by Thomas Hager
"It is hard to understand physicians, I must say," Pauling told a reporter. "They accept what they are told. . . . They believe in authoritarianism, and they apparently find it hard to understand that the world changes."
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In the summer of 1973, Pauling and Cameron tried a different approach to spurring interest in vitamin C and cancer. Moving away from Cameron's hard-to-prove antihyaluronidase theory, they now emphasized vitamin C as an immune-response booster that could help ease the side effects of chemotherapy and radiation therapy—an adjunct to accepted cancer treatments rather than a radical alternative. It was a clever move, both less threatening to the cancer establishment and better grounded in experimental fact, including the observation that vitamin C helped improve the functional ability of phagocytes, the white blood cells involved in the immune reaction to cancer.
But it was too late. By now, Pauling was almost completely ostracized from the medical profession. It did not help that he continued to argue his case in the popular press instead of scientific journals, even giving interviews to sensationalist tabloids like the National Enquirer and Midnight. Now he was saying that proper use of optimal doses of vitamins, coupled with a decrease in sugar consumption and quitting cigarette smoking, could lengthen the average American life span by somewhere around twenty years. He had upped his own daily dose of vitamin C to 6 grams. To physicians, he appeared increasingly strident and a little sad. What a shame it was, they agreed, to see such a great man turning into a crackpot.
By mid-1974, both Pauling's reputation and the financial condition of his fledgling institute had reached a nadir. In a medical echo of the McCarthy days, a talk Pauling had been scheduled to give on vitamin C to students at UC Santa Cruz was canceled when the sponsoring body, a local cancer society, told the students who had invited Pauling that they would not pay to bring him in. The campus chancellor, deciding that no outside body was going to determine what his students heard, paid for Pauling's visit out of university funds. As if in answer to Pauling, the U.S. RDA for vitamin C was lowered from 60 mg per day to 45 in 1974.
In the spring, two more of Cameron's papers on vitamin C's effects on cancer patients were rejected by one of America's leading cancer journals. The major criticism was that he had not carried out a contemporaneous double-blind trial, but had gauged the effect instead by comparing his vitamin C patients to similar cases pulled out of the hospital's files—"historical controls," as they were called in the profession. His results were also less than definitive because he used his high-dose regimen only in terminal patients, who would die of heart failure or kidney problems, conditions probably unrelated to vitamin C but which threw off the statistical analysis of his results. Pauling and Ava Helen flew to the Vale of Leven in June to see Cameron's work firsthand and to help him revise his manuscript. Later, by beefing up the theoretical side and adding his own name to the manuscript, Pauling was able to shepherd Cameron's findings through publication in the journal Chemical and Biological Interactions.
That was good news at least, and Pauling's institute needed it. He and Robinson had had little success in raising any significant amount of money from scientific agencies for work on vitamin C and cancer, and their failure resulted in a fiscal crunch so severe that they had to support the operation out of their own pockets. It was obvious that something would have to be done.
In July 1974, the institute's small board of directors decided to make some major changes. The medical-scientific establishment might not fund their work, but there was another source of money: the public. The public had consistently responded more favorably to Pauling's ideas on vitamin C than physicians had. They could be appealed to directly for money, as various cancer fund-raising charities had done for decades. If fund-raising went well, far from closing down the institute, they could expand it and open a small medical clinic to conduct their own studies. To capitalize on the institute's most important asset, they would rename it, dropping the "orthomolecular" part, which was tainted by the APA's attack and in any case required too much explanation to prospective donors. From now on, it would be the Linus Pauling Institute of Science and Medicine—a change to which Pauling acceded because, as he put it, "there seemed to be advantages to having my name attached to the institute in connection with raising funds."
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Pauling's feelings about the institute were mixed. While it was a necessary structure for pursuing the right course with vitamin C, in other ways it was a headache. He was by title the institute's president, but he did not like administration and tended to ignore day-to-day problems. "I don't waste time on needless details," he told an interviewer proudly around this time. "I think that, too, is a secret for success in life." He preferred to spend his time traveling and speaking on scientific issues and vitamin C, keeping up his theoretical work on the chemical bond and other problems by publishing a few papers every year, and spending time with Ava Helen.
And Ava Helen was taking more of his attention. Her health had been a matter of concern off and on for years; she had suffered a small stroke in late 1967—a frightening episode with a midnight ambulance ride to the hospital in San Diego, but followed by a quick and complete recovery—then in 1972 had had a cataract removed. She and Pauling spent quite a bit of time together at the ranch during the period of her eye problems and the next year took together a long-awaited trip to the People's Republic of China, where they toured communes and returned home with hand-forged tools given to them by appreciative farmworkers.
His continued traveling and desire to be with his wife, combined with the ongoing fiscal crisis at the institute, made it clear to Art Robinson that someone with a more direct interest in the day-to-day running of the facility would have to be put in charge. To Pauling, the institute might have been a grace note on a long career, but to Robinson, it was his entire future. It had to be run efficiently. "Pauling wasn't doing anything as president," said Robinson. "I got frustrated, and I don't know how I got my nerve up for this because I usually treated him with great deference, but one day I said, 'Look, why don't you do the job? This makes it very hard for us.' And he looks at me and says, 'Well, why don't you do the job? You be president.' So I became president."
That was the way things were done at the institute. In the summer of 1975, Robinson became president and director of the Linus Pauling Institute of Science and Medicine, with Pauling himself taking the role of fellow.
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As it turned out, Robinson was not the right man for the job, either. While Pauling continued traveling to speak about vitamins and accept more honors—capped with the first official honor bestowed on him by a president since Harry Truman's postwar award almost thirty years before, the National Medal of Science, awarded at the White House by President Ford in the fall of 1975—Robinson labored to put the institute on a stable funding course. There simply weren't enough dollars. Salary cuts were distributed among what few institute employees there were, with Robinson and Pauling leading the way by donating portions of their salaries. By the end of the year, Pauling had given up his salary entirely.
That did not make for a happy workforce, a situation worsened by Robinson's poor administrative skills. He was a laboratory man, good at writing grants and performing experiments but unskilled in management. Neither was he a fund-raiser at heart, for he had little patience dealing with prospective donors and lacked Pauling's persuasiveness in one-on-one conversations. He quickly found himself unhappy as president, spending half his time in airplanes with a briefcase looking for money instead of being where he wanted to be. "I was the best guy in the lab," he remembered, "and I wasn't in the lab."
It was an opportune moment for Richard Hicks to appear. The polished, well-dressed executive assistant to the chairman of the board of the Dean Witter brokerage firm in San Francisco was interested in a career change, possibly to the health field. He had first met Pauling when the scientist spoke to the Dean Witter board on vitamins and health. Hicks himself was a vitamin e
nthusiast, and in late 1975 he approached Pauling and Robinson with a scheme to help them raise money. They should do a direct-mail campaign, he said, which he would capitalize himself in exchange for 15 percent of whatever he raised and the title of executive vice president of the institute—that was how sure he was of their potential success. "He presented himself very well, he knew his way around the corporate world in terms of how to look and how to act, he was going to pay for everything, 15 percent looks good," Robinson said, "and I'd go back to the lab." Hicks was hired on March 1, 1976.
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While the institute struggled, Pauling continued the public fight for vitamin C. When JAMA published an analysis of existing studies concluding that vitamin C had little effect against colds, Pauling pointed out the shortcomings and underlined the importance of a new, double-blind Canadian study—set up in part, he noted with satisfaction, to disprove his ideas—showing that people receiving 1 gram per day had fewer and less severe colds. When Modern Medicine published an editorial railing against "self-deception" among scientists like Pauling— whom it accused of putting forward an unproven thesis, then demanding that others prove him wrong—Pauling threatened a libel suit and drafted for the editors a retraction he wanted to see printed. The editorial had indeed gone too far; the editor apologized for not having read Pauling's book more carefully, then published almost verbatim the retraction Pauling had provided.
Those were rearguard actions, however. Pauling wanted to move forward with new evidence, especially about vitamin C and cancer. Pauling and Robinson undertook animal studies of vitamin C in 1975, buying hundreds of hairless mice, putting them on different diets featuring various combinations of vitamins C and E and other antioxidants, and irradiating them to produce skin cancer. One group also received a formulation of high-dose vitamins and minerals called "the Linus Pauling Super Pill," an item there was some talk of marketing as a way to raise money for the institute. A final group of mice were fed seawater as well. The seawater idea came from a letter to Pauling by a Caltech alumnus who noted that marine invertebrates rarely suffered from cancer, so perhaps there was some trace element in seawater that protected them. Pauling decided to follow up the lead.
The test was ongoing when in the spring of 1976, an NCI site-visit team arrived to review the institute. They duly noted the small staff, Pauling's frequent absences, and staff complaints about Robinson's poor managerial abilities. Their report would help sink the institute's future grant requests.
At the same time, however, Pauling received some good news from the Vale of Leven. By the early summer, a new analysis by Cameron showed that his vitamin C-treated cancer patients lived more than four times as long—210 days versus 50 days—as the historical controls to whom he compared them. Pauling helped write the results in a paper that he submitted to both the PNAS and the Journal of the National Cancer Institute. "It will be interesting to see what happens," Pauling wrote Cameron.
The editors of both journals quickly voiced concerns about the study's design, especially the way the control group was chosen. How could the paper's reviewers be sure that similar criteria were used in all cases to determine who was included in the control group, and how far their cancers had progressed? All cases were supposed to be "terminal," but how could anyone be sure in the historical controls that the same definition had been consistently applied? The referees for the paper at the PNAS took "severe exception" to the fact that randomized concurrent controls had not been used.
As Pauling argued his case with the journals through the summer, saying that the large size of the control group—Cameron had used ten controls for every vitamin C subject—and Cameron's care in picking them had resulted in effective randomization, the story of Cameron's success hit the press. Britain's New Scientist magazine interviewed Cameron (who refused to be identified by name "to avoid causing mental distress to our many local patients") and reported that 15 of his 100 vitamin C-treated patients had lived more than one year after being deemed terminal, versus only four of one thousand control patients. In nearly 10 percent of the patients receiving vitamin C, Cameron said, there had been clear evidence of tumor regression. The article also quoted other cancer experts as saying that the study would have trouble getting published in any juried journal because of the inadequate information available for the control group. As the respected Oxford epidemiologist Richard Peto put it, "Historical controls are the source of more horseshit than anything else in the world."
Pauling's response to the criticisms was simple and aggressive. "I am beginning to think that the attitude of oncologists toward new ideas is largely responsible for the fact that, despite the expenditure of billions of dollars during the last 20 years, there has been essentially no change in the survival time of cancer patients," he said.
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To Pauling's consternation, Ava Helen's health had continued to decline, with unspecified ailments keeping her at home in bed at times when Pauling was traveling, and forcing her to miss the big celebration Caltech threw for his seventy-fifth birthday in 1976.
The root of her problem was finally diagnosed a few months later: She had stomach cancer. In mid-July, she underwent surgery to remove the tumor as well as most of her stomach. Ignoring the advice of oncology experts, she and Pauling decided that instead of additional chemotherapy or radiation, she would take vitamin C in the dose recommended by Cameron, 10 grams per day. And it seemed to work. Soon her strength returned, and she felt well enough to once again accompany Pauling on his many speaking trips.
Pauling would not have known what to do without her. They were closer now than ever, so much a part of each other's lives that being apart was difficult. Yes, they had arguments at times, "the hottest of arguments," Ava Helen had once told a reporter. But "to live with someone with whom one always agreed would be unbearable. Surely one would have to be a nincompoop and the other a tyrant. Or possibly both could be liars."
Pauling and Ava Helen were none of these. They were instead an evenly matched pair of bright, loving, humorous, intelligent, witty people. Their relationship at its best was caught on tape by a film crew in the mid-1970s as they shot a segment on Pauling for the science show Nova.
Interviewer: Does he have an ego?
Ava Helen: Oh yes he does, a very well-developed one. [Turning to Pauling] Don't you agree?
Pauling: Yes, I'm sure that's right.
Interviewer: Is he hard to live with?
Ava Helen: Yes, he is [laughter]. . . .
Pauling: Hard to live with? I thought I was just about the easiest-going person that there was in the world.
Ava Helen: Well, that may be—that could be true, too, but still be hard to live with.
Pauling: Well, in a sense, i think you are hard to live with. Your principles are so high, your standards are so high, that I have to behave myself all the time.
Ava Helen: [Laughing] And that's a great burden on you.
Pauling: Yes.
Ava Helen: Well now, you tell me the next time you want to misbehave. [Laughter]
Pauling: Okay.
Ava Helen: And we'll see. We'll just see what—
Pauling: It'll be with you, though.
Pauling was shaken by her cancer and by the way the operation had affected her. Her energy was returning but the loss of much of her stomach necessitated changes in diet, and she suddenly seemed smaller, frailer, her face more deeply lined than before. She did travel with Pauling, but she also seemed to treasure even more her time at the ranch at Big Sur, where she took up music again, learning to play folk songs on the guitar and buying a grand piano. She had her children and grandchildren over as often as she could, their visits made easier and more enjoyable when family members, led by Linus junior, helped build a guest cottage just out of sight of the main house. Those days in the late 1970s were good ones at Big Sur, full of love and music, and best of all, the weeks when Linus and Ava Helen were alone, just the two of them, old lovers listening to the sea.
CHAP
TER 24
Resurrection
A Very Persuasive Man
Ava Helen's illness made the question of the use of vitamin C in the treatment of cancer more than scientific; it was a personal cause, and Cameron's most recent work buttressed Pauling's opinion that it was more important than anyone realized. The same week in 1976 that his and Cameron's Proceedings of the National Academy of Sciences paper saw print, Pauling gave a presentation to the Royal Society in London. Instead of a moderate call for further research, Pauling now stated, "It is my opinion that ascorbic acid may turn out to be the most effective and most important substance in the control of cancer." Proper use of the vitamin could, he estimated, lead to a 75 percent reduction in incidence and mortality from the disease.
Blue-sky estimates like that, with as little data as Pauling had to base them on, only hardened the medical profession's disdain for his ideas.