by Thomas Hager
The international conference on "Ascorbic Acid: Biologic Functions in Relation to Cancer" that the NCI helped arrange in the fall of 1990 in Washington, D.C., was a tremendous success from Pauling's standpoint. It was, first of all, a legitimization of his ideas, a recognition by the establishment that it was worthwhile discussing the value of vitamin C in preventing and treating cancer. This in itself was a major step forward. But there was more. The breadth of effects presented by scores of researchers from around the world surprised even the conference organizers. There were presentations on vitamin C's importance in enzymatic and nonenzymatic reactions, its effects in delaying tumor onset and growth, prolonging survival times, reducing treatment toxicity, and increasing the efficacy of other treatments. Special attention was focused on its action as an antioxidant to quench free radicals implicated in cancer genesis. "It was great! A great affair! Very exciting!" Pauling said when it was over.
Gladys Block, a conference organizer, was pleased with the general results of the meeting—"There is no question that the status of vitamin C has changed in a lot of researchers' minds," she said—but she was less happy about the response within the NCI. She had invited all the branch chiefs at the NCI, and out of that group "essentially nobody came," she said. The proceedings were also shunned by virtually all the major medical journals, with the exception of Journal of the American Medical Association. Although the conference raised some excitement about vitamin C as a way of relieving the toxicity of chemotherapy, the NCI's interest continued to center around vitamins as healthful components of foods—there was no disagreement that foods high in vitamin C lowered the risk of cancer—and in its antioxidant action, not in the value of megadoses. That was reinforced when the panel of experts Broder gathered to review Cameron's clinical data concluded that, given the use of historical controls, the results were inconclusive.
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It was a halting step, but the NCI conference was the start of a shift in the attitude toward vitamin C. It was no longer a taboo subject at the NCI, and other researchers were beginning to get interested. Part of the growing legitimacy of vitamin C was rooted in a new interest in its role as an antioxidant capable of sopping up a dangerous class of molecules called free radicals inside the body. Free radicals, bits of molecular debris formed during chemical reactions, had been implicated in cell damage at a number of levels, and there was a growing consensus that they were contributors to everything from cancer and heart disease to the aging process. Antioxidants, it appeared, could lessen the threat, and vitamins C and E were excellent antioxidants.
Symbolic of the change in attitude—and toward Pauling—was a special meeting of the New York Academy of Sciences in early 1992 devoted to discussing high-dose vitamins and other nutrients. After multiple sessions addressing the antioxidant abilities of vitamin C and its value in other ways, a nutrition professor from Alabama said to the group during the discussion period, "For three days I have been listening to talks about the value of large intakes of vitamin C and other natural substances, and I have not heard a single mention of the name Linus Pauling. Has not the time come when we should admit that Linus Pauling was right all along?" The professor later wrote Pauling that the researchers responded by bursting into loud and enthusiastic applause.
In May of that year, a longtime Pauling collaborator, James Enstrom of UCLA, published an epidemiological study showing that men taking an average of 500 mg of extra vitamin C per day could expect to live on average five years longer than those who did not. Time magazine ran a cover story about the amazing properties of vitamins, with an emphasis on antioxidants such as vitamin C. The Medical World News told its readers in a cover story, "We may be in the midst of a grand upheaval that gives a handful of vitamins a protective role if consumed in higher-than-dietary amounts," and pointed to a recent NCI review that showed that vitamin C had a protective effect in thirty-four of forty-seven studies examined, helping prevent or control various cancers, including those of the lung, stomach, colon, and rectum.
All the good news was coming too late for Pauling's institute, which in 1991 was in the midst of a financial crisis. There was not enough money to pay the staff, who were nonetheless loyal enough to Pauling to donate their retirement benefits to the institute and in some cases work without pay to keep the place going. But by the end of 1991, even that wasn't enough. The operation was several hundred thousand dollars in debt. Hicks said that if they didn't get $3 million in short order, the institute would have to close.
When asked by reporters about the financial problems, Pauling, now ninety years old, responded by turning the conversation to something more upbeat.
Vitamin C, he said, could help prevent heart disease.
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Pauling had thought about a link between vitamin C and heart disease almost from the beginning, when he first read studies that increased ascorbic acid could help lower cholesterol in the body, especially the LDL cholesterol linked to atherosclerosis. As early as 1981 he had talked about starting research into vitamin C and heart disease at the institute. But cancer had captured his attention.
It wasn't until 1989 that his interest was revived by a visit from a charmingly enthusiastic young German physician named Matthias Rath. Rath had met Pauling years before, when Rath was still a student, when thev had shared a car ride during one of Pauling's peace tours in Germany. Inspired, Rath had followed Pauling's career. After he earned his M.D. and decided to relocate in the United States, he visited Pauling and told him about a great theory he had. Vitamin C, he was convinced, was somehow intimately related to lipoprotein (a), a carrier of cholesterol in the blood and a component of the plaque that forms on artery walls during atherosclerosis. A lot of interest was centering on Lp(a), as it was called, because of its increasingly well understood role as a risk factor in heart disease. Lp(a), according to Rath's theory, was an evolutionary tool used by the body in part to strengthen artery walls that had been weakened hundreds of thousands of years ago when man's predecessors lost the ability to produce vitamin C. With increased doses of vitamin C, Rath said, levels of Lp(a) would decrease. The risk of heart disease would be reduced.
With his usual enthusiasm for any new proposal that supported the value of vitamin C, Pauling took the idea and ran with it. He also took on Rath as a researcher in his institute, and together they published a paper in the PNAS describing their ideas about an Lp(a)/vitamin C link. Soon Pauling was discussing vitamin C in relation to heart disease in the same way he had talked about colds and cancer a decade earlier. At the institute, Rath began testing the idea in guinea pigs. He also worked hard to stay near Pauling, making sure that his work on heart disease remained close to the top of the great scientist's priority list.
It was exciting work. Evidence presented at a National Heart, Lung and Blood Institute (NHLBI) conference in September 1991 showed that antioxidants such as vitamin C could prevent atherosclerotic lesions in rabbits and indicated that the same might be true in humans. The theory about why that happened was different—the NHLBI researchers related it more to the oxidation of LDL—but the effect was the same.
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In December 1991, age finally caught up with Linus Pauling. He had been experiencing intestinal discomfort which he thought might be diverticulitis. After a series of tests, however, his physician told him the bad news: he had cancer of both the prostate and the rectum.
Pauling underwent two surgeries for the rectal cancer in the winter of 1991-92 and spent much of the time during that period recovering in bed, either at the ranch or his Stanford apartment. Rath was constantly by his side, giving him medical advice, boosting his spirits, keeping his enthusiasm up for the advances they would make in controlling heart disease. Rath now wrote papers with titles such as "Solution to the Puzzle of Human Cardiovascular Disease: Its Primary Cause Is Ascorbate Deficiency Leading to the Deposition of Lipoprotein (a) and Fibrinogen/Fibrin in the Vascular Wall" and "A Unified Theory of Human Cardiovascular Disease Leading th
e Way to the Abolition of This Disease as a Cause for Human Mortality." He convinced Pauling to add his name as an author. But the writing was unlike Pauling's.
Rath's growing influence over Pauling began to concern veteran employees and administrators at the institute. It especially worried one of the institute's trustees, Linus Pauling junior.
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Linus junior had been a member of the board of trustees since the institute’s founding. He watched with increasing concern as money woes mounted and his father fell ill. By 1992 the staff had been cut by a third, including some top researchers. In February, Pauling announced publicly that he had cancer. In March Richard Hicks resigned as vice president and Rath was put in charge of handling the institute's financial affairs. Zuckerkandl left in July to start his own research institute. He was succeeded as president by Linus Pauling junior.
A power struggle developed over what was left of the institute, with Pauling's eldest son on one side and Rath on the other. During the spring, Rath—now sporting a vanity license plate on his car that read "NBL4MATT"—traveled with the increasingly frail Pauling to meetings in Denver and Toronto, never far from his side, caring for him, constantly impressing upon him the importance of his heart-disease research. In Toronto he applauded as Pauling announced the formation of the Linus Pauling Heart Foundation.
The relationship between Rath and Pauling grew very close, very fast. It was capped on July 22, when Pauling, increasingly ill, signed a paper saying, "It is understood that Dr. Rath will continue the life work of Dr. Linus Pauling." The next day, at a meeting of the institute's newly reformulated board of trustees, Linus Pauling stepped down and Linus Pauling junior succeeded his father as chairman of the board.
The battle of wills between Linus Jr. and Rath was decided in the new chairman’s favor. Soon after Linus Jr. started running the institute, Rath left.
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Pauling no longer cared much. He was, after all this time, after all his work, ready to rest. He treated his cancer with vitamin C, raw fruits, vegetables, juices, and an experimental immune-system-boosting therapy. He spent his time doing what he liked at the ranch: making calculations and looking out to sea. If he had pain, he took some Tylenol. If there was too much, he had Darvocet and Valium.
"I am most interested in the human being's right to die with dignity," he had written not long before his cancer diagnosis. "If illness or injury puts me in a hopeless condition, I wish to be allowed to die, without unnecessary suffering, but with dignity."
That was the way he would have it. He stayed at the ranch as much as he could, still productive, still thinking, putting together a final version of his theory of the atomic nucleus, and seeing old colleagues who had heard about his illness and made the pilgrimage to see him one last time.
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His children cared for him at the end, at the ranch and at Crellin's home in Portola Valley, the place where Ava Helen had died. For months, defying death, he remained as active as possible. During the last few weeks of his life he met with friends, worked a little on problems, and gave a deposition, from his bed, to lawyers representing Matthias Rath, who had announced a lawsuit against both Pauling and the institute.
In the summer of 1994, at a meeting of the American Association for the Advancement of Science in San Francisco, Crellin arranged a special afternoon symposium to honor his father. The large lecture room was half-filled with an audience that seemed equal parts older, buttoned-down scientists; younger, long-haired students; and natural-fiber-clothed health devotees. Pauling arrived outside the hall in a wheelchair, looking thin and drawn. But once there, he insisted on walking into the room. The pain was so bad that his face beneath the black beret was ashen. As he entered, the audience started to applaud. The applause grew as he walked slowly to the front of the auditorium, until everyone was on their feet, cheering. Pauling stopped and waved. Then he gave the crowd one of his trademark ear-to-ear grins.
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Pauling died at the ranch at Big Sur on August 19, 1994.
