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Germany: Cancer therapy under scrutiny
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organisation that counsels business firms on containment of health-care costs. Included in the gory accounts was that of an outpatient knee operation for which a physician-owned surgery centre charged$3481. "The physician-owned charges were almost five times greater than the hospital charges for exactly the same procedure", the head of the business group testified. The criticisms of physician ownership were disputed by representatives of various medical organisations. For example, the 11000-member American Academy of Neurology assured the hearing that "the quality of the testing may be better in physician-owned imaging centers" because the proprietors are more likely to provide personal attention to patients. However, no data were offered to support this thesis. The hearing took place just as the US Department of Health and Human Services is preparing the final details on so-called safe regulations for business dealings by physicians who receive Medicare reimbursements. In general, the rules are intended to banish outrageous conflicts of interest, as are guidelines issued earlier by the Council on Medical Service of the American Medical Association. The spread of outlandish practices seems to have raised the level of outrage to a new high. The Federal Government, if it chooses to, can be extremely nasty about these matters. But virtually all the squalid practices described at the Ways and Means Committee hearing were either legally or morally proscribed under one or another existing code. Nonetheless, they have long thrived in the medical marketplace. The difference now may be that the US can no longer afford the extravagance of patients as economic prey. In any case, Shaw said it all, in 1906.
Daniel S.
Greenberg
Round the World Germany: Cancer therapy under scrutiny No visitor to the luxury villa with the spectacular view Dresden is likely to miss a tape-recording by the German Nobel prize winner Otto Warburg. What visitors to Prof Manfred von Ardenne’s study hear was one of the key factors that led to Ardenne’s 30-year fascination with cancer research-after a lecture by Ardenne in 1960 Warburg congragulated him on his ideas for cancer research and stated that "... he is just the right man for many reasons". However, it is not a statement that many cancer specialists concur with. Some regard him as irresponsible and his treatment as dangerous. He has not yet been able to secure Government funding for his work. Barely known in English-speaking countries because few of his publications have been translated into that language, Ardenne is widely regarded in Germany as a self-taught genius. Without a university education he became a pioneer of radio, television, isotope separation, and particle acceleration, and he holds several hundred patents. The Russians recognised his potential, and he spent the 10 years to 1955 in the USSR helping them to develop the atomic bomb. For this work he was awarded the Lenin prize in 1953. In 1955 he returned voluntarily to East Germany to found his institute in Dresden, where he and his co-workers, many over
of whom had accompanied him to the USSR and back, continued to produce technical innovations prolifically. But, encouraged by Warburg, who had discovered that cells in malignant tissue were more susceptible than normal cells to growth retardation and destruction by heat, Ardenne pursued his medical research on the effect of heat on cancer cells. He calls his treatment of malignant tumours cancer
multiple-step Although the
therapy
(Krebs-Mehrschritt-Therapie).
has been modified several times over the past 25 years, the basic principles have barely changed. According to Warburg’s ideas acidification of cancer cells by hyperglycaemia sensitises them to oxygen, and oxygen, says Ardenne, sensitises the cells to heat and helps to alleviate the stress of overheating the body. Thus, after a glucose injection the patient is made to breathe pure oxygen before being heated by infrared radiation to almost 42°C for an hour at a time by means of a computercontrolled device invented by Ardenne. The institute has been using this method to treat patients with metastatic disease unresponsive to conventional therapy. Efficacy is claimed, but there is no evidence that can be assessed treatment
scientifically. Ardenne has also devised what he terms oxygen-multiplestep therapy for the prevention of circulatory disorders and ageing. The treatment stems from his observation that capillary cells swell with stress and advancing age and contract when exposed to oxygen. This oxygen therapy, in which patients breathe pure oxygen for several hours at a time, has been adopted by many rehabilitation hospitals in West Germany, but its therapeutic value has never been proven by other scientists. Despite his wealth Ardenne, now 84, urgently needs financial support to carry on with his cancer research. He has asked the Federal Research Ministry in Bonn, or rather the Minister, Dr Heinz Riesenhuber, personally, for support. But in the unified system personal connections are not everything. Since unification research institutes in the former East Germany have been scrutinised by international expert committees. However, Ardenne’s institute, which employs several hundred scientists and technicians, and his new cancer and rehabilitation centre are private (despite the support of the East German Government, which had provided some 60 million East marks over the years) and therefore were not part of the evaluation routine. Nevertheless, a decision had to be taken as to whether the institute deserved further support. A small group of cancer specialists from Heidelberg appointed by the ministry spent a day in Dresden last autumn evaluating Ardenne’s work. The evaluation committee’s unanimous conclusion is that, since there is no effective treatment for solid metastatic tumours, Ardenne’s concepts ought not to be dismissed altogether and should be assessed in properly conducted trials. The committee also found that the standard rules of good clinical practice were not being observed in Ardenne’s institute. Treatment groups were not properly selected and characterised, statistics were lacking, and no ethics committee was ever consulted. The ministry’s response has been that the Institute might apply for a research grant that the Federal Government gives for testing alternative methods. The Dresden clinic is now trying to fulfil the scientific requirements to qualify for such support. Annette Tuffs
organisation that counsels business firms on containment of health-care costs. Included in the gory accounts was that of an outpatient knee operation for which a physician-owned surgery centre charged$3481. "The physician-owned charges were almost five times greater than the hospital charges for exactly the same procedure", the head of the business group testified. The criticisms of physician ownership were disputed by representatives of various medical organisations. For example, the 11000-member American Academy of Neurology assured the hearing that "the quality of the testing may be better in physician-owned imaging centers" because the proprietors are more likely to provide personal attention to patients. However, no data were offered to support this thesis. The hearing took place just as the US Department of Health and Human Services is preparing the final details on so-called safe regulations for business dealings by physicians who receive Medicare reimbursements. In general, the rules are intended to banish outrageous conflicts of interest, as are guidelines issued earlier by the Council on Medical Service of the American Medical Association. The spread of outlandish practices seems to have raised the level of outrage to a new high. The Federal Government, if it chooses to, can be extremely nasty about these matters. But virtually all the squalid practices described at the Ways and Means Committee hearing were either legally or morally proscribed under one or another existing code. Nonetheless, they have long thrived in the medical marketplace. The difference now may be that the US can no longer afford the extravagance of patients as economic prey. In any case, Shaw said it all, in 1906.
Daniel S.
Greenberg
Round the World Germany: Cancer therapy under scrutiny No visitor to the luxury villa with the spectacular view Dresden is likely to miss a tape-recording by the German Nobel prize winner Otto Warburg. What visitors to Prof Manfred von Ardenne’s study hear was one of the key factors that led to Ardenne’s 30-year fascination with cancer research-after a lecture by Ardenne in 1960 Warburg congragulated him on his ideas for cancer research and stated that "... he is just the right man for many reasons". However, it is not a statement that many cancer specialists concur with. Some regard him as irresponsible and his treatment as dangerous. He has not yet been able to secure Government funding for his work. Barely known in English-speaking countries because few of his publications have been translated into that language, Ardenne is widely regarded in Germany as a self-taught genius. Without a university education he became a pioneer of radio, television, isotope separation, and particle acceleration, and he holds several hundred patents. The Russians recognised his potential, and he spent the 10 years to 1955 in the USSR helping them to develop the atomic bomb. For this work he was awarded the Lenin prize in 1953. In 1955 he returned voluntarily to East Germany to found his institute in Dresden, where he and his co-workers, many over
of whom had accompanied him to the USSR and back, continued to produce technical innovations prolifically. But, encouraged by Warburg, who had discovered that cells in malignant tissue were more susceptible than normal cells to growth retardation and destruction by heat, Ardenne pursued his medical research on the effect of heat on cancer cells. He calls his treatment of malignant tumours cancer
multiple-step Although the
therapy
(Krebs-Mehrschritt-Therapie).
has been modified several times over the past 25 years, the basic principles have barely changed. According to Warburg’s ideas acidification of cancer cells by hyperglycaemia sensitises them to oxygen, and oxygen, says Ardenne, sensitises the cells to heat and helps to alleviate the stress of overheating the body. Thus, after a glucose injection the patient is made to breathe pure oxygen before being heated by infrared radiation to almost 42°C for an hour at a time by means of a computercontrolled device invented by Ardenne. The institute has been using this method to treat patients with metastatic disease unresponsive to conventional therapy. Efficacy is claimed, but there is no evidence that can be assessed treatment
scientifically. Ardenne has also devised what he terms oxygen-multiplestep therapy for the prevention of circulatory disorders and ageing. The treatment stems from his observation that capillary cells swell with stress and advancing age and contract when exposed to oxygen. This oxygen therapy, in which patients breathe pure oxygen for several hours at a time, has been adopted by many rehabilitation hospitals in West Germany, but its therapeutic value has never been proven by other scientists. Despite his wealth Ardenne, now 84, urgently needs financial support to carry on with his cancer research. He has asked the Federal Research Ministry in Bonn, or rather the Minister, Dr Heinz Riesenhuber, personally, for support. But in the unified system personal connections are not everything. Since unification research institutes in the former East Germany have been scrutinised by international expert committees. However, Ardenne’s institute, which employs several hundred scientists and technicians, and his new cancer and rehabilitation centre are private (despite the support of the East German Government, which had provided some 60 million East marks over the years) and therefore were not part of the evaluation routine. Nevertheless, a decision had to be taken as to whether the institute deserved further support. A small group of cancer specialists from Heidelberg appointed by the ministry spent a day in Dresden last autumn evaluating Ardenne’s work. The evaluation committee’s unanimous conclusion is that, since there is no effective treatment for solid metastatic tumours, Ardenne’s concepts ought not to be dismissed altogether and should be assessed in properly conducted trials. The committee also found that the standard rules of good clinical practice were not being observed in Ardenne’s institute. Treatment groups were not properly selected and characterised, statistics were lacking, and no ethics committee was ever consulted. The ministry’s response has been that the Institute might apply for a research grant that the Federal Government gives for testing alternative methods. The Dresden clinic is now trying to fulfil the scientific requirements to qualify for such support. Annette Tuffs