THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 4, Number 2, 1998, pp. 137-145 Mary Ann Liebert, Inc.

OBITUARIES

Cancer Treatment Pioneers The lives of two great physicians and pioneers of alternative cancer treatments were celebrated in New York City at the end of March. On March 28, the Foundation for the Advancement of Innovative Medicine (FAIM) presented its Pioneer Award posthumously to Josef Issels, MD, for a half century of work on diet and immunotherapy. The following evening, March 29, The Re- vici Foundation for Lipid Biomedical Research held a public memorial service at the Church of St. Paul and St. Andrew, Xew York City, to commemorate the life and work of Emanuel Revici, MD, originator of a lipid-based nontoxic cancer chemotherapy. It was fitting that a further FAIM Pioneer Award was presented to Stanislaw Burzynski, MD, for his unrelenting efforts to make antineoplaston therapy available to cancer patients. An obituary and appraisal of Drs. Issels and Revici replace the customary Photoessay for this issue of the journal. An Appraisal of the Life and Work of Dr. Josef Maria Issels 1907-1997

Dr. Josef Maria Issels

r. Josef Maria Issels, 90, was widely re- prove patient care led him to integrate stan- Dgarded as the "Father of Integrative Med- dard, traditional, experimental and alternative icine." Xearly 50 years ago, his efforts to im- treatments in a full-service German cancer hos-

137 ' OBITUARIES pital. His unexpected death on February 11, with alternative, complementary, experimen- 1998, was due to influenza-caused pneumonia, tal, and traditional forms of treatment, includ- Dr. Issels was born November 21, 1907, in ing behavioral (mind/body) medicine. Com- Munchen-GIadbach, Germany. In 1932, at the bined management with surgery, radio- age of 24, he received his medical doctorate therapy, chemotherapy, naturopathic medi- from the University of Wiirzburg in Germany, cine, homeopathy, nutritional immunology. He first achieved international recognition at Coley's toxins, tumor vaccines, biological den- the age of 28 when, as a ship's physician, he tistry, and neural therapy marked his practice defied orders from the vessel's owners and per- as thoroughly unique in the world, formed emergency surgery on a British woman In 1959, independent epidemiologist A.G. who suddenly presented with acute abdomen Audier concluded and published in the re- pain. Under unimaginably difficult circum- spected journal. Die Medizinische, the remark- stances, in the poorly equipped and long-un- able observation that Issels had cured nearly used operating room of an ocean liner tossed 17% of the exhaustively pretreated, refractory on the waves of a stormy sea, the young physi- cancer patients admitted to his practice. Au- cian operated with scalpels "as dull as a butter dier's exclusion criteria were extraordinarily knife." The surgery was a success, and the press rigorous, only allowing review of those pa- seized the story, which ran counter to the ris- tients with histologically verified, recurrent ing tide of international tension and conflict, disease who simply could not be given any The headlines read, "German Doctor Saves more standard treatments. Due to the relatively British Woman's Life!" large sample studied, Audier's comparison Dr. Issels' defiance of authority was never with world data was statistically significant, simple rebellion for its own sake. Despite in- Ironically, in 1960, on the heels of the Audier credible danger to himself and his family, when publication. Dr. Issels was arrested on charges Nazi officials insisted that he stop treating his of fraud and manslaughter. The "cancer trial of Jewish patients, he petitioned to resign from the century" spanned 4 years and reached Ger- the Nazi Party. The petition was granted, but many's highest court, where, in 1964, Dr. Issels he was immediately drafted as an Army medic was acquitted of all charges. In the course of and sent to the Russian Front. He was captured the trial, it came out that members of the Ger- and interred until the end of 1945 under cruel man medical establishment had sent confeder- circumstances. Each day, as his fellow prison- ates to apply for jobs in Issels' medical practice. ers died of starvation and disease, he forced A worker whom Dr. Issels initially admired be- himself to stand and walk, subsisting on mea- cause he stayed until midnight every evening ger prison rations and consuming snow to aug- meticulously cataloging and reviewing charts, ment fluid and mineral intake. This experience, turned out to be a plant combing the cases for more than any other, gave him a deep under- possible fodder for the impending lawsuit, standing and spiritual bond with the thousands Some of the top names in the German medical of exhaustively pretreated cancer patients who community were involved in the conspiracy, would later seek his help. "Don't talk to me which ultimately backfired, about survival," he would tell them, "I know In 1965, the Demographic Institute of Al- about survival." lensbach polled Germans to test recognition of Dr. Issels is regarded as the Father of Inte- people in the news. Not even the current Chan- grative Medicine because as a classically cellor of the Federal Republic of Germany was trained German physician and surgeon, he known to as many common people as Dr. Is- boldly incorporated alternative and comple- sels, who had become a national hero. His in- mentary therapies decades before their current sight and leadership continue to be of interest popularity. In 1951, he opened the Ringberg- to scholars and practitioners alike. Recent pub- Klinik in Rottach-Egern, Germany, the first lications, including Michael Lerner's Choices in full-service hospital in Europe to offer treat- Healing from MIT Press, and David Hess' NYU ment to cancer patients who had been rejected Press publication. Can Bacteria Cause Cancer? by other doctors. His comprehensive manage- Alternative Medicine Meets Big Science, continue ment consisted of standard care integrated to highlight his many contributions. OBITUARIES 139 In 1970, the British Broadcasting Corpora- For more than 40 years, Issels labored on be- tion's (BBC) scientific investigators concluded half of his patients. To his everlasting credit, he a 6-month critical review of Issels' methods and rose from adversity to become a coveted outcomes. With unprecedented enthusiasm, the speaker for international medical conferences, BBC reported that a new independent epidemi- at universities including Oxford and McGill, ological chart review had replicated the earlier and prestigious institutions such as Memorial findings of Audier—in fact, with a larger sam- Sloan Kettering Cancer Center. ple size and equally rigorous exclusion criteria, In 1981, capping his meteoric rise, Issels re- the new review demonstrated a statistically sig- ceived an invitation to join the German Federal nificant cure rate approaching 19%, even higher Cancer Commission, a post he held for nearly than the 1959 report. The documentary was en- 7 years until his retirement from the Ringberg titled "Go and Climb a Mountain," a reference Klinik. Professor Anderson summarized his re- to Dr. Issels' undisguised psychotherapeutic lationship with Issels: techniques: he would revive depleted cancer pa- tients so thoroughly that they were able to hike I have known Dr. Issels for 12 years and up the small peak near his hospital. Once they been involved in an assessment of him had done so, he would suggest, "Now that you both as a person and as a clinician. His have climbed the mountain, don't you think you reputation is international as well as na- can conquer the cancer?" His acceptance at ail tional and he is known for this clinical levels was such that the BBC film depicted Ger- work and research, not only in Europe, man Army helicopters delivering terminally ill but in North and South America. His new cancer patients for treatment, and related that ideas have aroused challenge and change their care would be fully covered by both gov- and there is no doubt his approaches have ernment and private insurance. forced others to reconsider theirs. He has The lead researcher contracted by the BBC had an impact internationally in the can- was Professor John Anderson, M.D., Chairman cer field. He has as I know treated over of the Department of Medicine, King's College 10,000 patients with proven cancer. His Hospital Medical School, University of Lon- long term remission rate is still signifi- don. A champion and defender of Issels, An- cantly greater than that of other physi- derson wrote. cians working in this field, and better than the standard cancer registry data. He has contributed to our understanding of the whole-person approach to cancer After relocating to the United States, Dr. Is- therapy and the problems involved in con- sels lectured and traveled extensively, main- trolling a serious whole-body disease. His taining a schedule that would have been diffi- patients have come from many countries cult for a considerably younger man. He and and his extensive records have enabled his wife. Use Marie, created the Issels Founda- him to produce data about his complete tion to advance and promote his approach to and long term remissions in seriously ill cancer management through education and cancer patients who had been rejected by medical research. His final project, embarked other doctors. on with his move to Rancho Santa Fe, Califor- nia in 1996, was the merger of his own inte- In 1972, Dr. Issels published details of his grated set of medical managements with the comprehensive immunotherapy and the guid- well-known dietotherapy developed by former ing principles behind it in More Cures for Can- University of Munich tuberculosis division cer, from Heifer Verlag. In 1975, Hodder and chief. Dr. Max Gerson. To accomplish this, at Stoughton, publisher of The Lancet, introduced the age of 88, Issels became a coprincipal in- Issels' Cancer: A Second Opinion. Biographer vestigator and senior medical consultant to a Gordon Thomas' Issels—The Biography of a Doc- three-way effort involving the Issels Founda- tor, also published by Hodder and Stoughton tion, the Gerson Research Organization (GRO), in 1975, chronicled the great physician's rise to and Centro Hospitalario Intemacional Pacifico, prominence. S.A. (Mexico) ((ZHIPSA). Until his unexpected 140 OBITUARIES illness. Dr. Issels worked daily with the Is- Marie, their sons Hellmut and Christian, two sels/CHIPSA/GRO Collaboration, writing, children from a former marriage, son Roif and publishing, and teaching. Two full days a daughter Ruthild, and six grandchildren. Ser- week, he engaged GRO researchers and vices were held at 2:00 PM Wednesday, Febru- CHIPSA physicians in technology transfer, ary 18 in San Diego. It is requested that any do- teaching the theory of integrated practice and nations be sent to the Issels Foundation, P.O. the practical issues of treatment delivery. Box 676047, Rancho Santa Fe, CA, 92067, tel Dr. Issels was a member of numerous profes- 888-374-7757. sional and government medical associations, in- cluding the Xew York Academy of Sciences, the REFERENCES American Association for the Advancement of Sciences, the German Cancer Society, the Lerner M. Choices in Healing: Integrating the best of con- Bavarian Cancer Societv, the Roval Medical So- ventional and complementary approaches to cancer. dety of Scotland, the Academia Teatina of Ro- Cambridge, MA: MIT Press, 1994. rence, Italy, and the German Federal Govern- Hess DJ. Can bacteria cause cancer?: Alternative medi- ment's Gesamtprogramm zur Krebsbekampfung cine confronts big science. Xew York: Xew York Uru- versity Press, 1997. (Commission for the Fight Against Cancer). Dr. Issels is survived bv his widow. Use —Gar Hildenbrand

Emanuel Revici, M.D.: Innovator in Nontoxic Cancer Chemotherapy 1896-1997

Dr. Emanuel Revici

manuel Revici, M.D., who died at the age ually guided lipid-based chemotherapy of neg- Eof 101 on January 9, 1998, left two legacies. ligible toxicity a generation before cytotoxic The first, and principal one, is research and chemotherapy became a mainstay of cancer treatment. He developed a system of individ- care, and he utilized this system to treat not OBITUARIES 141 only cancer but acquired immunodeficiency Roosevelt Administration as Undersecretary of syndrome (AIDS), narcotic addiction, radiation State from 1937 to 1942.) burns, arteriosclerosis, and arthritis, among When the dean of the Chicago University many other diseases. medical school resigned, Revici accepted an in- Revici's second, lesser legacy is health rights. vitation from physicians, businessmen, and It derives from precedent-setting opinions in civic leaders to open an experimental cancer several malpractice suits against him in the clinic in New York City in 1947. The clinic, 1980s that are consistent with an important lib- named the Institute of Applied Biology (IAB), eralizing trend toward assumption of risk by became operational that same year. Revici patients in choices of treatment. served as scientific director, a position he held Emanuel Revici was born in Bucharest, Ro- until the IAB ceased operations in 1990. He mania, in 1896. He received his doctorate in earned his medical license in New York by ex- medicine and surgery from the University of amination in 1947, and resided and maintained Bucharest in 1920 and his license to practice the his dual career as a scientist and physician in next year. Subsequently, he was appointed New York City until his death. "Preparator," then "Assistant," at the second Medical Clinic of the Faculty of Medicine, Uni- versity of Bucharest. SCIENTIFIC FINDINGS AND MEDICAL In the mid-1920s, he began to concentrate on APPLICATIONS biochemical research, specializing in the rela- tion between lipids and normal and abnormal Revici's medical insights derived from sev- cellular metabolism. From 1936 to 1941, after eral different lines of intertwining investiga- resettlement in France, he continued his stud- tion. Each one is simple enough by itself, but ies at academic and hospital laboratories di- when woven together they form a complex rected by prominent Parisian physicians. Dur- body of knowledge that cannot be assimilated ing this period, the sub-director of the Pasteur through a superficial examination of his writ- Institute deposited five papers by Revici in the ings. National Academy of Sciences, a prestigious During the early years of his clinical research, way of registering scientific innovations. These Revici noted that cancer patients presenting papers summarized observations Revici had with pain showed a cycling in their levels of made about the influence of lipids in patho- discomfort. Some patients felt more pain in the logical pain and cancer. morning, others suffered more at night. Some Revici's clandestine service with the French patients had their pain relieved by eating, oth- Resistance during World War 11 obliged lead- ers found their pain so exacerbated by eating ers of the Underground to provide sanctuary that eating became a fearful experience. Revici for him outside of Europe. In 1941, he resettled surmised that any cycling of this nature must in Mexico, advancing his studies in Mexico City be associated with an underlying cycling of the for the duration of the war. Between 1942 and patients' physiology, and he set out to discover 1945, he established and directed a free clinic, what such underlying fluctuations might be. staffing it with fellow physicians-in-exile and Utilizing the techniques available to him dur- local physicians. The clinic, which contained ing the first half of this century, he studied a over 100 rooms, mainly treated cancer patients. variety of aspects of blood and urine. These In 1946, Dr. George Dick, dean of the med- simple studies led to the finding that healthy ical school, Chicago University, invited Revici individuals characteristically showed daily to continue his research in the United States. In rhythmic fluctuations in fundamental physical recognition of both his assistance to the French parameters, such as urinary pH and levels of Underground and the potential of his scientific free potassium in the blood. Cancer patients, in discoveries, Sumner Welles, a high-level aide contrast, failed to show normal patterns of fluc- to President Franklin Roosevelt, arranged with tuation, exhibiting either patterns of acidic im- the U.S. Consulate in Mexico to grant special balance or alkaline imbalance (Revici, 1961a). visas to speed the entry of Revici and his fam- The next steps taken by Revici typify his abil- ily. (Mr. Welles, a diplomat, had served in the ity to penetrate directly to simple experiments. 142 OBITUARIES First, he found that ingestion of a small amount they primarily were inductive of anabolic or of sodium bicarbonate by patients in acidic im- catabolic metabolism (terms that, to some ex- balance would ameliorate their pain temporar- tent, became interchangeable in his thought ily, but would worsen the pain of patients in with categorization according to whether an el- alkaline imbalance. Experiments with dilute ement contributed to an acidic or alkaline phosphoric acid yielded approximately con- state). Remarkably, Revici found that within a verse results. Knowing that such small vertical series of the Periodic Table of the Ele- amounts of dilute base or acid would not ments, elements acted similarly; he deduced change body pH, he then placed platinum elec- that their valency shell in part determined their trodes into painful loci of patients with super- bioactivity. Based on his analysis of elements ficial tumors, as well as into nonpainful regions in different levels of organismal organization of the tumor mass and into normal tissue. (cell, tissue, organ, system), and the effects of These experiments led to a remarkable conclu- specific elements on cellular pathology, he sug- sion: the pH of painful local lesions was not gested that the concentration of an element in only different from the rest of the body, but different organizational levels was both pre- could be rapidly and specifically altered by the cisely regulated and a critical determinant of ingestion of small amounts of acid or base. As normal and pathological states (Revici, 1961a). a result of these initial studies, Revici proposed A further component of Revici's develop- that a critical distinction be made between ment stemmed from his observations on the pathological pain and what he termed "physi- molecular structure of carcinogens and other ological pain," a distinction supported by bioactive molecules. In contrast to the prevail- many subsequent years of research (Revici, ing wisdom (expressed most forcefully by Li- 1961a). nus Pauling), he observed that many bioactive Wishing to relieve pain in his cancer patients, molecules exhibited a charge structure in he decided to develop lipidic means of altering which adjacent carbon atoms could be pre- pH, realizing that interventions based on ions, dicted to carry identical charges. As with so amino acids, or proteins would prove too short- much of Revici's work, examination of molec- lived to provide meaningful benefit. Before ular structures makes one wonder why his Revici could carry out this work, however, he peers resisted this discovery: Perusal of the determined that it was necessary to define Merck Index reveals example after example of lipids as more than greasy, water-insoluble bioactive molecules with such an energetic con- substances extractable in ether (a definition figuration. The concepts Revici evolved from still found in many present-day biochemistry study of these "twin formations" (as he termed books). Decades earlier than anyone else in the them), or energetic centers, also played a cru- field, he redefined these important substances cial role in his design of medicaments (Revici, at a molecular level, accurately describing the 1961a). relative importance of the polar and nonpolar Time after time, his investigation of lipid regions of these molecules. This definition function and chemistry opened the way to find- guided Revici's utilization of lipids for thera- ings that predate ideas now widely accepted. peutic purposes by providing a precise struc- For instance, 20 or more years before Bengt tural guide to the analysis of the compounds Samuelsson described leukotrienes (1987) and he would go on to create (Revici, 1961a). received a Nobel Prize for his work, Revici es- While seeking to develop better means of an- sentially described them, recognizing their cru- alyzing the effects of lipids on the organism, cial role in inflammation (Revici, 1950; Revici, and being intrigued by his observations that 1961a). the mineral constituents of the nuclei and cy- Typically for him, though, Revici also saw toplasm resembled the Earth's crust rather than these compounds as a small part of a much sea water, Revici also initiated a systematic larger picture. Instead of choosing the tradi- study of the effects of different elements on tional scientific path of focusing the next 10 bodily function (Revici, 1961a). This research years of his research on this one topic, he went led him to categorize elements as to whether on to describe presciently the capital role of OBITUARIES 143 bioactive lipids in the early stages of cellular EXPRESS ASSUMPTION OF RISK and systemic host defense processes, deducing that intervention by lipids at this level of the In the last two decades of his life, Revid strug- body's defenses might drastically alter out- gled desperately to remain in practice. In No- come, and even the extent of mobilization, oc- vember 1983, two negligence suits, the first ma- curring at other levels (Revici, 1987). jor negligence actions agair\st him in 63 years of At this stage in his development, Revici in- continuous practice, commenced in the Federal corporated another important foundation prin- Court. In January 1984, the New York State ciple: that frequently, the damage done to any Health Department initiated a disciplinary pro- organism by disease is caused not by the path- ceeding against him, alleging gross negligence ogenic focus alone but by the body's defense and gross incompetence (among other charges, mechanisms as well. Although he may not have all of which basically reduce to departures from been the first to codify this key principle, Re- community standards resulting in claims of in- vici again seems to have been decades ahead jury to patients). Each proceeding could have of others in applying this understanding of ousted him from practice and closed the IAB. pathology in his treatment {Revici, 1961a; The story of how he kept, lost, and regained 1961b). his license in the New York State proceedings Because he believed that these defense mech- is eminently worth recounting, especially for anisms, activated into disequilibrium, may do the instrumental role played by his patients in more harm than the pathogenic focus itself, he saving the license in the first proceeding. How- therefore devoted himself to devise medica- ever, it is too lengthy (stretching over a period ments that would restore normal bodily func- of 14 years), and too complicated by different tion. Based on his earlier studies, Revici chose circumstances that necessitated different strate- to utilize the properties of elements to alter dif- gies for each proceeding, to tell here. The vic- ferent levels of function, and the ability of tories won by Revici in court comprise his "sec- lipids to cause longer lasting alterations, to cre- ond, lesser legacy," and they can be recounted ate a large series of therapeutic compounds in concisely. which elements were conjugated into lipids The cases went to trial before juries, and in (Revici, 1961a). He thereby anticipated, again both cases the juries returned verdicts against by decades, interest in lipids as carriers of phar- him and awarded damages in monetary maceutically useful compounds (Mizushima et amounts totally beyond his ability to pay. His al., 1986). As already noted, his research on attorneys filed appeals with the appellate court, "twin formations" also heavily influenced his and the appellate opinions reversed the lower thought on the structure of useful therapeutic court verdicts, remanding both cases for retrial agents. (Schneider v. Revici, 1985,1987, and Boyle v. Re- Taken altogether, the different paths of re- vici, 1989, 1992), The second case went to re- search explored during his life facilitated the trial, and the jury verdict this time was for Re- development, with foresight and intention, of vici (Boyle V. Revici, 1994). a great number of therapeutic compounds de- The reason for reversal in each case was the signed to have particular effects on the func- same. The appellate justices ruled that the tion of normal and diseased tissues. It may be lower court judges had failed to instruct the ju- said, then, in summary and without exaggera- ries to consider whether the patients had ex- tion, that Revici developed a theory of rational pressly assumed the risk of treatment that de- drug design decades before the concept entered parted from community standards. The ap- the imagination of the larger scientific com- pellate rulings set a legal precedent, "Express munity. And this theory helped Revici dis- Assumption of Risk" (technically speaking, an cover, among other therapeutic agents (again, affirmative defense). Under this precedent, if a many years before anyone else), such com- defendant physician proves to a jury that a pa- pounds as organo-selenium drugs for treat- tient expressly assumed the risk of unconven- ment of cancer, AIDS, and other terminal or tional care, this bars recovery of any damages. chronic degenerative diseases. To quote the appellate opinion in the first case: 144 OBITUARIES Appellees contend that it is against public had the potential to revolutionize the treatment policy for one expressly to assume the risk of numerous pathological conditions. After he of medical malpractice and thereby dis- established himself in New York City in 1947, solve the physician's duly to treat a pa- the United States medical community, for the tient according to community standards. most part, dismissed or reacted indifferently to We first note that the 'public policy' re- his findings. ferred to ... is defined solely by statute Since congressional establishment of the Of- . . . and appellant points to no statute im- fice of Alternative Medicine (OAM) in the Na- posing limitations upon such express tional Institutes of Health in 1992, the OAM agreements. Moreover, we see no reason and the Food and Drug Administration (FDA) why a patient should not be allowed to have cooperated in developing a protocol to make an informed decision to go outside test Revici's therapeutic agents. Recently, the currently approved medical methods in Center for Alternative Medicine at the Univer- search of an unconventional treatment. sity of Texas (Houston) agreed to assist in this While a patient should be encouraged to endeavor. exercise care for his own safety, we believe Independent validations of his findings that an informed decision to avoid surgery about lipid structure and function have accu- and conventional chemotherapy is vathin mulated over the past 20 years. The section on the patient's 'right to determine what shall his scientific discoveries in this article singles be done with his own body' (Schneider v. Revici out as the first medical scientist to elu- Revici, 1987). cidate the bioactivity of leukotrienes, the first to develop a safe, effective means of lipid trans- The two sentences that end this quote firmly port. Certainly, he pioneered in the use of se- place a significant development in the judicial lenium in a virtually nontoxic form to treat can- branch of government, a matter of relatively cer (Revici, 1961a; Schrauzer, 1981). It now also narrow interest, into a much more general appears that he predated his peers in adminis- trend toward liberalization of attitudes about tering (O-3 fatty acids derived from marine fish the risks patients (and the public) may take in oil to shrink tumors (Revici, 1961a; Simopou- choices affecting health. losetal, 1998). This trend is discernible in actions and poli- Reflecting on Revici's life, on the obstacles he cies of the legislative and executive branches of encountered in advancing his career and striv- government (U.S. Congress, notably. The Ac- ing to earn recognition as a seminal figure in cess To Medical Treatment Act, pending before 20th century medical science, certain questions both Houses since 1994, and notably the report arise about his temperament, about the ways delivered to President George Bush by the Na- he conducted research, and how he applied tional Committee to Review Current Proce- laboratory findings to clinical practice. In short, dures for Approval of New Drugs for Cancer how much did the personal factor count in and AIDS, 1990). It also is traceable in medi- building resistance to his theories and method cine, where mainly the patient-centered school of treatment, precipitating the trials that buf- of outcomes research supplies impetus (Wenn- feted him mercilessly toward the end of his berg, 1988, 1990; Reiser, 1993). days? Revici's approach to research was conven- tional: observation first, next hypothesis, then experiment. Theory seems to have appealed to SUMMARY him more than experimentation did. (He re- peated experiments to test his hypotheses and During the early, European years of Revici's data, but as soon as his experiments convinced career (1920 to 1941), his medical theories at- him that he was correct, he wasted no time re- tracted support, notably in France, where aca- peating them again.) Still, he clearly realized demic physicians who witnessed the results of that both weighed equally in discovering and his clinical applications thought his protocols perfecting treatment (Revici, 1961a). OBITUARIES 145 Temperamentally, though, Revici had little depends on how soon objective studies cor- tolerance for the time generally required to roborate the bulk of his lifework. bring new treatments from breakthroughs in the laboratory to approval by the FDA. He felt very strongly that gravely ill patients whose conditions were resistant to accepted modes of ACKNOWLEDGMENTS therapy could not wait for the approval process Mark Noble, PhD, Professor of Oncology, to run its course. Once his own careful experi- University of Utah Health Sciences Center, pre- ments confirmed to him that a therapeutic pared the section on Dr. Revici's scientific find- agent he developed was safe and effective, he ings. gave it to patients regardless of regulatory agency policy. Recovery, or relief for his pa- This appraisal of Revici's career is dedicated tients, was his primary, overriding rule. The to Nita Revici Taskier, and to the memory of J. medical community and regulatory agencies, Robert DeBragga, founder and first director of of course, adhere to a different, opposing rule, Project CURE. so Revici's stubborn insistence in guiding his clinical practice in accord with his rule was likely to engender suspicion, hostility, and REFERENCES eventually administrative investigation and civil prosecution. Mizushima Y, et al. Use of lipid microspheres as a drug carrier for antitumor drugs. J Pharm Pharmacol When the Office of Professional Medical 1986;38:132-134. Conduct succeeded in revoking his license Reiser SJ. The era of the patient. JAMA 1993;269:1012-1017. in 1993, on charges of probation violation Revici E. The influence of irradiation upon unsaturated amounting to inadequate record keeping, they fatly acids: Paper read before the Sixth International severed the ties to treatment and patients that Congress of Radiology, London, 1950. Revici E, Research in Physiopathology as Basis for Guided had challenged him intellectually and nour- Chemotherapy: With Special Apphcation to Cancer. ished him emotionally throughout his career. Princeton, D, Van Nostrand, 1961a. Too proud to admit that the revocation had Revici E. A physiopathological basis for therapy: Lecture dispirited and devitalized him, Revici merely to the Society for Promoting International Scientific Re- subsisted during his remaining years, until his lations. American Foundation for Cancer Research, appetite for life and food waned. He died New York, 1961b. Revici E. Research and theoretical background for treat- shrunken in body, painfully burdened at last ment of the acquired immunodeficiency syndrome by great age, a vestige of the constitutionally (AIC»S). Townsend Letter for Doctors 1987;45. sturdy, supremely optimistic and confident Samuelsson B. Leukotrienes. Science \987;237:\\7\-\176. man he had been prior to loss of his license. Schrauzer GN. Selenium and cancer: Historical develop- (New York State had restored his license in ments and perspectives. In: Spallholz JE, et al., eds. Se- lenium in Biology and Medicine. Westport, AVI Press, September 1997, a few months before his 1981:98-102. death.) Simopoulos AP, Robinson J. The Omega Plan. New York, At the end of Shakespeare's King Lear, im- HarperCollins, 1998:61-74. mediately after Lear dies, two loyal subjects Wennberg J. Improving the medical decision-making speak the following lines: process. Health Affairs 1988; Spring. Wennberg J. Outcomes research, cost containment, and Edgar. He is gone, indeed. the fear of health care rationing. N Engl J Med 1990;323: Kent. The wonder is he hath endur'd so long. 1202-1204. Now that Emanuel Revici is gone, how long will his medical legacy endure? The answer —Marcus A. Cohen