By Michael E. Miller
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By Chris Joseph
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Six-year-old Leandro Gonzáles sits attentively at the foot of his parents' double bed, his legs dangling along the faded flower-print bedspread. His tiny brown eyes follow Dr. Niudis Cruz's index finger left, right, up, and down. He rolls back and stretches his arms toward the ceiling for a count of ten. Then Dr. Cruz, a sandy-haired cancer specialist in her 40s, slips her lean fingers into the small boy's hands, and he squeezes tightly. "Good, good," the doctor says, nodding.
Yaima, the boy's quiet, petite mother, stands to the side, holding her breath as Leandro completes his bimonthly physical exam. Her boy has an inoperable tumor in his brain stem, and she's watched the ritual countless times. But seeing him push his legs forcefully against the doctor's hand still brings tears of relief to her eyes. A little more than a year ago, he was immobile and virtually mute.
When the exam concludes, Cruz rattles off doctor-speak about the child's muscle strength, response mechanisms, and the Lansky scale, an internationally recognized quality-of-life indicator for child cancer patients (he's a 90; 100 is perfect health). She whips out her laptop and pulls up the black-and-white CT scan images of Leandro's brain. "His is the most aggressive of all pediatric cancers, with an 80 percent mortality rate within one year," she says.
She points toward the images on the screen and measurements of the tumor's progression since its detection 18 months ago. From September 2011 to April 2012, it decreased in size approximately 15 percent. During that period, Leandro underwent no treatment other than swallowing doses of clear, tasteless liquid three times daily. "It's scientifically impossible for a tumor to shrink on its own," the doctor emphasizes. "It has to be the result of some outside intervention."
Intervention for Leandro has been the venom of a medium-size scorpion called Rhopalurus junceus, known in Cuba as the escorpión azul — blue scorpion. Four months after he was diagnosed in May 2011, Leandro's weight had fallen to that of a 2-year-old. But after consuming the venom-water mixture, his health has returned almost to normal. He can now walk and tell you about his favorite food (sunny-side-up eggs) and color (yellow), and he rides his bike (with training wheels) daily. "I give thanks to God," Yaima says, "and to the doctors who knew about the scorpion."
For more than 20 years, Cubans have been treating cancer patients with blue scorpion venom. And there have been too many Leandros to dismiss the miraculous recoveries as coincidence. Even when the results aren't quite as jaw-dropping, thousands attest to pain relief, increased muscle strength, and renewed energy while on the medicine.
The treatment is now poised for a global premiere. Cuba's state pharmaceutical company, Labiofam, recently began mass-producing a homeopathic version called Vidatox. A handful of countries have registered it for sale, and a small black market to move the product around the globe has emerged. It's impossible to know how many patients have imbibed the venom treatment from the small glass bottles over the past two decades, but the number is likely more than 55,000 globally.
Curing cancer such as Leandro's has arguably become the medical world's greatest conundrum. According to the World Health Organization, the disease killed approximately 7.6 million people in 2008, 13 percent of all deaths worldwide. Despite the billions of dollars invested in research, our treatment fallbacks — chemotherapy and radiation — are woefully inadequate. Doctors are only 7.3 percent more successful at treating cancer than they were in 1950, and it's expected that by 2030, twice the number of people will die from the disease as do today, predicts the World Health Organization.
"It's hard for people to let go of believing only in conventional treatments," says Labiofam's director, Dr. José Antonio Fraga, a big man with a big mustache. He speaks from behind his director-size desk at the sprawling state pharmaceutical company in Havana that, until recently, was best known for supplying 98 percent of Cuba's veterinary products.
He chooses his words carefully. "We have not found a cure, and we do not suggest that people refuse chemotherapy or radiation," he says. "But human medicine is based on evidence." And his evidence cannot be overlooked.
Perhaps the best-known case of blue scorpion success is that of Yarislenis Abreu, a shy 15-year-old who goes by "Yari" and lives in the third-floor apartment of concrete housing in the town of Valle Honda, near Cuba's western edge. She remembers being "a vegetable" just five years ago. The right half of her body was paralyzed, and she could form thoughts in her mind but couldn't express the words. At age 10, her brain tumor was growing weekly, radiation had failed, and her doctors sent her home to die.
Her mother, Iraíde, refused to give up hope and sent Yari's father on a mission: He was to bring back the scorpion medicine a fellow cancer patient's mom said could be obtained free in a nearby province. A month later, Iraíde recalls of her daughter, "She was yelling at me: 'Mom, get me out of this bed!' " Since then, Yari has learned to walk again and write with her left hand, because her right is still smaller and weaker from the paralysis. She studies with a state-paid tutor at home and hopes to start normal high school soon. She has not missed a day of the venom medicine — and has a new weekly routine. Saturday nights, she walks two miles roundtrip to the nearest reggaeton dance club. "My mom jokes that it's like my church," Yari says, "because I go every weekend without fail."
That she, like Leandro, survived a brain tumor with the help of the venom is telling, says Dr. Alexis Diaz, an enthusiastic young Cuban scientist who's on Labiofam's small venom-research team. He says the medicine has produced results only on solid or organ cancers like those in the lungs, pancreas, brain, or stomach. It hasn't been found effective for liquid or blood-based cancers such as leukemia or lymphoma. Nor does the medicine always yield results like those that occurred with the two children. "Most patients seek the venom after everything else has failed," Diaz says. "These patients have very weak immune systems and the cancer has already metastasized, so it's hard to expect really surprising results every time."
But if the treatment is administered in the early stages of sickness, its impact is more profound, he believes. "We hope to help turn cancer from being a fatal disease into a chronic and manageable one, like diabetes."
Along these lines, Cuban doctors actively encourage using the venom as a complement to conventional methods. For example, after taking the venom for seven months, Leandro was strong enough for surgeons to create a permanent solution to his brain-fluid buildup. So his physicians, while maintaining his scorpion treatment, started him on radiation. This led to a further reduction in the tumor's size.
Dr. Luigi Di Lorenzi, director of the neuroscience department's rehabilitation unit at the Azienda Hospital G. Rummo in Benevento, Italy, tells a similar story. Unbeknownst to him, in 2010, one of his cancer patients began taking the venom-based formula. "My patient experienced an unexpected total pain relief with a good recovery of muscle strength, vital energy, and capacity to cope with daily activities such as eating," Di Lorenzi recalls.
Impressed, the specialist in rehabilitative medicine traveled to Cuba to investigate. "It is difficult to determine where reality ends and fantasy begins," he says, but "the common denominator seems to be a significant reduction of pain obtained in 100 percent of patients."
This, he stresses, should not be underestimated: "Pain therapy [is] crucial," he says, explaining how he described his experience for the Open Cancer Journal. "We do not aim to promote unproven therapies, [but] this venom certainly warrants further investigation," he wrote in a letter published last year.
Labiofam claims to have studied the effects of the venom on 10,000 patients, including 3,500 foreigners. But there is no public compilation of the methodology or results. No independent experts have conducted experiments, and none of Labiofam's work has been submitted for publication in peer-reviewed journals.
The medical world is therefore skeptical. "Rhopalurus junceus, or blue scorpion venom, originated from Cuba... is often marketed as having anti-cancer, anti-inflammatory, and analgesic properties," reads the Memorial Sloan-Kettering Cancer Center website. "The manufacturers' research cannot be corroborated. Continued research... is needed."
What is established is the product's safety. Labiofam says it conducted toxicity tests before it began distributing it, and a reputable laboratory at the Biotechnology Institute of Mexico's largest university, Universidad Nacional Autónoma de México (UNAM), recently confirmed the venom formula to be nontoxic to mammals. Indeed, among thousands of online accounts of success or failure with the venom treatment worldwide, not one notes harmful side effects.
The harmlessness of the medicine, though, is curious considering its origins.
José Perera and Juan González race up the brambly hillside. It's late, almost noon, and their work will be more difficult when the midday sun sends their tiny, evasive targets out of sight. Lanky, with taut bronzed skin and matching buzzcuts, the two men in their early 40s make their way through spiny brush toward a cluster of rocks. They hold metal pincers in one hand and opaque plastic containers in the other. The pair crouches in unison, carefully yet quickly pushing aside rocks. After a few moments, a small wriggling mass appears. As if sensing something ominous, the scorpion scurries frantically. But these men are professionals. With one motion, Perera steadies his pincers. He quickly grabs the scorpion's tail, thus rendering it as harmless as a grasshopper, and drops it into the container.
"I'm a scorpion hunter!" Perera says with gusto, stretching his back and surveying the rolling hills of Cuba's Santa Clara valley. The duo is one of a dozen or so teams that spend their days scouring rocks throughout the country in search of the misnamed scorpion, which is actually beige and mauve, not blue.
Back at González's nearby house, they add their catch to the dozens already inside a large metal barrel, covered by several rusty slabs. No living creature could possibly escape. "I've been stung 13 times in five years," Perera says. But neither he nor González is afraid. Though the sting of R. junceus hurts like hell and can cause temporary numbness, it's not deadly to humans. "People hate these animals," Perera reflects, genuinely confounded. "I say, 'Bring on the scorpions!' "
Indeed, the scorpion might be one of the animal kingdom's most misunderstood creatures. Of the more than 2,000 species worldwide, only 20 to 30 are dangerous to humans, and in those cases, mainly to small children. Scorpions sting only when threatened.
They've also been used for centuries in healing. "One noticeable example is the use of Mesobuthus martensii in Chinese traditional medicine," says Jan Ove Rein, a senior research librarian at the Norwegian University of Science & Technology and editor of the website the Scorpion Files, which lists more than 25 species with medical applications ranging from pain relief to treatment for seizures and paralysis.
The complete history of how Cuba stumbled upon its curative arachnid might never be known. There's no written account, and the man who discovered the blue scorpion's powers, a biologist named Misael Bordier Chivas, died of a heart attack seven years ago. But the story goes something like this: While testing several snake, spider, and scorpion venoms for a variety of ailments during the 1980s for the University of Guantánamo, Professor Bordier noticed improvement in rats and dogs taking R. junceus venom. He expanded his experiments and soon saw tumors decrease in size.
In 1993, word of his research reached a hotel manager named José Felipe Monzón living on the other side of the country in a town called Jagüey Grande. Monzón's 15-year-old daughter, Niurys, had all but lost a four-year battle with pancreatic cancer that had spread to her liver and intestines. Unwilling to give up, Monzón traveled to Guantánamo and begged Bordier for some venom. The professor mixed the first human formula for the girl, who appears to be in good health today. (She declined a request for an interview.)
Labiofam approached Bordier several years later. The state firm began tests that confirmed the treatment's safety. Given the promising results, the company decided to make it available immediately. Because government health authorities couldn't approve the medicine for sale so quickly, the company found a loophole: It started distributing it free to anyone who gave informed consent in 2003.
That practice meant a large amount of venom was needed. To get it, Labiofam created a scorpionario in the city of Santa Clara, where today more than 7,000 of the creatures wriggle in individual plastic containers on metal shelves.
"This is where the milking happens," says Manuel Valdés, a veterinarian clad in medical scrubs, latex gloves, and a surgical cap and mask. He's standing inside a small bare room in the Labiofam outpost. In the adjoining acclimatized rooms (71.6 degrees Fahrenheit), every scorpion has an ID number, coded for its region of capture and date of entry. The animals spend 40 days in quarantine — long enough for any pregnant scorpions to give birth and for any potential illness to be detected. Then they enter the venom rotation.
The scorpion twists itself backward as one of Valdés' colleagues uses two long metal tongs to try to steady the five-inch arachnid. "It takes a certain technique," Valdés says. The man aims the tail over a small glass jar sitting in a bucket of ice, and the scientist steps on a pedal attached to an electro-stimulus machine. As a jolt transmitted through the tongs reaches the scorpion, it releases six to 12 "micro-drops" of milky-white venom. "Each scorpion is milked once a month for two years," explains Valdés, who says the average lifespan of R. junceus is ten years. "Then it's released back into the wild to repopulate the species." The venom moves on to Havana, where for years it has been diluted with distilled water depending upon a patient's condition.
As soon as Labiofam began production, news of the free treatment traveled quickly. "I'd arrive at the office at 6 a.m. and there would already be lines of people around the block," Dr. Fraga recalls. Charter flights full of cancer patients started arriving from Europe. Weeks after an Italian journalist aired a video segment about the venom, hundreds of Italians showed up each day. "We never turned anyone away," Fraga says.
By 2010, the situation had become untenable. First, the government was anxious. In 2004, 2006, and 2009, Cuba's State Control Center for Medicine, Equipment, and Medicinal Products (CECEMD) — the country's equivalent of the Food and Drug Administration — was compelled to issue warnings regarding scorpion treatment. "Cuba does not yet have any pharmaceutical product based on the venom of the blue scorpion," Dr. Rafael Pérez Cristiá, director of Cuba's Regulatory Bureau for the Health Protection and Center for Quality Control, said in 2009. "At this moment, we do not have the documented evidence of the therapeutic action... that would justify its safe and efficient usage."
And supplies were running short. "They would need more than the entire scorpion population in Cuba to keep up production," says a former Labiofam employee who asked that his name not be used.
So Labiofam opted for homeopathy. This approach quickly gained approval, and Vidatox was born. The extremely diluted solution made it more viable to mass-produce. The 30-milliliter bottle is now available at Cuban pharmacies at a cost of $220 for foreigners and 4 cents for Cubans. Labiofam still makes the original, drinkable formula but has stopped its all-access distribution program.
Another formula is in the works. Diaz's team has identified five proteins in the venom that have anti-tumor capacities and will use these as the basis for a recombinant or synthetic version. One of the proteins being researched is likely a peptide known as chlorotoxin (CTX), which can be derived from many scorpion species. It has been researched in relation to cancer for 20 years with limited results. Diaz says if these elements can be genetically cloned, the blue scorpions of the future will live in peace.
Perera, the scorpion trapper, might worry that these advances would put him out of a job — but he doesn't. He has something more important on his mind. "My father was diagnosed with prostate cancer about a year ago," he says, choking up. The elder Perera is undergoing chemo and drinking the venom daily. His son believes the fruits of his labor are helping his father feel stronger and more energetic. "I feel proud that I can be a part of bringing the scorpions to the people who need them."
Perera, González, and their fellow Labiofam employees who supply Valdés' scorpionario aren't the only ones scavenging Cuba's woods for venom producers. Every week, informal hunters make a drop-off on a dusty street at the edge of Jagüey Grande. There's a large scorpion engraved on the door of the home and, to the left, a sign that reads, "Escozul." It lists office hours and instructions for medical consultation in English. There's no doorbell on the steel gate that encloses the porch of the nicest house on the block.
When a guest arrives, a large dog barks and a clear-eyed young woman in her 30s greets us for José Felipe Monzón. "He doesn't talk to the press," the woman says politely. It's expected. He has already turned down interview requests.
So a last card is played: "Do you think maybe his daughter — the one he saved with the scorpion venom years ago — might be willing to chat?"
The woman smiles shyly and apologizes: "Sorry, I don't give interviews either."
The story, though, has been told. The father began bringing back extra venom from Guantánamo. His daughter improved. Neighbors and friends were impressed with the girl's recovery, and Bordier finally taught Monzón the recipe. Monzón soon set up a home office and started calling the medicine "escozul" (a blend of the words escorpión and azul).
"Lines around the block!" says Arturo Fernández, Monzón's next-door neighbor for the past three decades. "Italians, French, Australians, people from everywhere started arriving." Locals too.
But those who don't have the time or money or health to get to the tiny island have few other options. A handful of doctors outside Cuba administer the treatment, including a California oncologist who had an integrative-medicine practice in Tijuana, where he treated several patients from the States. "At first, we witnessed remarkable recoveries," Dr. Santiago Vargas wrote in an email, noting that he discovered escozul in 2005 and that his practice closed in 2011, but he did not indicate a reason. "Still, as we continued to recommend it, we found some inconsistency in the results; apparently it worked best for [gastrointestinal] tract cancers. I was told it worked well for most other forms of cancer; this was not our experience." He obtained the venom from Mexico City, where there's another physician who travels to Cuba every three months and claims to make the venom in collaboration with Bordier's son.
Those who can't travel to see these physicians must place their faith in online third parties. Labiofam has secured homeopathic licenses for Vidatox in 22 countries: China, Albania, and several in Latin America. The company's website lists official distributors for these nations. But because neither the United States nor Canada nor any European state has cleared Vidatox through a rigorous homeopathic standards process, venom seekers must rely on the black market.
"I have organized it for people in Europe, the USA, Vietnam, China, the Arabian States, Africa, Australia," says a German man named Oliver Binnenböse, who for 950 euros (about $1,200) will travel to Cuba and then deliver to you three bottles of Vidatox. He's one of many people who offer these services on cancer-treatment chat forums. With such small quantities, he has never had any problems slipping under customs' radar.
A more troubling black market, however, is emerging. In 2011, Italian police confiscated 236 bottles of Vidatox — more than $50,000 in resale value — being smuggled in from Albania, an easy access point of entry into Europe.
"[The confiscated material] is not a drug," Silvio Garattini, founder and director of the Mario Negri Institute of Pharmacological Research in Milan, said in a statement soon after, but rather "a preparation that has not been approved by any international regulatory agency." The Italian government's Natural Substances and Traditional Medicines Unit of the Italian National Institute of Health thought it wise to weigh in as well: "Despite the potential benefits of the registered drug, clinical trials in accordance with official protocols have not been so far undertaken, and it should be mandatory to achieve an appropriate European evaluation of this product," the 2011 statement read.
Labiofam says it laments the trafficking and is seeking approval in dozens of other countries, but it won't specify which are under way.
A plethora of websites offer to send the original drinkable formula — referred to as escozul, escoazul, or the trademarked Escozine — anywhere in the world. Some sites seem more trustworthy than others, such as LifEscozul, which claims to work in direct coordination with Monzón and Bordier's family. "We service mainly Europe," says LifEscozul's managing director, Ariel Portal, whose agency can either arrange travel to Cuba or deliver copies of the patient's medical history to the producers so they can prepare a personalized treatment for shipment.
It's particularly complicated for patients in the United States because an embargo prohibits any product of Cuban origin — be it medicine, a cigar, or a T-shirt — from entering the country, but companies say they have ways of getting the product to clients in the States regardless.
Physicians both on the island and abroad are careful in their judgment of the blue scorpion toxin. Questioned about the venom, several of Cuba's leading scientists shifted in their chairs. They have a powerful international reputation to protect. When the island lost its Soviet income in the 1990s, Fidel Castro's government decided to invest heavily in biotechnology as a potential long-term industry. The gamble paid off: Cuba has developed a top-tier research program and landmark achievements to show for it. Cuban scientists discovered the world's first human vaccine with a synthetic antigen for Haemophilus influenzae type B. They publish frequently in prestigious journals and have hundreds of patents in more than 50 countries for 13 different oncologic, autoimmune, infectious-disease, and cardiovascular projects. Their efforts are often lauded by U.S. and European scientists as well as international agencies such as the World Health Organization.
As the scorpion's fame outpaces other, more proven Cuban medical discoveries, there's worry that the little-studied natural treatment could tarnish the country's hard-earned reputation — or, worse, do greater harm. When a Greek TV program more than a decade ago highlighted a young boy who had been saved by Monzón's venom, Monzón told the media at the time: "Now half of the world is coming to see me. I don't want to raise people's expectations."
Indeed, every cancer expert consulted for this article, even those who have witnessed remarkable results, agrees that prudence is the best option. "It is wrong to play with the hopes of people in such desperate situations," says Di Lorenzi, the Roman doctor.
Back at his house, Leandro wears a jean jacket to protect against the Cuban winter's cool breeze. He's playing with his pet turtle. "I named her Cuca!" he says excitedly. The boy was sad to see his dog go when he became ill, but his mom was concerned that the fur and dirt might threaten her son's fragile health. Similarly, Leandro's parents keep him away from large crowds.
Yaima also prefers that he ride his bike only in the backyard. "Just until he gets better," she says, though no one knows whether he will make a full recovery. She doesn't seem bothered by the uncertainty; she began this therapy with her eyes open and knows there are no guarantees. She's just glad her son has a shot at surviving.
As a reporter and a photographer prepare to leave, the boy gives high-fives. Then he slaps the hand of the driver, whom he'll see again soon: It's the same driver in the same white van that drops off his free medicine a few times a month. Leandro thought New Times was there to take him for a visit to his physician. The miracle child can't conceive of his questionable future. But he already knows what he wants to be when he grows up: "a doctor."