用灌肠治疗癌症的另类疗法

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·冈萨雷斯(Nicholas Gonzalez)博士去世，没有引起多少瞩目。《纽约时报》杂志(The New York Times)和其他大多数主流媒体都没有为他发布讣告。

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.

然而冈萨雷斯博士在癌症界却因其游走于正统肿瘤学和替代医学(alternative medicine，现在称为补充医学[complementary medicine])之间的微妙边界上而十分引人注目。我曾在2003年采访过他。尽管他的观念和治疗方法饱受批评，但他的见解从一定程度上揭开了癌症的一角神秘面纱。

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.

从1980年开始成为医学生起，冈萨雷斯博士审查了牙医威廉·凯利(William Kelley)的1000多份病历。凯利博士声称，在20世纪60年代，他拒绝了手术、放疗和化疗，采用营养疗法（胰酶、矿物质、维生素和咖啡灌肠法等）治愈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.

凯利博士认为胰酶至关重要，因为它们可以消化肿瘤细胞。不过，他的治疗方法依赖于另外两个理论。首先，他声称自己的治疗方案也可以为身体排毒，从而使患者的免疫系统自己去消灭癌症。其次，他认为，不同癌症患者的病各有区别，因此每一位患者都应接受个体化治疗。

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.

于是凯利博士与一群持类似观念的医生开始治疗患者，这触发了美国癌症学会（该组织声称凯利是个江湖郎中）和数个专业学会的众怒。最终，凯利博士的牙医执照被吊销，对他的治疗方案感兴趣的患者不得不去墨西哥接受治疗。

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.

待冈萨雷斯博士审查完病例后，他又访问了凯利博士的400多位患者，然后他得出了结论：那个治疗方案是有效的。数以百计原本被认定癌症已到了终末转移阶段的患者活过了5年、10年乃至更长时间。

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.

再后来，冈萨雷斯博士完成了免疫学专科医学培训，开始在纽约市行医，治疗各种疾病，包括慢性疲劳和多发性硬化症等。他对癌症，尤其是终末期癌症的治疗既为他赢得了名望，也给他带来了争议。

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.

冈萨雷斯博士与另一位医生，他曾经的妻子琳达·伊萨克斯(Linda Isaacs)博士合作，倡导与凯利博士类似的，使用维生素、矿物质和抗氧化剂等的营养疗法。冈萨雷斯博士向患者处方咖啡灌肠剂，因为他认为这样可以改善肝功能并促进废物的排泄。最后，他还给癌症患者使用高达45克的胰酶。根据冈萨雷斯博士网站上的资料，其癌症患者每天要服用130至175粒胶囊，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，冈萨雷斯博士就他的治疗方案进行了一项实验性研究。该研究纳入了11名无法手术的晚期胰腺癌患者：其中五人活了两年以上，两人活了四年以上；而在接受标准化疗治疗的对照组中，没有患者活过19个月。这一研究结果促使美国国立卫生研究院(National Institutes of Health, N.I.H.)出资在哥伦比亚大学(Columbia University)进行了一项正式的对照试验，在55名晚期胰腺癌患者中对冈萨雷斯博士的方案与化疗进行了比较。该试验的结果于2010年发表在《临床肿瘤学杂志》(The Journal of Clinical Oncology)上，它表明，接受化疗的患者的平均存活时间是接受酶治疗者的三倍。

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.

我曾经研究过一本关于著名患者的书，那书中讲述了演员史蒂夫·麦奎因(Steve McQueen)的故事，他在1980年前往墨西哥，尝试使用凯利博士的方案来治疗自己的终末期间皮瘤（麦奎因最终死于这种疾病。）在此期间，我采访了冈萨雷斯博士。如果说我此行的目的是想揪出操纵脆弱患者的幕后黑手，那么应该说我失败了。冈萨雷斯博士既和蔼可亲又非常专业。他向我保证，他从未声称自己的治疗方法优于那些疗效已经过实证的癌症治疗方法，或将其优先推荐给患者们。他说，他只是向疾病发生了进展或者拒绝接受标准化疗的患者敞开了大门而已。

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.

不过，比起冈萨雷斯博士，他的患者们更令我震动。他向我介绍了一名女患者，虽然她10年前就被确诊为转移性卵巢癌，但经过他的治疗，她至今仍然活得好好的。冈萨雷斯博士还向我展示了她的病理报告，证实他所言非虚。我还会见了其他几位坚信自己的生命被每天摄入的数百粒胶囊所拯救的患者。

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.

这种观点在去年7月21日，67岁的冈萨雷斯博士意外去世之后网上的数十条评论留言当中都有流露。来自华盛顿的珍·H(Jen H)写道：“在患者已经万念俱灰的时候，他带来的一线希望是无价之宝。”还有人称，冈萨雷斯博士曾亲笔写信给他，解释他为何无法治疗他即将死去的父亲。

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.

作为一个接受过正统科学医学培训的人，冈萨雷斯博士让我感到充满挑战。并无良好的数据能证明他的治疗方案的效力，而且，他所处方的大部分东西在医学上都说不通。说起来，他的大部分患者只是被误诊了，又或者他们的癌症停止生长是出于别的原因，可能性不是更大些么？N.I.H.试验的领导者，哥伦比亚大学的教授约翰·沙博(John Chabot)表示自己钦佩冈萨雷斯博士对患者们的奉献精神，但他觉得他“被自己的狂热给误导了。”此外，由于保险公司几乎不报销非常规治疗的费用，冈萨雷斯博士的治疗方案往往要花掉患者数万美元。

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.

不过，在我拜访冈萨雷斯博士之后不久，当一个熟人用尽了所有的治疗方案，仍然行将被癌症夺去生命之时，我还是小心翼翼地向他提起了冈萨雷斯博士的工作，以及我曾在他的办公室里见过的那些所谓的“被治愈”的患者。她表示坚决不能接受。她还说，不管多么绝望，她都永远不会尝试如此不科学的东西。

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.

尽管缺乏疗效证据，伊萨克斯博士仍然继续向坚信癌症与营养有关的患者提供冈萨雷斯的治疗方案。此外，冈萨雷斯博士的成果还在以其他方式展示着其生命力。新的免疫疗法试图借助人体的免疫系统来对抗癌症。而且，最近有研究提出，不同患者的癌症各有差异，因此需要进行个性化治疗。