Cancer Treatment: Radiation

The story of radiotherapy for use in cancer begins with a strange man named Émil Hermann Grubbé. His father was from somewhere in Northern Europe, perhaps Prussia, and his mother was Pomeranian. They emigrated from the Baltic coast to Chicago in 1870—just in time to experience the great Chicago fire of October of 1871. Émil was born in 1875, a time when medicine was undergoing a revolution, namely the Golden Age of Bacteriology, on account of the works of Louis Pasteur and others (more on that another time). It was in the spring of 1890 that Émil decided that he wanted to go into medicine.

Not that credentials matter – obviously the Truth of what’s being said is independent of the credentials of the person saying it – but it is a sign of Grubbé’s character that he would flaunt an honorary PhD that he didn’t actually have. According to his biographer, Paul Chesley Hodges¹,

In 1959, in a tape-recorded interview with Elliot McCleary, Emil said, in answer to the latter’s questioning about college degrees:

Well, I was a teacher in medical school and assayer for the banks. They would put in the paper, “Our assayer has found such and such things at such and such places.” A classmate of mine sent this information to the President of Valparaiso [i.e. the medical school]. I was giving them a lot of publicity, so they gave me an honorary Ph.D. degree.

In material which he submitted to various biographical reference books on various occasions, and which appeared in, among others, Who’s Who in America, Vol. III, he listed this highly questionable Ph.D., sometimes as having been awarded in 1895, and at other times as an honorary degree which he received in 1910. Actually, the present-day [i.e. 1964] officers of Valparaiso University and Loyola Medical College [i.e. the institution that later took over Valparaiso’s medical department] find that records of their institutions contain no mention of such a degree on any date to anyone named Grubbe. Even more convincing is the fact that among Emil’s carefully preserved papers, including much trash, no Ph.D. diploma was found. The actual diplomas are four in number, as follows: Graduate in Pharmacy (Ph.G.), Northern Indiana Normal School, August 15, 1895. Bachelor of Science (B.Sc.), same institution and same date. Doctor of Medicine and Surgery (M.D.), Hahnemann Medical College and Hospital of Chicago, March 24, 1898. “Certificate” from the Illinois X-ray and Electro-Therapeutic Laboratory of Chicago, January 12, 1903.

I am convinced that, if Emil had in fact ever received other diplomas, they too would have been preserved in the original and with photographic reproductions as well.

In fact, he had a propensity for making up lots of grand stories about himself. He claimed to have explored all the diamond fields in the world and visited all the active volcanoes in the world. Allegedly he was trying to test the hypothesis that diamonds form in volcanoes, and he even claimed to have witnessed firsthand the destruction of San Pierre by Mount Pelee in 1902. He claimed to have produced synthetic diamonds using an electric furnace of his own design, even though today it’s believed that he wouldn’t have had the capability to produce enough pressure to form the diamond lattice, with the first synthetic diamonds only being produced decades after his claim. He claimed to have started a mining company in 1895 and found $25,000 worth of platinum in the sand at the bottom of the Snake River in Idaho, an incredible amount given that platinum is typically found in trace amounts and only discovered incidentally while mining for other minerals, and also given that, in the year 1913, the total platinum output from all the gold mines in California and Oregon combined amounted to only $18,477 worth. Moreover, when his biographer checked with the Secretary of State for Springfield, Illinois, the biographer was provided with information indicating that the company he claimed to have started was only established in 1902—seven years after Grubbé claimed to have started the company. He claimed to have visited the South Pole in 1913 and the North Pole in 1914. He claimed that he had personally been treated for his X-ray burns by William Osler, the most famous physician of the twentieth century, although Osler made no record of the alleged encounter with Grubbé, and the historians of medicine at Johns Hopkins University, the very school where Osler taught, considered that it would have been “out of character” for Osler not to record such an appointment. Moreover, Grubbé even claimed to teach radiology at Johns Hopkins University during World War I, where he certainly would have been rubbing shoulders with Osler during the Spanish Flu epidemic, although (am I having déjà vu?) that university contains no records of him teaching anything there. Moreover, his biographer listed chronological discrepancies in the stories, e.g. he could not have been attending med school and treating large numbers of patients in Chicago while also travelling the world and even going on polar expeditions, even though the dates given would indicate that he was doing these at the same time. When one of Grubbé’s friends accused him of making things up, having read his private papers about many of his alleged travels, she reported that he gave her a sheepish grin. He knew that he was a phoney, but he just liked the attention.

His biographer speculated that the reason for all these fantastic fictions about his life boils down to the fact that Grubbé was a staunch atheist, but particularly an atheist who was obsessed with immortality, and so the only way he could conceive of achieving immortality was to go down in history as one of the most interesting people to ever live. That way he’d be talked about forever. On the other hand, at least some of his false utterances appear to be due either to carelessness or a faulty memory rather than grandeur. For instance, his biographer also said,

None of us would be blameless if it were a character defect to be unable to recall accurately facts and dates about our affairs, ourselves, and our dear ones, but few are guilty of the degree of glibness with which Emil answered questions posed by others and spoke of himself. This glibness led him to give several different birth and death dates for his parents and siblings and conflicting information as to his father’s national origin, and to make statements, sometimes merely confused but often blatantly untrue, relative to his academic degrees and to events leading up to his early work with X-rays.

But whether his biographer’s speculation about atheistic immortality was an accurate psychoanalysis or not, it’s still the case that Grubbé had a habit of just making things up. There are so many contradicted stories in his biography that one can tell that his biographer was sick of all the lies. In fact, his biographer even said, “having read what he says, I have become more, rather than less, skeptical,” and called Grubbé “vain, boastful, incompletely truthful, and only moderately able.” In the final chapter of the biography, Hodges even said, “Readers who have persevered thus far with this little volume will appreciate how difficult is has been to present the man as he was in life without appearing unnecessarily to emphasize his shortcomings.” If the reader doubts that Emil Grubbé’s life was driven by vanity, he would have to consult for himself the biography, The Life and Times of Émil Grubbé, published in 1964. Therefore in the story that follows concerning the introduction of radiotherapy to medicine, it should be taken into account that this was not an honest man, and therefore there might be parts of the legend that aren’t accurate. Grubbé wasn’t exactly trustworthy.

The story of radiation physics made a leap forward in the mid-1890s. In November and December of 1895, the Prussian physicist Wilhelm Röntgen² discovered X-rays by accident. Upon further experimentation, he discovered that they would move in straight lines (hence “rays”), cast shadows, and that they would not be deflected by magnets (meaning that they possessed no electrical charge). This discovery led to R'́ontgen winning the very first Nobel Prize in physics in the year 1901.

According to Hodges,

Emil claims that because he was a chemist and a physicist as well as a manufacturer of vacuum tubes, the announcement of Roentgen’s discovery found him probably the only person in the United States equipped immediately to duplicate the experiments which led to the discovery.

In the investigations conducted by Grubbé and his assistant Albert Schmidt, they claimed to have invented the fluoroscope. Thomas Edison and others made similar claims, although Hodges contended that priority actually belonged to Röntgen himself.

Grubbé had a lot of fun playing with the newly discovered radiation, at least until it gave him health problems. Near the end of January of 1896, the back of his left hand (the hand which he often held close to the vacuum tube to form images of his bones) fell into disease. There was severe itching, swelling, blistering, loss of hair, and eventually breakdown of the skin. (For this, Grubbé claimed to be the first person to suffer radiation injury.)

It seemed plainly that the X-rays didn’t yield health, but rather disease. Nevertheless, Hodges related:

That was the state of affairs, he says, when on January 27, 1896, [the 21-year-old Grubbé] attended a faculty meeting of the medical college where he was both a student and teacher. Several of his physician colleagues and teachers, noticing that his hand was bandaged, inquired about it and when the bandage had been removed offered therapeutic suggestions. One of the group, Dr. J. E. Gilman, instead of advising as to treatment expressed the belief that if X-rays could be so damaging to normal tissues they might be effective against disease tissues such as neoplasm [i.e. cancer]. This idea impressed the other physicians who were present and two of them offered to send Emil cancer patients if he cared to make a therapeutic trial. In this manner, the ground was laid for the birth of radiation therapy.

At 10:00 a.m., on Wednesday, January 29, 1896, Mrs. Rose Lee, a patient of Dr. R. Ludlam, came to Emil’s little place at 12 Pacific Avenue and he administered the first of eighteen treatments to a carcinoma of her left breast which had recurred after a first and then a second operation. The treatments reduced her pain, but she died about a month after the first visit.

His second patient, an elderly man, also died shortly after treatment, although this man was so old that it might have been his time anyway. And so within a couple months of the discovery of X-rays, they were found to inflict radiation burns and already being employed in medicine. This was the genesis of the use of radiation in treating disease, which is called either radiation therapy or radiotherapy. It was only weeks before that Röntgen’s discovery had been in all the newspapers and it was the flashy, new high-tech thing everyone was talking about. Why wouldn’t medicos immediately start playing with it? Grubbé’s biographer referred to the “accidental, non-scientific, ill-advised nature of his early use of X-rays for the treatment of disease.”

Unsurprisingly, Grubbé claimed priority in many matters that he inadequately documented, and he sometimes gave excuses as to the poor documentation which don’t make sense. For example, he alleged that the reason he didn’t publish about using X-rays therapeutically in late January of 1896 was because he’d never published anything before and probably wouldn’t even know how to publish something. This is contradicted, however, by his book, X-Ray Treatment: Its Origin, Birth, and Early History, in which one of his listed publications is a dissertation that he published on the topic of distilled water in 1895. Hodges would have doubted the tale of priority altogether had it not been for the fact that Grubbé had preserved two letters from the time relevant to the episode. Moreover, because of doubts, Hodges even had these letters checked for forgery, or at least that they had the dates retroactively changed, but the letters came back as authentic, and the signatures even matched those of the physicians whose names were attached to the letters. They really did send him their patients in January of 1896. Therefore, even though there would have otherwise been reason to doubt, Grubbé’s priority in the therapeutic use of X-rays is established—whether it turns out X-rays are actually beneficial for health or not.

But there’s really not a whole lot of information on his patient outcomes. Concerning this, Hodges wrote,

There is no information about the physical findings, technique of therapy, or clinical results in other patients treated in the little room on Pacific Avenue or, after February, 1896, at 2614 Cottage Grove. Emil says merely, “Here I continued to make use of X-rays for treatment purposes for several years. Most of the ... patients referred to me ... were ... moribund and ... many ... died soon after I began to make X-ray applications. After ... a short period ... patients exhibiting more favorable ... conditions arrived for treatment [and] ... in some ... the results ... were so striking as to create quite a sensation.

It must be admitted that anyone would be hard-pressed to call this science. There doesn’t appear to have been an effort at organizing controlled experiments. Grubbé could have, for instance, conducted placebo-controlled trials in which a group of people would be given X-rays and another comparable group of people would be only made to think that they were given X-rays but with the X-rays deprived from them (obviously with informed consent about participation in the experiment), and then comparing the differences in outcomes between the two groups. That’s what would be required to figure out if X-ray therapy is actually useful³. Instead, all we’re left with is the fact that some of his patients were in bad shape when they came to him, and they died, and others came to him in better shape, and they had “striking” results. Oh, and these success stories are coming from a man who lied about everything. How can we trust his assertions?

We especially have to wonder this when we see some of the claims he made about the therapeutic powers of X-rays:

The use of X-Ray as a therapeutic agent is at present well established. Its phenomenal success as a curative agent in carcinoma, lupus, eczema, chronic ulcers, and pulmonary tuberculosis has opened up an enormous field wherein the general practitioner may well devote his time.

Under its influence, combined with constitutional treatment, numerous cases of consumption may be decidedly benefited, and many may have been actually cured⁴. The same may be said for tuberculosis of the bones. Among the other diseases in which X-Ray treatments have given good results may be mentioned: The various kinds of acne, sycosis, herpes, hypertrichosis, favus, chronic oedema, tubercular glands, birthmarks, moles, scars due to burns or scalds, varicose veins. Hair may also be removed by it.

So this guy would have us believe that health is to be found in the radiation that was only recently discovered. Eczema? X-rays. Herpes? X-rays. Acne? X-rays. Consumption? X-rays (and “constitutional treatment”). No matter what problem people are facing, he would yield the same answer. X-rays were his cure-all. But all these conditions are not united by the fact that they reflect deficiencies of the radiation that had only been discovered several years before. (Because of his zeal for pushing rays, his biographer even referred to him as an “uninhibited cultist” and a contemporary said that he had “radio mania.”)

But let’s focus on his published papers. He was working in a time when it was still popular for physicians to hand out things like mercury and arsenic. We’re now aware that these treatments weren’t so much based on experimental evidence (i.e. placebo-controlled trials), but on published case reports written up by physicians no more than insisting that their treatments work. So let’s go into some of Grubbé papers to see whether the conclusions follow from the methods (while being aware that he’s not the most honest person there ever was). Could his claims be supported?

In Grubbé’s November 1902 paper X-Rays in the Treatment of Cancer and Other Malignant Diseases, he stated that, for the previous year, he’d been treating an average of over seventy patients per day. That’s a lot, although who can say whether it was exaggeration? Maybe he was making it up. But rather than devising controlled experiments (which he allegedly had enough patients to be performing), he appears to have just indiscriminately blasted all his patients with radiation, appealing to what he called “the crucial test of practical experience.” Unfortunately “practical experience” doesn’t typically hold any sway in an empirical discipline like medicine; there need to be controlled experiments.

Much of this article is just him rambling about how “no one in the present light can doubt” the curative properties of X-rays for diseases like cancer, lupus, tuberculosis. With regard to cancer, he mentioned the hypothesis that cancer tissue might be transformed by X-rays into normal tissue. And since it was popular in those days – the Golden Age of Bacteriology – to attribute all these diseases to the action of harmful bacteria, he also mentioned the hypothesis that X-rays might bring about health by killing those disease-causing bacteria. Make sure to cook those cancer germs. Afterwards, he listed seven cases of his in which patients got better after being given X-ray therapy. These cases include four cases of breast cancer, two cases of lupus, and one case of uterine cancer, but who knows if he was even telling the Truth? But, of course, even if Grubbé had been telling the Truth, this situation doesn’t allow for a comparison with counterfactuals. We can’t know whether these patients would have improved on their own anyway, or – even if improvement really had been due to the treatment – whether their improvement might have been due to the placebo effect rather than the physical effects of the rays. Thus causal inferences simply can’t be made anyway.

The next paper of interest is his 1916 paper One Hundred and Thirty-Nine Cases of Skin Cancer Cured by X-Rays. Of this paper, Hodges, who by the way was a radiologist himself, said, “In my opinion this is Emil’s best writing and is on a subject in which he had indeed become recognized as having experience and competence.” So we should be in for a treat, right? Maybe the man was a liar, and maybe he was even wreckless about giving out X-rays for every disease under the sun, but at least on this topic we can trust that he put out some quality work, right?

First of all, Grubbé mentioned the toxic effects of the treatment in this paper, saying,

In the early days we gave comparatively small doses of the rays and produced proportionately small results. Now we give larger doses and get in return much better and quicker results. Like all other therapeutic agents the x-ray possesses dual action. Weak doses produce physiologic effects, while large doses produce toxic effects.

In the treatment of skin cancer too small doses of x-rays are harmful because they stimulate the cancerous growth to greater activity. This fact should be kept constantly before us. Half-way measures should not be used when heroic measures are in order. The treatment of epithelial cancers should be essentially destructive, and for that reason massive applications of the rays should always be given.

This is interesting because it seems to be that he was saying small doses cause cancer and stimulate cancer growth while large doses have plainly toxic effects. If both small and large doses are harmful, then it’s curious why X-rays would have any place in treating disease. It’s not a priori obvious that cancer patients would benefit from being given, in Grubbé’s own wording, “toxic” doses of radiation. Moreover it’s not clear what was “heroic” about always applying massive amounts of toxic rays to patients.

Unfortunately though, his data in this paper suffer the same uncontrolled methodology as before. Rather than having an experimental group and a control group which would be given a placebo, Grubbé merely gave everyone the X-rays and recorded how they did. He reported that, after treating 155 skin cancers with only X-rays and nothing else, 139 of them had no return of skin cancer for at least a year. Of the remaining 16 cases, Grubbé mentioned that he hadn’t been able to get a subsequent history of some of them, but that he knew that some of them had died. Even though he knew that some of them died, he didn’t list any numbers.

So even though this was Émil’s “best writing,” all we can really say is that, over the course of one year, 139 out of 155 patients didn’t die of cancer and that some number up to 16 out of the 155 did die (which is up to possibly 10 percent of them). What we really would need is to know how many would die with and without the treatment, or to even compare how many people die or get cancer again when compared to other treatments. For example, as a baseline, what would the comparable figures be for untreated skin cancer? Or what would be the comparable figures if his radiation therapy had been compared against surgery? (A comparison against surgery would be especially appropriate in a study on skin cancer, since, being on the outside of the body, skin cancer is said to be the easiest cancer to detect and often the easiest to surgically remove.) No effort was made to figure these things out, so we can’t actually say how helpful the treatment really was, either absolutely or in comparison to some other treatment.

Moreover, since it’s been found in an epidemiological study of 4.4 million people that those who were diagnosed with skin cancer have an increased life expectancy, it’s not immediately obvious that being free of skin cancer is even always synonymous with having a longer life. As always, hard endpoints are the most reasonable ones to use. Rather than even focusing on the cancer, we should really want to see how long patients lived when given X-rays compared to when they weren’t given X-rays, and what their quality of life is in either case. It matters whether a person is alive and healthy, alive and unhealthy, or dead; having cancer doesn’t matter if it doesn’t impact longevity and being cancer-free doesn’t matter if the actions taken to become cancer-free shorten one’s life or destroy one’s quality of life. We’re left wondering whether the treatment was actually helpful.

The cherry on top of Grubbé’s shoddy research is that he suffered a lot of cancer throughout his entire life. What would the world have had to look like for us to say that the radiation treatment didn’t help him? His obituary was published in the British Medical Journal in 1960, and part of it reads:

His whole life was afflicted with mounting disabilities resulting from overdosages of x rays to various parts of his body during his early experiments, and he had a succession of surgical amputations and tumor removals. The ninety-second operation was performed on him as recently as 1959. But his desire to contribute towards medical science through radiology, and particularly in the treatment of cancer, remained till the end of his life.

By the way, that doesn’t mean he had an operation that took ninety seconds; it means he had 92 surgical operations performed on him because of his cancers.

And according to his biographer,

Emil held pathologists in low esteem and did not hesitate to say so. Usually, he said, the things they called cancers were not cancers at all, and no one, he asserted, had ever heard of a radiation victim dying of metastases. ... As so frequently is the case, the pathologists had the last word; Emil’s death certificate described multiple squamous cell carcinomas with regional metastases, plus terminal bronchopneumonia.

Here was a guy who allegedly had a cure to cancer in the form of X-rays. He’d undergone 92 surgeries for cancer, and we can only imagine how many X-ray treatments he might have given himself. What ever happened to “little likelihood of recurrence”? Why did he suffer so much cancer if he was selling the cure?

The reader is invited to ponder: Would he take financial advice from a homeless man? Would he take dietary advice from a fat person? Would he take psychiatric advice from a psychiatrist who has suffered from life-long depression and anxiety? Why would it make sense to trust a guy who suffers tremendous amounts of cancer to know anything about treating cancer? If he actually knew anything about treating cancer, shouldn’t he not have so much cancer?

So it would be hard to argue that the story of Émil Grubbé was not that of a quack. When he hadn’t even been 21 years old for a full month, he heard about a newly discovered physical phenomenon, played with it, and cooked his hand. At the recommendation of a senior physician, the young man began selling it, going even further to sell it as a cure-all. There were a lot of extravagant claims, but he had a habit of lying, so these can’t even be taken very seriously. The papers he put out, even the one that continued to be taken seriously by radiologists into the 1960s, were of very low quality and couldn’t say anything about causality. Some number of patients didn’t have cancer over the course of the next year and some unspecified number (possibly as much as 10 percent) died, but no comparison was made to a placebo group. Of course, even if he did present us with a randomized placebo-controlled clinical trial, we still wouldn’t be able to believe its results any more than we would be able to believe that he created synthetic diamonds or visited the South Pole. He wasn’t above lying for fame, and so it would have been in his character to make up data.

But just because radiotherapy began with a quack, that doesn’t necessarily mean that it’s all bunk. After all, what if someone else had come along and actually did carry out the necessary placebo-controlled experiments, right? That would certainly make a case for X-ray therapy, right? Let’s go into some of the other early evidence gathered.

Despite the fact that Grubbé was the first to treat any disease with X-rays, he wasn’t the first to publish about it. That honor goes to Victor Despeignes, a French oncologist, who applied X-rays to a man with stomach cancer from July 4^th to July 12^th in 1896. This was only a little more than five months after Grubbé had started using X-rays. Despeignes claimed that the patient improved, but he later confessed that the improvement only lasted less than a week, with the patient dying on July 24^th. Decades later, it was realized that the setup Despeignes was using wouldn’t have been capable of delivering a significant dose to the stomach, so the short-lived improvement was probably due to a placebo effect. Because of that, this case doesn’t seem to count as evidence for or against the effectiveness of radiation therapy.

Then in November of 1896, just a few months after the work of Despeignes, there was another physician attempting to use X-rays to treat cancer, this time a German physician named A. Voigt, who published about it in December of that year. Voigt’s patient had inoperable cancer of the pharynx, and experienced pain relief, but nevertheless died shortly after treatment. Not promising.

After Grubbé, Despeignes, and Voigt, the next people to claim priority in the treatment of disease with X-rays were the Swedish physicians Tage Sjögren and Thor Stenbeck. They reported a pair of successful cancer treatments. This sounds good, but it’s really not a controlled experiment, and there’s no way to know what would have otherwise happened to these patients.

So in the early days, there were a lot of claims but not as much evidence. But in Chapter 8 of Grubbé’s biography, Paul Hodges mentioned in passing that radiation therapy “flowered ... when the wartime work of Robert Stone’s large group at the University of Chicago and of scientists at Los Alamos and other atomic bomb centers was declassified at the close of World War II and the workers scattered to resume clinical activities.” The reader will remember from the section dedicated to fluoride that the Manhattan Project was involved with injecting unsuspecting Americans with toxic radioactive metals to figure out how much could be tolerated. Robert Stone and the atomic bomb facilities were all a part of that Manhattan Project, including those ethically dubious experiments. Given that the Manhattan Project was deeply devoted to hiding any and all damages that could be attributed to fluoride, it’s not at all obvious that we should trust them not to do the exact same thing for radiation. In all probability they would lie about the dangers of X-rays just like they lied about the dangers of fluoride, publishing papers that they knew were fraudulent. But let’s just take a look anyway, just to see. Let’s go over some of the papers authored by Robert Stone before, during, and after the war.

In 1930, Stone co-authored a paper titled Lymphoblastoma Involving the Stomach—Roentgenologically Considered. The opening sentence states, “Lymphoblastoma of the stomach is such a rare condition that no one roentgenologist is likely to see more than a very limited number of cases.” Based on the rarity of the disease, the reader could anticipate that they wouldn’t even have enough people to perform a clinical trial. This is really just an epidemiological report of seven cases, urging radiologists that “response to x-ray therapy be tried.” He wasn’t claiming that X-rays worked on this kind of cancer; he was merely encouraging medicos to try X-rays out on this kind of cancer.

In 1941, Stone co-authored a paper titled Roentgen Irradiation of the Pelvis in Carcinoma Cervix Uteri. The paper mostly consisted of a description of the circulation and lymphatic systems in the vicinity of the female reproductive organs, as well as containing technical information about the authors’ preferred method of treating cervical cancer, namely by radium and by X-rays. (The authors reported, “An attempt is made to avoid carrying therapy to the stage of causing bloody discharge from the bowel, although severe diarrhea is almost always produced.” They also said, “The consequences of exessive irradiation of the bladder and rectum must be disregarded because these structures or adjacent tissues are involved.”) In the paper, the authors also mentioned how they had been testing using X-rays of different energies on the left and right sides of patients’ bodies, with the left sides of their patients receiving X-rays that were five times as powerful, but this obviously doesn’t allow for hard endpoints to be compared between groups of people, which makes it pretty useless. In any case, the authors reported that the patients’ gynecologists noticed no difference between their right and left sides. This even gives reason to doubt the effectiveness of the treatment.

Stone’s 1941 paper does cite a 1935 paper, claiming that that 1935 paper had promising results concerning the efficacy of radiation treatment. This was Daniel Morton’s paper Cervical Cancer: An Autopsy Study of Women Dying with Cervical Cancer After Radiation, and Stone actually helped write the discussion portion of this paper. Morton examined epidemiological data between women who received “adequate” and “inadequate” radiation. The group of women given “inadequate” radiation was considered to be “essentially untreated.” In fact, there wasn’t even a consistent definition of these terms: Women were classed as having received “adequate” radiation if their dose of radium exceeded a certain specified amount, but then there were women whose doses exceeded that amount and who were nevertheless classed as having been given “inadequate” amounts of radiation. Imagine being given a high dose of radium, dying, and then classed as “essentially untreated” for the purposes of data analysis. To be blunt, that’s lying. But even if we ignore that this wasn’t a controlled experiment, and even if we ignore that there was an inconsistently applied definition for the word “adequate,” the results still weren’t that impressive: The average duration of life after treatment for those given “adequate” radiation was 14.8 months, whereas in the group given “inadequate” radiation, it was 10.7 months, a difference of about four months. It’s not like the women given “adequate” radiation lived and the ones given “inadequate” radiation all died; this was a study based on autopsy data—all the women in the study were dead. (Given that it was an autopsy study, there might have been selection effects as well. After all, none of the women who went on to live ended up being studied. What were their outcomes?) So it seems that the researchers cooked the books by using an inconsistent definition for the word “adequate,” tipping the scales in favor of radiation, and even then the difference in survival wasn’t larger than about four months, which is utterly unimpressive. To top it all off, there were only autopsy data for 36 women, exceedingly small for an epidemiological study. Between the small sample size, the deceptive way statistics were counted up, and the utterly unimpressive results, if anything this study seems to prove the ineffectiveness of radiotherapy.

But these were the promising results that Stone was referencing. So even though Hodges would have led us to believe that Stone was a guy who, in his wording, made radiology “flower,” here we have Stone citing a paper of low enough quality on multiple metrics such that no useful information can really be derived from it. Probably the most interesting part of Morton’s paper was when he called attention to a couple of cases in which women had apparently died due to the radiation therapy. There’s really no way of knowing the counterfactual, so we actually can’t know whether they would have survived their conditions in the absence of radiation, or if they would have at least survived for longer. Morton was less reserved in his analysis, asserting that the deaths of at least two of the “adequately” treated women must have been due to radiation. One that stood out was the case of a 53-year-old woman who had no complaints prior to receiving radiation therapy, who then rapidly developed seventeen kidney stones and died with a urinary infection within a month of her X-ray therapy. An interesting occurrence, and perhaps causally related, but, again, we really can’t know the counterfactual. Nevertheless, it was Daniel Morton’s opinion that, “Facts such as these show definitely that radiation carries an appreciable mortality—a mortality which has been overlooked in the general enthusiasm for this method of treatment.”

The kill-rate due to the treatment should be emphasized, since this paper by Morton was supposed to be a paper Stone cited as having promising results. There were 21 cases classed as having been given “adequate” treatment, so if Morton was right in saying that two of them died because of the treatment (which is a big “if”), then that means that “adequate” treatment would have been directly responsible for killing about 10 percent of those who were given it. This could plausibly be a deadly treatment.

Back to Stone’s publications, in late 1941, he and some others gave a presentation that was published in 1942. The topic was the therapeutic use of artificially produced radioactive substances. It needs to be stressed that this was about innovating within the field of radiology, about the technology of treatment; it was not about proving that radiation treatment works. Stone was trying to make the case that artificially produced radioactive substances don’t have the same drawbacks as radium, which, given orally, was being incorporated into the skeletons of the people given it (yikes). Specifically Stone focused on radioactive forms of phosphorus, strontium, and iodine. In any case, this was merely a proposal for new kinds of treatments; it did not contain any evidence concerning the effectiveness of those newly proposed treatments, let alone the effectiveness of the more old-fashioned radiation treatments.

Then in 1958, Stone co-authored a paper titled Carcinoma of the Larynx in which he had the same methodological problems that Grubbé had, namely that he gave a bunch of people radiation, tallied up the survival rate after five years (which, to his credit, seems to be a good endpoint), but then didn’t bother to have a control group, so really no causal results can be drawn.

Stone’s other works include various papers about protection from radiation, the harms of radiation, and various innovations in radiological technology, such as the use of neutron radiation and the use of radon ointment. When Hodges said that Stone made radiology “flower,” he must have been impressed with him moreso as an inventor than as a cancer researcher, because Stone appears to have been more concerned about the technological side of things. On the clinical side of things, his work wasn’t so much about proving the efficacy of X-ray exposure as it was about warning people about the dangers of X-ray exposure.

So there simply was no evidence in the beginning. Nor as late as the 1960s was there any evidence both that Hodges could point to and that could stand up to scrutiny. So we have good reason to doubt that there was any solid evidence for the treatment in the first seven decades it was being used. But let’s just look for a recent overview of the evidence. Surely someone would have come up with solid evidence in more recent history, right? Surely there must be some evidence out there that retrospectively justifies more than a century of blasting sick people with toxic rays, right?

Fortunately, in 2021 there was a paper published that went over all the evidence. That paper was titled Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines, and it went over the evidence from randomized clinical trials. It found that many treatments are supported by broad and even uniform consensus despite not actually being supported by any evidence. The final sentence of the paper reads:

Despite major advances in the field of radiation therapy, these data underline that the majority of [National Comprehensive Cancer Network] recommendations are based on uniform expert opinion and not on higher level evidence.

But obviously even if a trillion “experts” agree on something, that wouldn’t make it so; consensus only matters to the extent that people arrive at it because of evidence. “Expert opinion” should be backed by evidence, but “expert opinion” itself is not a substitute for evidence. Therefore, the above quotation is equivalent to the confession that the majority of National Comprehensive Cancer Network recommendations simply aren’t based on any evidence.

The reader might be wondering what the big deal is; after all, maybe the reader has never even heard of the National Comprehensive Cancer Network. Well, according to Wikipedia, it’s “an alliance of 33 cancer centers in the United States, most of which are designated by the National Cancer Institute (one of the U.S. National Institutes of Health) as comprehensive cancer centers.” So the kinds of people who love putting blind faith in “experts” are exactly the kinds of people who would believe anything the National Comprehensive Cancer Network says about radiation treatment. There are those who demand that claims be supported by evidence, and then there are those who live by faith alone. This isn’t a matter of science, but a matter of that religion that masquerades as science: scientism.

And it should also be emphasized that this paper didn’t even specify that the authors only looked at randomized controlled clinical trials; they only said that 9.7 percent of radiation treatment regimens could find support from randomized clinical trials, i.e. ones that aren’t necessarily placebo-controlled, which is pitifully small. So the number of radiation regimens that have randomized controlled clinical trials to back them up is actually even lower than 9.7 percent. But it’s controlling the trial that allows for a comparison against something approximating a counterfactual, and comparison against the counterfactual is necessary for making causal claims. Therefore we’re not actually even left with any indication that any of the radiation treatment regimens have any supporting evidence. So the number of National Comprehensive Cancer Network recommendations that don’t have evidence to back them up must be somewhere between 90.3 and 100 percent, and we shouldn’t be surprised if it turns out to be 100 percent.

Moreover, one of the things about science that everyone likes to honor with their lips and then completely ignore is repeatability. Everyone likes to say that one of the strengths of science is that it’s repeatable. We hear it all the time. If Bob doesn’t agree with Alice, he can repeat her experiment for himself and see whether what she said is right. But that means in order to trust that the results aren’t some statistical fluke (or even to be sure that they aren’t outright fraud, which does sometimes happen in science), we should have multiple trials for convincing us that the treatments are effective. But if only somewhere between zero and 9.7 percent of recommendations have support from at least one placebo-controlled trial, then how many can be supported by two trials? Three trials? Four trials? Can we really say that there’s any good reason to believe this stuff at all if no one’s bothering to do (let alone repeat) the experiments that would convince us?

(And, as we’ll see when we study psychiatric medications, there are even ways of making the peer-reviewed literature have a bias in favor of treatments, so it’s not clear how much even these meagre results can be trusted. It’s easy to use something called publication bias to make the body of scientific literature not represent reality, skewing the results in favor of ineffective drugs and treatments. Therefore, even if non-fraudulent evidence were forthcoming, it would still make sense to be somewhat skeptical of it. Peer review is really just another golden calf to be idolized.)

And so it appears that the therapeutic use of X-rays in medicine was rushed at the beginning. A medical man only 21 years old started using them within months of their discovery and never carried out any clinical trials that would be capable of demonstrating their effectiveness. Lots of people after him have been obsessed by this treatment, but it doesn’t appear that any of them bothered to to carry out the trials either. It’s even admitted that there’s no evidence to back up the vast majority of treatment recommendations. This is not to say that X-ray therapy doesn’t work; just that, when one goes looking, there appears not to be solid evidence that it does. But if radiation therapy did work, we would expect there to be an abundant number of trials indicating so, so it’s strange that they’re all missing.

But there’s reason to be even more doubtful: High energy radiation is believed to cause cancer, in which case, it only makes sense to be weary about using it as a treatment for cancer. The reader might remember that this was already admitted by Grubbé, who suffered from lots of cancer throughout his life. In Stone’s 1946 paper Radiation Injury, on the topic of repeated chronic or local exposure to radiation, he stated,

Later on, crusts or warts will appear. In a few people these crusts and warts will turn into skin cancer.

Such changes as these are found on the fingers of dentists who habitually hold films in patients’ mouths; on the hands of physicians who work under the fluoroscope without proper protection or who hold babies or other patients too frequently while taking radiographs; on the hands of anyone handling inadequately protected radium repeatedly; on men improperly holding metal or other industrial materials while making industrial radiographs.

This is epidemiological data rather than experimental data, but it’s compelling as far as it goes. The common thread is obviously exposure.

Stone also mentioned that radiation might have the ability to cause infertility:

After excessive overexposure, as in medical treatment for cancer, the ability to produce children may be lost temporarily or permanently, but not the ability to perform or enjoy the sexual act.

For a treatment that has the potential to sterilize its victims, one would expect that it would have only the utmost certainty in its effectiveness. They wouldn’t just be sterilizing people willy-nilly for no good reason right?

For people who want to have children, it might be devastating to learn that sterilization is a possible outcome of the treatment, regardless of the fact that they might still have “the ability to perform or enjoy the sexual act.” But the story is actually a little bit more complicated than what Stone let on regarding enjoying the sexual act. The reality is that radiation is commonly used to treat prostate cancer, and there might be sexual consequences that result from cooking a man’s prostate with radiation. Many of those whose prostates get blasted by radiation start experiencing erectile dysfunction that they didn’t have before. Quantifying the amount of erectile dysfunction inflicted by radiation therapy hasn’t been conclusive, with results varying a lot from study to study. Nevertheless, this is something to think about when considering radiation therapy.

But anyway, Stone also noted that the blood is especially sensitive to radiation therapy, with observational data from humans and experimental data in animals indicating that radiation therapy can cause leukemia, which is a kind of blood cancer, or cause lymphoblastoma, a cancer of the lymphatic system. The final sentence of Stone’s paper Radiation Injury reads:

Prevention of exposure is the keynote for safety.

Read that sentence again while thinking about how intentional exposure to radiation has been a part of the medical business model for over a century.

There’s also some reason to believe that radiation might be better at killing healthy cells than it is at killing tumor cells. This has to do with the mechanism by which the radiation is believed to kill cells. It’s believed that the radiation has the ability to knock electrons loose from atoms, creating “free radicals,” a term for electrically charged atoms and molecules, which are then believed to be able to damage subcellular structures.

But it’s believed that the damaging effects of free radicals are enhanced by the presence of oxygen, since oxygen is supposed to have a high affinity for binding to electrons. So if an X-ray knocks an electron off of a chemical, leaving a positively charged chemical and an electron, oxygen can bind to that electron and prevent the charges from being restored to balance, lengthening the amount of time before the free radical is neutralized, and therefore lengthening the amount of time it can cause damage to subcellular structures. In short, radiation is believed to cause the production of free radicals in all tissues, but it’s believed that free radicals cause more damage in tissue that has more oxygen.

In Kenneth Krane’s classic textbook on nuclear physics, the final chapter is dedicated to applications of nuclear physics, and the final section of that chapter is on the topic of therapeutic nuclear medicine. The following is his description of the effect this has on using radiation to treat cancer:

This oxygen effect results in highly oxygenated tissue having greater sensitivity to radiation, and thus irradiated tissue that is rich in oxygen has a smaller survival rate than tissue that is less rich in oxygen. From the standpoint of treatment of tumors with radiation this is somewhat of an unfortunate situation, for tumors generally have an inferior blood supply compared with normal tissue and are thus less well oxygenated. The oxygen effect results in tumors being less sensitive to radiation than the surrounding tissue. [emphasis added]

Therefore, if radiation causes damage by the mechanism people believe it does (which we should also be suspicious of), then it’s the case that X-rays are better at killing healthy tissue than they are at killing tumors. So on the radiologists’ own terms, high energy radiation is something that both causes cancer and also something that harms healthy tissue more than it harms cancerous tissue. So how does it make sense to be giving it to cancer patients?

Moreover, not that we should rely on appeals to authority, but it makes sense to pay attention when the “authority” in question is saying two things that seem to be at odds with one another, and according to the National Cancer Institute, high energy radiation, including X-rays, can cause cancer. They even confess that getting a chest X-ray, a CT scan, a PET scan, or even radiation therapy comes with some risk of cancer (although they argue that the benefits of these things outweigh the risks). How much of childhood cancer might be the result of exposing kids to toxic rays when they visit a physician or a dentist?

Finally, as an interesting historical note: It’s actually very fitting that cancer is treated with something that’s known to cause cancer. Radiation therapy actually grew out of a philosophy of medicine known as homeopathy; this was the philosophy Grubbé subscribed to. He was a homeopath. This is even evident in the name of the hospital he worked at: The Hahnemann Medical College and Hospital of Chicago, founded in the early 1850s, was named after Christian Samuel Hahnemann, the man who created homeopathy in the last decade of the eighteenth century. The reason it’s so fitting that radiation therapy should have sprung from homeopathy is that one of the core principles of homeopathy is the belief that “like cures like.”⁵ This might sound crazy at first, but there are instances when it makes some amount of sense. For example, if someone eats some spoiled food and therefore has diarrhea, one interpretation of the diarrhea is that the gastro-intestinal tract is trying to purge toxins (i.e. the spoiled food) out of the body. Therefore a homeopath might prescribe something in order to speed up the process, causing the swifter evacuation of the GI tract. Instead of prescribing things to stop the diarrhea, preventing the spoiled food from leaving, the homeopath would prescribe something to encourage the diarrhea, to get the spoiled food out as quickly as possible. That said, there doesn’t appear to be a similar line of reasoning with respect to radiation and cancer; it nevertheless conforms to the core of homeopathy. This might explain why a homeopath like Grubbé would have insisted on using it, even though even in his day it was known to cause cancer. It also explains why J.E. Gilman, who worked at the same homeopathic college and hospital, would have suggested to Grubbé that toxic rays might have some therapeutic value, and so it makes sense why their homeopathic colleagues would have been impressed. (Of course, since homeopathy was invented a century before radiation therapy, there’s nothing in the writings of Hahnemann about radiation therapy, and modern homepaths don’t necessarily recommend it as a treatment. In defense of homeopaths, there probably aren’t very many if any who would endorse using X-rays as a cure for everything the way Grubbé did.) While homeopathy is usually considered to be a form of “alternative medicine,” this product of late-nineteenth century homeopathy continues to live on even in modern mainstream medicine, which is typically called allopathy. People can make fun of homeopathy all they want, but if they believe in radiotherapy, then they already believe in one small morsel of homeopathic medicine: the belief that cancer should be treated with something that causes cancer, in accordance with the homeopathic law of similars.

But whether we justify radiation therapy on allopathic or homeopathic grounds, it doesn’t seem to be getting at the root cause of cancer. Rather than being a key to a lock, it’s more like a blunt weapon for busting open locks—except that there doesn’t even seem to be convincing evidence that it’s good for busting open locks (and is possibly even better at destroying things that aren’t locks). But what about chemotherapy?