Here we go again.

Because he's been in the news lately, I've been writing a lot about the "brave maverick doctor" known as Stanislaw Burzynski who claims to have spectacular results treating normally incurable cancers using something he calls antineoplastons. Unfortunately, the reason Burzynski has featured prominently in the skeptical blogosphere over the last two weeks is because, unfortunately, the Texas Medical Board (TMB) dropped its case against him. Basically, Burzynski got off on a technicality.

For purposes of this post, I don't want to dwell on this case, because I've already pretty much beat it into the ground. I don't even want to visit any patients of Burzynski who trusted him but are dying or have died anyway. Sadly, we've met several of them over the last year, most recently Amelia Saunders. Rather, what I want to concentrate on is the perception of Burzynski by his followers versus the reality, and the way I want to get at that issue by going straight to the source. It just so happens that not too long ago, an alternative medicine rag published an interview with Burzynski, which Burzynski has posted on his very own website. (Hat tip to the reader who pointed this interview out.) The usual self-serving blather is there, of course, but it's the contrast between the picture of Burzynski as a misunderstood scientific and medical genius on par with Pasteur that his followers like to promote. And, of course, this genius is "persecuted" by the dogmatic medical establishment, who only wants to "cut, poison, and burn." Burzynski himself promotes both memes, but particularly the paranoia:

Do you think that understanding in the medical community about your research is improving with time or evolving? Dr Burzynski: Absolutely. Some of the brightest oncologists are working together with us. We have a group of about 100 top oncologists. We are treating patients together with oncologists from all over the world. We are talking about the brightest guys. The rest of the club does not understand what we do at all and hate us. They would like to get rid of us. They hate to see our good results. But this crowd also will change if the breakthrough comes. So at this moment, we have to convert oncologists one by one. Of course, I am giving lectures at the oncology congresses, but only a few of these doctors will pay attention to what I have to say because I am not from a big medical institution. They don’t believe something can come from a small clinic, a small research center. They all assume research must come from a big pharmaceutical company or big institutions. Unfortunately, not much good came from these institutions within the last decade. But a number of doctors are beginning to understand what we do, and the number of those who would like to be trained in our strategy is increasing all the time. We have oncologists coming to us from various countries almost all the time to learn how to use our approach.

This is about as unbelievable a paragraph as I've ever seen. In reality, oncologists shun Burzynski—and rightly so, given that he has yet to publish anything resembling a convincing result suggesting the efficacy of his antineoplastons against cancer. That's not to say he doesn't publish (although he hasn't published anything in a PubMed-indexed journal before 2006, not counting this interview, which is in a journal that should not be PubMed-indexed and isn't even an original research paper anyway). It's painfully obvious from this paragraph that Burzynski doesn't know academic oncologists. None of them whom I've ever met assume that nothing useful can come out of a small clinic or research institute. That's just rank stupidity if Burzynski really thinks that. The reason oncologists don't respect Burzynski is because of how he hasn't show that his treatments work better than conventional treatments—or even that they work at all—and because of the way he abuses patients by charging them huge sums of money to participate in a clinical trial. Those are the reasons legitimate oncologists, at least those familiar with Burzynski, look askance at him. How could they do otherwise? The ones who don't take him seriously are the ones who know him best.

Indeed, one could argue that that's why the FDA and the NCI couldn't work with him. They didn't know him when they agreed to work with him in the 1990s, but as they worked with him over the course of a few years they learned his true nature, leading to an inevitable schism, which taught the NCI a lesson about the consequences of dealing with pseudoscientists. Now here's where we see the sheer arrogance, the sheer ignorance of theman:

Dr Burzynski: I published the review article in a peer-reviewed journal almost 20 years ago on the principles of personalized gene-targeted therapy. But it was not understood yet at that time that cancer is a disease of the genes. The cancers have names like breast cancer or lung cancer but what is really causing cancer is abnormality in our genes. Now everybody knows about it, but 20 years ago, very few people realized it. The right way to treat cancer is to treat the genes that are causing the cancer. Do not treat just the name of cancer. Every case is somewhat different; that’s why we need to have a personalized approach. We need to identify changes in the genes and treat the genes which are “sick.” If we are successful, then we can have very good results. It’s not so difficult to understand. When antibiotics were introduced for the first time, they were used for the treatment of infections such as pneumonia or kidney infections or whatever. But after a number of years, the doctors realized that what they need to do is treat microorganisms which are causing the infection rather than the name of infection. Do not treat just pneumonia by the same antibiotics, but identify the germs which cause pneumonia and treat the germs. And then we can have success. Now the same principles are being applied to the treatment of cancer. We identify the genes which are causing the problem and treat the genes. It may happen that the same genes may cause breast cancer or stomach cancer, and then we would use the same medication for one patient’s breast cancer as well as another’s stomach cancer. Certainly, 20 years ago, this was heresy. And frankly speaking, very, very few medications could work on genes at that time.

I had to choke back a rising bile in the back of my throat as I read this. I mean, seriously, such a combination of arrogance (Burzynski apparently thinking that he really was the first person to think of the idea of personalized therapy and targeting genes for cancer) and ignorance of the entire field of cancer genetics and genomics is breathtaking! Let's put it this way. I was in graduate school 20 years ago, and was taught back then that cancer was primarily a genetic disease.. There's a term called "oncogene," which describes genes that, when either mutated or too much is made, can result in cancer. When do you think this term was first coined? Robert Huebner and George Todaro first coined it in 1969, and the first oncogene, src, was described in 1970, twenty years before Burzynski claims to have understood that cancer is a genetic disease. Has Burzynski ever heard of the term "tumor suppressor gene"? Tumor suppressors are genes that normally put the break on cell growth or other phenotypic changes necessary for cancer. When tumor suppressor function is lacking, cells can become cancerous. The first tumor suppressor gene, the retinoblastoma gene, was characterized in 1986, at least six years before Burzynski's apparent "revelation" that cancer is a "genetic disease." As usual, science was way ahead of Burzynski. In fact, the genetic basis of cancer was suspected at least as far back as 1902, when German zoologist Theodor Boveri proposed the existence of cell cycle check points, tumour suppressor genes and oncogenes. Boveri even speculated that cancers might be caused or promoted by radiation, physical or chemical insults or by pathogenic microorganisms! That's 90—count 'em—90 years before the time when Burzynski claims that it was "not understood yet at that time that cancer is a disease of the genes."

Curious as to just what the heck Burzynski was talking about here, I searched PubMed for this alleged review article. I couldn't find it on PubMed. His only publications from the 1990s had nothing to do with cancer as a "genetic disease" or "personalized gene-targeted cancer therapy" and everything to do with antineoplastons. Perhaps Burzynski proposed this "revolutionary" new idea in a peer-reviewed article that's not indexed in PubMed, but if he did I couldn't find it using Google and Google Scholar. (In fact when I entered "Burznski" and "personalized gene therapy" into Google Scholar, I got the article containing the transcript of Burzynski's interview that I'm discussing at the top of the hit list!) The earliest publication by Burzynski that I could find that dealt with genetics at all was one from 2003 entitled, Aging: gene silencing or gene activation?, published in 2003 in—surprise! surprise!—that rag of a vanity journal, Medical Hypotheses.

I will give Burzynski credit for inadvertently making an analogy that has a grain of truth, but even in making that analogy he mangles history. Yes, antibiotics were used to treat specific infections, but that was because it was known which bugs antibiotics killed and which bugs tended to cause which infections. So back in the early days of antibiotics, treatment tended to be more empiric because it wasn't always possible to culture the causative microorganisms. That doesn't mean that antibiotics were being used to treat "pnemonia" or "kidney infections" without little respect to the causative organisms. After all antibiotics are defined as antibiotics on the basis of their ability to kill or inhibit the growth of microorganisms! One could draw an analogy in that we now target various genetic abnormalities in cancer much more precisely than ever, in sort of the same way that antibiotics today can be much more specifically targeted to specific organisms causing specific infections than we used to do. It is also true that our considerations of subtypes of cancer are, thanks to the genomics revolution, becoming less organ-specific (i.e., based on what organ the cancer originates in) and more gene signature-specific, but it's a slow process, and the empirical knowledge of how to treat different cancers from different organs is still very useful. We haven't yet developed an organ-independent classification of cancers that is clinically useful, although it is possible that we might succeed in doing so in the next ten or twenty years. If we do, you can be certain that Stanislaw Burzynski will have had nothing to do with it and nothing to do to developing real "personalized gene-targeted cancer therapy."

I could go on and on, picking apart virtually every paragraph of this interview. They're all chock full of howlers like the passage above. But it's getting late, and even Orac needs down time; so I'll look at one last howler. Maybe I'll come back to this article sometime when I'm bored. In the meantime, consider this statement by Burzynski:

The first medication which worked on genes was Herceptin for the treatment of breast cancer. Even today, oncologists will attack you if you try to use Herceptin for something else. But suddenly a year ago, Herceptin was approved for the treatment of stomach cancer. If the patient has abnormality of the gene on which Herceptin works, it can work very well. The crowd of oncologists learns the medicine by heart without understanding of what’s going on. However, they have started to realize that there is a need to identify what is causing cancer in every patient who is coming for treatment and to use the right combination of medications. Unfortunately, we have a totalitarian approach toward treatment: Everybody should receive the same regimen for the same name of cancer. This is foolish. It contributes to billions of dollars in losses because typically the medications—single medications— work for less than 10% of patients. If you identify which patients will benefit from a particular medication, you can have good results and you can save a lot of money. But unfortunately, this approach still persists. I have been attacked by the Texas Medical Board for going overboard and using a logical, scientific approach toward treatment of the genes.

First off, Herceptin does not exactly "work on genes," and no oncologist would characterize it as doing so. Herceptin is a humanized mouse monoclonal antibody that targets the HER2 protein, which is the product of the HER2 oncogene, which is overexpressed (i.e., too much of it is made) in some breast cancers. It's been enormously successful in that HER2(+) breast cancer used to be considered a very bad actor. It still is a bad actor, but we have a targeted therapy that makes it less so. In any case, if Herceptin is a drug Burzynski defines as "targeting genes," then he's clearly wrong that it's the first one. It was not. Arguably, Tamoxifen was. Tamoxifen, after all, specifically targeted a gene product (the estrogen receptor) in the same way that Herceptin targets HER2, and Tamoxifen has been around since the 1970s. Be that as it may, it is not "heresy" to use Herceptin to treat other forms of cancer besides breast. It is true that Herceptin was first used in breast cancer, but that is because HER2 is frequently overexpressed in breast cancer. As soon as it was discovered that HER2 was overexpressed in other cancers, oncologists and scientists proposed using it for those other cancers. We cancer researchers are very happy to apply new drugs to new cancers if we think they might be useful, but unlike Burzynski we insist on testing them in clinical trials first, to make sure they work.

As for Burzynski's lament that we have a "totalitarian" approach towards treatment, all I can say is that it might seem that way to someone who has a "make it up as you go along" approach, like Burzynski. It's just another example of cranks pulling out the "fascism" gambit when they are told by scientists they are cranks. For instance, the TMB didn't go after Burzynski simply for off-label prescribing where there is a legitimate scientific argument. It went after Burzynski for mixing and matching targeted therapies willy-nilly in a reckless manner. Truly, it was personalized targeted gene therapy for dummies done by dummies.

In the end, it's hard not to be shocked by the combination of self-absorption, arrogance, and downright scientific ignorance that the "hero" of "alternative" cancer therapy demonstrates. I suppose I shouldn't be, but I am. And it takes a lot to shock me these days.