Nouvelles et analyses

accessibility, comprehensiveness, porta- moral authority than most of his Chrétien also knew that Bouchard bility and public administration. provincial counterparts. The unholy al- could not afford to walk away from the The deal also represents real progress liance between Harris and Bouchard, deal: his voters would never forgive in some directions that will improve the the exasperation that Harris triggered him. He simply told the pre- delivery of care and ensure a national in Ralph Klein, the unseemly spitting mier that if he didn’t sign, he wouldn’t rather than a patchwork system. The match between the have and have-not get the money. And billions of dollars initial $500 million for health data tech- provinces — all this revealed that Ot- will lubricate any negotiations. nology is only the first step in a potential tawa bashing is the only activity that In the end, Chrétien managed to $2.8 billion program. The federal gov- unites premiers. smooth over voters’ fears about health ernment also put $1 billion in the pot for Bouchard’s signature on the final care, reveal the rifts between the pre- medical equipment, an investment that deal must have been particularly grati- miers and reinforce his vision of health allows Ottawa to claim a leadership role fying for Chrétien. Only 3 days earlier, care as a national program, rather than in modernizing health care. Bouchard had expressed outrage that a crazy quilt of different provincial ser- Politically, this conference allowed Ottawa was trying to bring the vices. All in all, not bad for a day’s Jean Chrétien to emerge with more provinces “to their knees.” However, work. — Charlotte Gray, Ottawa

Canada’s only Di Bella cancer clinic a very lonely place

One year after Canada’s first Di Bella Under immense political and popu- month and $1300 for each month method (DBM) cancer clinic opened in lar pressure, Italian health officials sup- thereafter,” Malkin’s Web site advises. ’s Italian district, the number ported historical studies of DBM pa- The site acknowledges that evidence of patients it has attracted can be tients and 11 uncontrolled phase II of DBM’s efficacy is “anecdotal” and counted on 2 hands. In fact, 1 hand trials. The historical review, reported there is “currently no acceptable Cana- might do the trick. last year in Cancer (86[10]:2143-9), con- dian medical proof that this treatment “I must say, it is a little discouraging cluded that the 5-year survival rate for will cure cancer.” at times,” said Dr. Aaron Malkin, 12 DBM patients was significantly lower Why, then, did he bother introduc- months after setting up the Isola Bella than for patients receiving conventional ing the widely discredited protocol Oncological Multiple Therapy Clinic therapy, with no evidence of improved here? “I’m curious about the results, in a second-floor office in August 1999. survival prospects. The phase II trials, and I’m looking after the patient’s inter- During its first year the clinic received reported in the BMJ (1999;318:224-8), est,” he said. “All of the information un- many inquiries, Malkin said in an in- found insufficient efficacy to warrant til now has been anecdotal. Di Bella and terview, but it actually treated only “5 further clinical trials. his colleagues didn’t do a careful study.” to 10” patients. This was a far cry from Malkin thinks his Toronto clinic is Because some components of DBM the situation in 1997 and 1998, when the only one of its type in North Amer- have known anticancer properties, the “cure” developed by Italian physi- ica. The clinic’s original advertising was Malkin “thought it would be interesting ologist Luigi Di Bella was attracting a limited to the Buffalo News and a to see what happened” during treatment. firestorm of international attention. As Toronto-based Italian-language news- As for his own lack of patients, he says: Charlotte Gray reported in CMAJ in paper, but in August he began promot- “I’m not worried about that. I’m semi- 1998 (158[11]:1510-2), the phones of ing the clinic and DBM on a Web site, retired. I’m doing other things.” Toronto MP Joe Volpe were then www.oncomtc.com. At the Canadian Cancer Society, ringing 10 times a day with inquiries Three doctors are involved in the medical affairs director Dr. Barbara about DBM. Most callers wanted clinic. Malkin, an internist with a doc- Whylie was unwilling to express direct Volpe, an Italian-Canadian who was torate in biochemistry, was head of criticism of the Di Bella treatment. then to the clinical biochemistry at Toronto’s Sun- Whylie said the society recognizes the health minister, to explain why the nybrook Hospital from 1961 to 1992. growing public interest in complemen- “miracle” cocktail was not available in The other physicians are DBM special- tary cancer therapies and supports the Canada. ists based in . Malkin meets ini- right of patients to make their own de- Di Bella’s controversial cocktail com- tially with the patient, then consults cisions about treatment. However, “be- bines bromocriptine, melatonin and so- with his Italian colleagues, who develop fore abandoning conventional therapies matostatin or octreotide with comple- a treatment protocol that is prepared by and taking up any complementary ther- mentary substances, including vitamin an Italian pharmacy. Initial treatment apy, they should thoroughly discuss im- C and shark cartilage; it is taken with lasts at least 3 months. “For all of these plications with their physician or health low doses of chemotherapeutic agents services, the Isola Bella Clinic will re- care provider.” — David Helwig, Lon- such as cyclophosphamide. quire a retainer of $3800 for the first don, Ont.

1030 JAMC • 17 OCT. 2000; 163 (8)