DR. PALMER'S METHOD

Miami Herald, The (FL)
Author: Jonathan Sacks

There are five of them in the waiting room this afternoon, strangers to each other, brought together by a deadly habit.

"I've been smoking for 35 years," wheezes a thickset woman. In her lap she slowly destroys a facial tissue. "I've tried everything," Shred. "Cold turkey." Shred. "Hypnotism." Shred. "Everything." The other four-two women, two men-nod grimly. There is desperation in the big woman's voice. "I'm getting emphysema. I hope this works. I wouldn't know where else to turn."

There are hopeful signs. On a counter near the exit door of this SmokeMed clinic on Fort Lauderdale's Commercial Boulevard, crumpled, half-empty cigaret packs spill from a silver ashtray. Like cripples cured by a faith healer, customers here often cast away their crutches., presumably forever, as they leave. The rejected cigarets are left in the ashtrays all day, evidence of the treatment's success-or at least of the customers' hopes.

These people are about to pay $310 to endure painful injections in the ears and nose. They are here because of promises made to them in dozens of newspaper and radio ads, promises from a famed University of Miami pharmacologist that he will stop their smoking.

In the waiting room, a man with yellowed fingertips gestures toward a bulge in his breast pocket. "I could sure use one now," he says. He is debating whether to sneak outside for one last smoke when the door to the treatment room swings open. A tall, goateed man in a white lab coat leans into the room.

"Ready?" asks Dr. Roger Palmer.

He is a genius, a braggart; a doctor so outrageous and arrogant that he calls himself "the smartest man I've ever met." He says he will end the world's cigaret addiction and bring the American tobacco industry to its knees-with a "cure" that is as much theater as therapy. He consumes enormous quantities of alcohol, declaring it good for the brain. He says it's OK for him to use cocaine when he's depressed-that he can handle drugs better than the rest of us. He will make his wife cry, to prove to guests that he can.

University colleagues who once worked at his side, and who once thought him capable of winning a Nobel Prize, now call him a tragic figure. At his side now is a team of moneymen who swagger and talk like toughs from a grade-B movie.

To those who say he is in a professional and personal tailspin, he responds: "My only problem is that I'm so smart people don't understand what I'm doing. It's hard to be 50 years ahead of your time."

His SmokeMed is growing. The Commercial Boulevard clinic was so successful that Palmer opened a second in Miami this summer, and put three doctors on staff to administer the shots. Now SmokeMed claims to be seeing as many as 200 new patients a week. A third clinic is planned for West Palm Beach this month, a fourth in Atlanta by Jan. 1. Palmer is talking 500 nationwide within the decade. And even that, he says, is only a beginning.

His 10 per cent share of the profits, he says, will fund a giant research center in Key Biscayne, the biggest in the world, bigger than the Mayo Clinic. He says it will redefine what medicine is, what medical research can be. From it may spring, he says, the cures for mankind's worst diseases.

If all goes well, says Roger Palmer, "I'll have to learn how to say 'thank you, your majesty' in Swedish."

But first, you have to trust him.

Palmer's grand plan relies on the financial success of SmokeMed, and SmokeMed relies on trust.

Palmer admits that the effectiveness of his shots depends in large measure on the patient's believing that they will work. So he doesn't tell you, unless you ask, what he is injecting into your nose for $310.00.

It is a pennyworth of saltwater.

The Theory

The whole idea, explains Palmer, is to fool your brain into thinking you are smoking.

The doctor is behind his desk at the Fort Lauderdale clinic. That's where he spends much of his time these days. He has been stripped of his department chairmanship at the University and, though technically he still has a teaching position there, he has not been invited back this academic year. He has got troubles elsewhere, too: On Nov. 9, he will be brought before the state's medical licensing board to answer charges that he prescribed cocaine and narcotics for others, but used them himself.

He tells you, though, that he isn't worried, that he'll be cleared. And he returns to his favorite subject.

"What happens, when you smoke," says Palmer, "is that endorphins squirt into your brain and make you feel good. Endorphins are naturally occurring opiate-like proteins that we already know are released when you eat, have sex or jog. They are natural pain killers, which is why you hear stories of people who cut off their arm but don't feel any pain. The accident causes endorphins to be produced in the brain, and that kills the pain."

Is shots, he believes, cause the brain to produce this feelgood chemical.

Lots of things can produce endorphins, Palmer explains. The reaction is a queer one, stimulated by trauma or pleasure. Listening to a Henny Youngman routine will produce endorphins, he says, as will getting hit in the head with a baseball bat. Or seeing a naked woman. Or, says Palmer, the pain of a saltwater shot in the nose.

Palmer says he didn't discover the simplicity of the procedure until recently. In the beginning, his shots contained vitamin B1 and procaine, modeled after ananti-smoking treatment pioneered in the mid-'70s by a Frenchman, Michel Bicheron.

Later, her says, he realized that the ritual of the shot itself-the discomfort involved, the doctor's assurances that it would work-was more significant than what was injected. "I realized the importance of the placebo response," he says. Saltwater would do just fine.

Palmer argues that there is nothing deceptive about all this, and that his treatment is more than just a placebo. Saltwater is a perfect substance to use, he says-it keeps drawing water into the nose cartilage, irritating nerve endings, prolonging the amount of time endorphins are produced. Also , he says, the doctor's demeanor is part of its success. As is the location of the shot. "I like to think of it as a mosaic of effects," he says.

At times, Palmer is blunter. He will lean close, and confide:

"I could inject people with horseshit and they would quit smoking."

Does it work?

The doctor claims a remarkable success rate: 99 percent of his patients reduce their smoking or give it up entirely, he says. Seventy-three to 85 per cent stop smoking for at least a week, past the period of physical addiction. Palmer can produce many satisfied customers. Others have left SmokeMed in frustration, after enduring several sots. (For three months after initial treatment, SmokeMed doesn't charge for followup visits. They'll give you as many "booster" shots as you want.)

Palmer has never published his findings-either his SmokeMed record or proof of a link between smoking and endorphins-for review by th scientific community.

Under the circumstances, the scientific community is skeptical.

"A set of treatments that haven't been presented for peer review are like any other snake oil," says Dr. Avram Goldstein, a medical researcher at Stanford University. Goldstein is a pioneer in endorphin research. He says he has never seen any data indicating a relationship between smoking and endorphin production.

"There are some people who want to stop smoking so badly they are grasping at straws, and a few may benefit from this placebo treatment," says Dr. Norman Wasserman, past president of the Broward County chapter of the American Lung Association. "But as far as I'm concerned, this is merely a way for the physician to make money."

Palmer responds that his profit is "money that would ordinarily go to the American tobacco industry, and I feel very good about that."

"Can't you see what I'm doing?" he asks. "I'm a modern day Robin Hood, stealing from the rich tobacco companies to give to medical research."

As to the effectiveness of his treatment, he says that question will be cleared up soon. He claims he has proven the smoking-endorphin connection, and that he has submitted his findings to Dr. James Murdoch, whom he says is an editor of The Lancet, the prestigious British medical journal. He expects them to be published soon. "We're in the process of rewriting and discussion," he says.

In London, Lancet editors Ian Munro and Patrick Little say they have never heard of Palmer's studies on smoking.

And Dr. James Murdoch?

He says he knows Palmer, but he has no connection with The Lancet. He says Palmer once showed him some data on smoking and endorphins. Murdoch said he found it "interesting," but a bit out of his area of knowledge.

He is an expert in infectious diseases.

The Guys

It is getting near closing time at SmokeMed. Palmer has been drinking from iced tumblers of Jack Daniels for much of the afternoon, but he does not appear intoxicated.

"I'm not an alcoholic," he says with a smile. "But I like to drink. I know how to handle booze. To me, booze is important. Everybody is concerned about exercising their bodies. Well booze exercises the liver, kidneys and brain. It's good for you," the doctor says.

His nurse leans into the room and he dismisses her for the day, a little early. He is in a jaunty mood. The nurse is on her way out the door when three men breeze in.

Two are side by side: Quiana shirts, open at the neck. Gold chains, pinky rings. A short heavyset man wearing a three-piece polyester suit brings up the rear.

"Bruce. Get the books" one says as they sweep through the clinic toward Palmer's office. The fat man goes to the nurse's station and starts going over the day's receipts. Palmer greets the men warmly.

One is named Robert Kaplan. He is well over 6 feet tall, quite, with a heavy Boston accent. The man with him is darker, with a tic in one eye. When he speaks he points a finger and twists a hand as if he is working a screw into the target of his conversation. His name is Daniels Buonocore. They called him Danny.

Someone breaks out a skinny sausage. Palmer digs a pocketknfe out of his drawer and the whisky and meat are passed around. Several minutes later the little man with the company books joins the rest in Palmer's office. He is introduced as Bruce Paquette.

They act like they own the place. They do. These are Roger Palmer's financiers for SmokeMed.

Kaplan and Buonocore explain that they got interested in Palmer and his shots when they were patients of his during an experimental testing period at the University of Miami. The injections helped them quit smoking.

Paquette is their friend. He says he joined the project to benefit mankind.

"I've never done anything before that really helped people," says Paquette, who describes himself as a corporate headhunter, a recruiter of executive talent. "This is the kind of thing that will make my kids proud."

"We're entrepreneurs," Kaplan elaborates. "We saw the potential in this thing. We figured we could make a lot of money."

Palmer explains he had turned down several offers from other businessmen who waned to commercialize his injections. He says he ultimately chose these partners because, once SmokeMed goes national, they only want 20 per cent of his time. He would be free to spend the remainder working on the Key Biscayne research center.

"So we got a pretty impressive thing going here, huh?" Buonocore says, twisting that finger.

A question is put to him: These four men are getting ready to take on the likes of Schick and Smokenders, the big guys in the stop-smoking business. Isn't he afraid the big guys will like their idea and run away with it?

Buonocore nearly chokes on his sausage.

"What big guys is that?" He starts to laugh.

"Hear that, Bobby?" he says, turning the Kaplan. "He wants to know are we worried about the big guys."

Kaplan starts laughing too.

"Hear that, Bruce? He wants to know if we're worried about the big guys."

Then Bruce starts laugh.

"Hear that, Doc? The big guys."

The Doc smiles.

"They think that's pretty funny," he says.

"They may be a little rough around the edges," Palm says later," but their motives are altruistic. They're just a bunch of nice guys."

Meet the guys.

Buonocore, of Pembroke Pines, is part owner of a gay night spot in Miami called the Thirteen Buttons. Before that, he had an interest in Rum Bottoms, a Fort Lauderdale bar. According to court records, in 1976 he was named in a civil lawsuit by a former Rum Bottoms partner, who claimed Buonocore and others had pocketed money from the till, and had jeopardized company finances by dealing with "loan sharks and shylocks." The case was dropped.

Paquette, 36, lives in Palm Beach. He says he is part owner of the corporate recruitment firm of Career Advancement Personnel, Inc.

Kaplan, 39, lives in Coral Sprints. According to court records, he was convicted in 1976 of using a "blue box" to defraud the hone company on long-distance calls. It was charged as a felony but later reduced to a misdemeanor. Kaplan appealed the conviction, but lost.

Palmer says each man has contributed $75,000 toward the start up costs of SmokeMed, and among them they will split 90 per cent of the profits. None has any background in medicine or anti-smoking crusades. Nor does New York City businessman Bennie Villani, who came to two and met with Buonocore, an old friend. Villani was considering investing in SmokeMed. He owns a garbage-compacting company in the Bronx.

All four men decline to provide any further information about themselves.

The Suicide

Palmer is talking about his Key Biscayne research center, the real reason for SmokeMed, the thing SmokeMed is to finance. He is aflame with enthusiasm.

"I don't even know what we're going to do . . . the first year all I'm going to do is invite people from all over the world in a three-day symposium or something like that. I'm talking about the crème de la crème. We'll be talking about anything, about 'What would you do if you had $3 million for research?' Maybe we'll end up doing no research at all. Maybe we'll end up teaching research. There's a whole bunch of very very avant garde ideas that I have . . .

Right now, though, the research center is just a single room without a phone, out behind the Winn Dixie on Key Biscayne. But it already has a name. Palmer calls it the Alma J. Palmer Foundation, after his mother who died in 1957, when he was in medical school. She was, Palmer says, the strongest influence in his life.

She was emotionally disturbed, in and out of institutions during Palmer's childhood in Albany, N.Y.

"When she'd go off the deep end, forget it, you couldn't even talk to her. She'd talk about Jesus and she wrote a novel, which was just the ramblings and rantings of a schizophrenic individual." Once, when he was 6, Palmer watched in horror as hospital technicians doused his mother with cold water from a garden hose, to quell a psychotic episode.

He says she was loving and vulnerable, a free spirit.

"She was always driving a convertible with the top down, with the rumble seat down. I remember as a kid she used to take me around with an ice cream cone in my hand in the rumble seat, ice cream going all over the damn place, melting.

"She was a fragile flower. My father was a very insensitive man. If he had any sensitivity she probably would have been all right . . . "

At 13, Palmer ran away from home-from his father, really-and traveled across Canada. He ended up in St. Louis, where he stayed briefly at Father Dunn's Home for Boys, a shelter for troubled street urchins run by the Jesuits. Though he was eventually thrown out of the home when he was caught drinking beer, he remained close to several of his Jesuit teachers, finished public school and got a B.A. in chemistry from St. Louis University. He was accepted at the University of Florida Medical School. He stayed in touch with his mother by phone.

"When she was lucid, believe me, she was one of the nicest people you'd ever want to talk to. We had all kinds of intellectual discussions when she was well.

"Once she asked me what kind of a poison would be best to kill yourself with. I said, well, probably the easiest way to go would be carbon monoxide-you just fall asleep."

Some months later, she did it. "She went into a neighbor's garage, closed the door and turned the car on and sat there. With all the doors closed."

There is silence. Palmer laughs nervously. "I'm glad I told her."

"Look, this is a bright lady., she would have found something. If she did something like cut her wrists and hurt herself and didn't do the job properly, or hung herself in some improper fashion that caused her pain . . . " He leaves the thought unfinished.

Palmer says his mother's suicide drew him into the study of drugs: She was killed, he became convinced, by bungled medication--treatment with Thorazine, which she had been taking, is now contraindicated in cases of severe depression.

The Freak Shows

It is a Saturday morning. Palmer is in his apartment on the 20h floor of the Brickell Bay Club.

His third wife, Connie, a former stewardess, is in the kitchen, preparing snacks. She is five months pregnant. "I'm the perfect wife," she laughs, as she carries in a serving tray. "You know, Ann Landers once said that a wife should laugh 100 times at her husband's jokes, even if she's heard the joke 100 times. That's me."

Palmer scowls. This is not the image he wants her to project. "She's a very smart lady," he protests. "She's just been processed to act like a dumb blonde."

Later in the day, the doctor still seems obsessed with proving Connie isn't a bubblehead. He is at lunch at the Key Biscayne Yacht Club.

"Watch this," he whispers. "I'll prove to you she can be serious."

"Hey, Connie," he says. "That baby you're carrying is dead."

Connie is aghast. Tears well in her eyes.

Palmer looks delighted.

"See, I told you she could be serious."

Palmer says he and Connie get along fine, with occasional flare-ups. "Freak shows," he calls them. Once, he says, she threw the contents of his briefcase off the 20^th floor balcony. Once, she had him arrested. "Just a little argument," he says.

From the report of the Miami Police Department, May 25, 1981:

"White female, Palmer, Connie, the spouse of the offender, states that her husband became angered because she would not cook dinner for him. White female states that her husband then grabbed a Browning over-and-under shotgun and pointed it at her, stating to her that he was going to blow her head off. He then put the shotgun down and grabbed the victim, knocking her to the floor. He began choking her and punching her in the head . . . "

Connie was taken to the hospital. Palmer was taken to jail, charged with assault and battery, and aggravated assault. Connie ultimately dropped the charges.

Now they both say Palmer never really threatened Connie, that she had exaggerated the incident. "We were drunk," he says.

In the 1960s Palmer became one of the most prominent research pharmacologists in the country. He published nearly 100 studies and won national recognition for his pioneering work in using drug therapy to dissect aneurysms. In 1970 he was appointed chairman of the UM's Department of Pharmacology. Six years later, he was named chairman of the pharmacology section of the National Board of Medical Examiners. That meant he wrote the tests doctors had to pass to become board certified pharmacologists.

It was about that time that Palmer began to change.

He began abandoning primary research-the purely scientific study of how drugs worked-in favor of contract work for drug companies. In the world of academic medicine, this is seen as a lesser pursuit, a form of "selling out." He also began accepting fees to testify at trials as an expert witness on drugs and drug interaction.

He also began suffering repeated bouts of depression. He went through a divorce, his second. He gained a reputation as a two-fisted drinker.

Physician Abram Berens, a former student and a friend of Palmer's said that in his final months at the University, the doctor was a man in trouble.

"I've seen him ataxic," Berens said. "Just unable to walk."

"There's nothing anybody can do to help Roger Palmer except Roger Palmer. As a medical mind, he's still sharp. But he's self-destructive."

Finally, last year, Palmer was relieved of his chairmanship. Members of the UM staff are reluctant to discuss the dismissal in any detail.

"Roger was asked to step down as chairman because, in all candor, he wasn't doing what needed to be done," said Lincoln Potter, acting chairman of Palmer's old department. He's a very erratic man. Professionally speaking, he just seemed to lose his willingness to work."

Ken Lasseter, a former student of Palmer's, now a physician: "I think the most disturbing thing about Roger is that he could function at such an exceedingly high level and now he has fallen to such depths. He once had a better chance than anyone I've ever know to win the Nobel Prize. Functioning now at 5 per cent of his capacity, he's still better than most."

Duncan Haynes, a UM pharmacology professor: "He showed such promise . . . in certain ways he is a tragic figure."

The Painting

Hanging in the entrance hall of his Brickell Avenue apartment is a painting Palmer cherishes:

In the foreground a weary fisherman rides a dory through boiling seas, his gaze locked on a mother ship floating on the distant horizon. It is nearing nightfall, the sky is angry. The success of the fisherman's endeavor is evident: A large silver halibut is draped across his feet. There is a certain ambiguity about this painting, a quarrel in tone between the forbidding skies and the fisherman's lucky catch. Interpreting it is something of a Rorschach test.

It is a nightmarish interpretation that Palmer proffers:

"When the mother ship is ready to move on, the captain rings a bell to signal the dories back. If the fisherman doesn't get back in time, the mother ship leaves him to die. That's what is happening in this picture. The bell has been sounded and the fisherman doesn't know whether he will make it back.."

"It's a terrifying feeling," he says.

All of the talk about a personal collapse, says Roger Palmer with exasperation, is baloney.

He says he left academic life not because he had declined, but because he had risen above it.

"Well, I came to the conclusion that the important things in life were not working as a department chairman or working with cardiac sarcoplasmic reticula. I had other kinds of talents. I was searching for a way to improve the practice of medicine. I don't mean that I'm a con artist, but I have used techniques that I can turn a whole goddam committee room to my point of view. I could see I had the ability to do a lot of good."

Palmer then began testifying around the country, at trials and Congressional hearings. He was devoting less time to his duties at the University. He says the teachers in his department -the ones who are now speaking against him-were hurt, and jealous.

"Remember," he says, "research scientists are like hothouse plants. They need to be watered, fed and touched."

"Believe me, they loved me. It's like a father deserting his children. I outgrew them. I had abilities they didn't have.

"I mean, I was a real big shot. I was testifying before the FDA. I testified before Congress . . . I made a big impact. I was told I made a big impact. I didn't have the time to water the hothouse plants. It made them mad because I couldn't spend the time with them anymore.

"I could have hung in there, I could have been a dean. I could have played the games, and I wouldn't be happy with myself."

Palmer denies he is on any sort of decline.

"You've got to look at this as a growth spurt, an evolution."

The Cocaine

Palmer's evolution has led him to some very unorthodox points of view, in which he exempts himself from rules that other men must follow.

Take the matter of the cocaine, for example:

According to an administrative complaint issued by the department of professional regulation, on four occasions between August and October 1981, Palmer wrote prescriptions for almost four ounces of cocaine and 48 tablets of the narcotic Dilaudid. The prescriptions were for his own use, the complaint says, even though they were made out in the name of Palmer's wife and two other women.

The 27-count complaint alleges that the prescriptions constitute "gross or repeated malpractice or the failure to practice medicine with . . . care, skill and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances." Specifically, Palmer is alleged to have violated a half dozen Florida administrative statutes., including those prohibiting a doctor from prescribing certain drugs for his own use, from prescribing a controlled substance in bad faith, and from making a false representation in the practice of medicine.

Palmer says the allegations are "all false."

"Everything they say in there is all right, except it's the way they put it. It makes it look bad."

Palmer's version of events:

He was looking to do research on whether cocaine might be used to produce an endorphin reaction (he says he learned it cannot), or might be used in the treatment of illnesses. A nurse he knew put him in touch with a pharmacist who said he would supply him with cocaine to use in his experiments, and with Dilaudid, which he was going to use to treat an infection of the foot. The pharmacist told him it was legal to prescribe it for his own use.

He was ill with a fever at the time, and it affected his judgment. He never questioned the pharmacist.

Some of the "cocaine" he received from the druggist wasn't cocaine at all. "It was Cremora or something. He ripped me off."

"All in all, I received probably less than 10 grams. I was trying it out on different people to see if it took care of back pain, menstrual cramps, things like that."

Only for others?

"I used some of it myself. For depression."

Palmer is silent for a moment. He wants to dispel any suspicions.

"Look, I don't look at drugs the way other people do. I don't look at a drug as being a high . . . I am not a junkie. I was sicker than hell. I probably made a mistake of bad judgment at the time."

Though doctors aren't allowed to prescribe drugs for their own use, he said, they all do. "The typical physician, what he does to get pain pills, he prescribes them for his nurse and takes them himself. I'll tell you, 100 per cent of physicians do that."

He said once he had written the first prescription, the pharmacist blackmailed him into writing more, to account for the absence of cocaine that the pharmacist had embezzled. Otherwise, Palmer says, the pharmacist threatened to turn him into the authorities.

"I was sweating . . . " Palmer said. He wrote the additional prescriptions, but got very little cocaine. He thinks he was being framed, theorizing that the pharmacist was in league with a drug company against which Palmer had testified.

"I think I was set up. I know everyone has used that argument, but I tell you, there was an amazing set of circumstances here.

Palmer is trembling with rage. "Freud experimented with cocaine a long time ago, and he was a hero for it. And so I play a few games with it and I'm gonna get chastised by the board of watchacallit.

"I tell you I'm just as smart if not smarter than Freud ever was. All right?"

Meanwhile, Palmer says he has temporarily surrendered his license to prescribe narcotic drugs. If the ruling goes against him on Tuesday, possible sanctions range from a reprimand to loss of his license to practice.

The Phone Call

It is early in the evening. Roger palmer places a phone call to The Miami Herald.

How is the story on SmokeMed going, he wants to know.

Then: "You're supposed to get beat up," Palmer says. "You've offended the wrong people."

He won't say which people.

"You know who. They're going to get you. They told me. I don't want any part of this thing anymore. I got to get the hell out."

He says the threat will be carried out soon.

"It'll be so quick you won't even know what's going on."

The call is reported to the police. The next day, Palmer is apologetic.

"Nobody ever said they were going to beat you up. I made it up, all right? It was just drunken talk."

When you call the SmokeMed clinics these days to ask what they inject into your nose, you are told, "We don't give that information out. It's Dr. Palmer's solution. But we'll tell you it has no drugs in it, no harmful chemicals."

In September, several months after switching from vitamin B1 to saltwater, Dr. Palmer authorizes a change in is newspaper advertisements. Instead of calling the Palmer method a "treatment" for smokers, the ads now call it a "medical maneuver." I anyone notices the change, it doesn't seem to matter. Business is brisk.