Ralph Moss is a highly respected science writer and critic of conventional cancer treatment. Dr. Moss obtained his doctorate in classics from Stanford in 1974. He started work in the cancer field in the public relations department of New York’s Memorial Sloan-Kettering Cancer Center, one of the premier cancer centers in the world.
Over the last thirty years Dr. Moss has written many books on cancer, cancer treatment, and the cancer establishment, including Cancer Therapy: The Independent Consumer’s Guide to Non-Toxic Treatment and Prevention; Herbs Against Cancer: History and Controversy; The Cancer Industry: The Classic Exposé on the Cancer Establishment; Questioning Chemotherapy, a powerful and intelligent critique of chemotherapy; and Complementary Oncology with Josef Beuth, M.D.
His books provide a wealth of information on health and healing. He probes scientific and statistical evidence to reveal the shocking truth that chemotherapy is mostly inappropriate, ineffective, and in fact dangerous for most of the people who receive it—yet up to six hundred thousand Americans every year get chemo at their doctors’ recommendations.
When asked what lessons he has drawn from his thirty-plus years as a science writer, he says, “Once we start to reshape our writing about science to accommodate the wishes of doctors, patients, or institutions, rather than the facts, we are sure to end badly. We must always speak to cancer patients with a finely balanced mixture of compassion and honesty. Finally, we must always demand a fair evaluation of all treatments, conventional and alternative. Only on a level playing field can the true value of any cancer therapy be determined.”
I found speaking with him to be not only fascinating but enormously enlightening. His frankness is refreshing. He is a scholar not driven by the almighty dollar. You will enjoy and be shocked by what he has to say.
SS: Thanks for speaking with me, Dr. Moss. Tell me, why do doctors keep prescribing chemotherapy? If we know it’s not going to do any good in most cases and it robs the patient of all quality of life, why continue?
RM: It’s good to speak with you. First of all, let me chop this answer into little pieces. I am really only interested in what works and what doesn’t work. I’m especially interested in proof of effectiveness or ineffectiveness, and especially proof of the effectiveness of treatments through the gold standard of randomized controlled trials. This is what I learned from my nearly ten years of involvement with the National Institutes of Health, when I was an advisor for what was then the Office of Alternative Medicine.
The government and the medical establishment have a very high standard of proof, called “increased overall survival through randomized control trials.” The problem is that this standard is rigorously upheld only for the nonconventional cancer doctors; it’s bent for the conventional doctors.
SS: You mean the rules are bent for pharmaceutical-company-sponsored treatments?
RM: Yes. Because of that, you don’t have a level playing field. In fact, the people who are least able to perform those trials, and least able to afford to have them done, are the ones from whom it is most often demanded.
SS: You are speaking about alternative doctors who are in the trenches and having successes with patients?
RM: Correct. By and large, the people who have the money, and the organizations that have the resources and the knowledge to do those trials, aren’t required to do them.
There’s a terrible injustice in the way that drug development is set up. It’s an injustice to advocates. New, less toxic, and more promising treatments are never adequately researched to the point where they could be scientifically confirmed.
SS: The problem being the seeming partnership of the FDA with the pharmaceutical companies?
RM: Well, that’s the way the system works. I don’t think the FDA and the pharmaceutical companies are getting together and rubbing their hands and saying, “Isn’t it wonderful to screw the public?” At least, I hope not.
SS: Yes. But certainly the events of the last few years have given us enough reason to be cynical, given what is happening in the country relative to pharmaceuticals as a whole. I mean, just watch TV any one night and you will end up thinking you need a drug for something.
RM: Well, what I saw at Sloan-Kettering when I was there from 1974 to 1977 was a more complicated picture. The same people who covered up positive animal experiments with laetrile, a promising nontoxic cancer drug, were the same people who a couple of years before were trying to get clinical trials done with laetrile.
SS: I don’t understand.
RM: These people from Sloan-Kettering went to Washington on two occasions, in 1974 and 1975, to plead with the government and the powers that be to let them do clinical trials. They believed that laetrile had promise. The testing on their animals was coming out positive. Initially the people from Sloan-Kettering were perceived to be the “good guys.” But the same people who initially tried to break the blockade against nontoxic agents in general, and against laetrile in particular, lost their nerve. The price of continuing to present this drug as a viable answer in the face of blistering opposition from the FDA, the American Cancer Society, and somewhat from the National Cancer Institute would probably have been the ruination of their careers.
SS: In other words, keep your mouth shut or you’re out. That’s terrible.
RM: Right. When I got up and said these things in November 1977, I was fired from Sloan-Kettering because I had broken ranks with the party line, which had declared that laetrile was completely ineffective, and had been proven so. But in fact, the reality was that laetrile had performed excellently in our animal studies, and it had been proven.
SS: But you were instructed to inform the public that the results of the test had been negative.
RM: Right. When I refused to do that, they fired me. Here’s the irony: the same people who fired me would admit these things in private. This was a common conversation among the administrators.
I was a relatively low-level employee, but I was in a crowd of very powerful people and it was common knowledge that laetrile was coming up positive in our tests. But any one of them would have been easily taken out in terms of their careers, and selectively they would have been damaged as a leadership group. Eventually many of them did suffer for even having let it go as far as it did.
SS: So all this was a result of a wall of opposition from the FDA and the American Cancer Society?
RM: With a powerful assist from most of the people at the National Cancer Institute.
SS: As a layperson listening to this, I’m thinking, It’s coming from the FDA. But the question is why?
RM: Everything points back to the pharmaceutical industry. But I also have never seen the pharmaceutical industry dirty its hands, as it were, by itself coming forward as the opponent of nonconventional cancer treatments. I think they are much too smart to do that.
SS: So they have FDA agents do their work?
RM: Again, I have no proof of that. All I know is that in the thirty-five years that I’ve been studying the situation, the FDA has never approved any nontoxic drug, herb, vitamin, or anything like that for cancer. The rule seems to be that nothing of a nonpatented, less profitable nature gets through the FDA system. The only things that get through are these synthetic patented agents that are generally very toxic and ineffective. They are so ineffective that the FDA keeps lowering the bar and allowing things to be approved on lower and lower standards of effectiveness and lower and lower standards of safety.
SS: It’s very clear the FDA is a handmaiden of the pharmaceutical companies.
RM: How it all goes down, who gets what from whom, I don’t know. I don’t particularly care; to me it’s quite enough to know that they act like the loyal enforcer for Big Pharma. And that’s what they are.
SS: Well, I read the report of the internal investigation the FDA did of itself last year, where they declared themselves incompetent, unable to keep up with the science, understaffed, overwhelmed, and so on. They have declared themselves ineffective.
RM: I’ve had some friends, believe it or not, in the FDA—most of them maverick types—who aren’t the worst people in the world, no different from the average person, really, and I didn’t get the feeling that they were corrupt or taking money personally from Big Pharma. However it happens, it’s a mind-set, vehemently pro big business, pro Big Pharma, and vehemently against alternative medicine.
SS: How did this happen? How did it get this way?
RM: It goes back to the founding of the FDA. Initially there was this rampant patent medicine advertising going on in the United States and the FDA was created to stop this quackery and allow for more scientific drug development. So in their own DNA they have this attitude that if something is coming from small developers whose ideas are not mainstream, who don’t have deep pockets and can’t easily do things the way the FDA likes things done, in a multimillion-dollar fashion, then there is a presumption of guilt rather than a presumption of innocence or interest. They are very much disposed against the individual or small company that has a bright idea in the cancer field.
SS: I think about the full-body chemo I was offered earlier this year and where I would be today healthwise had I been another kind of patient who would have gone for it.
RM: Here’s the irony: you would have been considered a success story. If your fungus went away on its own, then you might have been considered to be cured of some cancer you never had.
SS: You are right. Yet my immune system and quality of life would have been degraded seriously.
RM: Probably true. Yet there is some wiggle room in chemotherapy … it comes down to the individual in every single case, which has to be evaluated on its own merits. I do consultations for cancer patients. Recently I spoke to a young woman, thirty-three years old, with an estrogen-receptor-negative (ER-negative) tumor, over two centimeters in size, grade III, with two positive lymph nodes, triple negative. This is a very poor prognosis. The odds of her being alive in ten years are about 50 percent. Now, all the data I’ve seen indicated that if she does chemotherapy like Adriamycin, Cytoxan, and Taxotere, she would increase her chance of being alive in ten years by about another 13 percent.
SS: Yes, but her quality of life would suck.
RM: It could be very bad initially, but because she’s young she would probably recover. I’m not arguing for it; I’m just saying that every case has to be evaluated on its own merit. To go from a 50 to a 65 percent chance of being alive is to me quite significant.
Now, I have absolutely no doubt, Suzanne, that there are better cancer treatments than chemotherapy. But because of the bias we know relatively little about the predictable outcome of doing those other treatments. For instance, Dr. Gonzalez is doing important work, but there are no studies really to tell us what the likely outcome of his treatment is.
SS: Speaking to his cured patients is more than I would need to convince me of what choice I would make were I ever to be in that situation again. Last year my oncologist told me that the cancer chemotherapy drug that I turned down, Adriamycin, has been proven to be ineffective.
RM: That is correct. A study done at the University of California, Los Angeles (UCLA), and now confirmed in the Journal of the National Cancer Institute, has proven that Adriamycin is ineffective in up to 92 percent of women to whom it was given, which is shocking.
SS: Because …?
RM: Because in the most common kind of cancers, which are ER-positive cancers, it doesn’t work. There’s no need for it, yet it has potentially very serious cardiac side effects. Dennis Slamon, M.D., who is a very brave and brilliant scientist heading the Revlon Center at UCLA, took on the whole breast cancer oncology community with a speech at ASCO [American Society of Clinical Oncology] a couple of years ago in which he basically challenged them and said that most of the time they are giving Adriamycin for no good reason. Now, admittedly, he invented the drug Herceptin, which he said could be given instead of Adriamycin.
SS: Herceptin is for the HER2/neu type of cancer, right?
RM: Yes, it is primarily for HER2/neu-positive tumors.
SS: I have to say, I’m really not interested in Herceptin or Adriamycin. I’m interested in why we can’t treat cancer or manage cancer naturally if we desire. Why not be offered a choice? Why put the body through such a grueling chemical invasion? Why, when the doctors in this book are having success without chemicals, do we have to keep going over and over the same crap about drugs? Isn’t there a better way? I really think there is. At the very least, why aren’t they giving chemosensitivity tests?
RM: The medical community doesn’t believe in it. And that’s a scandal of the first order.
SS: Walk me through that scandal.
RM: Sensitivity testing is done for antibiotics. For instance, if you have a really bad infection, they’ll test the bugs against the different antibiotics to see which one works. You can do the same thing with cancer. An early version came out in the 1970s that was endorsed by the National Cancer Institute. That test relied basically upon inhibiting the growth of colonies of cancer cells. It turned out to be ineffective, so the bottom fell out. One of the people involved with the NCI sensitivity testing program, Dr. Larry Weisenthal, figured out a much better way to do the testing, which was to look for signs of programmed cell death (apoptosis) in the cancer cells.
So if you take the cancer cells and put them in little plates with all the different cancer drugs and combinations of the drugs, then you can easily measure the amount of apoptosis, or programmed cell death, in each of the wells, and that gives you a comparative number for which is working. In other words, you are not trying to just murder the cancer cells, you are trying to induce the best type of destruction of the cancer cells, which is programmed cell death.
But because of earlier failure of the test, the medical community didn’t want to hear about it. It’s like the crowd had moved on to something else, the fashion had changed, and that was the end of that.
SS: What a shame. So now chemo is “one size fits all.” They just throw it at the patient and hope it works. I have just buried too many friends due to death by chemo.
RM: Well, there is light—there are Dr. Robert Nagourney and Dr. Weisenthal and a few other people who recognize the need for this and are doing these tests. But these people have been pushed aside by the mainstream oncologists. The harder these doctors pushed for this testing, the more there was pushback against them by the leaders of the cancer field.
SS: It’s pretty shocking.
RM: At ASCO a few years ago they put the final nail in the coffin. They declared that these tests were ineffective. The amazing thing is that they evaluated it on the original older techniques, which Weisenthal and Nagourney do not use and haven’t used for over twenty years.
SS: This is astonishing.
RM: You are right about that. Nagourney was beside himself with rage when this happened. I understand and I agree with him. I think there is very good preliminary evidence that sensitivity testing works. I think what this is really about is whether or not medicine is going to be individual or cookie-cutter, and the economics favors the cookie-cutter approach. But the science trends toward individualization; the science is screaming out on this point. We have to take each person’s cancer, each person’s tumor cells, and treat that particular person’s cancer. That’s what the science is saying.
SS: You are talking about economics, right?
RM: Yes, the economics are “Let’s keep that assembly line running and push through as many patients as possible, so we can maximize our profits.”
SS: I have come to that same place…. Maybe they don’t want to know if this particular chemotherapy is going to work. I mean after all, the profits are so huge, what if the tests come back and say it’s not going to work? They just lost all that revenue.
RM: It’s a matter of pushing through a million patients a year. At least six hundred thousand a year are getting chemo. How are you going to do that and simultaneously analyze every patient and come up with a unique combination of drugs that can’t be written up in a textbook and prescribed? You just can’t hand it to a nurse and give her the recipe for a particular kind of cancer.
Everybody’s different, everybody’s going to respond differently; we have to titrate this, we have to give different amounts for each patient. Then, of course, it gets into other kinds of individualization: vaccines and other things that we know are beneficial to cancer patients; chronomodulation of drugs, which means giving drugs at particular times of day and night when they are the most effective. This leads to a boutique type of treatment. But as I say, the push relative to the level of profitability is toward mass production.
SS: If there was individualized treatment, everyone would want it.
RM: Right, and they are not prepared to give it to everybody, although I think it will be cost-effective in the long run.
SS: Why? Because people would have better outcomes and fewer side effects? I don’t know why this can’t be seen as the bigger picture.
RM: They are focused on how many patients they can see today.
SS: But if I were an oncologist and I took the oath to do no harm, I would think from a place of morality I would investigate every possible approach. It is arrogant to think the present template is the only way, especially when the outcomes at present are so dismal.
RM: I agree it’s outrageous and at the point where none of us wants to be treated. When doctors become sick themselves, then they sing a different tune. There was a study done in Canada relative to lung cancer and chemotherapy. When asked, 75 percent of the doctors said they would not take platinum-containing chemotherapy themselves.
SS: That should tell you something.
RM: Right, but still, they give it. A very eminent neurologist once stood in my living room and told me that if he were to get brain cancer he wouldn’t take radiation. I said, “Well, then, how do you treat for brain cancer?” He answered, “Radiation.” There was no irony in his voice, no recognition of the fact that on one hand he’s telling me that both he and his department chief had decided they wouldn’t take radiation, but every day they send people with brain cancer for radiation.
SS: In the chemotherapy world, what is considered success? Months? Is that how it works?
RM: I just like to state what the facts state. For instance, with Avastin, which will cost the average person about $100,000 a year, it may, when given with chemo, increase survival for four or five months within the confines of a clinical trial. On the other hand, for breast cancer it has not been proven to extend survival. The advisory council of the FDA just approved it or recommended approval for brain cancer, with no evidence of increased survival. They couldn’t even prove that it shrank the tumor. There was a 25 percent shrinkage of the size of the growth on an X-ray for a couple of weeks, but that shrinkage was not proven to be of cancer cells. It probably was the swelling around the tumor. Despite that, they approved this. According to press reports, it’s going to generate an extra $200 million a year in sales for the parent company of Avastin, with no evidence, really nothing. If we came to the FDA with an alternative treatment with that level of evidence, they would laugh us out of the room.
SS: Again, I hate to be a broken record, but this is shocking. What was the criterion for approval?
RM: Aside from the meager clinical trial data, it was based on a few anecdotes of patients who said, “We feel we benefited by this.” They were tearful and their relatives were tearful and people stood up and literally cheered when the advisory board committee agreed to approve this usage. I respect the experiences of patients, regardless of what kind of treatment they opt for. But what disturbs me is that drug companies have actually helped create some of these patient advocacy groups and they certainly fund many of the others. It’s no coincidence that Breast Cancer Action, headed by Barbara Brenner in San Francisco, is the only group to my knowledge that refuses to take pharmaceutical money. And this group is the one that opposed the approval of Avastin for breast cancer last December. They get labeled militant because they insist on the science rather than just the PR.
SS: What about the drug Gemzar?
RM: Gemzar [gemcitabine] was originally approved by the FDA based on a very small quality-of-life improvement in pancreatic cancer patients. The effect in the community setting was that 20 percent had improved quality of life. Once the company got approval, they could start using it off-label for everything under the sun. But this is a drug that is relatively benign, and also has minimal effects. You rarely hear about people having major side effects with Gemzar.
SS: But this is chemotherapy, right?
SS: Yes. These are chemotherapy drugs, but they are mild forms of chemotherapy. They are given as a kind of placebo, meaning when they have nothing else to give and they don’t want to burden the patient with a lot of side effects, they give this drug and everybody is happy. The patients feel that something is being done for them, and the doctor gets paid for administering or prescribing something. Then the patients expire and the families feel that at least they tried.
SS: This is the part I don’t understand—the patient is given drugs that don’t do much and at the end the family is grateful. Recently a young friend of mine died of pancreatic cancer, stage IV. I have never seen such destruction to a human body as I watched him disintegrate and die in four months. Then a few weeks after the death, his wife called and asked if I would come perform for a fund-raiser for his doctor. And I thought, They just killed your husband.
RM: Right, and you’re going to do a fund-raiser for him!
SS: How much money does a doctor make per patient on chemotherapy?
RM: Of course, it varies; I don’t know exactly because it would vary from drug to drug. It would even vary from month to month. I’ll give you two sets of facts. One is that the cost of treating stage IV colon cancer ten years ago was $500. The drugs they were giving at Sloan-Kettering at that time were 5-fluorouracil and leucovorin. These are inexpensive drugs to buy and administer. But ten years later the cost of treating colon cancer is around $250,000, and that’s only, as they say, for parts, not labor.
SS: You mean that is only for the cost of the drugs, and not counting all the costs of the doctor administering it?
RM: The doctor, the oncologist, in private practice can make money three ways off the drug, maybe four ways. First of all, they get paid by the patient or his or her insurance for the office visit. Second, they have the chemotherapy concession, which means, alone among all doctors in the United States and probably any other industrialized country, they get to sell the drug at retail—buy it at wholesale and sell it retail.
SS: Basically they are the pharmacy for the drug.
RM: Correct. So when the mainstream doctors criticize the CAM [complementary and alternative medicine] doctors for selling vitamins out of their offices, oncologists are doing it in spades because they are selling chemotherapy out of their offices. It’s called the chemotherapy concession. There have been front-page articles in the New York Times business section about this.
The third way they get money—and this was also exposed in the New York Times—is by getting kickbacks from particular drug companies for volume prescribing. So if this month a special premium for drug X is being given, the doctor would benefit financially by prescribing that drug. There’s also a lot of wiggle room in what is prescribed. It’s not so cut-and-dried, so that a doctor could decide that this month all his or her patients need to take a particular drug. You get the picture. Prescribing drugs that are tied into the promotional discounts could determine a much greater profit for the doctor.
SS: And what is the fourth way?
RM: The fourth way is to become a so-called marquee professor, where you get to promote the drug in question and they pay you an honorarium or a fee from a speaker’s bureau or so forth. Sometimes when you go to ASCO, particular professors are basically doing blurbs, you know, infomercials for particular anticancer drugs. I remember one who shall remain nameless who said, “It brings tears to my eyes when I think about the beneficiaries of this treatment.” Now of course, he’s on the payroll of the company making that particular drug. So there are a lot of ways for doctors to make money off the administration and sales of the drugs.
SS: What I’m hearing is incentive to prescribe, not only for the oncologists, but also for the hospitals to make sure that there’s enough chemotherapy administered. And it feels … well, a little evil.
RM: It just tips the scale even further toward the use of these expensive, patented, toxic, and relatively ineffective drugs, and that much further away from the so-called enemy, which is inexpensive: natural, nutritional, usually nonconventional treatment. It gives them another reason to resist and I would say to hate the natural treatments, and they do.
SS: The people have to know this. The patients are so vulnerable, and to think that this is going on. It’s all a big mess. I also hear that hospitals could not afford to stay open without the revenue from chemotherapy.
RM: A lot of things need to be restructured in many ways. It goes back again to “Are we going to have individualized care or cookie-cutter care?” Of course we all want the individualized care, but we are not offered that. Part of the reason there are alternative treatments is that they cannot fit into the dominant kind of treatment that’s being given.
I’ve looked at the cases of Drs. Gonzalez and Burzynski, and I personally know some of their cases. I am in agreement with you that these men are doing exciting work, but we don’t know the sum total of what happens to people who go to them for treatment. We don’t know all the factors that lead them to having success. So I’m not arguing with you, just telling you how I deal with the question. To me it’s enough to expose the fact that these treatments exist, and to expose the realities of the drugs being administered in orthodox medicine. The alternative guys have had some success and they are not being given a fair shake.
Just saying this is an extremely revolutionary position. Burzynski and Gonzalez are innovative doctors, and they have made advances in cancer and they’ve helped a lot of people. But their successes are not 100 percent.
SS: No one could say that. That would be Nobel Prize time. I am presenting all the doctors and protocols in this book as a choice. I present to my reader the realities of the orthodox cancer world and the realities of the alternative world. Perhaps someone will read this book and decide they want to roll the dice and go the chemotherapy route. It’s not for me to decide; it’s all about choice.
Tell me, will alternative medicine ever grow enough to have an equal voice or even overtake this other force that owns America, owns our government? Can little voices like ours see the light of day?
RM: I have to believe we will. To maintain my own sanity and to get me going every day for thirty-five years, I must believe it. But then again, none of us ever believes we’re going to die, either, but the evidence seems to speak to the contrary.
I don’t see a clear path to it, but I do see that the system is crumbling, so that might be the opening. I do see a little bit of sunlight. You, Suzanne, have a tremendous opportunity to reach the masses of people. It’s unprecedented. I can’t think of anybody in the country who has the ear of more people on this issue than you do. I’m not that popular a person, I’m a scholar, but I am an independent scholar. So I try to document things as best I can. Somehow I feel that if I continue to do that, eventually someone will listen. At least I’m laying down a standard of scholarship in this area that is higher than what it was before. And I think you need both.
I like to make arguments that are difficult to refute, where somebody will read what I’ve written and can’t argue effectively against it. I’ve had that reaction from many scientists and doctors over the years. Most of them started out hostile but in the end were won over because I was quietly pulling up facts, and it’s hard to argue with facts. I try not to go overboard with my enthusiasm or endorsement of alternative treatments because I’ve been burned too often. But I try to keep it all in balance, in perspective, and that’s my basis or philosophy.
SS: As I have been working on this project your name has come up over and over, and always with great respect. You need to know that you are making an impact. You are very highly regarded, and I am honored to have you be part of this project.
Now that we know how we got here, just what can we do about it? Read on to see what some brilliant, cutting-edge doctors have to say.