case of vitamin C, Pauling argued. Vitamin C was not a drug; it was a food. Taking patients off of it in mid-test could result in a rebound effect, where blood levels of C could drop dangerously low. Cameron had kept his patients on vitamin C until they died, giving the vitamin maximum time to do its work; by taking them off early, Moertel had not only failed to replicate Cameron's work; he may have hastened his patients' deaths.
When the Moertel study appeared in the NEJM on January 17, the results were accompanied by an editorial written by an NCI official who called them "definitive" and offered the suggestion that Cameron's earlier findings were the result of "case selection bias." Vitamin C produced no significant increase in survival time. Pauling and Cameron were wrong. Case closed.
"I have never seen him so upset," Cameron wrote about Pauling a few weeks after the Moertel paper appeared. "He regards this whole affair as a personal attack on his integrity." But it was more than that, more even than the fact that the Moertel study might spell the end of any significant financial support for the Pauling institute's work on cancer. There may have been an emotional dimension to Pauling's reaction as
well. By saying that vitamin C was worthless, Moertel's study cast doubt on everything Pauling had done to save Ava Helen's life.
So, at age eighty-four, Pauling fought the second Moertel study as hard as he had ever fought anything in his life. He sent out a press release calling the Mayo group's claim to have replicated Cameron's work "false and misleading." He wrote letters to DeVita, Moertel and his five coauthors, the author of the accompanying editorial, and the editor of the NEJM, Arthur Relman, demanding a "correction, retraction and apology" for their work. He threatened to sue the NEJM, the NCI, and the Mayo Clinic. He put together a slide show of flaws in the Moertel study and showed it to health groups. He wrote a paper showing that taking the patients off vitamin C increased their death rate and submitted it to the NEJM. He tried to spur congressional hearings. He went to the media—looking, Cameron said, "tired, old and upset" in his television interviews.
None of it worked. Pauling's frenzied attack allowed Moertel to take the high ground, saying, "We should move on to more hopeful areas of treatment and not remain dead set on a worthless treatment." Moertel had followed all the proper procedures for the clinical testing of a new drug; by saying now that vitamin C shouldn't be treated like a new drug, Pauling was attempting to change the rules in mid-game. He stopped responding to Pauling's letters. At the NCI, DeVita considered the matter closed. Pauling's lawyer talked him out of any legal action, noting that a judge was unlikely to take sides in such a technical, scientific problem. At the NEJM, Relman refused to print the two letters of refutation Pauling wrote—one for Moertel's study, the other for the accompanying editorial—saying one was enough. Pauling argued with him about it for almost a year, so alienating Relman that the influential editor also stopped communicating. Neither Pauling's letter nor his death rate paper saw print in the NEJM.
By the summer, Pauling had lost the battle in the scientific and popular arenas. The mainstream medical community could now say that it had gone out of its way to test Pauling's ideas and they had been twice disproven. Pauling's angry response only underlined his lack of objectivity. The popular press, incapable in general of analyzing the counterarguments Pauling presented would from now on always qualify their reports on Pauling with a mention of the Moertel results. The only group that stuck with Pauling was the alternative health crowd, a development that further marginalized him within the medical community. As one respondent to a fund-raising appeal from the institute scrawled across the reply form, "Are you guys whacked out? I respect Dr. Pauling, but you don't settle medical controversies by suing a medical journal."
Even Cameron thought Pauling's claims of bias and conspiracy were extreme, saying privately, "I think we are dealing with a bunch of fools rather than a bunch of knaves." He was careful to disassociate himself from Pauling's threats against Relman while he tried to get some of his own research published in the NEJM. Cameron's opinion moved more toward Pauling's, however, a year later, after he had revised his NEJM paper three times in response to reviewers' comments and still saw it rejected.
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But Pauling still had a case. The Mayo study did not constitute a definitive refutation of Cameron's work. As the Australian science historian Evelleen Richards pointed out in a book-length analysis of the vitamin C and cancer controversy, Moertel had not only treated his patients differently by taking them off vitamin C earlier than Cameron, he had used a different scale for determining results. Moertel was treating vitamin C like an anticancer drug, where proof of efficacy is determined by a measurable change in the disease's progression: in this case, shrinkage of the tumor. Cameron had worked within a different framework, looking as well for an easing of pain, heightened energy, and increased survival time—improved quality of life, in other words. Sometimes tumors had shrunk in Cameron's experience, but that was only one effect out of several. Making it the only measuring stick of success skewed Moertel's study.
Rather than the final word on vitamin C and cancer, Richards said, "the history of this dispute has become an almost paradigmatic instance of the limitations of the clinical trial in resolving issues of medical controversy."
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If not the final word in fact, the Moertel studies proved, for the moment, the final word in practice. Two months after the second Mayo study came out, Pauling struck up a conversation with a cattle rancher sitting next to him on an airplane. The rancher, not knowing who he was talking to, mentioned that it's dangerous to visit a doctor because "you might get in with one of those kooks who talk about massive doses of vitamin C." Pauling looked at him for a moment and said, "I am the main kook."
He was, he noted to himself later, surprised to find that people thought of vitamin C this way.
So he decided to educate the public again. Pauling made plans to write a health book for the mass market, a popular overview that would distill everything he knew about the field and bring it to the public. The book, How to Live Longer and Feel Better, was finished in the fall of 1985 and published in early 1986 by Pauling's longtime publisher, Freeman. The front cover was its best advertising: A full-color close-up of Linus Pauling in his eighties: vibrant, ruddy, bright-eyed, glowing with evident good health as he grinned into the camera. Inside was a typically clear and straightforward review of nutrition, vitamins, and orthomolecular medicine. An entire chapter was spent discussing the way his ideas had been treated by the medical profession, with special attention paid to the Moertel studies, which Pauling called "the Mayo Clinic fraud." But the tone was upbeat in the end, with Pauling noting that the American Orthomolecular Medical Association now had five hundred members and that his ideas were being given a serious hearing in at least some medical schools.
Pauling recommended eating what you like in moderation—including eggs and meat—enjoying a drink or two every day, cutting down on sugar, and taking large doses of most vitamins. "You should eat some vegetables and fruits," too, he wrote. A little exercise couldn't hurt, smoking was out, and stress should be avoided. The only thing radically "alternative" about his approach to health was the megavitamin recommendation; Pauling was now advising between 6 and 18 grams of vitamin C per day, plus 400-16,000 IU of vitamin E (40-160 times the RDA), 25,000 IU of vitamin A (five times the RDA), and one or two "super B" vitamin tablets, along with a basic mineral supplement.
The book was well received critically and sold well—for a short time even making the New York Times best-seller list—a modest success that helped raise morale at the institute and brought in some money as well. Fund-raising at the institute had again nosedived after the second Moertel study, with direct-mail appeals bringing in only one-quarter as much as they had just a few months earlier. Part of Pauling's book income was devoted to keeping the institute running.
At the same time, Pauling's personal morale was boosted by a party Caltech threw for his eighty-fifth birthday. The relationship between the school and its distinguished alumnus had been strained ever since his decision to leave more than twenty years earlier, but now it seemed that all that was forgiven. Caltech declared an academic holiday for the occasion. A banquet was given at which the speakers praised Pauling as the greatest chemist of the twentieth century, a man who deserved a third Nobel for his sickle-cell work, and the true father of molecular biology. Francis Crick was there to help celebrate. For the first time in many years, Pauling felt welcome in his own academic home.
To the Heart
In April 1989, the new head of the National Cancer Institute, Samuel Broder, agreed to have a short chat with Pauling. Two and a half hours later, Broder had altered his thinking about vitamin C.
During that talk, Pauling brought his persuasive powers to bear, convincingly marshaling all of his arguments for vitamin C, new statistical interpretations of Cameron's data, and attacks on the Moertel studies. It was a tough sell. Broder, he remembered, "was not interested whatever in what I said during the first two hours." But by the end of the meeting, Broder was asking Pauling to send him some of Cameron's case histories and
inviting him to speak to bigwigs in the NCI division of cancer prevention and control.
Then better news came. A few months after Cameron's data arrived, in January 1990, the NCI announced that it would cosponsor an international symposium on vitamin C and cancer later that year. The featured speaker would be Linus Pauling.
It was the result of a great deal of work on Pauling's part. He had never given up after the second Moertel trial, although for a while his attention had focused less on vitamin C than on other topics. During 1987, at age eighty-six, Pauling was still producing as much as three average scientists half his age, publishing within those twelve months six letters to editors, four forewords to books, three long historical reviews, and fifteen original scientific papers—about one publication every three weeks—in journals from Nature to the Physical Review, on topics from crystal structure to nuclear physics, superconductivity to metabolism, chemical bonding to world peace.
Vitamin C had not shown up much in his publications, but it was constantly on his mind. Research at the institute continued to buttress the idea that ascorbic acid could be of benefit in a wide variety of conditions—new research was now focusing on its effect on AIDS—and Pauling personally had been working with a colleague at the institute, Zelek Herman, on a new way to statistically analyze clinical trial data. When they used their new method on Moertel's and Cameron's cancer trials, they again found a strong positive effect of vitamin C. A version of their paper about this research had been delayed, rejected after months of consideration by the NEJM, but now, buoyed by his talk with Broder, Pauling submitted it to the PNAS. It was the start of a new campaign to legitimize the use of vitamin C in cancer treatment. On the same day the paper was published, in September 1989, Pauling made a sortie into the heart of the enemy camp, giving a talk on cancer and vitamin C at the Mayo Clinic. He followed the talk with a televised news conference.