Ian Dryden

Centro Medico del Mar in Playas de Tijuana. It is here that the hopeful, prayerful, and desperate come.

THE MAN checked his package one last time. In the battered shoe-box. all things seemed in order. There were four slices cf white bread on the bottom of the box. topped by a layer of white cotton. Next came an assortment of small glass vials and waxed sandwich bags. The vials tapered to a fine point and contained a clear liquid. The bags contained hundreds of yellow tablets, each roughly twice the size of aspirin.

The large painting depicts a melodramatic battle between a nude male and a giant, pincer-wielding, insect-like monster. Dr. Contreras’ patients like to think of themselves in that heroic light.

Ian Dryden

One bag held several disposable syringes, needles, and a small metal file with which to open the vials. Over all this he spread another layer of cotton, and finished with a final stratum of white bread. This combination of materials served several purposes. The waxed bags would protect the pills from moisture; the cotton would act as a shock absorber to prevent breakage; the bread would help contain the pills' pungent odor and hopefully reduce the possibility of detection.

Dr. Ernesto Contreras is one of those who is supposedly making a fortune on the dispensing of Laetrile.

Ian Dryden

The man replaced the shoebox lid. swaddled the cargo in newspaper and brown wrapping paper, and took it to the post office. There he insured the parcel for the minimum amount, claiming that it was a camera outfit for his nephew in Chicago. The unsuspecting postal clerk followed his familiar routine, and deposited the package in an outgoing wagon. By this simple act, he was an unwitting accessory to several felonies—for example, the illegal use of the postal system for the transportation of contraband—which could mean several years in federal prison for the man in front of him. But the parcel was just one of dozens of plainly wrapped packages, and the man walked unmolested toward the door. His facade of nonchalance was a thin disguise for the anxious tempest that raged within him. For this was no ordinary smuggler, no street-hardened veteran of the drug wars to whom conscience was a four-letter word. This was an elderly, middle-American grandfather who had never as much as jaywalked, a man saturated with fright at the thought of the consequences of breaking his country's heaviest laws. And his expensive contraband was not heroin or amphetamines, but Laetrile, the so-called "wonder drug" that he prayed would assist his aging sister in her fight with cancer.

TO UNDERSTAND the Laetrile situation, which has become a hotly-contested tug-of-war between doctors, legislators, and private citizens, it is necessary to examine the nature of the drug and the disease it is supposed to curb. Cancer, of course, is the one major disease that still has the world of medicine throwing up its collective hands in exasperation. It is believed that Cancer begins as an abnormal cell divides and multiplies, somehow bypassing the normal body defenses against such an occurrence. Doctors still don’t know why cancer strikes some people and not others. There are dozens of questions about the disease that these professionals can’t come close to answering. The only point they seem to agree upon is that they have yet to find a cure for it. Cancer to the layman is even more of a mystery, and because of this it is almost certainly the most frightening disease of all. Even heart disease does not cause as much alarm. Heart attack victims can be placed on a strict regimen that greatly reduces the danger and probability of recurrence, and heart patients can often lead very normal lives, even after a severe attack. But cancer is a different animal altogether. It literally feeds on the body tissues, causing a great deal of pain, and by the time it is detected, may be so far advanced that death can follow in a matter of weeks. It is the overwhelming fear of an agonizing death that has driven many desperate cancer patients to the use of Laetrile, an illegal drug whose existence is as much an irritation to the American Medical Association as it is an apparent relief for cancer patients.

Laetrile (actually a brand name for the compound Amygdalin) is a substance derived from apricot kernels, and was developed as a potential cancer antidote by the late Dr. Ernst Krebs and his son Ernst, Jr. of California. In attempting to isolate the growth factor of cancer cells. Dr. Krebs concentrated on the behavior of the protein element in these cells. In his observations. Dr. Krebs "noted that the gluco-protein activity seemed to greatly accelerate in cancerous growths. The natural deduction was that if this action could be slowed down, the cancer growth might also be slowed down. Dr. Krebs decided to experiment with enzymes as a possible decelerating substance. Enzymes are organic substances which are produced in plants and animals, and which cause changes in other substances by catalytic action. What Dr. Krebs needed, then, was an enzyme that would effect the breakdown of gluco-protein in much the same way that compounds are broken down j during digestion. Dr. Krebs decided that the substance he needed existed in the gluco-protease group. Next, he had to find an ample supply of the compound in order to conduct the long, involved experiments. He concluded that apricot kernels, which are rich in vegetable enzymes, would serve as a perfect source of the substance needed, and after months of work, he was able to prepare a satisfactory extract from these kernels.

Dr. Krebs administered his extract to cancerous laboratory mice, in the hope that the condition of the mice would improve sufficiently to substantiate his beliefs. The results were encouraging and disappointing at the same time. Some of the mice showed signs of improving, and there was evidence that the growth of their cancers had actually been slowed. But Others showed no reactions to the drug whatsoever. Worse yet, some of the mice died suddenly. Since scientific judgments are based on recognizable and predictable patterns, and since no definite pattern of success had emerged. Dr. Krebs could only conclude that the substance in its present form was not adequate. Obviously, there was a toxic ingredient in the compound that was killing the mice. It was then Dr. Krebs’ unenviable task to discern which element in the substance was poisonous-, and how that element could be removed from the drug. It was frustrating to be so close to a “breakthrough,” and yet realize that a disclosure of your findings to colleagues would only expose evidence that was at best inconclusive. Many years would go by before the toxic roadblock could be overcome. The turning point came when Ernst, Jr. conducted experiments to test the theories of a Scotsman, John Beard, who had written a book many years before explaining his belief that enzymes in the pancreas routinely destroyed trophoblasts, or renegade cells. Beard contended that when the pancreas failed in its responsibility to kill cancer cells, it logically followed that enzymes would have to be injected into the system to do the job. The younger Krebs had already hydrolized the apricot kernel extract, discovering in the process that it contained cyanide. In his subsequent experiments, he found that certain enzymes, called beta-glucosidases, accumulated in far greater quantities in cancerous areas, and as an active agent actually broke down his father’s apricot kernel extract, thereby releasing cyanide into the body. This explained the unexpected deaths of the laboratory mice years earlier.

Krebs also discovered that the cyanide was the ingredient that killed off cancer cells. The dilemma was obvious: cyanide was simultaneously the anti-cancer element in the extract and the toxic ingredient as well. With this knowledge, Krebs set out to find the combination of substances which would prevent the cyanide from escaping until contact was made with the beta-glucosidase enzyme, thus unleashing the cyanide onto the defenseless cancer cells without poisoning the rest of the system. The result of his efforts was the specific compound — Amygdalin (Laetrile). To test his new drug, Krebs placed an amount of beta-glucosidase in a crucible and added Laetrile. If his calculations were correct, the beta-gluc’osi-dase would break down the Laetrile, thereby releasing cyanide gas into the air. He waited. After a few moments he sniffed cautiously at the crucible. There was the peculiarly strong smell of cyanide gas. Krebs’ theory about the cyanide was correct.

After trying the Laetrile on lab mice and finding that it had no ill effects on them whatsoever, Krebs decided to test its effect on the human body by injecting the substance into his own system. He knew of the enzyme in the body, rhodanese, that regularly detoxifies any traces of cyanide brought into the body via food substances.

Doctors scoff at Krebs’ simplified conception of cancer treatment, citing evidence that cancer comes in too many forms to be considered a single, isolated disease. Even given the remote possibility that Laetrile could be effective in controlling one type of cancer— and medical people deny that possibility—it would still be useless in treating other forms of the disease. The very idea that the discovery of Laetrile was a “major breakthrough” in cancer research is regarded as ludicrous by most physicians. But people continue to use it, illegally, and many swear to its effectiveness.

IF THERE is one common thread binding local cancer experts in the medical profession together, it is their aversion to and dismissal of the use of Laetrile as a cancer fighting agent. It is an especially touchy issue with these people, since the entire medical profession from A M A. director to lowly Ub technician, has been indicted by segments of the public for supposedly “suppressing the facts” about Laetrile's effectiveness in treating cancer patients. The mere mention of Laetrile is sufficient to make these doctors bristle, and they believe they have just cause for their barely-concealed vitriol. The official A.M.A. line, as filtered through practicing oncologists across the nation, is that Laetrile has been extensively tested, alone and in combination with beta-glucosidase, and has not shown any appreciable signs of effectively controlling or curing cancer. The key argument against the drug’s use is that no “scientifically acceptable” evidence has ever been produced to prove Laetrile’s value. Not only does the medical science fraternity refute the claims made by Ernst Krebs, Jr. that the timed release of cyanide acts as a cancer combatant, it goes further to declare that the premise on which those claims were based is totally false. According to medical experts, there is far more beta-glucosidase present in the tissue of the spleen, liver, kidneys, and rhodanese in the system was adequate for dealing with the amount of cyanide released in the Laetrile-beta-glucosidase process. With Laetrile in his bloodstream, several things could occur. If he had cancer, the beta-glucosidase in the cancerous region would trigger the break-down of the Laetrile compound, and the amount of cyanide able to escape confrontation with the cancer cells would hopefully be taken care of by the rhodanese in his body. If he didn’t have cancer, there would still be enough beta-glucosidase in his liver, kidneys, spleen, and brain to trigger the same breakdown. Either way, his safety depended on the ability of the rhodanese to dispose of the cyanide. At the risk of his own life, Ernst Krebs injected a dose of Laetrile into his arm. A minute passed. Ten minutes: After half an hour, there was still no toxic effect from Laetrile, and Krebs could officially declare to the world a major breakthrough in cancer treatment research. Unfortunately for Krebs, the rest of the world, especially the medical science segment of it, reacted to the news with something less than enthusiasm. In fact, a heated controversy arose over the use of Laetrile, its safety, effectiveness, and legality. The controversy still rages today, more than 30 years after Ernst Krebs, Jr. rolled up his sleeve for science.

ONE LOCAL cancer expert, who wishes to remain anonymous, feels very strongly that the public must be aware of the Laetrile “hoax" and its financial side-effects. I asked him about the various claims made by cancer patients attesting to the effectiveness of Laetrile in keeping their cancer in check. The following exchange ensued:

A: Both. But I'm mainly talking about groups whose sole interest in Laetrile is a business one.

Q: In other words, there are relatively “innocent" Laetrile proponents, but there are also more malevolent promoters?

A: That’s right. There’s an organization called “International Friends of Cancer Victims,” or something like that, who claim to have an altruistic interest in this thing. But then there’s the other element. The Birchers. . . the Mafia . . .

Q: I assume that the John Birch Society would be interested in making a political issue out of the Laetrile situation, due to the claims of “suppression of facts” by government, etc., but am I right in assuming that the underworld’s interest is an economic one?

A: Of course. People are making a fortune off the sale of this stuff. And the tragedy of it is, the people who take Laetrile are using something that to the best of my knowledge is an inert substance that passes through the urine without helping anything. The stuff is just no damn good.

Q: To what do you attribute the apparent relief obtained by patients who have used Laetrile?

A: To the fact that most of them underwent other forms of treatment first. Their claims are usually encouraged by Laetrile promoters who convince these people that it was Amygdalin and not the other treatments that brought their cancer under control. Logic dictates that it was the other way around. Whenever these patients are asked for medical records to verify their claims, they invariably refuse, again at the urging of Laetrile proponents.

Q. If Laetrile is completely ineffective, then why do so many cancer victims decide to use it?

A: Out of fear. They hear the “scare” stories about radiation, chemotherapy, and surgery, and are persuaded to try something less painful.

Q: But wouldn't Laetrile’s ineffectiveness automatically preclude its widespread use?

A: It’s not all that widespread. Use of Laetrile is actually decreasing. Its supporters are fighting like hell to keep it from disappearing altogether.

Q: I sense that you feel there are a lot of people interested in pushing for Laetrile’s acceptance. Are these people organized, or does the pressure come from unrelated and otherwise well-meaning individuals?

HE MIDDLE-AGED man sat in his doctor's office awaiting the news. He had experienced a persistently sore throat and difficulty in swallowing for quite some time and his persona!physician had ordered a biopsy (a microscopic examination of a small specimen of tissue). When the doctor delivered the dreaded report, confirming his own fears that the man had cancer, it was suggested that surgery he performed as soon as possible. The patient balked, realizing that surgery would almost certainly cost him his livelihood as a radio announcer. Instead, he opted for radiation treatment, under the supervision of the chief radiologist at a well-known radium institute. When the results of extensive radiation treatment proved discouraging, the announcer again forewent surgery to undergo several months of cobalt therapy. Not only did the therapy prove ineffective, but the cancer seemed to have actually spread during the treatment, prompting the. man's doctor to insist on immediate surgery. Again the patient refused, and disappeared for about eight months, during which time the doctors were unable to contact him. When he finally showed up again, his physician decided that the cancer was now inoperable, implying imminent death.

Shortly thereafter, the announcer began Laetrile treatment. Only weeks after the first injection of Laetrile, the doctor noted that his patient’s cancer actually appeared to be receding, and was being replaced by normal cells. Three months after he was started on Laetrile, the announcer was regaining the weight he had lost, and for the first time in almost a year he could comfortably eat a steak dinner. As the man's condition improved, the amount of Laetrile administered was decreased until finally the treatment was discontinued altogether. It was then that an important discovery was made: as soon as the Laetrile injections ceased, the symptoms began to return and it was feared that the cancer may have reestablished itself. Laetrile injections were resumed, and the symptoms again abated. It was decided that the announcer would be kept on Laetrile “maintenance" for as long as was necessary to prevent the cancer from recurring. The man returned to his job as a radio announcer and his life proceeded with a relative degree of normalcy.

THE CONTENTION that Laetrile is not only ineffective in controlling cancer but, worse yet. a carrot of hope dangled cruelly in front of cancer victims for reasons of monetary profit, has actually seemed to dissuade few people from actively seeking it out. Since it is illegal in the United States, people are compelled to walk, drive, and/or fly to Tijuana to obtain the contraband substance, fully realizing that they are resorting to criminal means in securing what they hope will be blessed relief from the horrors of the disease. This situation is unusual for a number of reasons, not the least of which is the fact that this “smuggling” of dope for health reasons is considered by many law-abiding citizens to be an absolute necessity brought on by the government. Naturally, in most drug smuggling cases, the prosecution of the purveyors by the government has been regarded as necessary for the health of the community. The “contact” in Tijuana, Dr. Ernesto Contreras, is one of those who is supposedly making a fortune on the dispensing of Laetrile. His clinic is the very heart of the Laetrile business in this part of the world, and to him stream the endless numbers of people looking for a miracle that will stave off death.

Contreras’ headquarters is the Centro Medico del Mar in Playas de Tijuana. It is here that the hopeful, prayerful, and desperate come in a pilgrimage that would do justice to Lourdes, France. The clinic itself is located in an area near the beaches west of Tijuana proper, directly across the street from the bullring. There is much land development surrounding the clinic, and without too much imagination one can picture a “La Jolla” erf the future situated on these now-vacant lots. The clinic itself is an unassuming structure, and together with the coffee shop and pharmacy that also occupy the grounds, could be any one of a number of nondescript one-level professional buildings in San Diego. The one unique feature which immediately catches the eye. and symbolically identifies the building as Contreras’ clinic is a large painting hung on an exterior wall, which depicts a melodramatic battle between a nude male and a giant, pincer-wielding, insect-like monster. Dr. Contreras’ patients, of course, like^to think of themselves in that heroic light, and the painting undoubtedly encourages them in their own private battles with cancer. Behind the dominant building are several small “casitas,” or “little homes,” where temporary live-in patients stay in modest comfort. Each “casita” is actually one tentacle of the starfish-shaped structures that were built to house those patients who once slept outdoors at night rather than leave the premises. The patient is afforded a single bed, wash basin, and toilet.

Stepping inside the actual clinic, one is struck by the sight and sound of a hundred or more people of varying ages and stations in life, chatting good-naturedly with one another, pacing nervously and talking in serious tones, or merely sitting quietly and staring into space. There is more noise than one would expect, and at times the camaraderie between familiar patients gives the assemblage the air of a church group waiting for a chartered bus to take them to Disneyland.

While waiting for an audience with Dr. Contreras, I spolce to one elderly man and his wife, who had flown all the way from Mississippi to visit the clinic. The gentleman was tall and well dressed, and appeared to be in relatively good shape. He said that he had been given up for dead seven years ago by his doctor, who had diagnosed lung cancer after several tests. Following the usual treadmill of treatments, including the chemotherapy that almost killed him, the man began to receive Laetrile injections. That was three years ago, and he is still at about the same level of health as he was when he began the injections. For this patient, Laetrile has literally been a life-saver.

After waiting an hour or so, I was ushered into a small, modestly-appointed office where Dr. Contreras greeted me warmly and seemed genuinely anxious to answer questions about his clinic. He is a Mexican man of average size and weight, with a thin mustache and just a hint of grey hair. His admirable command of the English language and vocabulary made the interview run smoothly. In talking to him I learned that his huge supply of Laetrile is obtained from two factories in Tijuana itself, factories reportedly sanctioned by the Mexican government. Raw apricot kernels are imported from West Germany and Monte Carlo and processed into the highest grade of Amygdalin before being used at the Centro Medico. There it is dispensed in either three-gram vials of liquid Laetrile, or 500 milligram Laetrile tablets.

Dr. Contreras is well aware of the risks his American patients take by smuggling their contraband and paraphernalia across the border into San Diego, and gladly refunds any money spent on drugs that are confiscated at the border. In the majority of cases, the Laetrile is detained at the border, and the patient is allowed to return to the clinic for his refund. Sometimes the patient is permitted to cross the border with his Amygdalin, and a warning, if the amount is obviously for personal use. When the quantity appears destined for resale, the guards will confiscate it outright, and the penalties for this larger scale smuggling can be pretty severe.

As a clinician. Dr. Contreras is surprisingly not interested in becoming embroiled in the controversy over the chemical process allegedly triggered by Laetrile. To him it is merely a question of “does it work?” And the answer, in Dr. Contreras’ opinion, is a definite “yes.” He claims that roughly 60% of the people who come to him with cancer are successfully treated, meaning that they experience some sort of relief from the ravages of the disease, or even actual reversal of the cancer activity. If that statistic seems somewhat exaggerated, it has nevertheless attracted the world-wide attention of scientists who are involved in setting up centers similar to the Centro Medico in their own respective countries. Lest the impression be given that these scientists are merely opportunists anxious to cash in on the apparently successful business formula of the Centro Medico, Dr. Contreras hastens to add that, unlike the United States, the other governments who have shown interest are fully prepared to publish his reports in official medical journals.

This brought up the subject of scientific validity, the actual documentation of patient recovery or amelioration due to Laetrile administration. 1 had been informed at one San Diego cancer institute that a request had been made of Dr. Contreras for actual medical proof of his success in treating cancer—without reply. According to Dr. Contreras, he had not replied to the request because he is simply-waiting for his own government to review his compilation of data before distributing the information to other governments. His studies, he says, will show the results of ten years of gathering valid medical proof of Laetrile’s effectiveness. Even then, he is not sure that the American medical establishment will look favorably on his work. One country which is supposedly anxious not only to publish Contreras’ writings but also to build Laetrile treatment centers is Israel. Dr. Contreras believes that American doctors will have to eventually come around to Laetrile use in order to stem the tide of black market involvement. Yet he fully realizes the contempt felt by many American experts for Laetrile use, and while he believes that these experts are honestly convinced of Laetrile’s ineffectiveness, he also thinks that they have been mislead by too-harsh conclusions drawn from the tests on rodents, some of which, he says, proved positive.

Dr. Contreras bluntly refutes the idea that Laetrile use is in decline, stating instead that it has actually curved steadily upward since he first became involved in 1963. In fact, none of my quotes or queries caused the least bit of uneasiness on the doctor’s part until I turned my questions toward the area of financial gain. To the allegation that he has “made a fortune” at his clinic. Dr. Contreras gave a vague disavowal and persistently dodged any specific questions as to the clinic’s revenue. He did, however, mention that about ten to fiteen new patients begin treatment each day, and that the average person spends roughly $150 to $200 per week for a three-week stay at the clinic, taking along a six-month supply of Laetrile for use at home. A seven-month treatment, then, will average about $1200 in expenses. Since patients are actively encouraged to continue Laetrile treatment for as long as it appears beneficial, the duration of Laetrile involvement can be many years. Taken at a conservative figure, then, simple arithmetic will show that more than nine million dollars' worth of new-patient revenue pours in annually. Whether Laetrile works or not, it is obvious that it has been beneficial to Dr. Ernesto Contreras, who also grudgingly admitted part ownership of one of the Tijuana factories that manufactures the drug.

But Dr. Contreras is not the only one enjoying dividends from the dispersion of Laetrile. If he does make millions from the sale of the drug, it is still within the confines of his country’s laws. Those who profit from it in this country are part of a very different picture. The American “contacts" do not operate clinics or treat hundreds of people daily. They prefer the more clandestine approach of black market dealing, and theirs is the world of whispers and secret movement. Laetrile may be many things to many people, but to the law enforcement folks it is simply another illegal substance smuggled into the United States by profiteers who. couldn’t care less about its effectiveness in treating disease. The government is only now concluding years of investigation into the large-scale smuggling of Laetrile into this country, and is finding that of the 50 or so co-conspirators who are believed to make up the largest Laetrile ring in Southern California, many are reputable professionals, including doctors, who could not resist the lure of big money.

WHAT HAS made the prosecution of these criminals difficult is the fact that Laetrile is not considered a “controlled" substance by the federal government. This means that, unlike heroin or even marijuana. it is not actually against the law to possess Laetrile. It is only illegal to buy, sell, or receive the drug if it has been smuggled. The reason for this is that the Food and Drug Administration considers Laetrile an “unknown,” a compound which has never been registered as a drug with a specific use or purpose. Whenever a new drug is developed, an application must be filed with the F.D.A. for official recognition of the drug’s properties. Reportedly, the only person to ever file such an application with regard to Laetrile was Andrew McNaughton of the McNaughton Foundation in Canada, an organization dedicated to the acceptance of Laetrile in cancer treatment. McNaughton, according to the story, sent his application to the F.D.A. with the written request that investigation into the drug’s usefulness be conducted under the auspices of the McNaughton Foundation, rather than the F.D.A. Naturally, the F.D.A. refused such a request, denying McNaughton's application. No second application was ever sent. Because of the lack of a definite ruling as to Laetrile’s capabilities, the drug remains in a chemical limbo.

This muddy situation has created a sort of Catch 22 for law enforcement officials. They know that the drug is almost always smuggled into the country, which is a federal offense due to the F.D.A.’s refusal to officially recognize it as a “safe” substance; but they usually can’t confiscate the drug or prosecute its possessors without first proving that the drug was indeed smuggled. Fortunately, the D. A.’s office has been more interested in the “mules,” or “smugglers,” than in the users, so their attention has focused on the operation of those who bring the drug across the border. After five or six years of surveillance, the law enforcement people have started a crackdown on the major offenders, some of whom have netted as much as two million a year. By proving that these people have smuggled Laetrile into the United States in quantities intended for resale, the government can impose the heaviest of penalties for such activity—usually five years in federal prison and/or a $10,000 fine. Of course, the transportation of that smuggled contraband across state lines, or the use of the postal system for that purpose, adds even more liability to the case.

Whether Laetrile is effective or not in treating cancer is still the overriding question, regardless of the legal or financial pitfalls one may encounter. Law enforcement officials are not scientists, and scientists (with a few exceptions) are not desperate cancer patients anxious for some good news. So while everyone else is deciding the medical-legal issue, some brave soul is still shooting or popping Laetrile, trying with all his might to stay alive. And if he only imagines, that the drug is doing him some good, the expense and effort will have been well worth it.

On the thirteenth of October, an appellate court in Oklahoma ruled in favor of Glen L. Rutherford of Conway Springs, Kansas, thus upholding a lower court's ruling earlier in the month in which the plaintiff was granted permission to import Laetrile. This came despite the government’s persistent claims that the drug is ineffective as a cancer treatment. According to Rutherford, the drug was necessary to keep him alive. The judge, Luther’ Bohanon, decided that the laws passed in the name of the Food and Drug Administration in 1973, which banned the importation or sale of Laetrile, were based on “vagaries” and possibly incorrect information regarding the number of years during which Laetrile has been in use. Since a great deal of the F.D.A.’s and A.M.A.’s opposition to the legalization of Laetrile is based on the technicalities involved in.scrutinizing “new” drugs, the question of Laetrile’s “age” is an important one. This particular decision is1 similar to other recent court rulings across the country. By forcing the burden of proof onto the medical-science wing of the government, the courts are bringing the Laetrile issue out into the open, where significant changes in attitude may be brought about by public pressure.