Alternative Medicine and Cancer

 

 


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Dr Max Gerson and his Fifty cases  (How sincere practitioners Can get it wrong)

 

"I think I can claim that I have, even in these far advanced cases, 50% results. " Dr Max Gerson   

(From: "The cure of Advanced cancer by diet Therapy: a summary of thirty years of clinical experimentations" Lecture. 1956)

How can we possibly doubt obviously sincere people who claim to be able to cure "incurable" cancer?   And how come there are so many of them?

A clue: almost without exception those with dubious cancer cures had little or no personal experience  of cancer therapy before trying out  their pet treatment on patients. Think about it.  They are naturopaths, psychiatrists, dentists, nurses, bacteriologists, biochemists, laboratory scientists of various types, lay persons, etc.   They will have mainly come into contact with cancer in relatives and friends, and never previously in a responsible clinical capacity.     Gerson was a doctor but his experience was with internal medicine and especially with tuberculosis, not cancer. He developed his treatment method initially for tuberculosis,  in  a TB sanatorium where few cases of cancer will be encountered.

It is quite easy to get an inflated impression of a treatment's worth  if you don't have the right clinical skills and background knowledge,  and especially if you are inclined to let personal enthusiasms  and quirky beliefs  sway your judgment.   A very favourite quirky belief is that conventional methods  patients may have received can be dismissed as hardly ever working, as a living member of the Gerson clan has recently assured me in private correspondence.  

How weak background knowledge may mislead:  

Gerson says that he first realized he may have a treatment for cancer when he successfully treated a woman with pancreatic cancer. We are told that she was jaundiced and had fever, but no biopsy is mentioned. 

Did Gerson know that in those days pancreatic cancer was not infrequently wrongly diagnosed by surgeons?  Even now surgeons are reluctant to biopsy pancreatic masses at operation, because of the real risk of fatal pancreatitis or fistula.

Fever is also not a characteristic of pancreatic cancer, even  when jaundice is present.  Its presence  heightens the possibility that the suspicious mass in the  pancreas was inflammatory, and due to an impacted gallstone, or an infected duodenal diverticulum, or localized pancreatitis, all of which are known to mislead surgeons, and all of which are capable of self resolution.  Did Gerson check to see how certain the diagnosis was, or did he rely solely on the patient’s account?  

The offering of an alternative explanation for the events proves nothing. of course.  My contention is simply  that the claim to be able to cure cancer was and always will be far too important to hang upon the uncertainties  characteristic of so many "alternative" claims  ( for an extreme example see  a common  deceptive breast cancer testimonial.)  

You don't agree?   You are content that should you get cancer you will be offered several dozen different "alternative" treatment methods with not the slightest assurance that  any of them really do anything, or even which ones can be dismissed outright?     O K.  Fine.

Gerson's "famous" fifty cases

Let's look at Gerson’s “famous” fifty cases as published in his book, A Cancer Therapy .  These were collected shortly before his death and presumably contain the cream of the results obtainable with  the final flowering of his methods.

I have annotated them all individually later.  You are encouraged to check them yourself if you think you have the necessary clinical background.

First, a summary of the findings ----  Of the fifty cases (many had multiple problems so the numbers don’t add up):

Two (8,23) did not have cancer at all, or even benign tumors: one was a haemangioma (a birthmark-like vascular mass- treated also by radiotherapy which can be an effective treatment), and one was a case of osteomyelitis following removal of a bone tumour many years previously.

Eight (15,28,30,31,32,35,37,43) almost certainly did not have cancer at the time of Gerson's treatment, on the evidence given.

Four (1,2,5,6) had tumors or suspected tumors that are nearly always benign, namely pituitary tumors or acoustic neuromata, and three of these had medical treatment that would explain the outcomes.

Thirty-one (3,5,7,12,13, 14,15,16,17,18,20,21,24,25,26,27, 30, 31, 32, 33,35,37,38, 39,40, 41,43,44,46,47,48) did not have a biopsy or other incontrovertible evidence of cancer in the target lesions . This by no means excludes cancer, but it leaves varying degrees of room for doubt.  

In fifteen  of these (3,12,11,13,14,16,19,20,21,22,27,37,38,43,48) the diagnosis of a cancerous lesion depends wholly upon  Max Gerson's personal clinical judgment.  In many  (e.g.11,12,37,43,48)  Gerson's diagnosis is unlikely enough to call into question his knowledge and experience of cancer and his awareness of the effects of recent surgery and radiotherapy.  In a number of cases he describes (unbiopsied) lymph gland metastases in extremely unlikely places without comment.   

In eight (10,11,16,29,34,42,45,49) there was fairly definite cancer in the dominant lesion but the outcome can be readily attributed to other treatments received.

In four (3,5,22,42) there was insufficiently long enough follow-up for the cases to be meaningful.

Two (45,49) had clear indications of persistent or worsening cancer despite being treated by Gerson, although Gerson tries to obscure that fact in his account.

Four (4,6,19,50) are uninterpretable but probably consistent with the natural progress of the condition or other treatment received.

This leaves only four (9,33,36,40) that are strongly or moderately suggestive of a treatment effect, always assuming no other treatment was given  that might have produced the effect described, that the biopsies or other evidence given for cancer are being interpreted correctly, and also that none were examples of so-called spontaneous remission.   36 is possibly the most convincing. Gerson does not always state whether other treatments were being used or not, e.g. in 40.

 

I found Gerson too eager to find success in very dubious cases.  This erodes confidence in the accuracy of  his account in the better cases.  He  seems to have obvious clinical shortcomings and limited knowledge about cancer.    It is disturbing that some cases depend entirely upon Gerson's undocumented assertion that other doctors ("twelve tumor specialists" in one case) have given the patient a hopeless prognosis, when  there is no obvious reason  for such an opinion  on the information provided.   Another problem is that despite the Gerson quote with which I have introduced this section, there are hardly any "advanced" cancers of the most commonly encountered types!  There should, for example,  be more than one  patient with obvious,  multiple, characteristic lung metastases if this claim were true.   There are none with obvious liver metastases, and hardly any clear-cut cases of bony metastases.  

On the other  hand, we cannot say with certainty that Gerson's approach NEVER  works.   All we can say is that the number of probably or possibly favourable outcomes arising out of a practice treating  hundreds of cancer patients yearly  over some decades is  not enough to overcome extreme scepticism as to the worth of most of the components of his therapy (coffee enemata, extreme low salt diet, thyroid hormone etc).     We experience a significant number of unexpected outcomes within conventional medical care, and none of Gerson's  theories have found support in half a century of subsequent research.   

Much else about the case histories is understandable given Gerson's background and the times. 

His  preparedness  to include diverse benign conditions and a lot of irrelevant symptoms in  cancer  case reports is partly explained by  his theories. He believed, very naively in my opinion even for those days, that because some contemporary pathologists classified cancer as a degenerative condition it must share features in common with other “degenerative” conditions such as arthritis and tuberculosis (!?).   They thus would be treated the same, and showing benefits for one would confirm probable usefulness for the others.

 Hence also the rather  cure-all flavour to these stories, with often as much emphasis on improvement in his patients' migraine, nervous and other symptoms as on  findings related to the cancer.  

Obviously, few of the cases had a definite enough cancer status to qualify for a modern clinical trial of a cancer treatment.    But Gerson  did have to cope with major limitations to the art of cancer diagnosis in those times.  Needle biopsy and tumour cytology  were in their infancy in the 1940s and 50s, otherwise many of the lesions he thinks were cancer would have been subjected to FNA (fine needle aspiration) or core biopsies.  The quality of radiology was variable.   CT scanning, PET scans and MRI were still the stuff of science fiction.  Clinical ultrasound had not yet been invented, otherwise case 28 may well have been shown to be an example of the quite common haemorrhage into a thyroid cyst, as I strongly suspect.  

 Very few tumour markers were available then, although I wondered why serum acid phosphatase levels were not offered for two cases of suspected metastatic prostate cancer. This very useful marker for metastatic prostate cancer should have been widely available in the 1950s, having been first discovered in 1938 and being well-established by 1960.   

Relevance for the present

Present day promoters of alternative cancer treatments don’t have any of Gerson's excuses.  Cancer is  now a more clearly defined and better understood state and  present technology makes cancer much easier to demonstrate and follow up.   Mistakes in diagnosis and staging can still occasionally occur, but with hundreds of thousands of patients with unequivocal cancer and   easily measurable cancer pathology, some untreated by any other means,   passing through the hands of those promoting the "alternative" care of cancer each year in the USA alone,  it is about  time we saw more convincing contemporary results in support of sometimes extravagant claims.  ( I cannot believe I am even having to say this!!).

The cancer patient deserves better, even if also quite entitled through their special position to make choices based upon hope and hype rather than solid information.   But what to say of so many who think that their scientific and ethical obligations are complete, so long as a few sick, desperate souls can be attracted by a shoddy  testimonial or two?     

Please note that I respect most of those associated with the Gerson method as sincere people. We know this because, unusually for an “alternative” cancer clinic, they tried (through Gar Hildenbrand) to gather some systematic data regarding their methods, deeply flawed though that may be through the generally poor level of patient documentation and follow-up in "alternative" clinics. When we examine the books of other “alternative” clinics we find similar problems, which is why the NCCAM has had such a difficult time in finding “alternative” cancer treatments worthy of further investigation.. 

Have I been too hard on Gerson's cases?

No!   I say again:  the claim to be able to cure cancer is  far too important to too many people to hang upon the uncertainties  that are characteristic of so many "alternative" claims.  

The fifty cases In detail  (as numbered by him):

1. A slow growing pituitary tumor (almost always benign) producing progressive blindness over a period of several years. Treated by radiotherapy and later by Gerson after the patient lapsed into a near coma. Cause of coma not clear, but hypopituitarism could well have played a part.    These tumours rarely get large enough or grow quickly enough to cause coma.  The blindness and radiological changes stayed unchanged. 

Not clear what effect  Gerson treatment had (except that Gerson usually prescribed thyroid hormone as part of his treatment and that could have helped correct  mental obtundation due myxoedema secondary to pituitary failure).

2, Acoustic neuroma supposedly partially removed surgically. Treated when recovering from surgery and still with a variety of neurological disabilities. Nine years later largely recovered from neurological difficulties and otherwise well. Uncertain benefit in what can be an extremely slowly growing tumour.

3. A 17year old patient with neurofibromatosis and suspected malignant change in a thoracic neurofibroma that was removed surgically in 1950.  Saw Gerson shortly after the surgery.   Had previously had surgery for multiple superficial "tumors", presumably the typical benign neurofibromata and the local giantism (plexiform neurofibroma) that that can occur with this inherited condition.

Even though malignancy was never confirmed, and is unlikely at this girl's tender age, and it would be an exceptional manifestation of metastases from the type of cancers that can occur in patients with neurofibromatosis, Gerson regarded 12 subcutaneous tumors  as metastases.   He claims most of these disappeared within a month of him starting treatment and all had gone by two months!   None of the lesions were biopsied.  They are not documented by photography and there is no independent confirmation of this miraculous cure.    It requires a considerable investment of trust to believe this story, especially when  what follows raises doubts about Gerson's objectivity concerning this case.

The patient developed neurological symptoms in December 1955. An ophthalmologist suspected a brain tumor,  as there was papilledema when examined May 1956.    There was some temporary clinical improvement and diminution in papilledema at reexamination in June 1956.    Gerson seems to be claiming this as a response to his treatment.   Against this is the fact that the papilledema was worse at a further examination in October 1956 and diplopia was persistent.  .

Furthermore, she began having "strong" epileptic fits at the end of May 1957.  While these were attributed by other doctors to cerebral tumor,  Gerson chose to regard them as due to food poisoning from poor cleaning of the grinder used for the raw liver treatments.     He dismissed the papilledema, which has now been present and apparently worsening  for at least six months (Gerson does not offer the results of earlier examinations by the ophthalmologist that indicated "advanced symptoms of a brain tumor") thus:  " I observed it also in other cases temporarily, indicating hyperemia in the scars and whatever is left of the tumor, repeated flare ups, so-called allergic healing inflammation."   

 In any case, last contact with the patient was made in July 1957 so that the ultimate fate of the patient is unknown.

Suspected brain tumor never confirmed. Malignant change in the thoracic lesion never confirmed. A dubious story on several grounds, including the mere eighteen months follow-up of the patient from the time a brain tumor was first mooted. 

4.Another brain tumour (spongioblastoma) in a 16 year old, where patient died. Had two operations but details of second not given, and Xray therapy was advised but not mentioned whether performed or not. Patient ultimately died seven years after initial operation, but attributed by Gerson to cessation of his treatment.

5, Clinically thought to have acoustic neuroma (normally benign) and ?evidence of pituitary tumour on xray, but no diagnosis established.  Only two and a half years of follow-up. Pointless case.

6. Suspected pituitary tumor (usually benign) four year follow-up period- unexplained previous neurosurgery evident on skull x-ray  - known to have syphilis since age of 21 (now 47) and previous "psychotic episodes" - Presented to Gerson July 1953 with headache and loss of vision and dizziness. Skull  x-rays  showed minor changes raising the possibility of a pituitary tumor.  Said to have "no special complaints" in Nov 1955, but no significant improvement in vision when last assessed and advanced optic atrophy (numerous possible causes including syphillis) present.    Too many unknowns here.

7. Undiagnosed and unbiopsied spinal tumor, surgically decompressed with clinical improvement after the surgery while on Gerson's treatment but later pursuing a relapsing course . Indefinite. Case given to NCI.

8. Haemangioma of spinal cord surgically decompressed. Not cancer. Radiotherapy used.  No reason to attribute partial recovery in neurological symptoms to Gerson.

9. Chorionepithelioma.   Diagnosis seems fairly certain. Total hysterectomy  April 9 1953 because of persistent bleeding and positive pregnancy test after curettage for miscarriage on February 17th, but operative findings and histology not described.  Less than a month postoperatively  (May 4 1953) Dr Gerson diagnosed lower abdominal masses as metastases on clinical grounds –(and with near absolute improbability, in view of the impossibly short time frame, the failure to describe extensive cancer deposits at the recent surgery,  and the fact that he also says "It was almost impossible to examine her, as every little touch was painful".)

Pregnancy test (an indication of chorionepithelioma) remained positive until June 12 1953 but not mentioned thereafter.

The main basis of Gerson's claim is two small (5-10mm) lung nodules regarded as metastases. These were evident on x-ray on 22nd May 1953, but not easily seen on x-ray a bare fortnight later (3rd June), although other somewhat similar small nodules in size and density persisted and are evident on chest x-ray in 1957.   A radiologist's report on 35rd May 1957 says "The metastatic nodules previously noted in May, June, August 1953, in the right fifth interspace, as well as the left 6th interspace, are no longer in evidence."   

Hard to know for sure about this case. The x-rays suggest the possibility of minimal metastatic disease without being at all characteristic. I will class this as a possible effect of Gerson, but with some reservations in view of the minimal evidence of persistent cancer at the time he saw her, and in spite of his extremely dubious and otherwise unsupported diagnosis of abdominal metastases..

10. A case of longstanding hyperparathyroidism (nearly always due to benign adenoma or hyperplasia) previously treated by radiotherapy, with a breast cancer treated surgically . Not clear what is claimed for Gerson’s treatment..

11. Garbled history. August 1955 had removal R testis and paraaortic nodes for embryonal cell carcinoma of testis. In March 1956 shown to have metastases of to lungs and given additional radiotherapy. Seen by Gerson in April 13th 1956.  X-ray May26th 1956 metastases smaller and some no longer visible. X-ray chest April 30 1957 no metastases seen.

X-rays look convincing and seems to be a clear treatment effect, but  ? simply due to the radiotherapy in what is normally a very radiosensitive tumor. The time frame would suit the latter and there is only two years of follow up.

This patient also had a mass in the right groin that disappeared after about four weeks of Gerson. Initially Gerson describes bilateral inguinal glands which would be an extraordinarily  unusual metastatic pattern from a testicular tumor.   They metastasize to para-aortic glands, not inguinal ones, but Gerson apparently  did not know this. No biopsies. 

12. Had removal of melanoma ankle and sub-inguinal block dissection for melanocytic sarcoma, July 1, 1946. At end August, i.e. within two months, had two further "recurrences" --- " one as large as a tomato above the femoral resection scar, a large dark subcutaneous mass, and the other a hard nodule in the left adductor triangle below the scar of the last operation". She had some lymphoedema at the time.. 

A hopeless prognosis was given, according to Gerson, but why? (see below).

After three months of Gerson treatment both masses had disappeared. On two occasions the masses became red, hot and swollen. Last known well in 1957.

The masses were not biopsied.  Now, as a surgeon involved with this kind of work I say it would be extraordinary for a mass this size to develop from recurrent cancer in this short time frame. The common postoperative haematomata and early wound induration are far more likely explanations for the masses and will resolve in the time frame described (the skin over a haematoma will often be black and this presumably led a somewhat naive Gerson to think of recurrent melanoma)   Although numerous glands were found involved at surgery stage 11 melanoma has a fair prognosis for cure with surgery alone.

13. Had melanoma removed from back (right scapular region) March 1950. Lump found under R arm October 1950 and found to have two small (1,5cm) firm glands. In November 1950 had a radical arm amputation (Good Heavens!!! Far too radical a treatment on today's knowledge). Not stated whether glands actually involved my melanoma or not.

Saw Gerson for first time on October 25 1951. Complained of lump under left ear (developing over three weeks) and cough. A "large black swelling" swelling left side of neck and "three smaller glands". Chest x-ray clear.

On November 3rd 1951 (nine days later!!!) the main mass had disappeared and no glands now palpable. No biopsy. No photographs. Seems an improbable outcome on these facts, unless a haematoma or abscess discharged itself.   The diagnosis of cancer depends wholly on Gerson's claim. Even if instant total tumor necrosis (death) occurred with Gerson's treatment it would take any sizeable mass many weeks to disappear completely. But I suppose a dating error is possible.

Last known well 1957.

A chest xray shows no definite evidence of metastases to my eyes.

14. 30 year old male had a small hard nodule and a mole removed from left side of neck April 1954. Pathological examination revealed metastatic melanoma in a lymph node. Lung x-rays clear.

May 25th 1954 "Patient went to Portland clinic, Portland, Oregon, as new black nodes appeared (within one month?). The doctor recommended radical operation of both axillae, the left half of the neck with removal of the muscles and removal of glands in groin".

???? Some serious questions about this. It is not common for melanoma in lymph nodes to appear black, unless very large, and these glands apparently were only present for a short time.   I also can understand a block dissection of the neck being advised in this case if this was the only known site of cancer,  but not if melanoma was suspected in the axillae and groins, since spread to these areas would mean quite incurable disease.   And how often will glandular secondaries occur in groin glands from a melanoma on the neck?!!!   No other biopsies performed.

First seen by Gerson May 27th 1954. “There are several nodes at the neck, in both axillae and groins. Treatment immediately applied. In a few weeks all glands and nodes <sic> disappeared and the patient remained in the best of health and working condition up to the present time". (Last contact 1957)

Glands now not black? No comment about an extremely unusual pattern of nodal metastases from melanoma, if these were metastases?

I am not convinced that Gerson was treating active cancer here.  .The history and clinical features are somewhat baffling and seem designed to reinforce a weak diagnosis of metastatic melanoma. If only one gland was involved by melanoma and removed at the initial surgery then the results might be expected over this short period of follow-up.   Even ultimate cure is possible,  although it would be risky not to remove the other neck glands as the doctors advised.

15. Had fibrosarcoma removed from L shoulder on July 5, 1950. "When the shoulder started to swell and the operation wound began to secrete, the physician assumed a regrowing of the tumour and recommended radical amputation." This does not ring true, as the patient first saw Gerson on July 25th, far too soon to be diagnosing a recurrence on the basis of findings that could have many other explanations so soon after surgery. Either Gerson is exaggerating in a few cases like this, or the other doctors he was dealing with were incompetent.

No biopsy. No reasonable certainty that residual cancer was present. Improbable history, if dates are correct.

16. Large retroperitoneal mass. Inoperable. Biopsy report not given but said to be a lymphosarcoma. Given twenty x-ray treatments in September and October 1949.

"Twenty deep x-ray therapy treatments were applied in September and October 1949. Two more masses disappeared after X-ray treatment for about six or seven months. Then she felt weak, tired, nervous, could not sleep, and a growing mass was palpable again in the left part of the abdomen near the navel."

Seen Sept 17 1950. "Examination revealed in the left lower abdominal quadrant a large mass with irregular surface, palpable at the depths of the abdomen just in front of the spine, extending downwards and to the left. ----------- After one month lump was no longer palpable."

Last known well 1957.

Comment--- Difficult to interpret. Again everything depends upon Gerson's clinical description, and if there was a mass present, was it a residue of one recently treated by the  radiotherapy?  

17. Osteofibrosarcoma (or giant cell tumor <usually benign>-  said to be more likely by other pathologists) of mastoid process. Treated by radical surgery on Jan 23 1947 and fifteen “deep xray” treatments.

Gerson states "Drainage remained, the tumor regrew, and a hopeless prognosis was given to the child's parents by both radiologist <?> and surgeon."

But why, so soon after radical surgery and radiotherapy? This is another inadequately  unexplained medical pronouncement being used to as the sole basis for a Gerson case history. There were no further biopsies, and Gerson's description of the patient when first seen on March 13th is merely suggestive of healing delay after surgery and radiotherapy rather than tumor recurrence: "There was a large suppurating cavity, eleven cm deep (?) filled with gauze packing, which required changing every day." .

Had a torrid further course with abscesses and other problems but last known well in 1958.

No certainty of persistent cancer and no clear reason to postulate any effect of Gerson here.

18. Large cell lymphosarcoma of glands in right lower abdomen. Resected June 1951, and given radiotherapy, In September 1951 a new mass appeared and disappeared after further radiotherapy.

A few months later "new glands appeared, took spleen extract injections---".

Seen by Gerson March 24 1952. Reported seeing further glands from time to time. "On examination a larger gland (than what?) in left axilla, two small tumours in left lower quadrant, a few glands in right groin, more in the left. The place where he got the first mesenteric gland near the right iliac bone appeared to be free".

" In the following months the glands disappeared." But Gerson describes that at the last examination in September 1953 there were still glands in both axillae. Last known well 1957.

No biopsies to show that this cancer was ever extra-abdominal. . Many of Gerson’s cases depend upon his finding of glandular masses that were never biopsied.

19, Lymphoblastoma in a 38-year old treated by repeated radiotherapy. Glands in groins, right axilla , mesenteric and bronchial glands. .

"The last treatment was applied in March 1947. However "glands regrew and the Mayo clinic decided not to take any more biopsies , as it might have activated new spreadings. Patient was treated twice more once in a clinic and once by a doctor."

When first seen March 10th 1948 there was a large mass of glands left neck.  A new tumour mass appeared at the base of the right sternomastoid muscle, the size of a small tomato, hard, indurated not growing, and no other glands were palpable.

Re-examination January 30th 1950 showed smaller harder mass in this region. Impression of calcification. "It was shrunken in the last year."

Patient died July 1953, about five years after initial treatment. Gerson appears to be claiming some cancer regression (to his judgment) from his treatment, and that the patient died after not following his treatment, but details of the case sketchy.

20 Lymphosarcoma.

11- year old  who on November 26 1954 had 2 cm lump removed left upper arm near deltoid insertion.  Histology lymphosarcoma, December 10 1954 had dissection of axillary lymph glands which also contained lymphosarcoma. Subsequently had sixteen days of radiotherapy. Chest xray clear. Amputation was "recommended and considered" when last seen by the oncologists in early January 1955.

There was no mention of other sites of cancer by the referring doctor, and it is highly unlikely she would have had aggressive treatment such as amputation considered if she had remote  sites of cancer. Nevertheless, Dr Gerson, a mere month later, on February 12 1955, describes "nodes" and "other glands" in the scar on the arm, in both groins, in the neck, in the scar in the axilla, and also large mass in the middle of the abdomen.

In October 1955 her own doctor reported no abnormal findings now, and patient was alive and well in June 1958

Everything here hangs on Dr Gerson's  clinical findings.   Did the surgeons miss all this other  spread when considering amputation of this little girl's arm?   Unlikely.   In other cases listed here Gerson interprets lumps in surgical scars in the early months after surgery as recurrent cancer when they are at least as as likely to be due to a variety of postoperative effects.   There is also a pattern of Gerson diagnosing malignant gland enlargements in unlikely places.  Can we trust him regarding the abdominal mass?   Abdominal examinations require skills that not all doctors possess and I would give the surgeon's opinions more weight than Gerson's...

No biopsy.  No independent clinical confirmation of widespread cancer.

21 Lymphosarcoma, This patient had several operations for involvement of both axillae with giant follicular lymphoma, with multiple nodes last excised 17th November 1953

Seen by Gerson April 1954. "Two larger masses were below the left mandibula <sic>. In addition there were a few glands in left axilla. All these pathological findings disappeared within three weeks." No biopsy or photograph.  Recurring glandular enlargements described by Gerson over the next few years, but responding to his treatment when faithfully applied.

Last known well in August 1957.    Can any treatment cause sizable deposits of cancer to disappear completely in a three week time frame, even if it causes immedaite total tumor necrosis?   It all hangs upon Gerson's clinical judgment, which is rendered suspect by the readiness with which he has diagnosed recurrent cancer in glands under unlikely circumstances in other cases.

22 Abdominal lymphoma. Inoperable.

Presented with intestinal obstruction and a tumour was partially removed at operation on January 9th 1954. 40 xray treatments given after recovery for surgery – dates not stated..

Seen by Dr Gerson on April 2nd 1954. Dr Gerson found two masses in the right lower quadrant of the abdomen, painful to touch. Found to be settled in May. Last known well June 22 1956.

What were the masses? Lymphosarcoma is a very radiosensitive cancer and the masses may have been deposits of the cancer still responding to the radiotherapy. Another possibility is an post-operative/post-radiotherapy artefact. We can't know for sure and follow-up also too short to make any serious claims..

23 Myosarcoma. and osteomyelitis. Growth on femur removed and treated by xray with multiple subsequent operations for osteomyelitis with sequestrum formation. Initial operation in 1923 and last in 1956 to try and get healing. No evidence at all that Gerson was treating cancer, but he is taking credit for ultimate healing.

24 Paget's disease of bone, No evidence that she had cancer. A quote from a doctor's letter describes a sterile abscess being drained on the right side of the neck.  No histology, but this is what Gerson seems to be referring to as cancer.

25 Hilar enlargement on x-ray. No diagnosis ever made.

26. Malignant mixed parotid tumour. Operated upon March 1946. In March 1948 found a mass below right ear and another in the other parotid gland. Refused further surgery.

Saw Gerson Sept 19 1949. "The right parotid gland presented tumour mass, the size of a walnut and some swollen glands below the mandibular angle.. On the left parotid, she presented in front of the ear a round, hard movable mass, the size of a hazel nut."

The right mass subsided somewhat with Gerson's treatment but when last seen in 1957 there were still lumps about the size of a hazel nut in both parotids.

A possible effect of Gerson, but not definite in the absence of pathology/cytology. Inflammatory masses can occur in the parotid gland, and are not infrequently the source of suspicious masses at operation. After surgery other pathologies such as stitch granulomata can cause persistent lumps.

27 Recurrent Hurtle cell carcinoma of thyroid and sigmoid colon cancer. both treated surgically, the bowel cancer in 1946 and several thyroid operations for cancer between May 1940 to December 1948.

First seen April 1949. Two hazelnut sized "nodes" “around the thyroid” (?postoperative effect) . Also two "tumors" palpable in left lower quadrant of abdomen.

"During the following years all tumors disappeared." Patient last known well in July 1957. No biopsies..

One of many cases where only Dr Gerson's clinical findings and his own interpretation of them points to the presence of cancer.

28 Carcinoma of thyroid? In November 1945 presented with 5X6 cm mass in thyroid, only noted three weeks(!) previously and growing rapidly. Aspiration biopsy diagnosed "carcinoma" (?actual wording of report). Refused operation.

Seen By Gerson March 1946. Clinical examination of neck at this time not described, but Gerson states "Tumour disappeared in about six weeks."

Comment. Cytology in those days would be extremely suspect, and even now can be unreliable in thyroid masses. Very unlikely that a 6 cm thyroid cancer would appear in three weeks and disappear in six. Rapidly developing thyroid lumps are usually due to haemorrhage into benign nodules or cysts and they will subside as quickly.

29 Carcinoma of breast. R radical mastectomy March 29 1945. "Marked involvement of axillary glands".

IN November 1949 was found to have lesions suggestive of metastases in 5th and 6th thoracic vertebrae. Treated by radiotherapy, male hormones and 20 injections of Krebiozen.

In February 1951 "Artificial sterilisation" << In a single woman at least 47 year old? Almost certainly had removal of the ovaries rather than the more common tubal ligation of these days. This was a common treatment of metastatic breast cancer in those days, and capable of producing prolonged remissions.>>

"Because of progressive deterioration, she sought treatments in several clinics all over the country.” What treatments?

“May22 1952 First seen. Complains of very intense pain in upper back, both arms, shoulders, very weak, extraordinarily nervous. She wrote her own "death sermon".
“In six months restored to full working power, free of pain. Has been working up to the present. " (last report August 1957)

From 22nd May 1952 to Ist August 1957 there is a series of x-rays showing sclerotic lesions in the fifth and sixth thoracic vertebrae gradually resolving.

An impressive case, but difficult to be sure how much Gerson contributed. Patients with a relatively long latent period (41/2 years) prior to the development of metastatic disease, as in this case, are more likely to respond to hormonal treatments such as removal of the ovaries, and eight year survival is not very unusual.

30. 47 YO Ca Breast. Right radical mastectomy May 1945. Had severe postoperative wound infection. Adenocarcinoma with "diffuse axillary lymph node involvement" Radiotherapy apparently given postop, but dates of this not stated. At review Oct 1 1946 Some evidence bronchitis. Xray clouding of "upper mid-third of right lung. "had the appearances of xray infiltration but not necessarily metastatic in nature. Family was advised no further treatment would be of benefit." <Why? Treatment of what? --PM>

Gerson saw patient Oct 29 1945 describes cachexia, cyanosis, severe cough, dyspnoea increasing left adenopathy <always the lymph nodes!- and an extremely unexpected site for recurrence of a RIGHT breast cancer -PM> , extreme weakness, nausea and vomiting, abdominal distension and enlarged liver.

Gerson actually admits that there was no objective evidence of cancer in this case. The radiological features are very suggestive of radiation pneumonitis, and the shadows were described by Gerson as appearing to be "less marked' on xrays. in 1949. Last known well in 1957.

Almost certainly not cancer. 

31. 61 year old . March 20 1947 right radical mastectomy for anaplastic cancer with involvement of axillary lymph nodes. First seen by Gerson June 26 1947. "Patient showed a larger swelling <not clear what it was larger than -PJM >  which was located at the right fifth rib near the sternum. There were a few small glands in right axilla <despite radical mastectomy? – again unlikely gland involvement PJM>."

No biopsy and such a lump within the operative field  three months of such radical surgery would almost certainly be a resolving haematoma or seroma rather than recurrent cancer.  "Within five weeks the tumor and glands disappeared and other symptoms were greatly reduced."

Last known well 1957.

No evidence persistent cancer.

32 44 year old . Had left mastectomy March 16 1949 for a very small breast cancer. No axillary gland involvement. Had more glands removed left axilla in March 1950 and again no cancer found.

Further small lump noted left axilla in Feb 1951 and on removal was found to contain "metastatic carcinoma, probably of breast origin". Treated by radiotherapy in April 1951

First seen by Gerson June 12 1952. " --- a new gland was found in the RIGHT axilla <Again Gerson finding glands of dubious significance. Cancer of the breast does not usually spread to the other armpit -PJM>  Examination revealed a new node LEFT axilla the size of a walnut, just in the scar where the second and third operations were done." No biopsies.

In June 5 1953 "Tumor and glands disappeared.  Later we found -at the place of the tumor a small very hard probably calcified scar formation".

Only the presumption of cancer here. Quite possibly an old haematoma or stitch granuloma.

33. 62 year old woman. This could have been a good case if better documented. Had surgery performed for "lump and ulceration" below right nipple.  "Mammary cancer infiltrating skin" in pathology report dated 12/5/47, elsewhere described by Gerson as Paget's disease. Patient refused further surgery. Nature of original surgery i.e. whether incision biopsy or excision not stated.

When seen by Gerson (on same date given for the  pathology report) had open ulceration and a "larger infiltrating mass". After four weeks the induration was barely palpable and the ulceration appeared to be healing. Complete healing by February and remained well until at least 1957.

A remarkable case if the ulceration and induration were cancerous as opposed to a wound breakdown after an excision biopsy.  Unfortunate that no biopsy was taken of the ulceration.  Many breast cancers will be cured permanently by adequate excision-biopsy <1>.  This case was published with pictures in Exper. med. and Surg. Vol V11 No 4 1949.

One of the better convincing cases, but not conclusive.

34. Advanced BCC on nose ultimately treated by amputation of nose. Not clear what is being claimed for the Gerson treatment, as results entirely attributable to the aggressive surgery.

35. Had BCC excised from below and posterior to R mastoid region August 1944. In April 1945 <in my opinion too early to develop any substantial recurrence from such a slow growing tumour as BCC -PM> a large lump appeared. No biopsy. Someone suggested Xray treatment but specialists refused <why? Because diagnosis not clear?-PM>.   Refused surgery.

When seen by Gerson in October 1945 --- in severe pain, eyes closed by swelling, face more and more cyanotic. Mass the size of a small fist below the right mastoid process and fixed to the base of the skull.

"Diagnosis of several neurologists uncertain-probably a sinus thrombosis" <a cavernous sinus thrombosis- an infective lesion does seem the most likely explanation, as it is not clear how a malignant mass in the mastoid region would cause such findings.-PM>

" In four weeks the tumour mass had almost disappeared." Face no longer swollen. Last seen well 1957. This case was presented to a senate subcommittee.

Summary. No biopsy. Pathology not proven. Neck sepsis with secondary cavernous sinus thrombosis would explain the findings.

36. BCC? upper lip Biopsy "closely packed epithelial cells in subcutaneous tissue." Many years "little wart" below patient's nose. 11/2 X 2cm rodent ulcer at junction of right nostril and upper lip forming deep crater when seen Feb 3 1946.

Healing apparent July 1946.

A published case. If no other treatment and if the biopsy typical of BCC this  counts as good case.

37. Basal cell epithelioma (on biopsy)  left foot. Recurring lesion on sole of foot since 1929.  Treated by cautery and brief radiotherapy. Finally,  had excision and graft October 1945. Treated by Gerson about one month later when described as having deep ulcer 21/2 X 11/2 cm. <Once again, far too early for such a large tumor recurrence --PM >  Almost healed in four weeks.

Entirely consistent with failed skin graft after wide excision of a normally readily cured kind of cancer. . No reason at all to assume  persistent cancer.   The inclusion of such cases seriously undermines Gerson's credibility.

38 "Regrowth of left kidney sarcoma" At operation Feb 1945 had large retroperitoneal tumor removed.   Shelled out until apparently arising from pedicle attached to left kidney which was also removed. Described as small round cell or spindle cell sarcoma. radiotherapy given in both 1946 (18 treatments) and 1947 (42 treatments!!!). terminated in august 1947, when "could no longer stand these treatments". . Generally unwell.

Seen in October 1947. Although referring surgeon said "could not find any gross mass" Gerson described "large tumour mass ---- a little below the old operation scar".

Gradually improved and last known well 1957.

Most of patient's illness at the time Gerson took over her care could be attributed to the radiotherapy. No independent confirmation of persistent cancer.

39.”Prostate cancer with metastases to lumbar spine”. 75 year old man. August 1951 diagnosed and treated with several types female hormones. Gave fifteen years history of urinary difficulties and saw Gerson May 1952 with recently diagnosed metastatic prostate cancer.. Very large prostate with nodular surface left side. Xrays showed osteosclerosis and osteolytic processes consistent with prostate cancer. July 1953 x-ray reported changes a little improved. Urination became more difficult and had prostatectomy November 1955. No cancer found in tissue removed. Last seen 1957 and reported as well.

Unable to interpret the x-rays well on the photographs given, but if the patient had metastatic prostate cancer, the results would be consistent with the good results that often occur in the elderly with the hormonal treatment this patient also received.  .

40. Cancer of prostate with suspected metastases. Clinical and radiological improvements claimed over several years.  Similar to previous case but no mention as to whether received concurrent hormonal treatment.  No biopsy and difficult to interpret. 

Curiously, this patient had his serum alkaline phosphatase measured monthly and the results are tabulated.  The serum acid phosphatase might have been a much more relevant test.   Was this an error?   Did Gerson mean to report acid phosphatase levels, but misprinted?  Either way the results offer little support for either the diagnosis of metastatic prostate cancer or any response to treatment over the four years.    

41. "Bronchogenic carcinoma. Bronchoscopy and biopsy revealed malignancy" No details as to pathological findings otherwise. Had total right pneumonectomy October 1949. In June 1950 cough, weight loss, anaemia and fever. Thought probably recurrent cancer, but no definite evidence of this. First seen October 1950 . Was receiving Xray treatments. High fever, shortness of breath. Gradual recovery over some months and also well in 1957..

No proof of recurrent cancer. Original prognosis uncertain.

42, In November 1953 cough bronchoscopy negative March 1954 but washings showed few nests of bizarre cells, mucus and pus. "positive for malignancy". Xray showed "tumour left lung". Had deep xray treatment. recovered voice and lost cough for a while.
Developed neurological symptoms in legs, but these never explained, as myelogram showed no cord compression - ? from primitive radiotherapy. Last known well 1957. Still disabled. radiological findings never quite resolved and still substantial mass in left lung on last xray shown in 1956.

Not clear what Gerson treatment contributed. Confused clinical picture. Radiotherapy possibly played a part. Short follow-up.

43, “Left maxillary gland tumor, metastases in right upper lung.”

Had submaxillary gland tumor (most common would be a benign pleomorphic adenoma) removed February 1942. Pathology not stated – why?). Three months later developed cough with bloody sputum, severe pain in right chest with difficulty in breathing. Bronchoscopy shows some congestion and narrowing of bronchi. No biopsies. Symptoms settled over a month or so.

X-rays: “an irregular opacity with varying degree of intensity, occupying right upper lung field. Some streak-like opacities extending from the right hilum upwards.” Changes nearly cleared within five weeks.

Comment. Neither the xrays shown nor the clinical picture described suggest pulmonary secondaries, and no evidence given for patient having a malignant tumor in the first place. Probably had pneumonia or pulmonary infarct due to embolism.

44. 45 year-old woman with carcinoma of rectum treated by resection of rectum and anus.

Operation report March 1946: “one stage abdominal procto-sigmoidectomy with partial preservation of the sphincter mechanism (and I assume a pull-through procedure with anastomosis of the sigmoid colon to the anal skin, since there is no mention of colostomy). No metastases seen at operation..

Pathology:” section of rectum and anal canal and anus 14.0 cm long.” Grade 2 adenocarcinoma on histology, not invading through full thickness of bowel wall and no glands were found (i.e. should be a good prognosis lesion).

Surgeon states “at the time that I examined her in July 1948, she had a recurrence of carcinoma outside of the rectal wall, which means that the recurrence is metastatic.” No biopsy and no mention of any lesion in the bowel itself. However rectoscope examination (by whom- Gerson?) describes “recurrence of cancer growth and in addition some metastases outside the rectal wall” (also in July 1948). This is difficult to interpret, as any visible recurrence would presumably have been biopsied by the surgeon, in order to be sure of the diagnosis.

Symptoms at that time consisted of abdominal soreness, difficulty in defecation and painfulness and difficulty with enemata.

She improved quickly on Gerson’s treatment and a  gynaecological examination in 1949 described only some thickening in both adnexal regions consistent with post-operative changes.

Comment: Difficult to interpret this case. After resection of the rectum there is normally intense induration of the surrounding tissues and scarring that can be quite misleading, in my experience. The absence of a biopsy means this case is no more than a possible effect of Gerson.

45   64 year old man who had PR bleeding and difficulty in defaecation when seen July 1954. Barium enema  June 1954 showed a filling defect suggestive of a cancer in the lower sigmoid colon.  Two months later repeat x-ray showed a typical annular carcinoma.

Patient refused operation. Treated by Gerson, but motions became narrower and more frequent, but with less blood and mucus.   X-ray (films not illustrated) in April 1955 now showed obstruction at the cancer "which had to be removed".  After surgery the patient did well until last seen in August 57.

Comment: This case describes deterioration in colon cancer while on Gerson’s treatment. He tries to interpret it to his advantage, thus: “On April 18 1955, the xray report revealed that there was a stricture where the cancer ulcer was localized before. He found the cancer not extended, but, on the contrary, reduced; however, there was a partial obstruction which had to be removed.”

This ignores the findings on the three barium enema examinations that are illustrated,  labeled  6/23/54, 8/20/54 and 2/8/55.  These show progressive deterioration  in a distal sigmoid carcinoma, most clearly shown by worsening involvement of the upper margin of the sigmoid.  There is an obviously much larger cancer in the last film despite some overlapping of the bowel loops in the film chosen for display..   

The April 1955 radiologists report (regarding the films not illustrated) describes the rectum and distal sigmoid dilated by the pressure of barium while attempting to fill the colon. “after sometime <sic -presumably  “some time” -pjm> also the proximal sigmoid filled out <and?> between them there is a ring-like deep indentation.”  The portion of the report quoted does not mention the signs of improvement Gerson refers to.   It can also be quite difficult for radiologists to demonstrate the full extent of obstructing lesions.

This case reveals a unflattering side to Gerson, or at least inferior clinical acumen.   The patient clearly got worse on his treatment, behaving as would an untreated cancer.

46. A brief account of a woman with cervical cancer presenting with vaginal discharge in January 1946. Treated by “deep x-ray treatments for two months. In April 1948, “a gynaecologist found new tumors, but advised that no more x-rays should be given at present.”

Saw Gerson in June 1046. On examination no cervix but a crater covered with pus and some nodules in left vaginal vault and towards rectum.

Last known well in 1957.

Comment: No further biopsy and uncertain clinical findings, especially so soon after radiotherapy.

47. A similar case of cancer of the cervix treated by both radium and xray.

Saw Gerson six months later with large ulcerated cervix and multiple unrelated symptoms. Not biopsied. Last known well in 1954. Could well be another  radiation ulcer.

48. A case of papillary carcinoma of the bladder treated by fulguration and radon seeds.   Saw Gerson five months later with bladder pain, passing blood and pus (consistent with radiation cystitis, the residue of which was noted at a later cystoscopy) but also with a “growing mass of glands in the left groin”. These were not biopsied, although this would be a very unusual site for metastases from a bladder tumor. . Also “two smaller tumors palpable in left lower quadrant” (of abdomen, presumably).

Yes, the patient got better and the glands went away.

No proof of persistent cancer. Unexplained inguinal lymphadenopathy not likely to be related to the known pathology.

49. This case had a bare two year follow-up of a patient who initially had multiple (eight or nine) papillary transitional cell carcinomata (normally relatively easily treated cancers, but which can progress to more invasive and dangerous forms). Initially diagnosed August 1955 and all tumours resected at cystoscopy in two separate sessions. In June 1956, and again in May 1957 further papillomas were found and treated. A cystoscopy in September 1957 was clear. No information as to subsequent progress.

This patient was advised initially to have a total cystectomy, because of the risk to her of more serious bladder cancers. Her survival for a mere two years without major problems is apparently significant to Gerson, but is not expectional.  Note also that she developed further papillomata despite nearly two years of his treatment (from Sept 1955 to May 1957, when three further tumours the "size of cherries" were found on cystoscopy.)

No evidence of a Gerson treatment effect, in fact his treatment failed to prevent further tumours..  Follow-up too short to know that this lady’s problems are over and that she escaped total cystectomy.   

50. A very sketchy account of a 71 year old woman with a supposedly inoperable adenocarcinoma of uterus, treated by radiotherapy and with a fistula between the bladder and vagina. Although a biopsy report is quoted as saying "adenocarcinoma of body of uterus" this raises some questions. A cancer of the body of the uterus is not likely to cause such a fistula, or reach the inoperable state described, or be treated with aggressive radiotherapy in 1952. It is also not clear from the description whether the fistula was caused by cancer or by the radiotherapy. The history in some ways favours a cervical cancer which is more likely to be treated by aggressive radiotherapy and more likely to end up with such a fistula. But they are usually squamous cell carcinomata, not the adenocarcinoma Gerson states. Did Gerson actually have a pathology report? He does not show indications of directly quoting one, such as by using quotation marks, as he does in other cases.

Gerson also started treating her in the early months after radiotherapy and some of the effects he describes are almost certainly from that and the urinary incontinence rather than the cancer. He also describes masses "around the vagina", which is also unlikely with a cancer of the body of the uterus. His summary of the case includes "metastases to the bladder", something for which no evidence is offered, and which suggests a poor grasp of cancer pathology, as this is most unlikely with any uterine cancer, or for that matter any other kind of cancer other than direct invasion from a cancer of the cervix. I think this adds to other cases where Gerson seems to want to exaggerate the pathology.

The fistula was persistent, but patient was otherwise last known well otherwise four years after the radiotherapy.

A lot that is unclear about this case, but in view of the radiotherapy in a radiosensitive cancer, it is difficult to attribute the  cancer control to Gerson.

References.

1. Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456-61.

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