NATURE MEDICINE • VOLUME 4 • NUMBER 10 • OCTOBER 1998 1197

BOOK REVIEW

Can Bacteria CauseCancer?

By David J. HessNew York University Press, $26.95, 288 pp.

ISBN 0-814-73561-4, 1997

REVIEWED BY ROBERT S. SCHWARTZ

Deputy Editor, New England Journal of Medicine10 Shattuck Street, Boston, MA 02115

If it is true that a combination of anti-bac-terial vaccines, antibiotics and coffee ene-mas can cure over 80 percent of cancerpatients, many with metastases, why hasmainstream medicine ignored this star-tling result? David Hess, an AssociateProfessor of Anthropology at RensselaerPolytechnic Institute, and a recipient of aNational Science Foundation grant for hisstudies, ponders this question in CanBacteria Cause Cancer? His agenda is clearfrom the book’s subtitle, “AlternativeMedicine Confronts Big Science.”

Hess’s book deals with not only the the-ory that bacteria can cause cancer but alsothe evidence that bacterial vaccines andantibiotics are effective treatments for can-cer. He rightly points to H. pylori andleukemia viruses as examples of microbesthat have been linked to cancer (but, curi-ously, omits Epstein-Barr virus), and sug-gests that equally valid examples ofoncogenic microorganisms have been dis-covered by investigators outside the main-stream of medical research.

Hess begins his brief by recounting thework of pioneers in the field of microbialcarcinogenesis. Among them are RoyalRaymond Rife, a one-time handyman andchauffeur who, in the 1930s, asserted thathe had found the viruses that cause can-cer, poliomyelitis, typhoid and herpes;Virginia Livingston, discoverer of an ever-changing, pleomorphic oncogenic bac-terium that causes both cancer andscleroderma; and Gaston Naessens, whowas able to see, with a microscope of hisown design, an organism with a life cycleof 16 stages in the blood of cancer pa-tients. With this cast of characters, andmany more, Hess builds his argument thata cabalistic conspiracy has suppressed re-search on the bacterial theory of carcino-genesis and blocked the development ofbacterial vaccines against cancer.

According to Hess, the plot began in the1920s with such notables as James Ewingand Cornelius Rhodes, of MemorialHospital in New York, and Morris

Fishbein, editor of JAMA. Later, Hess ar-gues, the opposition was institutionalizedwithin the National Cancer Institute andthe American Cancer Society, whichjoined forces to suppress unconventionalcancer research. He asserts that the “cancerestablishment” and “cancer insiders,” con-trolled by giant pharmaceutical companiesand manufacturers of X-ray machines,have worked assiduously to keep bacterialvaccines against cancerfrom the American public.Hess surrounds these ideaswith scholarly cautions, butdoes so disingenuously:“Did the Rockefeller empiredevelop clear financial in-terests in the nascent phar-maceutical industry, andfrom behind the scenespush cancer research to-ward chemotherapy…? It ispossible that future researchwill reveal the answers…”

Virginia Livingston is a key figure in thealternative medicine story. In the 1940s,while employed as a school doctor inNewark, NJ, Livingston was consulted by anurse with scleroderma. Livingstonclaimed to have found in a skin biopsyfrom the nurse a new form of mycobacte-ria, which she named sclerobacillus.Working in the basement of her home,Livingston found that sclerobacilluscaused cancer in animals (presumably a ro-dent species). Moreover, this new acid-fastbacterium, now re-named Progenitoraceaecryptocides, was found to be part of the lifecycle of the Rous sarcoma virus of chick-ens. Further work was difficult, however,because according to Hess the cancer es-tablishment blocked Livingston at almostevery turn. Moreover, the demonstrationby another investigator thatProgenitoraceae cryptocides was nothingmore than Staphylococcus epidermidiswas not helpful to her cause. Livingstoneventually moved to San Diego and set upthe Livingston-Wheeler Clinic. There sheclaimed to have found that her cancer-causing microbe produced a substance re-sembling human chorionic gonadotropin.Thus was born the rationale for her vac-cine: it strips away the protective coatingof chorionic gonadotropin on cancer cells.Since it opened in 1969, the clinic hastreated more than 10,000 cancer patientswith the Livingston vaccine, vitamins, dietand group therapy. The clinic employs sixphysicians and charges about $7,000 for a10-day course of therapy. Livingston, whodied in 1990, contended that her regimen

benefited over 80 percent of patients withcancer.

If you believe in coffee enemas, thenLivingston’s bizarre story might makesense. It is wrong, however, to think thatthe hundreds, perhaps thousands, ofLivingstons would take notice of ridiculefrom mainstream scientists. They thriveon incredulity, and succeed by offeringwhat patients with cancer and other hard-

to-treat diseases want:hope, psychological sup-port, and magical solutionsto insoluble problems.Physicians cannot providethe last, but by not offeringhope and empathy they aresurely driving patients intothe arms of the Livingstons.

In 1990, the Office ofTechnology Assessment, aninvestigative bureau thatprovided Congress withevaluations of scientific

and technological problems, concludedthat alternative medicine treatments forcancer have not been shown to be safe oreffective. No clinical study has yet over-turned that judgement, but Hess justifi-ably argues that there has been a paucity ofrigorous studies. He complains that inter-locking interests of the National CancerInstitute and the American Cancer Societyhave blocked the funding of such trials. Hecalls for “Reallocation of a substantial partof the budget of the NCI for primary pre-vention and testing alternative thera-pies…” and asserts that funding from theNational Institutes of Health’s Office ofAlternative Medicine is a mere drop in thebucket. However, despite grant awards ashigh as $1 million to a single institution,recipients of support from the Office ofAlternative Medicine published only ninepapers, almost all of them in obscure jour-nals, in fiscal year 1993.

Hess wants to reform the Food and DrugAdministration, which he accuses of perse-cuting practitioners of alternative medi-cine, over-regulating vitamins and foodsupplements (“to the great benefit of thepharmaceutical industry”) and demand-ing excessive documentation of the safetyand efficacy of a new drug. Unlike Hess, Idon’t think that the Food and DrugAdministration’s requirement that two in-dependent controlled trials show thera-peutic efficacy of a candidate drug isexcessive. Hess says that the alternativemedicine community cannot afford tofund clinical or basic investigation, buteven if its followers would fund such work

1198 NATURE MEDICINE • VOLUME 4 • NUMBER 10 • OCTOBER 1998

BOOK REVIEW

stage in the life cycle of a chicken virus,and Barry Marshall’s claim that a spiro-chete causes gastric ulcers were difficult tobelieve. However, in less than ten years,the pathogenic features of H. pylori werewell-established and Marshall, an outsider,was showered with honors by the estab-lishment. After almost 100 years, the advo-cates of a bacterial cause of cancer havefailed to convince anyone but themselves.

Hess’s book blames the failures of alter-native medicine on a conspiracy, but asAnthony Lewis once wrote in the NewYork Times, “the search for conspiracyonly increases the elements of morbidityand paranoia and fantasy… It obscures ournecessary understanding…that in this lifethere is often tragedy without reason.” Isuppose that my review, coming as it doesfrom a card-carrying member of the estab-lishment, is itself suspect. So, by all meansread Hess’s book and come to your ownconclusion.

(like the volunteers who support theAmerican Cancer Society), failure is in-evitable because practitioners of alterna-tive medicine abjure the fundamentalrules of objective scientific research.Moreover, Hess contends that the ran-domized controlled trials for such reme-dies as laetrile were deliberately designed“to introduce bias against the [alternativemedicine] therapies.”

One likely reason why the efficacy of al-ternative medicine treatments for cancerwill never be validated is reflected in Hess’sadmission that, “It is hard to imagine qual-ity of life being better under chemother-apy and radiation in comparison withcarrot juice, organic foods, and vac-cines…” And now that Deepak Chopraand Andrew Weil, two of the leadingspokesman for alternative medicine, havebeen booked into Radio City Music Hall(the home of the Rockettes), we may beseeing a shift in the basis of alternative

medicine from insupportable anecdotes toevangelistic showmanship..

In the last chapter of Can Bacteria CauseCancer?, Hess makes reasonable sugges-tions for changes in federal policies aboutalternative medicine, such as public auditsof the contents of “nutritional supple-ments”, and improving access to the re-sults of alternative treatments. These andmany more of his ideas are worth seriousconsideration. But Hess stumbles when heconfuses culture with science—for exam-ple, when he asserts that a petri dish is im-plicitly feminine and nurturing, whereassurgery and chemotherapy are “heroic,masculine methods of destroying cancer,”and complains that to outsiders the alter-native approach “resonated with sexistviews of undesirable female traits.”

The default mode in science is skepti-cism until rigorous evidence appears.Livingston’s contention that herProgenitoraceae cryptocides bacterium is a

TherapeuticApplications of

RibozymesMethods in Molecular

Medicine, 11

Edited by Kevin J. ScanlonThe Humana Press, $99.50, 480 pp.

ISBN 0-89603-477-1

REVIEWED BY JOHN ROSSI

Department of Molecular BiologyBeckman Research Institute of the City of Hope

Duarte, CA 91010

The discovery in the early 1980s that cer-tain RNAs can behave as enzymes that cat-alyze RNA cleavage and ligation reactionshas had a large effect on both basic andapplied research. Catalytic RNAs, or ri-bozymes, have distinct and unique rolesin nature, but the unifying mechanismfor each of the ribozymes is that speci-ficity is achieved through RNA–RNA inter-actions. For most of the ribozymes, this isaccomplished by Watson-Crick base pair-ing. The combination of base pairing andenzymatic function makes these mole-cules useful tools for targeted destructionof other RNA molecules. Ribozymes canbe engineered to base pair with any targetRNA of interest and can also cleave thetarget RNA and functionally destroy it.

During the past decade there have been

several hundred publications describingribozyme applications for the targetedcleavage of a variety of RNAs. The mostcommonly used ribozyme catalytic motifsare derived from five ribozymes found innature: the hammerhead, hairpin, RNAseP, group I intron, and hepatitis delta ri-bozymes. The principles that guide the de-sign, engineering and cleavage siterequirements for each of these ribozymemotifs are different. For anyone interestedin using a ribozyme to inactivate a givenRNA target, there is no simple formula forchoosing the best catalytic motif.Literature searches more often than notresult in a confusing morassof publications that primar-ily describe successful ri-bozyme applications. As inmost disciplines, unsuccess-ful applications are usuallyunpublished. Given themany variables affecting ri-bozyme function, it is im-portant to have access to acollection of articles andprotocols that survey thelarge spectrum of ribozymeapplications.

Therapeutic Applications ofRibozymes has been compiled by the edi-tor, Kevin Scanlon, with the goal in mindof “providing an overview of the utility ofribozymes to selectively inhibit expres-sion of RNA.” The volume is a collectionof 29 chapters, each containing a brief in-troduction followed by a detailed protocol

for application. This volume provides acompendium of ribozyme applicationsthat illustrate the broad potential for ri-bozyme therapeutics. The collection ofchapters provided by ribozyme practition-ers gives the reader a glimpse into themany applications of ribozymes as boththerapeutic agents and surrogate genetictools. These applications range from an-tiviral to anticancer. Most chapters discussthe simple hammerhead ribozyme, butthere are also a few chapters devoted tothe design and use of the hairpin, hepati-tis delta and RNAse P ribozymes.

For the first-time ribozyme researcher,this book provides only aminimum amount of back-ground information to guidethe choice of ribozyme motifas well as rules governingcleavage site selection. Thevolume is heavily weightedin favor of specific applica-tions of ribozymes, with fourchapters devoted to ri-bozyme inhibition of viralinfection, eleven chapters inwhich ribozymes are used todownregulate transcripts in-volved directly or indirectly

in oncogenesis, and three chapters de-scribing ribozyme methodologies fordownregulation of other cellular targets. Asingle chapter is devoted to the use of ri-bozymes in a transgenic setting. A greatdiversity of RNA targets is represented inthese studies but the emphasis on specific