用灌腸治療癌症的另類療法

When Dr. Nicholas Gonzalez died in July, there was not much notice. He did not get an obituary in The New York Times or in most other major media outlets.

去年7月，尼古拉斯·岡薩雷斯(Nicholas Gonzalez)博士去世，沒有引起多少矚目。《紐約時報》雜誌(The New York Times)和其他大多數主流媒體都沒有爲他發佈訃告。

Yet Dr. Gonzalez, whom I interviewed in 2003, was a fascinating figure in the world of cancer, walking a tenuous boundary between orthodox oncology and alternative medicine — or what is now called complementary medicine. Though his beliefs and treatments have fierce critics, his insights shed light on the mysteries of cancer.

然而岡薩雷斯博士在癌症界卻因其遊走於正統腫瘤學和替代醫學(alternative medicine，現在稱爲補充醫學[complementary medicine])之間的微妙邊界上而十分引人注目。我曾在2003年採訪過他。儘管他的觀念和治療方法飽受批評，但他的見解從一定程度上揭開了癌症的一角神祕面紗。

Beginning in 1980 as a medical student, Dr. Gonzalez reviewed more than 1,000 medical charts from a dentist named William Kelley. Dr. Kelley claimed to have cured his own liver and pancreatic cancer in the 1960s by rejecting surgery, radiation and chemotherapy in favor of nutritional therapy, consisting of pancreatic enzymes, minerals, vitamins and coffee enemas.

從1980年開始成爲醫學生起，岡薩雷斯博士審查了牙醫威廉·凱利(William Kelley)的1000多份病歷。凱利博士聲稱，在20世紀60年代，他拒絕了手術、放療和化療，採用營養療法（胰酶、礦物質、維生素和咖啡灌腸法等）治癒了自己的肝癌和胰腺癌。

The pancreatic enzymes were critical because, Dr. Kelley believed, they digested cancer cells. But his treatment relied on two other theories. First, he claimed that the regimen also detoxified the body, allowing patients’ immune systems to destroy cancer. Second, he believed that all cancers differed from patient to patient, so each patient should receive individualized treatment.

凱利博士認爲胰酶至關重要，因爲它們可以消化腫瘤細胞。不過，他的治療方法依賴於另外兩個理論。首先，他聲稱自己的治療方案也可以爲身體排毒，從而使患者的免疫系統自己去消滅癌症。其次，他認爲，不同癌症患者的病各有區別，因此每一位患者都應接受個體化治療。

Once Dr. Kelley — working with a group of like-minded physicians — began treating patients, he ran afoul of the American Cancer Society (who claimed he was a quack) and various professional societies. Eventually, his dental license was suspended; patients interested in his regimen had to travel to Mexico to be treated by him.

於是凱利博士與一羣持類似觀念的醫生開始治療患者，這觸發了美國癌症學會（該組織聲稱凱利是個江湖郎中）和數個專業學會的衆怒。最終，凱利博士的牙醫執照被吊銷，對他的治療方案感興趣的患者不得不去墨西哥接受治療。

After Dr. Gonzalez finished his chart review and interviewed more than 400 of Dr. Kelley’s patients, he concluded that the regimen worked. Hundreds of people who supposedly had terminal metastatic cancer had lived for five, 10 or more years.

待岡薩雷斯博士審查完病例後，他又訪問了凱利博士的400多位患者，然後他得出了結論：那個治療方案是有效的。數以百計原本被認定癌症已到了終末轉移階段的患者活過了5年、10年乃至更長時間。

Dr. Gonzalez later completed a fellowship in immunology and began practicing in New York City, treating a wide range of ailments, including chronic fatigue and multiple sclerosis. But it was the treatment of cancer — especially end-stage cancer — that brought him both fame and controversy.

再後來，岡薩雷斯博士完成了免疫學專科醫學培訓，開始在紐約市行醫，治療各種疾病，包括慢性疲勞和多發性硬化症等。他對癌症，尤其是終末期癌症的治療既爲他贏得了名望，也給他帶來了爭議。

Working with another physician, Dr. Linda Isaacs, who at one point was his wife, Dr. Gonzalez advocated a nutritional regimen similar to that of Dr. Kelley, including vitamins, minerals and antioxidants. He prescribed coffee enemas, which Dr. Gonzalez believed improved liver function and the excretion of waste. Finally, he gave cancer patients up to 45 grams of pancreatic enzymes. According to Dr. Gonzalez’s website, his cancer patients took 130 to 175 capsules daily, and his noncancer patients took 80 to 100 each day.

岡薩雷斯博士與另一位醫生，他曾經的妻子琳達·伊薩克斯(Linda Isaacs)博士合作，倡導與凱利博士類似的，使用維生素、礦物質和抗氧化劑等的營養療法。岡薩雷斯博士向患者處方咖啡灌腸劑，因爲他認爲這樣可以改善肝功能並促進廢物的排泄。最後，他還給癌症患者使用高達45克的胰酶。根據岡薩雷斯博士網站上的資料，其癌症患者每天要服用130至175粒膠囊，而非癌症患者每天要服用80至100粒。

In 1994, Dr. Gonzalez conducted a pilot study of his program for 11 patients with inoperable pancreatic cancer. Five lived longer than two years, and two lived longer than four years. No patients in a comparison group treated with standard chemotherapy survived more than 19 months. This led the National Institutes of Health to fund a controlled trial at Columbia University that formally compared Dr. Gonzalez’s regimen with chemotherapy for 55 patients who had advanced pancreatic cancer. The results, published in the Journal of Clinical Oncology in 2010, showed that on average, the patients getting the chemotherapy lived three times as long than those getting the enzymes.

1994年，岡薩雷斯博士就他的治療方案進行了一項實驗性研究。該研究納入了11名無法手術的晚期胰腺癌患者：其中五人活了兩年以上，兩人活了四年以上；而在接受標準化療治療的對照組中，沒有患者活過19個月。這一研究結果促使美國國立衛生研究院(National Institutes of Health, N.I.H.)出資在哥倫比亞大學(Columbia University)進行了一項正式的對照試驗，在55名晚期胰腺癌患者中對岡薩雷斯博士的方案與化療進行了比較。該試驗的結果於2010年發表在《臨牀腫瘤學雜誌》(The Journal of Clinical Oncology)上，它表明，接受化療的患者的平均存活時間是接受酶治療者的三倍。

I interviewed Dr. Gonzalez while researching a book on famous patients, which included the story of the actor Steve McQueen, who traveled to Mexico in 1980 to try Dr. Kelley’s regimen for his terminal mesothelioma. (Mr. McQueen ultimately died of his disease.) If I arrived expecting to find a shady character who manipulated vulnerable patients, I did not find one. Dr. Gonzalez was highly affable and professional. He assured me that he never recommended his treatment over cancer therapies with proven value. He was available, he said, for those with progressive disease or those who rejected standard chemotherapy.

我曾經研究過一本關於著名患者的書，那書中講述了演員史蒂夫·麥奎因(Steve McQueen)的故事，他在1980年前往墨西哥，嘗試使用凱利博士的方案來治療自己的終末期間皮瘤（麥奎因最終死於這種疾病。）在此期間，我採訪了岡薩雷斯博士。如果說我此行的目的是想揪出操縱脆弱患者的幕後黑手，那麼應該說我失敗了。岡薩雷斯博士既和藹可親又非常專業。他向我保證，他從未聲稱自己的治療方法優於那些療效已經過實證的癌症治療方法，或將其優先推薦給患者們。他說，他只是向疾病發生了進展或者拒絕接受標準化療的患者敞開了大門而已。

But more affecting than Dr. Gonzalez were his patients. He introduced me to one woman who had been diagnosed with metastatic ovarian cancer more than 10 years earlier but was alive and well on his protocol. To underscore his point, Dr. Gonzalez showed me her pathology report, which confirmed what he had said. I met several other patients whose lives, they believed, had been saved by the hundreds of capsules they ingested each day.

不過，比起岡薩雷斯博士，他的患者們更令我震動。他向我介紹了一名女患者，雖然她10年前就被確診爲轉移性卵巢癌，但經過他的治療，她至今仍然活得好好的。岡薩雷斯博士還向我展示了她的病理報告，證實他所言非虛。我還會見了其他幾位堅信自己的生命被每天攝入的數百粒膠囊所拯救的患者。

This sentiment is reflected in dozens of online comments recorded after Dr. Gonzalez died unexpectedly at age 67 on July 21. Jen H. from Washington wrote: “The hope he provided to his patients when all hope had been removed was and is invaluable.” Another person wrote that Dr. Gonzalez had sent him a hand-written note explaining why he would not be able to treat the writer’s dying father.

這種觀點在去年7月21日，67歲的岡薩雷斯博士意外去世之後網上的數十條評論留言當中都有流露。來自華盛頓的珍·H(Jen H)寫道：“在患者已經萬念俱灰的時候，他帶來的一線希望是無價之寶。”還有人稱，岡薩雷斯博士曾親筆寫信給他，解釋他爲何無法治療他即將死去的父親。

As someone trained to practice scientific medicine, I found my encounter with Dr. Gonzalez to be a challenge. Not only was there no good data showing his regimen to be effective, but much of what he prescribed did not really make medical sense. Wasn’t it more likely that most of his patients had been misdiagnosed or that their cancers had stopped growing for other reasons? Dr. John Chabot, the Columbia professor who ran the N.I.H. trial, admired Dr. Gonzalez’s devotion to his patients but felt he was “misguided due to his zealotry.” Also, because insurance companies rarely pay for unconventional treatments, Dr. Gonzalez’s regimen often cost his patients tens of thousands of dollars.

作爲一個接受過正統科學醫學培訓的人，岡薩雷斯博士讓我感到充滿挑戰。並無良好的數據能證明他的治療方案的效力，而且，他所處方的大部分東西在醫學上都說不通。說起來，他的大部分患者只是被誤診了，又或者他們的癌症停止生長是出於別的原因，可能性不是更大些麼？N.I.H.試驗的領導者，哥倫比亞大學的教授約翰·沙博(John Chabot)表示自己欽佩岡薩雷斯博士對患者們的奉獻精神，但他覺得他“被自己的狂熱給誤導了。”此外，由於保險公司幾乎不報銷非常規治療的費用，岡薩雷斯博士的治療方案往往要花掉患者數萬美元。

Still, shortly after my visit with Dr. Gonzalez, when an acquaintance was dying of cancer and had exhausted all treatment options, I gingerly mentioned his work and the supposedly cured patients I had met in his office. She was not receptive. She told me that she would never try anything so unscientific, no matter how desperate she was.

不過，在我拜訪岡薩雷斯博士之後不久，當一個熟人用盡了所有的治療方案，仍然行將被癌症奪去生命之時，我還是小心翼翼地向他提起了岡薩雷斯博士的工作，以及我曾在他的辦公室裏見過的那些所謂的“被治癒”的患者。她表示堅決不能接受。她還說，不管多麼絕望，她都永遠不會嘗試如此不科學的東西。

Despite the lack of evidence of the treatment’s efficacy, Dr. Isaacs continues to use the Gonzalez protocol for patients who see a connection between cancer and nutrition. And Dr. Gonzalez’s work lives on in other ways. New immunotherapy treatments seek to harness the body’s immune system to fight cancer. And recent studies suggest that cancer is a different disease in different people and that treatments need to be personalized.

儘管缺乏療效證據，伊薩克斯博士仍然繼續向堅信癌症與營養有關的患者提供岡薩雷斯的治療方案。此外，岡薩雷斯博士的成果還在以其他方式展示着其生命力。新的免疫療法試圖藉助人體的免疫系統來對抗癌症。而且，最近有研究提出，不同患者的癌症各有差異，因此需要進行個性化治療。