By: Marcus A. Cohen

Emanuel Revici, M.D., who died at the age of 101, January 9, 1998, left two legacies.

The first, and principal one, is in research and treatment. He developed a system of individually-guided lipid-based chemotherapy of negligible toxicity a generation before cytotoxic chemotherapy became a mainstay of cancer care; and he utilized this sytem to treat not only cancer but AIDS, narcotic addiction, radiation bums, arteriosclerosis, and arthritis, among many other diseases. Rich as it may prove to be, Revici's chief legacy remains obscured at present by the iconoclastic novelty of his conceptual and methodological approaches, and by the controversies that developed over them in the U.S.

Revici's second, lesser legacy, is in health rights. It derives from precedent-setting opinions in several malpractice suits against him in the 1980s which are consistent with an important liberalizing trend toward assumption of risk by patients in choices of treatment. (The trend runs through our tripartite government system, grows stronger in medicine and coverage of care, and feeds on increasing use of advanced communications technology.).

This appraisal examines both legacies in an attempt to spotlight reasons for thorough revisitation of Revici's life work and to illuminate the origins of the controversies surrounding it.

During the early, European years of Revici's career (1920-41), his medical theories attracted support, notably in France, where academic physicians who witnessed the results of his clinical applications thought his protocols held the potential to revolutionize the treatment of numerous pathological conditions (personal communications, letters of reference about Revici, from Dr. Leroux, Professor of Pathologic Anatomy, University of Paris, 3/21/41, and from Dr. Chifoliau, member of the hospitals of Paris, member of the French Academy of Surgery, 3/22/41). After he established himself in New York City in 1947, the U.S. medical community, for the most part, dismissed or reacted indifferently to his findings. Now that he is dead, what may prevent his theories and applications from vanishing into oblivion?

Despite the detractors and indifference, throughout his American years a small number of scientists and clinical researchers have regarded his ideas as sound and believed his therapeutic agents effective; and these "dissidents" certainly were or are authorities in their specialties.

Professor Joseph Maisin (a. 1971), Director of the Institute of Cancer, University of Louvain,

Belgium (former director of the International Union Against Cancer), found Revici's medications effective in numerous terminal cases refractive to other treatment (personal communications to Revici ; 2/26/65, 3/8/67, 3/18/68,11/11/69,1/13/70; O.T.A., 1990).

Gerhard N. Schrauzer, PhD (Professor of Chemistry, University of California, La Jolla), an authority on selenium, has credited Revici with "having discovered pharmacologically active selenium compounds of very low toxicity," appraising him as "an innovative medical genius, outstanding chemist, and a highly creative thinker" (personal communication to the Board of Regents of the University of the State of N.Y., 2/14/86, in an administrative proceeding that is a matter of public record).

Mark Noble, PhD (Professor of Oncology, University of Utah), a noted cell biologist, is currently "studying Dr. Revici's work because ... there is a significant chance that he has created a coherent chain of scientific discoveries" (personal communication to the N.Y. State Department of Education, 1/20/97, entered into the record of Revici's re-licensing proceeding).

Lastly, there is the list of cancer patients in the U.S., spanning half a century, reportedly in long-term remission under his method of treatment after failing to benefit in any way from accepted modes of therapy (Plumb, 1955; Molinari, 1988; O.T.A., 1990).

BIOGRAPHICAL SKETCH

Emanuel Revici was born in Bucharest, Romania, in 1896. He received his doctorate in medicine and surgery from the University of Bucharest in 1920 and his license to practice the next year. Subsequently, he was appointed "Preparator," then "Assistant" at the second Medical Clinic of the Faculty of Medicine, University of Bucharest. (Sworn and notarized affidavit by Revici, 2/3/55, p. 1; specific utilization uncertain.)

In the mid- 920s, he began to concentrate on biochemical research, specializing in the relationship between lipids and normal and abnormal cellular metabolism. From 1936 to 1941, following resettlement in France, he continued his studies at academic and hospital laboratories directed by prominent Parisian physicians (affidavit, Revici, 1955, p. 2). During this period, the sub-director of the Pasteur Institute deposited five papers by Revici in the National Academy of Sciences, a prestigious way of registering scientific innovations (affidavit, Revici, 1955, p. 2; personal communication from C. Pouret, archivist, French Academy of Sciences to Revici, 5/21/85, giving the deposit numbers and years: 11273, 4/12/37; 11322, 8/30/37; 11391, 2/28/38; 11417, 4/25/38; 11440, 7/4/38). These papers sum manized observations he had made about the influence of lipids in pathological pain and cancer.

His clandestine service with the French Resistance during World War 11 obliged leaders of the Underground to provide him sanctuary outside of Europe (personal communication from Andre Girard, a leader of the French Resistance in southern France, to Laurence H. Eldredge, Esq., 4/12/65; also, affidavit, Revici, 1955, p. 3). In 1941, he resettled in Mexico, advancing his studies in Mexico City for the duration of the war. Between 1942 and 1945, he established and directed a free clinic, staffing it with fellow physicians-in-exile and local physicians. The clinic, which contained over 100 rooms, mainly attended to cancer patients (affidavit, Revici, 1955, pp. 4-22).

In 1946, Dr. George Dick, dean of the medical school, Chicago University, invited him to carry forward his research in the U.S. (affidavit, Revici, 1955, pp. 23-26). In recognition of both his assistance to the French Underground and the potential of his scientific discoveries, Sumner Welles, a high-level aide to President Franklin Roosevelt, arranged with the U.S. Consulate in Mexico to grant special visas to speed the entry of Revici and his family (personal communication, A. Girard to L.H. Eldredge, 4/12/65). Mr. Welles, a diplomat, had served in the Roosevelt Administration as Undersecretary of State from 1937 to 1942.

When the dean of the Chicago University medical school resigned, Revici accepted an invitation from physicians, businessmen, and civic leaders in 1947 to open an experimental cancer clinic in New York City. The clinic, named the "Institute of Applied Biology," (I.A.B.), became operational that same year (personal communication, Robert A. Ravich, MD, I.A.B., to William A. Stovall, MD, 4/18/49, p. 1; also, affidavit, Revici, 1955, pp. 27-30). Revici served as scientific director, a position he held until the I.A.B. ceased operations in 1990. He earned his medical license in NY by examination in 1947, and resided and maintained his dual career as a scientist and physician in New York City until his death.

SCIENTIFIC FINDINGS AND MEDICAL APPLICATIONS

Revici's medical insights derived from several different lines of intertwining investigation. Each one is simple enough by itself, but when woven together they form a complex body of knowledge that cannot be assimilated through superficial examination of his writings. Thus, any summary can present his work only in an oversimplified manner.

During the early years of his clinical research, he noted that cancer patients presenting with pain showed a cycling in their levels of discomfort. Some patients felt more pain in the morning. Others suffered more at night Some patients had their pain relieved by eating, Others found their pain so exacerbated by eating that eating became a fearful experience for them. Revici

surmised that any cycling of this nature must be associated with an underlying cycling of the patients' physiology, and he set out to discover what such underlying fluctuations might be.

Utilizing the techniques available to him during the first half of this century, he studied a variety of aspects of blood and urine. These simple studies led to the finding that healthy individuals characteristically showed daily rhythmic fluctuations in fundamental physical parameters, such as urinary pH and levels of free potassium in the blood. Cancer patients, in contrast, failed to show normal patterns of fluctuation, exhibiting either patterns of acidic imbalance or alkaline imbalance (Revici, 1961).

The next steps taken by him typify his ability to penetrate directly to simple experiments. First, he found that ingestion of a small amount of sodium bicarbonate by a patient in acidic imbalance would ameliorate their pain temporarily, but would worsen the pain of a patient in alkaline imbalance. Experiments with dilute phosphoric acid yielded approximately converse results. Knowing that such small amounts of dilute base or acid would not change bodily pH, he then placed platinum electrodes into painful loci of patients with superficial tumors, as well as into non-painful regions of the tumor mass and into normal tissue. These experiments led to a remarkable conclusion: The pH of painful local lesions was not only different from the rest of the body, but could be rapidly and specifically altered by the ingestion of small amounts of acid or base. As a result of these initial studies, Revici proposed that a critical distinction be made between pathological pain and what he termed "physiological pain," a distinction supported by many subsequent years of research (Revici, 1961).

Wishing to relieve pain in his cancer patients, he decided to develop lipidic means of altering pH, realizing that interventions based on ions, amino acids, or proteins would prove too shortlived to provide meaningful benefit. Before he could carry out this work, however, he determined that it was necessary to define lipids as more than greasy, water-insoluble substances extractable in ether (a definition still found in many present-day biochemistry books). Decades earlier than anyone else in the field, he redefined these important substances at a molecular level, describing accurately the relative importance of the polar and non-polar regions of these molecules. This definition guided his utilization of lipids for therapeutic purposes by providing a precise structural guide to the analysis of compounds he would go on to create (Revici, 1961).

While seeking to develop better means of analyzing the effects of lipids on the organism, and being intrigued by his observations that the mineral constituents of the nuclei and cytoplasm resembled the earth's crust rather than sea water, Revici also initiated a systematic study of the effects of different elements on bodily function (Revici, 1961). This research led him to

categorize elements as to whether they primarily were inductive of anabolic or catabolic metabolism (terms which, to some extent, became interchangeable in his thought with categorization according to whether an element contributed to an acidic or alkaline state). Remarkably, he found that within a vertical series of the Periodic Table of the Elements, elements acted similarly; and he deduced that their valency shell in part determined their bioactivity. Based upon his analysis of elements in different levels of organismal organization (cell, tissue organ, system), and the effects of specific elements on cellular pathology, he suggested that the concentration of an element in different organizational levels was both precisely regulated and a critical determinant of normal and pathological states (Revici, 1961).

A further component of Revici's development stemmed from his observations on the molecular structure of carcinogens and other bioactive molecules. In contrast to the prevailing wisdom (expressed most forcefully by Linus Pauling), he observed that many bioactive molecules exhibited a charge structure in which adjacent carbon atoms would be predicted to carry identical charges. As with so. much of his work, examination of molecular structures makes one wonder why his peers resisted this discovery: Perusal of the Merck Index reveals example after example of bioactive molecules with such an energetic configuration. The concepts Revici evolved from study of these "twin formations" (as he termed them), or energetic centers, also played a crucial role in his design of medicaments (Revici, 1961).

Time after time, his investigation of lipid function and chemistry opened the way to findings that predate ideas now widely accepted. For instance: 20 or more years before Bengt Samuelson described leukotrienes, receiving a Nobel Prize for his work (Samuelsson, 1987), Revici described them in essence, recognizing their crucial role in inflammation (Revici, 1961; Revici, paper titled "The Influence of Irradiation upon Unsaturated Fatty Acids," read before the Sixth International Congress of Radiology, London, 1950).

Typically for him, though, he also saw these compounds as a small part of a much larger picture. Instead of choosing the traditional scientific path of focusing the next 10 years of his research on this one topic, he went on to describe presciently the capital role of bioactive lipids in the early stages of cellular and systemic host defense processes, deducing that intervention by lipids at this level of the body's defenses might drastically alter outcome, and even the extent of mobilization, occurring at other levels (Townsend Letter for Doctors, 1987).

At this stage in his development, Revici incorporated another important foundation principle: That frequently the damage done to any organism by disease is caused not by the pathogenic focus but by the body's defense mechanisms as well. Although he may not have been the first to codify this key principle, he again seems to have been decades ahead of others in applying

this understanding of pathology in his treatment (Revici, 1961; Revici, 1961, published address, Nov. 13,1961).

Because he believed that these defense mechanisms, activated into disequilibrium, may do more harm than the pathogenic focus itself might, he therefore devoted himself to devise medicaments that would restore normal bodily function. Based upon his earlier studies, he chose to utilize the properties of elements to alter different levels of function, and the ability of lipids to cause longer-lasting alterations, to create a large series of therapeutic compounds in which elements were conjugated into lipids (Revici, 1961): He thereby anticipated, again by decades, interest in lipids as carriers of pharmaceutically useful compounds (Mizushima, et al, 1986). As already noted, his research on "twin formations" also heavily influenced his thought on the structure of useful therapeutic agents.

Taken altogether, the different paths of research he explored during his life facilitated the development, with foresight and intention, of a great number of therapeutic compounds designed to have particular effects.-on the function of normal and diseased tissues said, then, in summary, and without exaggeration, that Revici developed a theory of rational drug design decades before the concept entered the imagination of the larger scientific community. And this theory helped him to discover, among other therapeutic agents (again, many years before anyone else did), such compounds as organo-selenium drugs for treatment of cancer, AIDS, and other terminal or chronic degenerative diseases.

ATTEMPTS TO PUBLISH

Soon after he set up his free clinic in Mexico City, and from the moment he co-established the Institute of Applied Biology in N.Y., Revici sought to disseminate his theories and therapeutic results (Affidavit, Revici, 1955, pp. 38-40, and personal communication from Benjamin C. Ribman, Esq., to the American Medical Association, 1/28/49).

He published papers, often in co-authorship, in peer-reviewed journals (Revici et al, 1953, Revici et al, 1954, Willheim et al, 1959). He and his colleagues presented papers on different aspects of his research before scientific and medical organizations (Revici , paper titled "The Influence of Irradiation upon Unsaturated Fatty Acids," read before the Sixth International Congress of Radiology, London, 1950; Kaempffert, 1951; Schmeck, 1959; Revici, address before the Society for Promoting International Scientific Relations, 1961).

These attempts to acquaint, the medical community with his studies at the Institute of Applied

Biology encountered resistance. In particular, correspondence and articles critical of his

method of cancer treatment, published in the Journal of the American Medical Association in 1945 and 1949, severely hindered wider circulation of information about him and damaged his capability to raise funds and operate normally (Leake et al, 1945, Council on Pharmacy and Chemistry, 1949).

Revici claimed that the letter appearing in JAMA in 1945, warning against his Mexican clinic, contradicted favorable reports in the private correspondence of the signatories to the public letter; and JAMA did print a brief rebuttal from the I.A.B. pointing out that pivotal contradiction in 1949. (Institute of Applied Biology, 1949). The I.A.B. sued a local arm of the A.C.S., the Brooklyn Cancer Society, for libel in 1949 when the Brooklyn Cancer Society circulated an excerpt from the 1949 JAMA piece. The suit was settled through arbitration the same year (retraction, authorized and signed by the Brooklyn Cancer Society, 6/13/49), and the arbitrator, the president of the Medical Society of the State of N.Y., apparently impressed by the potential of Revici's treatment, subsequently joined the I.A.B.'s board of directors (Laurence, 1952).

In July, 1961, the D. Van Nostrand Co. brought out his 772-page textbook, Research in Physiopathology as Basis for Guided Chemotherapy, With Special Application to Cancer (personal communication from Edward M. Crane, president of Van Nostrand, to the Institute of Applied Biology, 6/8/61). Teeming with ideas constituting the conceptual bases for his method of treatment (while mostly appending his experimental and clinical data as footnotes), the book summarized his life work from the mid-1920s through the 1950s (Revici, 1961).

Release of Revici's text in July of 1961 by a publishing house long known for the quality of its scientific books marks the high point in his efforts to convince the U.S. medical community of the value of his research; but in April of that same year, the American Cancer Society had placed him on its "unproven methods" list, and few physicians, researchers, or medical libraries purchased his text once it became available (American Cancer Society, 1961).

ATTEMPTS TO EVALUATE

The American Cancer Society in the section about Revici in its literature on unproven methods of cancer management alludes to evaluations of his therapy at the University of Wisconsin and Chicago University in the mid-1 940s (American Cancer Society, 1989). The extant documentation from this period suggests the A.C.S. has mistaken informal visits to his Mexican clinic by physicians associated with the University of Wisconsin for a formal investigation. The documentation also suggests that the A.C.S. has attributed to Revici a test of his treatment at Chicago University that a colleague at this university appears to have

attempted. There is no contemporaneous evidence that Revici treated any patients there (personal communication from B.C. Ribman, Esq., to the A.M.A., 1/28/49; F.B.I. dossier on Revici, 1959).

In its phrasing of actual negotiations with the National Research Council to evaluate him in the early 1950s, the A.C.S. creates the impression that Revici and his associates at the Institute of Applied Biology refused to accept scientifically appropriate protocols for clinical trials (American Cancer Society, 1989). The documents from parties on both sides, compared carefully, do not support the A.C.S.'s interpretation of the collapse of I.A.B./N.R.C. negotiations (unpublished memorandum by the Committee on Cancer Diagnosis and Therapy, National Research Council, 2/17/53; unpublished commentary by Abraham Ravich, MD, Institute of Applied Biology, to Dr. George Lull, executive director, American Medical Association, 7/14/53).

An unpublished description detailing Revici's approach to cancer treatment, prepared by an associate in 1962, refers to a June meeting with the National Cancer Institute to explore a prospective N.C.I. evaluation (paper, titled "Cancer: Concept, Method, Therapy of Emanuel Revici, MD," stating in the addenda that it "was the topic of discussion" at meetings with the N.C.I., 6/5-6/62). The N.C.I. presumably declined, because Revici next entered into discussions for a clinical appraisal by oncologists associated with two medical institutions in N.Y.C. The protocols they worked out divided the oncologists into roughly even groups: one group to observe patients refractory to mainstream therapy treated by Revici and his staff at his inpatient facility; the other group to administer his treatment to similar patients at their own hospital. Each group was to publish their conclusions separately.

The 2-page summary report of this evaluation published in JAMA in November, 1965, stating that no benefit resulted from his treatment in the 33 patients studied, devastated him and undermined his support among the trustees of his inpatient facility (Lyall et a], 1965; personal communication, A. Girard to L.H. Eldredge, 4/12/65)). He wrote a massive point-by-point rebuttal, profusely documented, which JAMA rejected (needing no reason beyond its length).

The Office of Technology Assessment (U.S. Congress), in its report about unconventional cancer treatments, condenses his rebuttal to its essential points, saying that he "presented summaries of patient records that he claimed showed objective responses to treatment, contradicting the C.A.G.'s interpretation of the same data," and that "he noted, among other things, that several patients in the study had tumor remissions that the study group allegedly failed to recognize" (O.T.A., 1990).

The American Cancer Society, in a recent revision of its piece putting Revici on its unproven methods list, airs an objection by him omitted by the O.T.A.; "that he had been excluded from

the group's deliberations" (A.C.S., 1989). The documents, showing that the two groups violated the protocols by merging into one group and signing their names to one report, indicate that his contention seems solidly grounded (Francis Delafield Hospital, "Delafield Clinical Appraisal Protocol," undated).

Now, 33 years after the appearance of the Clinical Appraisal Group's summary, enough time has passed to note additional, currently more pertinent "flaws." The C.A.G. trial fell far below the 11 gold standard" for such trials -- a randomized, controlled, blinded study; it was a simple observational study, without controls, without randomization, without blinding of the evaluators to avoid bias. Moreover, besides being subject to bias, it occurred a generation ago! Which makes it, in the eyes of today's literature-saturated researchers, a relic of "ancient" history.

In 1990, Seymour Brenner, a board-certified radiation oncologist: in private practice in N.Y.C., presented a retrospective "best case study" of Revici's cancer patients before the Office of Technology Assessment. The O.T.A. had convened a special meeting to enable critics of the final draft of its report on unconventional cancer treatments to suggest corrections. Brenner discussed 10 cases, documented by him (but not subjected to rigorous peer review), which he believed to be in remarkable remission; and the O.T.A. added his study to its section on evaluations of Revici (O.T.A., 1990).

The O.T.A. report cites a much earlier evaluation warranting mention, an unpublished paper by Robert A. Ravich, MID, written while still a junior colleague of Revici at the Institute of Applied Biology. The paper summarizes the results in all 1,047 cases treated at the I.A.B. from its founding to 1955. The O.T.A. devotes considerable space to discussion of Ravich's review, detailing his criteria for inclusion of patients, his classification of treatment groups according to Revici's method for determining the predominant anabolic or catabolic imbalance present in each case, and his "tabulation" of objective and subjective responses to treatment (O.T.A., 1990).

Since congressional establishment of the Office of Alternative Medicine in the National Institutes of Health in 1992, the O.A.M. and the FDA. have cooperated in developing a protocol to test Revici's therapeutic agents. Recently, the Center for Alternative Medicine at the University of Texas (Houston), signed on to assist.

EXPRESS ASSUMPTION OF RISK

The last two decades of his life enmeshed Revici in desperate battles to remain in practice. He had survived the Clinical Appraisal Group's evaluation in 1965, suffering a drastic blow to

his reputation. In the early 1970s, he had survived temporary suspension from the Medicaid program and a threat by the N.Y.C. health commissioner to prosecute him for administering allegedly unapproved compounds to detoxify some 3,000 drugs addicts (House Select Subcommittee on Crime, U.S. Congress, 1971, Barron's, 1972, Toxicomanies, 1973, Revici v. N.Y. News Incorporated and William Sherman, 1977).

Then, in November 1983 and again in January 1984, the deadliest attacks ever mounted against him commenced in the federal court and before the Office of Professional Medical Conduct (N.Y. State health department). In the court, he faced two malpractice suits, the first major negligence actions against him in 63 years of continuous practice. Before the O.P.M.C., he faced charges of gross negligence and gross incompetence (to cite the gravest of the charges, which basically reduce to departures from community standards resulting in claims of injury to patients -- the simple definition of medical malpractice in negligence law). Each proceeding could oust him from practice and close the Institute of Applied Biology.

The story of how he kept, lost, and regained his license in the State proceedings is eminently worth recounting, especially for the instrumental role played by his patients in saving the license in the first proceeding; but it is too lengthy (stretching over a period of 14 years), and too complicated by different circumstances that necessitated different strategies for each proceeding to tell here. The victories won by Revici in court, comprising his "second, lesser legacy," necessarily must be told here (and can be recounted concisely).

The cases went to trial before juries, and in both cases the juries returned verdicts against him and awarded damages in monetary amounts totally beyond his capability to pay. His attorneys filed appeals with the appellate court, and the appellate opinions reversed the lower court verdicts, remanding both cases for retrial (Schneider v. Revici, 1985, 1987, and Boyle v. Revici, 1989, 1992). The second case proceeded to retrial, and the jury verdict this time was for Revici (Boyle v. Revici, 1994).

The reason for reversal in each case was the same. The appellate justices ruled that the lower court judges had failed to instruct the juries to consider whether the patients had expressly assumed the risk of treatment that departed from community standards. The appellate rulings set a legal precedent, "Express Assumption of Risk" (technically speaking, an affirmative defense). Under this precedent, if a defendant physician proves to a jury that a patient expressly assumed the risk of unconventional care, this bars recovery of any damages. To quote the appellate opinion in the first case:

'Appellees contend that it is against public policy for one expressly to assume the risk of medical malpractice and thereby dissolve the physician's duty to treat a patient according to community

standards. We first note that the 'public policy' referred to ... is defined solely by statute ... and appellant points to no statute imposing limitations upon such express agreements. Moreover, we see no reason why a patient should not be allowed to make an informed decision to go outside currently approved medical methods in search of an unconventional treatment While a patient should be encouraged to exercise care for his own safety, we believe that an informed decision to avoid surgery and conventional chemotherapy is within the patient's' right to determine what shall be done with his own body* (Schneider v. Revici, 1987).

The two sentences that end this quote firmly place a significant development in the judicial branch of government, a matter of relatively narrow interest, into a much more general trend toward liberalization of attitudes about the risks patients (and the public) may take in choices affecting health.

This trend is discernible in actions and policies of the legislative and executive branches of government (U.S. Congress, notably The Access To Medical Treatment Act, pending before both Houses since 1994, and notably the report delivered to President George Bush by the National Committee to Review Current Procedures for Approval of New Drugs for Cancer and AIDS, 1990).

It is traceable in medicine, where mainly the patient-centered school of outcomes research supplies impetus (Wennberg, 1988,1990, and Reiser, 1993), and where increasing use of modem electronic communications devices tends to foster it (Silberg, et a], 1997).

The trend has been growing noticeable in these areas at different rates of progression, but its affect in common has been to expand the therapeutic options available to patients, especially for alternatives to mainstream care. Revici's malpractice cases make a signal, historically secure contribution to this trend.

AFTER WORD

Reflecting on his life, on the obstacles he encountered in advancing his career and striving to earn recognition as a seminal figure in 20th-century medical science, certain questions arise about his temperament, about the ways he conducted research and applied laboratory findings to clinical practice. In short, how much did the personal factor count in building resistance to his theories and method of treatment? In precipitating the trials that buffeted him mercilessy toward the end of his days?

His approach to research was traditional: observation first, next hypothesis, then experiment. Theory seems to have appealed to him more than experimentation did. (He repeated experiments to confirm his hypotheses and data, but as soon as his

experiments convinced him that he was correct, he wasted no time repeating them again.) Still, he clearly realized that both weighed equally in discovering and perfecting treatment (Revici, 1961).

Temperamentally, though, Revici had little tolerance for the time generally required to bring new treatments from breakthroughs in the laboratory to approval by the FDA. He felt very strongly that gravely ill patients whose conditions were resistant to accepted modes of therapy could not wait for the approval process to run its usual dilatory course. Once his own careful experiments confirmed to him that a therapeutic agent he developed was safe and effective, he gave it to patients regardless of regulatory agency policy. Recovery, or relief for his patients was his primary, overriding rule. The medical community and regulatory agencies, of course, adhere to a different, opposing rule, so his stubborn insistence in guiding his clinical practice in accord with his rule was likely to engender suspicion, hostility, and eventually administrative investigation and civil prosecution.

Independent validations of Revici's findings about lipid structure and function have begun to accumulate over the past 20 years. The section on his scientific discoveries in this article singles him out as the first medical scientist to elucidate the bioactivity of leukotrienes, the first to develop a safe, effective means of lipid transport. Certainly, he pioneered in the use of selenium in a virtually non-toxic form to treat cancer (Revici, 1961; Schrauzer, 1981). It now also appears that he predated his peers in administering omega-3 fatty acids derived from marine fish oil to shrink tumors (Revici, 1961; Simopoulos, et al, 1998).

When the Office of Professional Medical Conduct succeeded in revoking his license, on charges of probation violation amounting to inadequate record keeping (N.Y. State Health Department, 1993), they severed the ties to treatment and patients that had challenged him intellectually and nourished him emotionally throughout his career. Too proud to admit that the revocation had dispirited and devitalized him, he merely subsisted during his remaining years, until his appetite for life and food petered out. He died shrunken in body, painfully burdened at last by great age, a vestige of the constitutionally sturdy, supremely optimistic and confident man he had been prior to loss of his license.

At the end of Shakespeare's King Lear, immediately after Lear dies, two loyal subjects speak the following lines:

Edgar. He is gone, indeed. Kent The wonder is he hath endured so long.

Now that Emanuel Revici is gone, how long will his medical legacy endure? The answer is:

I hinges on how soon objective studies corroborate the bulk of his life work