Nicholas Gonzalez (physician)

Nicholas James Gonzalez, M.D., is a New York-based physician known for developing the Gonzalez regimen (or Gonzalez protocol), an alternative cancer treatment.[1][2][3] Gonzalez's treatments are based on the belief that pancreatic enzymes are the body's main defense against cancer and can be used as a cancer treatment.[4] His methods have been generally rejected by the medical community,[1] and he has been characterized as a quack and fraud by other doctors[3] and health fraud watchdog groups. In 1994 Gonzalez was reprimanded and placed on two years' probation by the New York state medical board for "departing from accepted practice".[1][3]

In one non-randomized clinical trial of terminally ill patients with pancreatic cancer, the Gonzalez-treated patients were found to have died much earlier than those treated with conventional chemotherapy. A better quality of life was reported by the chemotherapy arm.[5]

Biography

Gonzalez graduated Phi Beta Kappa and magna cum laude from Brown University, with a degree in English literature. From 1970-1977, Gonzalez worked as a journalist for Time Inc. and as a freelance writer, covering a variety of health-related topics, including a July 1972 cover story in New York Magazine, a 1976 cover story for Family Health Magazine, and an article for Prevention Magazine. Gonzalez became interested in medical research, cancer research in particular, while covering these topics.[6]

Gonzalez completed postgraduate premedical work at Columbia University and received his medical degree from Cornell University in 1983.[7] Gonzalez worked with Robert A. Good at Memorial Sloan-Kettering Cancer Center while in medical school. After receiving his medical degree, Gonzalez completed an internship in internal medicine at Vanderbilt University. From 1984-1986, Gonzalez worked with Good again, completing a fellowship in immunology while at University of Oklahoma and All Children's Hospital in St. Petersburg, Florida.[3][6]

Cancer treatment and its effectiveness

Gonzalez's treatment methods, which he's been using since 1987, are developed from previous work by the orthodontist William Donald Kelley. Gonzalez believes that cancer is caused by poor diet, a problem compounded when one does not eat a diet that corresponds with one's metabolic type; environmental pollution and daily stress contribute to health problems.[7] The Gonzalez regimen proposes as a treatment the use of oral pancreatic enzymes, large numbers of dietary supplements (up to 150 pills per day) and twice daily coffee enemas.[8] According to the National Cancer Institute, which co-sponsored with the National Center for Complementary and Alternative Medicine a clinical trial on Gonzalez's treatments produced "limited and inconclusive" results regarding the efficacy of the Gonzalez Regimen as a treatment for cancer.[8]

In 1999 Gonzalez published an article describing prolonged life in a small group of patients with pancreatic cancer in the peer-reviewed journal Nutrition and Cancer.[9] Subsequently others concluded that the longer survival time reported by Gonzalez was due to selection bias and other confounds.[10][11]

Rejection by mainstream medicine

Like his mentor, William Donald Kelley, Gonzalez's treatment method has been "rejected" by the "medical establishment".[1] Gonzalez has been characterized as a quack and fraud by other doctors[3] and health fraud watchdog groups, and in 1994 was reprimanded and placed on two years' probation by the New York state medical board for "departing from accepted practice".[1][3] Forced to submit to psychological examinations and undergo retraining,[3] Gonzalez was given two years of probation with a stipulation that he undergo retraining and do 200 hours of community service, which he completed satisfactorily.[12] He is currently fully licensed to practice in New York.[13]

Gonzalez has lost two malpractice lawsuits. In 1997, a New York court found Gonzalez "negligent" for his cancer treatment;[14][15] according to news reports, Gonzalez "had to pay $2.5 million in damages to a patient he wrongly claimed to have cured" of cancer.[16][17] The former patient had been diagnosed with uterine cancer but "Gonzalez discouraged her from following through on her cancer specialist's advice, instead recommending dietary supplements and frequent coffee enemas".[18] The patient had refused both standard treatment and an experimental protocol, but after the cancer spread to her spine, she discontinued Gonzalez's treatment and received chemotherapy and external beam radiation. Sometime in this period, she began having problems with her eyesight, back and hip, and she eventually became blind.[17][19] In 2000, Gonzalez was found partly liable (49%) in the death of a patient with Hodgkin's disease and ordered to pay $282,000 in damages, due to his use of an unproven cancer screening method instead of standard cancer testing.[20]

The American Cancer Society notes that there is "no convincing scientific evidence that [the Gonzalez treatment] is effective in treating cancer" and that some portions of the treatment may be harmful. A review article from the Journal of Clinical Gastroenterology is cited that notes the clinical efficacy of coffee enemas has not been proven and the therapy is associated with severe adverse effects previously described in a few case reports. Gonzalez's study published in Nutrition and Cancer in 1999 was criticized by an expert in integrative oncology research methods for its small sample size, selection bias, and failure to account for confounding variables.[10][11]

Gonzalez "has never explicitly rejected the more orthodox precepts of his profession", insisting that he wants his research evaluated by independent scientists.[3]

Clinical trial

A randomized phase III clinical trial for the possible treatment of pancreatic cancer with the Gonzalez Regimen was funded by a $1.4 million grant from the National Center for Complementary and Alternative Medicine, and co-sponsored by the National Cancer Institute, awarded in 1999 to Columbia University's Rosenthal Center for Alternative Medicine.[3][8][21] The trial was designed to compare the efficacy of pancreatic enzyme therapy plus specialized diet with gemcitabine for stage II, stage III, or stage IV pancreatic cancer.[22] However, the study had difficulty attracting patients,[23] and most eligible patients refused random assignment, so the trial was changed in 2001 to a controlled, observational study.[24]

The trial found that patients treated with the Gonzalez regime survived on average for 4.3 months; those using standard chemotherapy survived on average for 14 months and reported a better quality of life.[5]

An accompanying editorial said it was troubling that expensive CAM therapies were not backed by firm evidence, and that the trial of the Gonzalez regimen was not capable of providing a definitive conclusion because of flaws in its design.[25] Kimball Atwood said that flaws in the trial design might have led to bias in favor of the Gonzalez regimen but that it nevertheless amounted to "a slam-dunk condemnation" of the therapy.[26]

This trial had been criticized for its implausible and unsupported theoretical model of cancer development which bears no resemblance to the scientific understanding of neoplasia,[21] and because of Gonzalez's history of malpractice.[16][27][28]

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 ""Alternative practitioner embraces scrutiny" SignOnSanDiego.com". Retrieved 2008-07-29.
  2. ↑ "The Alternative Fix". Frontline (PBS).
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Specter, M (2001-05-02). "The Outlaw Doctor; Cancer researchers used to call him a fraud. What's changed?". The New Yorker. p. 48.
  4. ↑ Gonzalez, Nicholas (Nov–Dec 2012). "Nicholas Gonzalez, MD: an enzyme approach to cancer. Interview by Karen Burnett." (PDF). Altern Ther Health Med 18 (6): 54–65. PMID 23251944.
  5. ↑ 5.0 5.1 "Gonzalez Regimen". National Cancer Institute. 24 May 2012. Retrieved February 2014.
  6. ↑ 6.0 6.1 "Nicholas James Gonzalez, M.D., curriculum vitae" (PDF). dr-gonzalez.com. Retrieved 2012-08-30.
  7. ↑ 7.0 7.1 Gonzalez, N. J. (2007). "Nicholas J. Gonzalez, MD: Seeking the truth in the fight against cancer" (PDF). Alternative therapies in health and medicine 13 (1): 66–73. PMID 17283743.
  8. ↑ 8.0 8.1 8.2 "Gonzalez Regimen". National Cancer Institute. Retrieved 2008-07-29.
  9. ↑ Gonzalez NJ, Isaacs LL (1999). "Evaluation of pancreatic proteolytic enzyme treatment of adenocarcinoma of the pancreas, with nutrition and detoxification support". Nutr Cancer 33 (2): 117–24. doi:10.1207/S15327914NC330201. PMID 10368805.
  10. ↑ 10.0 10.1 Vickers, A. (2004). "Alternative cancer cures: "unproven" or "disproven"?". CA: a cancer journal for clinicians 54 (2): 110–118. doi:10.3322/canjclin.54.2.110. PMID 15061600.
  11. ↑ 11.0 11.1 "Metabolic Therapy". American Cancer Society. 2012-08-03. Retrieved 2014-02. Check date values in: |accessdate= (help)
  12. ↑ "Professional Misconduct and Professional Discipline: Nicholas Gonzalez, MD". 1994-10-24.
  13. ↑ "Office of the Professions: Nicholas James Gonzalez License Information". New York State Education Department.
  14. ↑ Charell v. Gonzalez, 660 N.Y.S. 2d 665 (Sup Ct., 1997).
  15. ↑ Cohen, MH (2004). "Negotiating Integrative Medicine: A Framework for Provider–Patient Conversations". Negotiation Journal 20 (3): 409–433. doi:10.1111/j.1571-9979.2004.00035.x.
  16. ↑ 16.0 16.1 "A cure for quacks". New Scientist. 1998-08-22.
  17. ↑ 17.0 17.1 "Cancer doc hit for $2.5M plus". New York Daily News. 1997-03-31.
  18. ↑ "When Medicine is Murder". Village Voice. 2002-03-26.
  19. ↑ Gonzalez v. Ellenberg, 2004 NY Slip Op 51518(U) (NY 10/12/2004), 2004 NY Slip Op 51518 (NY, 2004), retrieved January 1, 2009
  20. ↑ "Doctor liable in death of patient". New York Daily News. 20020-04-21. Check date values in: |date= (help)
  21. ↑ 21.0 21.1 Josefson D (September 2000). "US cancer institute funds trial of complementary therapy". West. J. Med. 173 (3): 153–4. doi:10.1136/ewjm.173.3.153. PMC 1071044. PMID 10986163.
  22. ↑ "Gemcitabine Compared With Pancreatic Enzyme Therapy Plus Specialized Diet (Gonzalez Regimen) in Treating Patients Who Have Stage II, Stage III, or Stage IV Pancreatic Cancer". clinicaltrials.gov.
  23. ↑ "Cancer's Enema No. 1? Make That 2", Wired, 30 October 2002
  24. ↑ Chabot JA, Tsai WY, Fine RL et al. (April 2010). "Pancreatic proteolytic enzyme therapy compared with gemcitabine-based chemotherapy for the treatment of pancreatic cancer". J. Clin. Oncol. (Comparative study) 28 (12): 2058–63. doi:10.1200/JCO.2009.22.8429. PMC 2860407. PMID 19687327.
  25. ↑ Levine MN. (April 2010). "Conventional and Complementary Therapies: A Tale of Two Research Standards?". J. Clin. Oncol. 28 (12): 1979–81. doi:10.1200/JCO.2010.28.5320. PMID 20308650.
  26. ↑ Atwood K (11 September 2009). "'Gonzalez Regimen' for Cancer of the Pancreas: Even Worse than We Thought (Part I: Results)". Science-Based Medicine. Retrieved February 2014.
  27. ↑ Dreifus, C (2001-04-03). "A Conversation with Stephen Straus; Separating remedies from snake oil". The New York Times.
  28. ↑ Marcus, DM; Grollman, AP (2006-07-21). "Science and Government: Review for NCCAM Is Overdue" (PDF). Science 313 (5785): 301–302. doi:10.1126/science.1126978. PMID 16857923.

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