In the US, the vitamin is on trial as a main therapy for ovarian cancer, writes Haydn Shaughnessy.
For the privilege of entering one of the most controversial areas of modern medicine, Dr Jeanne Driskoe (the name is a corruption of O'Driscoll) gave up her lucrative private medical practice in Kansas in Missouri, retrained as a nutritionist, and accepted a job as director of the Centre for Integrative Medicine at Kansas University Medical School on a salary below that of her peers in mainstream university medicine.
She also accepted the lower rank of associate professor, so as not to raise hackles, she says, among status-minded colleagues who would not accept that the "alternative" area of medicine deserves a ranking of professorship.
The privilege she made these sacrifices for is vitamin C and a phase II medical trial in which vitamin C is the main therapy for ovarian cancer.
As recently as October 2004, medical journal The Lancet carried a story that antioxidants, of which vitamin C is the most popular, not only have no effect on gastro-intestinal cancers, but they probably also increase mortality.
The report reflects the misgivings of conventional medicine when faced with a self-administered and unproved alternative, but it also stands as an oddly emphatic rejection of antioxidants at a time when the American National Institutes for Health (NIH) are adopting a significantly more tolerant attitude towards the alternative scene.
That is where Driskoe comes in. "Ovarian cancer is a death sentence," she says. "Survival is around 17 months."
She joins Dr Nick Gonzalez, a New York doctor running a phase III clinical trial with pancreatic enzymes and diet to cure pancreatic cancer, as two of a small band of conventionally trained doctors running alternative therapy trials under the aegis of the medical establishment.
The vitamin C trial began in 2002 and had the goal of recruiting 40 patients. It is an integrative trial in that patients will still be taking chemotherapy. Alongside vitamin C, she administers vitamin A and mixed carotenoids. She says the use of vitamin C as a general and powerful antioxidant, with a role in cancer treatment, is an old theory.
Vitamin C was discovered and first synthesized by Albert Szent-Gyorgyi in 1928, for which he later won the Nobel Prize. Vitamin C was then taken up by two times Nobel Prize winner Linus Pauling as a cure for the common cold.
That early enthusiasm for a cure for a relatively minor ailment overshadows and potentially trivialised the work Pauling did later on the use of vitamin C for serious degenerative illnesses such as cancer.
In the Pauling version of vitamin C therapy, he and his followers recommended vitamin C be administered intravenously in very large doses. This is very much a "don't try this at home" therapy. Doses can exceed 100g a day and the average individual can tolerate little more than 1g or 2g a day before diarrhoea sets in.
Pauling was so convinced of vitamin C's anti-cancer role that he directed a major part of his research at why a water soluble vitamin could have such a powerful impact at the molecular level of our bodies.
The speculation took his team in the direction of a model for DNA. Pauling believed DNA had a triple helical structure in which the third helix had a role in disease replication. Crick and Watson brought out a more plausible double helix at the same time and Pauling's additional DNA element lay forgotten for 50 years. It has recently been revived but Pauling remains the genius who also made the biggest mistake in science.
The debate and the science goes much deeper than most of us are able to understand, but that in itself is suggestive that proponents of vitamin C are hardly quacks.
As Driskoe tells it, there are now hundreds of doctors in clinics around the world administering high-dose vitamin C "but keeping very quiet about it".
The effect of that, unfortunately, is patients, desperate because they are in the late stages of their cancers, hear these therapies are available and seek them out with scant regard for the expertise of the doctor.
Eighty per cent of cancer patients now seek alternative treatments, says Driskoe. In the case of vitamin C, there is no agreed protocol. The combination of desperate patients and the absence of a scientifically grounded protocol could not be worse. "People need good information," she says.
This is what she has dedicated the latest stage of her career to. A mother of four children, none of whom has chosen medicine, Driskoe has already established that high-dose antioxidants do not interfere with chemotherapy regimes, opening the way for wider acceptance by the medical profession that this alternative can operate as an integral part of treatment. Instead of patients taking their treatment into their own hands or into the hands of inexperienced professionals, she urges practitioners to adopt this integrative approach. Meanwhile, the NIH are researching the mechanisms through which vitamin C interacts with tumours.
Based on the NIH work and her own trials, Driskoe concludes: "Vitamin C is bound to play a supporting role in integrative care," she says.
"In some cases, it may replace chemotherapy." Assuming, she infers, we can clear 50 years of prejudice out of the way, a possibility that seems to be emerging, at least in the US.
Unorthodox scientific trials
Pancreatic enzymes and nutrition: Dr Nick Gonzalez is running a phase III clinical trial in New York using enzymes and diet to attack pancreatic cancer. Gonzalez doubled the life-expectancy of some patients in a phase II trial and says he is confident, two-and-a-half years into his phase II, that those results will hold up. Gonzalez was struck off by the New York Medical Board in the early 1990s for his unorthodox treatments. After a legal battle, he was forced to retrain and has since fought his way back into the integrative cancer care vanguard.
Hyperthermia: A treatment growing in stature in Germany, it is used at clinics such as the BioMed Kliniek where Dr Dieter Hager, vice-president of the German Society of Oncology, is chief clinician. Hyperthermia therapy is based on replicating the body's fever response to illness. Whole body hyperthermia is a therapy that stimulates fever in order to activate the body's natural immunity. Targeted hyperthermia directs heat at tumours and the area around them.
Chapparal: This native Indian remedy from the US has been exposed to widespread criticism over the years - but now a derivative, M4N, can visibly shrink tumours of the neck and head. Doctors at the Medical University of South Carolina have used the derivative without toxic side-effects in a phase I trial. Other doctors at the respected Duke Comprehensive Cancer Center, Durham, North Carolina are also experimenting with M4N