Patients push for experimental cancer cure
Doctors debate value of 'devitalization' procedure
By James Pitkin
Lubos Olejar is hoping he didn't go too far to prove a point.
"I hope there won't be a scar left on my face -- that it won't turn me ugly. I'm sacrificing myself for science here," he said with a laugh.
The head of the Czech Patients' Union, Olejar is at the forefront of a fight to bring an experimental cancer treatment known as devitalization into mainstream practice.
Olejar himself underwent a devitalization procedure May 24 to remove a benign tumor in his left cheek. In a simple 10-minute operation, doctors used surgical string to tie off the blood vessels leading to and from the tumor.
Advocates say the innovative technique, discovered by a Czech doctor more than four decades ago, is 95 percent successful in eliminating tumors.
Even better, it appears to completely destroy a cancer without the debilitating effects of chemotherapy and radiation. But medical critics say the procedure violates a cardinal rule of surgery by leaving dead tissue in the body, which could lead to a massive infection known as sepsis.
Devitalization has yet to gain mainstream acceptance here and abroad. The Health Ministry and the Czech Medical Chamber strongly oppose its use in humans, saying that further animal testing is needed.
The Czech Republic and France are currently the only countries researching devitalization.
Olejar insists the country's 53,000 cancer patients -- one-third of whom do not respond to traditional treatment -- are entitled to any chance for a cure. He hopes his highly publicized operation will push the issue, forcing medical authorities here to accept the technique.
"What we wanted was to break the barriers," Olejar said. "Devitalization must not be a matter of permanent hiding. A public presentation is a must."
Working largely in secret, a handful of doctors around the country are already performing devitalization surgery.
On May 15, Vladimir Dryml, director of a private hospital in Vrchlabi, east Bohemia, announced he was beginning a program to treat 10 patients using the method.
Now he receives daily requests for the procedure. But Dryml declined to give further details, fearing officials would shut down the project.
Olejar said two other locations are also currently offering devitalization, though to protect the physicians, he declined to offer specifics.
Though the Health Ministry has not banned devitalization outright, it strongly opposes using the method on humans. That would open doctors to malpractice suits for the deaths of patients, many of whom are already diagnosed as terminal.
"It goes without saying that doctors could face legal action," said Otakar Cerny, a spokesman for the ministry.
Last October the ministry ended a one-year project to test devitalization on humans. Though it has yet to make the results public, officials say the experiment was unsuccessful, and the ministry has so far refused to sanction further human testing.
Dr. Pavel Kubicek of the Medical Chamber said performing devitalization could end a doctor's career.
"Should there be any damage done to the patient, then the chamber must take action," he said. "The sanctions could include anything from a reprimand or a fine to conditional or complete expulsion from the Medical Chamber."
The result, Olejar said, is a climate of fear. Patients desperate for a cure continue to demand the treatment and doctors continue to oblige, though the consequences scare them.
"We're under a lot of pressure from the chamber and the ministry," he said. "Everyone is afraid."
Karel Fortyn, the doctor who stumbled on devitalization in 1957, claimed he used it successfully on about 20 human patients. He died in 2001, before he could persuade the authorities to accept the technique. Most resistance was based on fears that devitalization could induce sepsis -- massive and often fatal internal infection.
A team of doctors at the Academy of Sciences Institute of Animal Physiology and Genetics in Libechov, north Bohemia, is carrying on Fortyn's work. Experimenting on pigs and dogs, they study the immune response that devitalization triggers in the body; the response results in the destruction of all cancerous growths, not just the primary tumor.
"The use of devitalization proved to be surprisingly easy," said Dr. Vratislav Horak, a member of the research team. "The question is not whether the method works but rather how it works."
Horak said his team is 95 percent successful in eliminating melanomas in pigs. With stomach tumors in dogs, the rate is nearly that high in young animals but lower in older ones.
He questions the Health Ministry's study, which he said used people who had already undergone chemotherapy. Devitalization relies on the body's own immune system, which is weakened by other cancer therapies.
Horak's team presented its animal findings to the Health Ministry on three different occasions in the last three years. Each time, the team was told that further research was needed before the technique could be considered acceptable for humans.
Team members hope that new findings, to be published later this year, will finally convince officials.
"It's unclear what exactly they're looking for," Horak said. "If they insist on further research again, it will amount to at least another year of work, maybe more."
Until devitalization gains official acceptance, Olejar said doctors will continue to perform the operation in secret.
"If a method that is not yet part of regular clinical practice is the only hope for a patient, it's still a doctor's obligation to use it. He must not be prevented from doing so," he said.
--Petr Kaspar contributed to this report.
James Pitkin's e-mail address is firstname.lastname@example.org
(June 12, 2002)
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