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Click here to return to chowka.com Evaluating Alternative Cancer Therapies:
© By David J. Hess, Ph.D.
Section Four
Peter Barry Chowka
Peter Barry Chowka is one of the veterans of cancer journalism. His career began as a student in the early 1970s when he was the station manager and program director of WGTB in Washington, D.C., a 22,000-watt FM station that was affiliated with Georgetown University. That work allowed him to gain experience reporting on a wide variety of high-level news events, including national political campaigns and conventions, Presidential press conferences at the White House, and traveling around the country with Senator George McGovern when he ran for President. "When I had the opportunity to write and produce stories on the health issues that beginning to emerge in the early 1970s, I had considerable experience already in doing fairly sophisticated national political journalism." Chowka covered the McGovern-Dole U.S. Senate nutrition subcommittee in the mid-1970s when it held hearings on the national cancer program, and eventually he was given an assignment to write an article on cancer for East West Journal. "In the period from 1973 to 1975, there were the first stirrings within policy circles in Washington and in the mainstream media that diet and nutrition had something to do with health, including cancer causation. As I started to delve into all of this further for East West, I was shocked to find a situation that reeked of politics. In fact, cancer was much more of a political issue than a scientific issue. Having covered mainstream national politics for several years, when I began to interview people at the National Cancer Institute, the American Cancer Society, the FDA, etc., about their work, I had an instinctive feeling that I was talking with politicians, not with clinicians, researchers, or healers. I became aware that there was a very large subtext running through all of medicine and medical policy, affecting our choices and medical freedom, involving politics and its driving force -- economics. The medical-industrial complex was expanding, entrenching its power and reach, and clinical effectiveness or truth often had little to do with the process. This was the period, after all, of Marcus Welby, M.D., before words like ‘medical Establishment’ had come into common usage, and prior to there being much recognition that medicine is a big business, influenced by serious conflicts of interest, vested interests, etc. All of this was fascinating to me and became grist for my investigative journalist’s mill." The article in East West expanded to a five-part series on the politics of cancer that was published over a two-year period, and was subsequently re-published and quoted widely. "I also had a personal inspiration for my interest in cancer. A friend of mine during this period (the 1970s) who was in his early twenties was diagnosed with lung cancer, and very soon he died from it, despite the fact that his father was a VIP and my friend had access to state-of-the-art conventional care at the NIH. I was shocked and confused by that personal loss, so when given the opportunity to explore the area journalistically, it had more meaning to me, because I felt like I was beginning to understand the context of what might have really happened to him." After examining the cancer Establishment in dozens of hard hitting exposes, Chowka began to explore the fledgling field of alternative therapies, traveling to clinics around the U.S. and beyond the border and interviewing leading physicians and hundreds of their patients. Since the 1970s his articles have appeared in numerous magazines here and abroad, and he has been a frequent guest on radio and television talk shows around the U.S and in Canada. He developed a national reputation as a particularly hard-hitting inquisitor. Yet, he writes not "from an advocacy point of view but rather advocating fair evaluation of alternative medicine." Chowka has also served as a consultant to major television programs such as ABC's 20/20; he was the national affairs editor of New Age Journal and a contributing editor to East West Journal; and his articles were the inspiration behind, and he appears prominently in, the awarding winning documentary film Hoxsey: Quacks Who Cure Cancer? (1988). Chowka was also very involved in the Office of Technology Assessment's 1990 study Unconventional Cancer Treatments (U.S. Congress 1990), and he served on several advisory panels of the National Institutes of Health's Office of Alternative Medicine. Lately, he has turned his focus to the Internet; his ground breaking work in alternative medicine on the World Wide Web is featured in Web Publisher’s Design Guide, Second Edition by Mary Jo Fahey (Coriolis, 1997). Today, Chowka continues to write for various print magazines and newsletters in addition to his work on the Internet. His website is <http://chowka.com>. Evaluation Criteria Chowka is one of the interviewees whose contribution to the evaluation discussion focuses on providing a better understanding of the political context of evaluation. As a long-time student of cancer politics, he was actively involved in some of the most dramatic developments, such as the formation of the Office of Alternative Medicine (OAM). "When I first heard about the OAM after it was voted in by Congress in 1991, I was very skeptical." By that point Chowka had had a great deal of experience with cancer politics and policy. "I had been through the mill, and I knew that the whole NIH process would be riddled with politics, and that there were still many influential, well-funded key players who were not sympathetic to alternative medicine. My initial reservations were confirmed by the first year or two of the office’s operations. They were chaotic, whimsical, unresponsive, and wasteful, especially given the microscopic or homeopathic budget that the Congress had initially provided to the OAM. "However, I must say that my opinion overall of the OAM has risen, particularly because of the accession to the directorship of Wayne Jonas, M.D. He seems to me to be a very sincere, well-motivated, and ethical individual. The downside remains that the OAM currently has a very small budget, $12 million a year, or only about 0.1 percent of the NIH’s total budget -- and the Clinton Administration is proposing cutting that by almost 40 percent. This is an absurdly lukewarm commitment when you consider that, as studies like Eisenberg’s have shown, more than one third of all Americans use alternative therapies. Unfortunately, then, more than five years into it, the OAM continues to face serious challenges in terms of being able to organize, fund, and conduct the range and depth of studies that would help to confirm the validity of alternative methods of healing." Chowka remains skeptical of the likelihood of fair evaluation of alternative cancer therapies occurring through the NCI. He had frequently talked about the issue with his friend, the late Robert DeBragga, a patient advocate leader whose contributions, Chowka contends, are unparalleled but largely overlooked. According to Chowka, DeBragga "did more substantive work in the field from a patient advocacy point of view than just about anyone and should receive the majority of the credit for positive political developments like the OTA study and the creation of the OAM. Bob was diagnosed with squamous cell carcinoma in 1978, and after a limited course of conventional therapy he was given six to eight months to live. He became a patient advocate without peer for the next twelve years of his life; he died in 1990. In 1979 he founded Project Cure, Inc., which he ran out of his post office box; it was basically him, talking on the telephone one-to-one with people all over the country and also appearing in the media and lobbying Congress and anyone else in a position of authority who would listen, on behalf of fair evaluation of alternative cancer treatments. He was impressive, articulate, and sincere and he personally influenced many political figures, including Rep. Guy Molinari (R-NY), to become involved in this area. I worked a lot with Bob doing radio and TV talk shows and bringing the issue to policy makers and the public, which is what much of my career has been about, too.
"Over the years, Bob and I would have a running conversation, asking each other questions like, ‘Can we ever get fair evaluation from the powers that be? How can we do this? What clinicians can we put forward who have the best shot at convincing the skeptics?’ The answers were elusive. The frustrations and challenges, as always, included the fact that the powers that be--the medical Establishment, the government, academia--are riddled with conflicts of interest. The process itself is conflicted. And the peer-review system it relies on is rotten to the core." Another person who influenced Chowka's skepticism regarding the current possibilities of fair evaluation is Linus Pauling, Ph.D., whom Chowka interviewed on a number of occasions, including the last interview before the two-time Nobel Prize winner died. Consequently, Chowka is very familiar with the political biases introduced into the vitamin C clinical trials, which in turn are representative of the serious political problems that occur when the Establishment tests alternative therapies. Regarding the Mayo clinic studies, Chowka commented, "The patients were subjected to chemotherapy, and there was no control for patients dosing themselves with vitamin C." Another well-known problem was the rebound effect that is provoked when high doses of vitamin C are ended abruptly, as occurred in the Mayo clinic studies. Chowka added that the biases extend well beyond the original Mayo studies. The subsequent review by the former Office of Technology Assessment of the U.S. Congress (1990) also revealed an entrenched bias against vitamin C as a therapeutic modality for cancer treatment. "When the OTA looked at vitamin C and pooh-poohed it based on the Mayo report, Pauling’s late colleague Dr. Ewan Cameron was chomping at the bit to respond. The OTA had never even bothered to contact Pauling or Cameron to get their input, if you can imagine that. I was trying to network them all together, providing Pauling and Cameron with the negative and inaccurate contract reports the OTA was paying for and which Cameron then prepared responses to. But the contract report authors weren’t interested in contacting or even listening to Pauling and Cameron! The end result is that a supposedly definitive, official study ignored the world-class proponents of the therapy." Chowka did add that some sections of the OTA study were more balanced, such as the section on the Hoxsey therapy, but he attributes the fairness of that section to the contract report by the late historian Patricia Spain Ward, Ph.D. Her reports--particularly the one on the Gerson therapy--were also the subject of great internal controversy within the OTA because the OTA had originally tried to suppress them (Haught 1991). "The bottom line is that my own perspective has evolved to the point that I now think that viable, credible evaluation of primary alternative medicine for cancer is probably never going to happen in a way that would satisfy somebody like me--that is, not only as a journalist and a seeker of the truth, but as a person who wants unfettered access to medical options (of my choosing). I tend to think now along the lines of a populist/libertarian approach: Let’s open the floodgates of information and truly achieve a‘level playing field’ by providing medical practitioners a fair shot at openly practicing their art or science and the public with the resources to be fully informed and educated by a free flow of information and protected by legal options. "Meanwhile, the public--the great unwashed public--is driving this. In 1982 when I asked Linus Pauling how change was coming, from the top down or bottom up, he told me something I’ll never forget. He said, ‘Well, of course, Peter, it’s coming from the bottom up, from the people.’ In my experience, also, that’s exactly the case, and it was confirmed by Eisenberg’s 1993 study about the massive utilization of alternative medicine as a primary resource by millions of people in this country. As I’ve made the rounds for over twenty years, talking with thousands of patients, giving hundreds of lectures, and appearing on literally thousands of radio and TV call-in talk shows, I continue to be impressed--if not more impressed--with the knowledge, awareness, and level of sophistication of many members of the uncredentialed public in terms of their ability to gain access to this information, take control of their own health decisions, make a difference in their own lives, and serve as an example for the medical Establishment, notwithstanding what the medical Establishment or even the self-appointed leaders of alternative medicine think about it. "I am reminded that the American Cancer Society (ACS)--at the time I started covering it journalistically--was an extremely reactionary organization. They’ve reformed to some extent, but at the time, in their Unproven Methods book, they wrote about how we--the ACS--need to be very wary of the public, because the public shares information about quackery by word of mouth. This was one of the greatest dangers in their view--that uneducated, unskilled, uncredentialed people will tell their neighbors about quack therapies and they’ll all be off like lemmings to the sea! But in my view, another way to look at it is, What is more valid than word-of-mouth information that represents real experience? News about one of the most impressive therapies that I’ve ever run into--the Hoxsey herbal therapy--is disseminated almost completely by word of mouth." Chowka pointed out that the Hoxsey therapy has never advertised, in contrast with many of the other alternative and complementary therapies. "The Hoxsey therapy became my gold standard for what legitimate referral is about."
Chowka noted that in contrast, "The New York Times published an article a few years ago about how 90% of the stories in the mainstream media about medicine are generated by a public relations firm working on behalf of the government, a drug company, a hospital, a university, etc. So, ultimately, which is more valid? Word of mouth or media-p.r. spin?" I asked Chowka what he thought about alternative methods of evaluation, such as the retrospective studies of Hildenbrand. He answered that one of the recommendations of the OTA report Unconventional Cancer Treatments was "that the NCI rechristen anecdotal case reports as ‘best case series’ or ‘best case reviews,’ and that these should serve as a starting point for serious evaluation. The NCI rejected most if not all of the recommendations, but I think that the OTA study was a turning point nonetheless. People like Gar Hildenbrand, who are picking up the thread and trying to move forward to the next generation of outcomes analysis, have got something. But again, whatever they comes up with will need to run the gauntlet of the mindset that prevails at every level of officialdom. "As Bob DeBragga used to point out, we’re dealing with a systemic problem that has grown up around medicine in this country. A way of business has been established, and we can’t forget that ultimately it is a business. The medical-industrial complex has grown to become a trillion-dollar-a-year industry in the United States--and cancer is at least a $110 billion part of that. Enormous financial stakes, therefore, enter into every level of the evaluation process, consciously or unconsciously." Click here to read part two of this chapter from Evaluating Alternative Cancer Therapies Click here to return to chowka.com home page |