by Patrick M. McGrady Jr.

Concerning Bonn, Germany, travel writer Temple Fielding says he'll take downtown Detroit anytime. You visit Bonn, like Detroit, only on business, unless you happen to be a Beethoven nut, or unless you happen to have cancer.

In this corrosively frumpy city (population 300,000) is one of the world's least known and most interesting cancer hospitals, the Janker (pronounced Yahnker) Radiation Clinic. It consistently gets better results with its inoperable patients than university hospitals do with many of their operables. And the day my doctor does a double take over the X rays of my lumpy whatever and tenderly inquires if my life insurance and will are in order, I shall arrange for the Red Baron to whisk me off to dreary old Bonn and its dreary old (established 1936) Janker Clinic for treatment.

I had known about the Janker Clinic for five years. I had read its technical publications, interviewed its doctors at medical gatherings and been briefed on its functioning by American cancer specialists who had been there. Finally,

Patrick M. McGrady Jr. is a free-lance writer, specializing in science and medicine, and president of The American Society of Journalists and Authors.

I saw for myself. Last year I visited the hospital. For nearly a week, I grafted myself onto my host, Janker medical director Wolfgang Scheef M.D. I stayed at his home, accompanied him on rounds, shared meals with him, toured the entire hospital, and kept my tape recorder on for hours at a time.

That sojourn gave me an uncomfortable high. Despite walls that needed paint, halls too dimly lit, creaking wood floors and prewar johns, the place thrilled me. The super competence of the Janker staff overwhelmed me. I worried that my report on it would be uncautiously flattering. For a quarter of a century my father wrote press releases on research, especially that sponsored by the American Cancer Society, and he bequeathed to me his dread of being rapidly enthusiastic over anything related to cancer. One visit to Bonn clearly was not enough.

I persuaded a steely-eyed, nullifidian American cancer-specialist friend to join me on a second visit to the Janker. If anyone could scare out the bugs from under the chips, he could. I secretly wanted to be proved wrong.

Here was a private hospital (one hundred ten beds) with no government or foundation subsidy that seemed to have

developed better cancer treatments than the best of those available anywhere else in the world. A patient at, say, Sloan-Kettering Memorial Hospital in New York (which is funded by practically everybody) does not have the benefit of either the professional dedication or several of the techniques available at the Janker. Nor does any American patient enjoy the flat sixty-dollar-per-day rate (which covers doctors, nurses, the room, radiation, drugs and good food).

Here was a collection of patients, each of whom had been forwarded by other doctors and institutions with a "hopeless" or "terminal" label on the chart, and all of whom seemed irrepressibly cheerful.

Here were two men, Scheef and his boss, hospital director Dr. Hans Hoefer-Janker (who customarily omits the second half of his surname), who were largely responsible for developing four of the most potent anti-cancer agents known to the medical world. These include the nitrogen-mustard compound cyclophosphamide (or Cytoxan), the only one of the four that is currently available in the United States; isophosphamide, a nitrogen-mustard compound that is far more powerful than cyclophosphamide and which can be used on a greater range of malignant tumors; A-Mulsin, a highly concentrated vitamin-A emulsion, which is administered in colossal (up to three million units daily) dosages safely; and Wobe-Mugos enzymes, a carefully balanced complex of enzymes that decomposes proteins and fats and is used to prolong remissions obtained with other drugs.

This German hospital seemed just too good to be true. If only my doctor friend would dampen my fervor, he would reaffirm what I wanted to believe and what most American science writers accepted as an article of faith: that the best cancer care is available only in the United States of America. If it isn't available here, then what are the National Cancer Institute and the American Cancer Society spending almost a billion dollars a year on?

Regrettably, my friend was absolutely perfervid in his enthusiasm for the Janker's staff and techniques. In the few days he spent working alongside Drs. Hoefer and Scheef, he experienced a clinical freedom he said he had never known in the United States. I say "regrettably" because his comparisons terrified him. If he were to praise publicly what amounted to a refutation of the bureaucratic system he worked under, it could cost him dearly. He asked that I not mention his name, and I agreed.

He came, in fact, to be in full agreement with the Janker Clinic's flouting of some of the most sacred tenets of the American cancer establishment, to wit:

1) That all radiation or drug treatment must cease if the patient's white blood cell count dips below 1500. The normal count varies between 4800 and 10,800 per cubic millimeter of blood. Scheef will push therapies even with zero counts! He claims that if infections are avoided the count will rebound automatically.

The American

Knee-Jerk objection

The Janker Clinic is not a laetrile mill. This needs saying because American doctors doggedly confuse the Janker with the Neiper Silbersee Hospital in Hanover -- where laetrile is given to cancer patients.

Far and away the most modish of what the American Cancer Society calls unproved methods, laetrile (also called amygdalin or vitamin B-17) is obtained from de-fatted apricot kernels (and, less efficiently, from twelve hundred other plants) by extraction and recrystallization. Amygdalin, some of its proponents maintain, releases cyanide that destroys cancer cells and does not harm normal cells.

Dr. Scheef of the Janker Clinic once tried laetrile orally on twenty patients -- with no observable success. Since the presumably more potent injectable laetrile is unavailable in Germany, Scheef is not sure he gave the drug a fair chance. He keeps an open mind on the matter.

You can entertain yourself by asking your family doctor how much he knows about the Janker Clinic.

Chances are no better than one in five that he will confess his ignorance.

Chances are four in five that he will reply in one of three ways: warn you that this is where you're given peach pits for your tumor, or scold you for believing everything you read about old Whatshis name, "that guy who gives goat glands, sheep cells, Novocain, horse piss and peach pits for cancer," or tell you brutally that the hospital isn't even in Germany, but somewhere in Mexico or Spain.

2) That all cancers should be managed either by surgery, radiation or drugs. Or, if more than one technique is used, they should be used separately. The Janker often uses light radiation to increase the performance of one or more drugs. It also routinely uses immune system stimulants to help the patient's own body to fight the cancer.

3) That postoperative drug therapy interferes with wound-healing and thus should be delayed. The Janker finds this shibboleth unsupported by the evidence and wastes no time in administering drugs after surgery.

For most doctors in the United States, 1984 arrived a long time ago. My oncologist friend* has worked under the benevolent gaze of Big Brother for his entire career. He may not touch any drug or technique that has not filtered down through the paper-pushing process at the National Cancer Institute and the Food and Drug Administration. If one of his patients on an experimental therapy takes a turn for the worse, he may not vary the protocol a jot without risking the wrath of his section chief and cessation of government funding. If he tries to import a drug that has proved itself abroad but is not manufactured here, it can be confiscated without notice.

What impressed my friend most was the freedom the Janker staff enjoyed. Hoefer and Scheef control their one

hundred forty employees with an enlightened paternalism. Decisions are reached by a rapid consensus. Protocols are revised the moment they are perceived to be ineffectual -without any need to kowtow to government kibitzers, medical societies, do-good propaganda and fund-raising agencies, boards of directors or groups of "peer" on-lookers.

The Janker Clinic's preemptive focus is the patient. Nothing is permitted to interfere with the primary goal of prolonging the patient's productive life-span. The patients' cheerfulness probably can be explained by their knowledge that this is the one place in the whole world where they will be given the best available combinations of drugs, hormones, biologicals and radiation in the quest to dethrone King Cancer.

The Janker may well be the only cancer hospital where the owner arrives on the scene at five a.m. sharp so that he can get the paper work out of the way early and spend the remainder of his working day (till nine or ten p.m.) with his patients, each of whom he sees twice a week. Scheef sees each patient four times a week.

Scheef's data show that he induces a full or partial remission^* in seventy percent of the Janker's patients, of whom some 76,000 have been treated since 1936. The clinic gets exquisite results with many tumors that resist any type of treatment elsewhere. These results are more stunning even than the statistics would seem to show because, whereas most compilations of remis- sions refer to newly diagnosed, primary treatments, the Janker successes are almost entirely achieved upon patients who have been through one therapeutic mill or another and been jilted by other doctors. This fact makes their win-loss ratio almost flabbergasting.

Take pancreatic carcinomas. The mean survival time of patients after diagnosis elsewhere is three months and eighteen days. The Janker treats the most irredeemable of these, most of whom have bloated liver metastases. Of twelve such patients treated so far, the mean survival time has been eight months. One woman patient has had a two-year remission.

At best, some testicular cancers are tantamount to a three-month death notice. All of the Janker's patients with testicular cancers were practically D.O.A., with their tumors spread throughout their lungs. Using two drugs prohibited by the Food and Drug Administration (A-Mulsin and the Wobe enzymes) and isophosphamide (available only to five investigators here), Scheef was able to save thirteen of his first forty-three patients–all thirteen, at this writing, alive, working and apparently healthy.

Of twenty patients suffering from a variety of head, neck and tongue cancers treated exclusively with A-Mulsin, there have been no failures and many complete remissions.

Results consistently better than average are achieved in other cancers, including all cornifying squamous cell carcinomas (mostly cancers of the skin and mucosal tissues), cancer of the penis, pancreatic cancers, all lung cancers, stomach cancers, most sarcomas (which afflict

bones, muscles and connective tissue, mainly in children) and cylindromas (rare honeycomb like carcinomas).

However, the Janker gets results no better than average with childhood leukemia and Hodgkin's disease (cancerous enlargement of the lymph nodes, spleen and, sometimes, the liver and kidneys)–two forms in which some American centers have made notable progress.

The Janker started its prewar existence as a radiation clinic, pioneering in the development of sophisticated X-ray modalities, including the first use of television X-ray diagnostic work-ups, in 1949. It claims to have the world's largest collection of radiological films, which are distributed to hospitals worldwide. Its X-ray cameras can take up to eight large (35 cm. x 40 cm.) pictures per second. It has the case histories of 60,000 patients, as well as a mammoth collection of slides classified by patient category, neoplasm, stage, response and so forth. If some charitable soul ever bequeaths them $250,000, they'll computerize their data.

Nearly a decade ago, the Janker broadened its attack on cancer by hiring Wolfgang Scheef, a chemotherapist then barely thirty years old. Scheef had successfully pushed the highly toxic cyclophosphamide dose levels three times higher than the regulation thirty milligrams per kilogram of patient body weight at his previous hospital.

Almost all cytostatic agents depress the body's immune system, including the white blood cell count. Few or no American physicians knowingly allow the patient's w.b.c. to go lower than 1500. If the count goes lower than 2000, the theory goes, the body will be: 1) unable to fight even slight infections and 2) unable to regenerate white blood cells to a normal level.

Scheef theorized that if care were taken to keep the patient infection- free, the w.b.c. could go down to zero and still come back up. The drug kills only the young cells, leaving mother cells alive to proliferate.

While working at a general hospital in a Bonn suburb thirteen years ago, Scheef asked his chief's permission to increase the cyclo-phosphamide dose on a cancer patient from 30 to 40 mg./kg. of body weight.

"Don't worry," said Scheef, "I'm sure the white blood cells will regenerate."

They did. The stronger dose improved remissions. But when Scheef asked to bump the dose to 50, he was vetoed. This would put the w.b.c. to under 1000. Every manual said that death was a virtual certainty at that level.

One of his patients, a close friend, urged Scheef to give him the higher dose. Scheef agreed, provided the patient tell no one. He then confided his plan to an intern assistant. When the room was finally emptied of hospital personnel, Scheef injected a whopping four grams of the cyclophosphamide and asked the intern to keep a close eye on the situation.

Later the intern asked the patient if he'd been injected. Loyally, the patient said no. The intern, hearing this, injected another four grams.

The w.b.c. plummeted to zero. By the book, he was as good as dead.

Proud of his ruse, the intern whispered to Scheef that he'd given the injection without being noticed.

"What injection?" asked Scheef.

"The cyclophosphamide."

Frantic, both men devoured the literature on the drug–at that time some four hundred papers–to save the patient's life. The animal work made clear that corticosteroids, usually administered to patients on cyclophosphamide, should not be given. They kept their eyes peeled for signs of monilia, a fungus infection, which could have wiped out the patient in days. For three weeks Scheef got practically no sleep, but within the three weeks, as predicted, the patient's white blood cell count rose to normal. Moreover, there wasn't a cancer cell to be found in his body.

Still nervous– but eager –Scheef tried the accidentally found 100 mg./kg. regimen on four female patients, two with breast cancers and two with ovarian carcinomas. All got full remissions.

The hospital director was confoun-ded by Scheef's mysterious behavior.

"Why," he asked the young physician, "are you letting the w.b.c. go so low? And why are you doing the counts yourself, and spending your nights in the lab? And why is it that our cancer patients are doing so well?"

Scheef explained the conspiracy–and got his boss's permission to use the higher dosages routinely. Since they did not use corticosteroids, as most other institutions did, they were not plagued with the usual bleeding complications.

In fact, Scheef freely admits that there was an element of luck in his calculated risk. Very quickly, on later patients, he encountered unexpected side effects from the higher dosages. But as they appeared, he found ways of treating them.

His most important find was that bone marrow poisoning by the drug was reversible as long as corticosteroids were not given. (These hormones–still widely used in general practice–insidiously deactivate the white blood cells. By seducing them away from cancer sites and into the bloodstream–where they show up in blood counts–by reducing inflammation and making the patient feel better, corticosteroids counterfeit evidence of a remission. In fact, however, the white blood cells are careening about like cops on a drunken holiday–disarmed and useless.) Infections were avoided by having the patient keep his mouth clean with antiseptic gargles and warning nurses to give antibiotics the moment any sign of infection appeared.

Bleeding in the bladder, caused by acid urine, was avoided by giving baking soda. Cysteine, an amino acid, gave added protection to the entire genitourinary system.

Much of any patient's anguish over chemotherapy stems from the temporary baldness that often accompanies use of drugs like cyclophosphamide and isophos-phamide. Scheef believed that he might be able to reduce hair loss by getting cysteine into the scalp by electrophoresis.

One day he made an aqueous solution of cysteine with the solvent dimethyl sulfoxide (DMSO) and a dye, indigo carmine. The dye, when it showed up in his urine, would tell him how fast the cysteine had penetrated the system. Urine would show him if the drug was working.

After soaking his scalp in the solution, he attached silver plates to the nape of his neck and forehead and hooked them up to his car battery, which, his slide rule told him, provided the precise voltage required. The second he turned on the current he passed out. Two hours later, when he awoke, he realized that he had misplaced the decimal point on his slide rule and given himself ten times the power necessary for the experiment!

To determine whether the cysteine had been absorbed by his system, he went around the garage to a corner of his garden and sprinkled the posies.

Marveling at the sight of his father pissing deep purple, his four-year-old son exclaimed: "Please, Papa, teach me how to do that. With that trick I can get elected president of the kindergarten!"

When I first visited the Janker Clinic in March of last year, Scheef gave me the guest bedroom in his home in Brühl, a suburb lying halfway between Bonn and Cologne. We spent the whole day of my arrival, Sunday, talking cancer and drinking Schinkenhäger and Beck. His capacity was awesome and his coherence, even by three a.m., never diminished.

But the next morning, his left foot had swollen monstrously. Next to the bitchy blights of Venus, no ailment so mortifies the victim as flaming gout– particularly when he is a hospital medical doctor. As he hobbled past terry-clothed patients and starch-smocked nurses and doctors, he uttered brief explanations, sometimes with the old doggerel: "Des kleinen Mannes Sonnenschein ist Fressen und Besoffensein!" (Roughly: "The little man finds his sunshine in eating and drinking like swine.")

Scheef is a chunky, balding man with a black-bramble beard and soft hazel eyes; he is given to ebullient laughter and ebullient scowls. He picks occasionally from a tin of menthol snuff that serves as surrogate for the cigarettes he gave up in 1974. After the Sunday bout he never drank during his workweek. Instead, he took Antabuse, whose threat of violent nausea powered his will from Monday through Friday.

"I must constantly ask myself," Scheef told me, "Am I really giving this patient what I would take myself– or give to my father or to my daughter?' It's not always easy to answer.

"Treating a cancer patient is like preparing food. Each patient requires seasoning to taste. You must rationalize each ingredient from your data. But no two patients are alike. Each is special.

"The only way I can learn about cancer is by spending a lot of time with my patients. I talk to them about themselves, their families, anything and everything. often, in the middle of conversation, an idea will come to me. out of the blue I hit the proper therapy. But I can't learn unless I see patients every day. What I call 'mathematical doctors' don't do this."

Our chat is interrupted by a phone call from a physician who asks if his sister can be treated at the Janker. Her doctor, a high official of the German cancer society, had sent her home with palliatives–to die.

"Yes," says Scheef, "we can treat her here. We've had considerable success with ovarian cancer–even with metastases to the liver. Get her here quickly, though."

After hanging up, he fumes: "That son of a bitch, Dr. So-and-so. He dropped a patient he had no business dropping. He was concerned about his success statistic. That's all he thinks about."

When I returned for my second visit to the Janker, in the company of my specialist friend, the news from Scheef was that he had become teetotal. He missed the beer and schnapps, he said. Hugely. They always brought him his best ideas.

"I only need moments to know that something is true. Maybe five seconds. I might need weeks to understand why it's true. But when I'm sure, I'm completely sure. And I have to be drinking to come up with the idea."

A case in point was his first approach to the cyclophosphamide problem. The doses were too small. How to raise them, safely?

One night he brought home a pile of books and periodicals. He poured himself a drink, several drinks. Then he noticed a technical paper from the Ministry of Defense archives on skin conditions afflicting workers engaged in deactivating mustard gases stockpiled during World War II. His eyes widened when cysteine was mentioned as a prophylactic. Further on into his nocturnal swill, he read another technical paper on the skin irritations caused by cyclo-phosphamide, a nitrogen- mustard compound. Eureka!

"I said to myself: 'okay, Mensch, now I know that we can deactivate all of these mustards with cysteine.'

We began a big investigation. And today cysteine is the major protection we have against all the alkylating cytostatic agents. Without it, we couldn't use them as we do so routinely everywhere. And I got this idea while drinking."

The Janker's most formidable weapon is isophosphamide, a sister nitrogen mustard with more indications than any other cytostatic drug–thanks to Scheef's own ingenuity.

First introduced in 1967 at an International Congress for Chemotherapy, isophosphamide began most impressively on the basis of eye-popping results on animals. But clinicians quickly found that the drug was death on patients' kidneys. It annihilated the small distal tubules, causing hemorrhagic cystitis. Patients on more than 50 mg. / kg. of body weight became gravely ill. Many died.

In 1969, at a Congress for Internal Medicine at Wiesbaden, the Asta Company convened representatives from the twelve European clinics researching isophosphamide to eliminate the drug. (Anti-cancer drugs are a notoriously unprofitable item.) One by one, they all voted to stop their research -- except Scheef and Hoefer.

"It's too good not to use," Scheef told Asta official Professor Norbert Brock. "Moreover, we have solved the kidney and bladder problems. Let me prove it to you."

Asta replied that it was too late. The company had stopped pro-duction. Moreover, in the whole world there were only seven pounds left.

"Okay," urged Scheef. "Give us those seven pounds and let us do a clinical study. If this were merely an insecticide, you'd have solved them already. But because it's a cancer drug, nobody's bothered to. This drug knocks out tumors that fail to respond to any other drug."

Brock gave in -- but there was one problem. All the drug companies, including Asta, refused to give Scheef animals to work with. The drug was dangerous. The animals were, ah, too expensive. And since all the university clinics had given up on isophosphamide, how could the Janker hope to succeed anyway?

Scheef was forced to work with his patients as his guinea pigs. He chose only volunteers whose cancers could not be remitted by any other therapy and who had a maximum three week life expectancy.

In the fall of 1975, Hoefer and Scheef published a landmark four year study on isophosphamide, showing it to be the most useful anti-cancer drug known to man. Not only did it have a wider application than its sister cyclophosphamide, but it could be used on previously treated patients who were resistant to any further therapy. If scrupulously monitored, it was also less toxic than cyclophosphamide.

What made the results even more significant was the fact that most of their patients were terminals for whom the potential of surgery, radiation and cytostatics had been exhausted. The majority had cancers that had spread so gruesomely that the grave seemed at most a few days or weeks away. Indeed, sixteen of the first patients kept their rendezvous with death within the predicted three-week period.

The isophosphamide power- boosting process involved several steps:

— By merely keeping the urine alkaline with baking soda, they boosted the maximum tolerated dose from 50 to 70 mg./kg. body weight.

— Giving the patient up to six quarts of liquid a day brought it up to 120.

— By protecting the bladder with cysteine and spreading the injections over five or ten days, it went up to 300. At around 400, however, the isophosphamide began to kill the bone marrow and there the dose raising had to stop.

They devised still more tricks to increase its cancer-killing ability. They avoided the infections that could have been lethal during the low white blood cell stage by instructing the patient on the importance of oral hygiene and the high liquid intake. They used vincristine to synchronize the cancer cells' mitotic division so that the drug would strike them all at the most vulnerable point (the so-called G2 phase) in cell repli-cation. They gave a little radiation, wherever possible, to increase cell absorption of the water-soluble drug.

Of their 360 patients, l01 had a full remission, 150 a partial remission, and only 79 were complete failures. Thirty cases were not evaluated.

Extraordinarily good results were seen in ovarian carcinomas, breast cancers and small-cell bronchial (lung) carcinomas. Equally striking were remissions in the untreatable pancreatic carcinomas, various testi-cular tumors, osteo-sarcomas (bone), chondrosarcomas (cartilage), myo-sarcomas (muscle) and gastro-intestinal adenocarcinomas.

The investigators warned, how-ever, that owing to the danger of complications the drug should only be given at special cancer hospitals equipped to administer the compli-cated treatment of its side effects.

Five years ago, the Janker system of using isophosphamide was disclosed at a chemotherapy congress in Prague. Just before Scheef delivered his paper the N.C.I.'s Stephen Carter, deputy director of cancer treatment, walked out of the room, muttering to a colleague that he had no interest in the drug since it was "just another cyclophosphamide" and that he was perilously swamped with new drugs anyway. Although Milan Slavik, chief of the N.C.I.'s investigational drug branch, has reported those results to American investigators, they have been met with disbelief. Admittedly, use of the drug is so delicate an undertaking that the Asta firm will supply it to German clinicians only if they have worked with it at the Janker Clinic. Yet it seems nothing short of scandalous that neither the American Cancer Society nor the National Cancer Institute has been able to spare a couple thousand dollars to send one American investigator to Bonn to learn how isophosphamide (and the other Janker therapies) could save the lives of thousands of American cancer patients.

Ever since 1966, when I began researching a book on medical work relating to the prolongation of youth, I have known the two men responsible for creating the Janker's special vitamin-A and enzyme preparations. Max Wolf M.D. concocted the original formula of proteolytic (protein- decomposing) and lipolytic (fat- dissolving) enzymes he registered under the label Wobe (an acronym for Wolf and his assistant, Mrs. Helene Benitez). Karl Ransberger, president of the Munich pharmaceutical firm Mucos, strengthened the formula until it became a powerful agent in the treatment of various inflammations, including cancer. Later, he turned his attention to developing for veterinary use an old German World War II vitamin-A emulsion formula. The enzymes and vitamin formulas have since made him one of Germany's leading cancer-drug manufacturers.

To date more than two thousand patients have used the high- concentrate A-Mulsin for their cancers at the Janker. The little green and white aerosol cans (for oral administration) adorn approximately one-third of the patients' night tables.

At the suggestion of a veterinarian, Scheef experimented with the Mucos A-Mulsin to increase cancer cells' vulnerability to cyclophosphamide. Prior to these tests, he had already tried every other available form of the vitamin with varying degrees of unsuccess. But with the new emulsion, cancers formerly resistant to chemotherapy began to respond. Lung metastases vanished. Scheef wondered if the vitamin-A alone might be responsible.

When an order from the hospital for two hundred twenty pounds of the vitamin crossed Ransberger's desk, he called Scheef to ask why an oncologist wanted a veterinary product. Scheef said he wanted to use it clinically on cancers–but wished that it were more potent. Extrapolating from animal data, he said, a cancer patient should be receiving up to thirty million units.

Ransberger prodded his chemists to come up with a more concen-trated product. After several weeks, he delivered to Scheef several bottles labeled A-MULSIN, HOCHKONZENTRAT.

Once again, as he had done with the cysteine to prevent balding, Scheef tried the preparation on himself first. It almost killed him. In five days he swallowed thirty million units of the emulsion. His hair fell out; his skin peeled; his lips and mouth fissured into a miniature Grand Canyon. But he survived–and learned that dosages should start low and increase gradually.

One day, Scheef found himself confronted with an octogenarian patient with cancer of the penis. The conventional treatment–excision –was a loathsome notion for the old man.

"Anything but surgery," he told Scheef. "It's been my best friend for as long as I can remember. I'm not going to let it go now. I shall die with it as I've lived with it."

Scheef began a topical treatment with vitamin-A acid and systemic treatment with the A-Mulsin orally, bracing them with small amounts of radiation. The tumor disappeared totally.

Three years later, the patient died–his treasure still secure and intact–of cancers elsewhere in the body.

When he was still unsure about A-Mulsin for lung cancer, Scheef put fifty bronchogenic-carcinoma patients from one floor on a vitamin-and-radiation combination. He also put eighty-two comparable patients from another floor on radiation alone. In September, 1972 after a year of the trial, the results conclusively favored the new therapy: in the experimental section, eighteen out of the fifty patients were still alive, while only seven of the eighty-two on conventional radiation had survived. Thirty-six percent versus 8.5 percent. Moreover, the mean survival time of patients in the experimental section who did not live out the year was sixty-seven percent better than the controls.

The Wobe enzymes are as beguiling as the vitamin-A preparations. Scheef is convinced of their value as adjuvant therapy in

pancreatic cancers, adenocarcinomas, and malignant melanomas even though they have not been submitted for solid, controlled testing. He also puts many post-intensive-care patients on enzymes in the belief that they may prolong remissions. They have earned them-selves a niche as treatment of choice at the Janker in many inflammations, hematomas, thrombophlebitis, even cold sores and herpes zoster of which Scheef says: "We don't know of anything that works as well as enzymes for herpes zoster. We've treated at least twenty-five or thirty patients with them. If you catch it in the first three or four days, the patient will be cured without further pain, lesions and so forth. The best modality is an intramuscular injection of two hundred milligrams."

In Scheef's home, the enzymes are standard medicine-chest fare. "If I get a runny nose, bronchitis, pneumonia, or a sore finger, I first take a handful of enzymes. Often I need nothing else."

The enzymes, when injected, occasionally devastate certain solid tumors that have not spread. Six years ago, Scheef injected several ampules of liquid enzymes into a fifty-five year-old woman's adenocarcinoma of the uterine corpus. The cantaloupe-size tumor promptly liquified, oozing forth three pints of a dark muck, populated by dead cancer cells. As of two years later, when she last checked in, the woman was totally cancer free.

Most beguiling of all is the question of whether the enzymes alone can destroy benign and/or cancerous lumps in a woman's breast.

Several uncontrolled tests on women who rejected biopsies and surgery seem encouraging, if inconclusive. With twenty such women, whose mammo-graphies were extremely ominous Scheef administered thirty Wobe pills daily to each over a period of three or four months. In well over half of the group, the lumps vanished permanently. Those women whose lumps remained were treated conventionally.

The successes achieved at the Janker are, as I have said, the more noteworthy for the fact that it is, almost always, a hospital of last resort. It is far more difficult to heal cancerous lesions that have metastasized after the second or third go-round with conventional therapies. A case in point is that of a Spanish actress who, midway through her third pregnancy, observed hard, menacing lumps nudging through the soft contours of her right breast. In a short time, she was unable to lift the breast from her rib cage. She panicked.

A Madrid surgeon took a biopsy of the breast. It was positive. If he operated, an abortion would have been necessary. On those grounds alone, she refused surgery. But the cancer had spread so far that the surgeon would have achieved little but a grand and useless mutilation.

She then booked in at a London hospital and was given a drug combination that did not work. Within days, she was told that her case was hopeless.

Then she flew to New York and was checked out at Sloan-Kettering Memorial Hospital. After examining the scans, the X rays and the by now grotesque right breast, the doctors there refused to proceed with treatment.

Before leaving New York, friends urged her to consult Max Wolf. Wolf, they said, had a knack for bizarre treatments, which, often amazingly, got the job done. This seems to be the case. One of Wolf's patients was W. Somerset Maugham, who had suffered from intractable malaria for fourteen years. Twenty-two doctors had treated the condition unsuccessfully. Maugham told Wolf that if the torment were not exorcised, he would commit suicide. Wolf brazenly replied that he would give him the largest dose of quinine ever injected into a patient. "It's the only thing I can think of " Wolf told the writer. "It will either kill you or cure you." It cured him.

Wolf sent the Spanish actress straight away to the Janker Clinic.

Treating a celebrity is one thing. Treating a celebrity with a rampaging, widespread cancer, who had been abandoned by the best specialists of three countries, was another. Scheef did not welcome the challenge.

They waited till she had given birth to her baby, a girl. Then Scheef began an aggressive therapy of low-dose radiation to synergize the various drugs they would use: cyclophosphamide, trophosphamide, isophosphamide, A-Mulsin and the enzymes. It would be impossible, of course, to know which parts of the therapy were the most effective. But that, of course, was of secondary importance to getting her better.

Within six weeks, the actress was well enough to leave the hospital. She continued on the enzymes, which Scheef advised her to stay on the rest of her life. In months, the breast returned to normal. Every palpable abnormality had disap-peared.

Three years later, she revisited her Madrid surgeon. He could not believe that anything had "cured" her cancer – and told her so. (Most surgeons seem to believe that cancer can only be cured by cutting it out with cold steel.) He informed her that biopsies would be unnecessary, since the presence of the cancer had been established unquestionably three years ago.

"At least your breast is now operable," he said. "I can remove it without difficulty."

Which he did. Interestingly, the pathologists were unable to find a single cancer cell in the mastec-tomized breast, although its tissues had seriously degenerated because of the radiation and chemotherapy assaults.

The efficiency and absence of political backbiting at the Janker is due to the unique climate created by its owner, Hans Hoefer-Janker M.D. Twice married, with five children, Hoefer, fifty four, works eighty hours a week and is the very antithesis of the classical German hospital director who often vanishes for weeks without explanation, spends inordinate time with his private patients, never inconven-iences his career and generally plays the role of tyrant.

"In most hospitals," explains Hoefer, "the cleaning women are the soldiers; the nurses the corporals and sergeants; the doctors the commanding officers. In our clinic we have no ranks. Too much democracy is better than too little–but you can only have it with good and intelligent people. In certain situations, you have to rule like a despot. Such as with young doctors, fresh from the university, who tell you that you're all wrong because Professor So-and-so from some university has written the contrary in his book on the subject. But they learn."

Dr. Hans Hoefer-Janker will probably die of leukemia. His death will be a long-term, self-contrived suicide. He will die of leukemia because of his regular, prolonged exposure to radiation incurred in a therapeutic technique he has evolved for treating cancers of the anal-rectal area.

He places radium in a bronze capsule, which is then inserted by hand between the tumor and the intestinal wall. Precision of placement of the capsule is all-important and it can only be done manually, its location determined by a TV screen's projection of the fluoroscope. Placement may require up to twenty minutes, and there is no possible shielding. With the capsule finally in place, the patient's tumor is then bombarded with X-rays in the radiation room.

For the patient, the double-barreled attack is a dream. Survival rates on inoperable patients are at least as good as any other institution's results on operable patients (i.e., a five-year survival rate, without recurrence, of forty five percent, which is half-again better than plain cobalt treatment).

When Scheef tried the technique on a patient once, Hoefer was furious.

"Please do not do this again, Wolfgang. You know how dangerous it is. I am the only person in this clinic permitted to perform it."

With each five minutes of exposure, Hoefer absorbs from five hundred to one thousand millirads. The procedure is done about twenty times per year.

An American surgeon watching Hoefer in the radiation room cringed: "Dr. Hoefer, this is insane. If you continue this, you will certainly die from leukemia. Surely with all your ingenuity you should be able to find a way to protect yourself."

"Maybe," replied Hoefer. "If you can think of something, let me know. But aren’t the results beautiful?"

One wonders why the Janker's work should have eluded the powers that be in the United States. The answer is that it hasn't– not completely. However, the few physicians who have taken the trouble to investigate the clinic usually have spent no more than a day or two there. To my knowledge, there is but one institution here seriously investigating the gamut of the Janker's methods: the Whitestone General Hospital in Whitestone, New York.

I asked a National Cancer Institute official who had visited the Janker why American patients could not get isophosphamide, A-Mulsin, Wobe enzymes and the various Janker techniques that had proved so superior. His replies were disturbing: five investigators were trying isophosphamide clinically but hadn't found it too promising. Were they using the Janker's aggressive, fractionated high dosages? No, small, intermittent dosages. Why? Every doctor could use a drug as he saw fit.

Almost certainly the investigators will find isophosphamide "unpromising." The chances are high that Mead Johnson–the pharmaceutical company that is experimenting with the drug here –will propose euthanasia for it, discreet burial and no flowers.

The N.C.I. official was waiting for Scheef to send him the results on A-Mulsin therapy, but he suspected that the most useful part was the radiation. He had been unaware that A-Mulsin could be used without radiation. In any event, there was no rush.

The enzymes he had no interest in based on "insufficient documen-tation" provided by the Janker.

That the National Cancer Institute, with a several hundred million dollar budget, should insist that two overworked German oncologists should be versed in the American medical establishment's talent for paper work seems unrea-sonable.

The American Cancer Society is even more rigid. It prides itself on keeping the Janker techniques out of the United States. At its inception, the society should have played the role of ombudsman for cancer victims, keeping researchers and doctors on their toes, calling foul when new drug development is road blocked by the F.D.A., testing unusual methods that showed some promise.

Instead, it has become a major part of the problem. It eschews sponsor-ship of clinical and research innovation and instead goes in for propaganda (cigarettes are harmful, the seven danger signals, celebrity radio and TV spots) and it ritually condemns and suppresses unorth-odox methods which, incidentally it does not even trouble itself to investigate thoroughly.

Under vice-president Arthur Holleb M.D., who appears to delight in criticizing out-of-town techniques, the A.C.S. wages a covert and effective campaign to keep methods it disapproves of from seeing daylight in the research it funds.

Owing perhaps to an oversight in Holleb's department, I was offered access to the "Unproven Methods" files for a half-hour. When the powers that be learned I was reading their correspondence, I was ordered to leave the premises. I did have time, however, to copy some interesting documentation.

Of some personal interest was a letter Holleb had sent to New York's late-night radio-talk-show host Long John Nebel just after the appearance of Karl Ransberger, the purveyor of the enzymes and the vitamin-A emulsion, and myself.

The note included a "résumé" which pointed out that Ransberger once had received a doctorate from an English diploma mill. Since I was on the show with Ransberger, I was surprised Holleb didn't mention the fact that I once had been sent an unsolicited degree in naturopathy (an honor I returned promptly to the bestower). In any event, Holleb did not bother to discuss the merits of Ransberger's work or his prepa-rations. He closed his briefing with a plea for Nebel's discretion: ". .

We would prefer that the A.C.S. not be referred to by name, since this might lead to legal action. We would rather spend our time, energy and funds on continuing cancer research, education and service."

Later, in a letter to Robert A. Good Ph.D., M.D., who heads research at the Sloan-Kettering Institute, Holleb warned Good about monkeying with these "unproven methods":

"The other night the Long John Nebel radio show (WMCA) carried a several-hour interview with Karl Ransberger. He and Dr. Max Wolf are promoters of the 'Wobe Enzymes-Vitamin-A Emulsion' treatment for cancer. Both men have been well-known to us for many years. Our extensive files may contain information, which can be helpful to you if Karl Ransberger's comment that 'Dr. Lloyd Old of the SloanKettering Institute is testing my treatment' is true. The prior training of Karl Ransberger makes for interesting reading....

"I wish I knew how one could better control the unfortunate and premature publicity which links my distinguished alma mater to the promotional side of these unproven methods. We have both agreed that the public will be best served if tests are properly conducted in a prestigious institution, but the exploitation of the good name of the Sloan-Kettering Institute is becoming embarrassing. Perhaps your staff would be willing to consult with us and review our files before commitments are made."

Interestingly, despite the considerable millions in annual funding received by Sloan- Kettering, Max Wolf was asked two years ago to donate $15,000, to defray the costs of doing animal research on his Wobe enzymes–which he promptly paid.

Drs. Good and Old, once fair- haired hopes of the cancer-research vanguard, particularly for their interest in new forms of immuno-therapy for cancer have declined categorically to answer any questions regarding Wolf or their interest in the Janker therapies.

Poor America. Its money-fat, Gutstein biomedical research establish-ment has more and more to do with paper and abstract mathematics and fear and less and less to do with new therapies or even with people suffering from cancer.

If it would only send some good doctors to the Janker Clinic, it might not only learn something about cancer care but it might get a good lesson or two on freedom. ##

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