Pulitzer Prize-winning “The
emperor of all maladies” by Siddhartha Mukherjee looks at the long drawn battle
between man and cancer over the past 2000 years. The story has several twists
and turns and Siddhartha has written it like a thriller. In this article I want
to focus on two ideas from the book that occurred to a paediatric pathologist Dr.
Sidney Farber. These ideas transformed cancer research from a “who-cares”
situation to a massive innovation sandbox eventually creating modern
chemotherapy technique. Let’s look at each of the ideas in brief.
Antifolates: In 1946 Sidney
Farber was a reputed paediatric pathologist working in his fourteen-by-twenty-foot
laboratory in the basement of Children’s Hospital in Boston. Aged 43, Farber
had been a “doctor of the dead” for close to two decades. However, perhaps
going through a mid-career introspection was itching to work with almost-dead –
the cancer patients. Farber’s first insight was that he could actually perform “experiment”
on cancer by focusing on blood cancer or leukaemia. Because, unlike other forms
of cancer, he could count the change in cancer cells after an intervention.
Unfortunately, Farber’s first trial
towards this direction turned into a horrible error. Based on the work by a British
haematologist Lucy Wills in treating anaemia, Farber injected folic acid into
leukemic children. Instead of slowing down the leukaemia, folic acid
accelerated the process resulting in hastened deaths of the children. Paediatricians
at Children’s Hospital got mad at Farber. Notwithstanding the ire, Farber went
from the error to the next trial. He asked himself, “If folic acid accelerates
the leukaemia, why not try anti-folic acid?” That indeed generated the first
flicker of hope.
In 1947, two year old Robert
Sandler, the first leukaemia patient whom Farber treated with antifolates, showed
improvement for a few months before the cancer relapsed. By summer of 1948, Farber
had treated sixteen patients out of whom ten had responded and five had
remained alive 4 to 6 months after their diagnosis. Farber published his
results on June 3, 1948. Initial reaction was “scepticism, disbelief and
outrage”. However, soon patients started pouring in from near and far. And
Farber was forced to move out of Children’s Hospital to accommodate them.
Jimmy fund
campaign: With more patients and more
drugs Farber’s experimentation capacity increased. However, he realized how awfully
limited it is for the enemy he was battling with. This is when he performed a
totally different kind of experiment in collaboration with Bill Koster of Variety
Club, a children’s welfare organization. Together they launched a Jimmy Fund
campaign by making a patient in the hospital a mascot. In fact, the
campaign was launched on May 22, 1948 through a radio show Truth
of Consequences. The entire Boston
Braves baseball team showed up at Jimmy’s room in the hospital and they
together sang a song. The eight minutes show was ended with a plea, “Let’s make
Jimmy and thousands of boys and girls who are suffering from cancer happy by
aiding research to help find a cure for cancer in children.” Within a month more
than a hundred thousand dollars had poured in.
Siddhartha writes: For any illness to rise to political prominence,
it needed to be marketed. If
Farber’s antifolates were his first discovery in oncology, then this critical
truth (about marketing) was his second. It set off a seismic
transformation in his career that would far outstrip his transformation from a
pathologist to a leukaemia doctor. This second transformation – from a clinician
to an advocate of cancer research – reflected the transformation of cancer
itself.
Together with a high-profile
health activist, Mary Lasker, Farber managed to take cancer research in the US to a
completely different level. Between 1954 and 1964, Cancer Chemotherapy National
Service Center would test 82,700 synthetic chemicals, 115,000 fermentation
products, 17,200 plant derivatives and treat nearly 1 million mice every year
with various chemicals to find an idea drug.
In short, two things helped move a basement lab into an innovation
sandbox: (1) Focused experimentation on solving a tough problem (such as cancer
treatment) (2) Marketing “cancer research” so that many other labs can perform
the experiments too. In some sense, it is like opening up the experimentation
effort.
Photo sources: Book image (flipkart.com), Dr. Sidney Farber (wikipedia.org)