Chapter 04: Oncology Research at a New Hospital at the National Institutes of Health
In this chapter, Dr. Freireich talks about being drafted into the Army, why he thinks that World War II was won by the defeat of malaria, going to work at the National Institutes of Health, and dedicating himself to curing leukemia. “You could either go to Bethesda and take care of leukemia patients,” he was told, “or you could serve in the military and go get blown up in Korea. So what the heck? Cure leukemia—that’s what I’ll do.”
The University of Texas MD Anderson Cancer Center
Professional Path; The Researcher; Military Experience; Professional Path; Evolution of Career; Personal Background; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care
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History of Science, Technology, and Medicine | Oncology | Oral History
Emil J Freireich, MD
In 1954 the United States Congress, passed a law that the doctor draft was illegal. A number of physicians who had been drafted out of their careers went to the courts, and the Supreme Court ruled that the doctor draft was illegal because you were conscripting a person against his will, based on his profession, and that's a bias that could not exist, even though the military had no way to get doctors. But that resulted in them creating the military medical school in Washington, DC, so that the military could train its own doctors rather than draft doctors.
At the time that bill was passed, the military had no doctors, so in order to continue their military medical services, they drafted every physician who was eligible to be drafted but had not served, and I was one. I was deferred because of the Atomic Energy Commission thing that Dr. Ross had. Unbeknownst to me, when the doctor draft began in '53, Dr. Ross wrote a letter saying I'm essential to the war effort because I was working on radioisotopes, so I was drafted. I became a second lieutenant in the army. The military drafted everybody, but they didn't need everybody. You got commissioned, but you didn't have any orders. In other words, they had a pool of several thousand, and when they had a vacancy they called. So I accepted my commission, but I didn't have a report date. I got a call from Dr. Chester Scott Keefer, who was the dean of our medical school, Mass Memorial Hospital, Boston University School of Medicine. In those days, we were very respectful of our seniors, and Dr. Keefer was so brilliant, it was unbelievable. He was smarter than Howard Armstrong. He was someone everybody admired. He was a man of high quality, high character, and enormous intelligence, and he was hardworking. He taught the students every day. But he was very demanding of discipline. When the house staff presented a case to Dr. Keefer, you had to have your shoes shined. You had to have a clean uniform on. You had to have a tie. You had to have your hair fixed properly. The nurses were all meticulous. The beds were all made. The patients were ready. "Dr. Keefer's coming." It was like the Pope.
Dr. Keefer called me to his office. Now, not many people got in to see Dr. Keefer. It's like going to see the Pope. You don't get a hearing with the Pope very often. I walked into his office, trembling. "Dr. Freireich, Dr. Ross tells me you're doing a very good job." "Thank you, sir." "Have you ever heard of a place called the National Institutes of Health?" "No, sir." "Well, let me tell you. There's this place in Washington. The government has decided that they want to put a hospital in the middle of the National Institutes of Health." During the Eisenhower administration, Eisenhower created the Department of Health, Education, and Welfare. He merged Education, Welfare and Health into a single department, and the first secretary of that department was Oveta Culp Hobby. Oveta Culp Hobby was a publisher, and she knew that she didn't know anything about health, so she created a new position called the Undersecretary for Health, which still exists today. The surgeon general currently holds that post. The first person appointed to that was Chester Scott Keefer, but he accepted the job on the condition he not give up his deaning. He spent 3 days in Washington with the bureaucrats, and then he came home over the weekend and spent 2 days in Boston with his medical school. He had a hot phone, and he worked both jobs simultaneously. His job was to staff the Clinical Center in the National Institutes of Health. It opened in the fall of 1954, and they had a handful of doctors they recruited from Public Health Service units. None of them had done research, just 1 or 2. They had to staff it somehow. Keefer got the idea of finding young people who had been drafted, and sticking them out there to see if they could do anything.
"No, sir, I haven't heard of it." He said, "Well, they have this new hospital there, and there's a big opportunity for people who have talent, like you. So what I want you to do is go up there." He made a telephone call. "Fred? I have a young man in my office named Freireich. He'll be there tomorrow morning." Then he told me, "What I want you to do, Freireich, is I want you to go to Washington tomorrow and see Fred. And here's how you get to Fred in this office, and he'll take care of the rest." "Yes, sir." You wouldn't have an argument with Dr. Keefer.
I left there, and I called my wife and said, "Deanie, I have to go to Washington." We had our first daughter, Debra Ann Freireich. We had her 14 months after we got married. She was not planned. We were poor. My wife worked at Mass General for $3,000, so we had $6,000 a year. We lived in a fourth-floor walkup. My son David Alan Freireich was born 14 months after my first baby. So she was pregnant at the time. She lived in this place, and they didn't turn on the heat. She had to walk up 4 stories, pregnant, to do the laundry, and carry the baby. We struggled. She struggled more than I did, but she said, "Okay." So I got on a bus, went to Washington, and took the streetcar to this place. The guy says, "Go to NIH. It's here. You go there and walk around and talk to people."
I met a guy named Gordon Zubrod. Gordon Zubrod was a Johns Hopkins alumnus. The NIH director at the time was a guy named James Shannon, who was an MD who worked in the malaria program. The malaria program was really revolutionary for medicine, because, as you know, more military died of malaria during the war than of gunshot wounds. We would have lost to the Japanese if we didn't conquer malaria. What won the war was beating malaria, and the way they did it was a crash program, like the atomic bomb program. There are a lot of skeptics who don't believe that you can cure things with money, but the fact is you can.
They had a crash program on malaria. They had to work out something that had never been done before. They had to get the organism. They had to work out a model system. They had to get a screening system. They had to synthesize chemicals. They had to do a clinical trial on people. All this technology of research in medicine was worked out during the war, something that didn't exist before the war. Then they opened the Clinical Center out in Bethesda, in the middle of nowhere. It was really the middle of nowhere. This is in 1954. Now, in 1954, this is 12 miles away from Washington. It was still totally segregated. They had black fountains, white fountains, no department stores, and no apartment buildings. It was a burg, believe me. Bethesda was in Maryland, in the country. It was just trees and grass. The nearest thing was the Naval Medical Center across the street, and it was a military operation. As far as a hospital, you were 40 minutes from any hospital where there were any medical people. Medical schools were downtown Washington and Baltimore: Hopkins, University of Maryland, George Washington University, and Georgetown University.
The idea was to create a place which was not an academic medical center. You're not teaching. You're not doing service work. You're just going to do research, like you do in your laboratory. It's a hospital. You've got beds, laboratories, and you cure disease. Keefer thought that was a good idea.
Gordon Zubrod was in the malaria program with James Shannon. After the war, Gordon Zubrod accepted a job at St. Louis University, which is a Catholic school. In the postwar boom, when all the medical schools realized that all these veterans were coming back and the schools were booming, they recruited a guy named Phil Tumulty from Johns Hopkins, and he recruited Gordon Zubrod. They began to do real science and clinical trials. The first formal clinical trial was published in 1948. Remember now, this is '54. They were busy just using antibiotics. Dr. Keefer was famous because he ran the penicillin program. During the war, penicillin, sulfonamides, streptomycin—it was a dynamic area for the treatment of disease, and science was coming into medicine. They were very academic, and they went into this medical school. If you're going to be innovative, you create antibodies, so they created a lot of antibodies, and Dr. Tumulty got fired. Like Dr. Armstrong, Dr. Zubrod was there, and Tumulty was gone. He had to look for a job, so he found this opportunity at the Cancer Institute. There was Dr. Zubrod. He was head of the medicine branch. The Cancer Institute had surgery, medicine, and radiotherapy. They didn't know what to do, any of them. It was a bunch of empty beds and empty labs in an empty hospital.
The NIH consisted of the Public Health laboratories, which were where all the basic science laboratories run by the government were, and it was all started by an epidemiologist. They began by discovering that the cause of pellagra was the food and discovering that infectious diseases were polluting the water. It was a Public Health Service organization, and there were a lot of basic scientists working on mice and screening and things like that. Then all of a sudden, they put a hospital in there. Now you're going to have doctors and patients. That was a new idea. It opened in '54, and Zubrod was the head of the medicine branch. I walked into his office, and he says, "What do you do?" I said, "I'm a hematologist. I have spent 2 years with the great Dr. Ross in Boston. I'm an expert."
Zubrod was a wonderful, wonderful person. He's dead now. Everybody adored him. He was one of these extremely nice people, and he was very smart and very motivated. He said, "You know, I took this job because I think that what we learned in curing malaria can apply to curing cancer. I think we can develop model systems of cancer in experimental animals. We can get large numbers of chemicals and screen them against these model systems. If they work, we can do clinical trials in man and find out if we can cure cancer. I think we can."
This was in 1954. At that time, the only treatment for cancer was surgery. When Dr. Gilbert Fletcher came here, the surgeons thought radiotherapy was a joke, but by that time radiotherapy was doing a little. Fletcher would claim they could cure a few cancers, but as far as metastatic cancer, forget it. That was hospice stuff. In fact, in medical school you weren't even taught anything about cancer. Zubrod said, "I think we can cure cancer. You're a hematologist? Cure leukemia."
Lesley Brunet, MA
That's what he actually said?
Emil J Freireich, MD
That's what he said. "Your job. Cure leukemia."
Lesley Brunet, MA
So that's what you did.
Emil J Freireich, MD
He told me what to do, and I said, "Yes, sir." You could either go to Bethesda and take care of leukemia patients or you could serve in the military and go get blown up in Korea. So what the heck? Cure leukemia—that's what I'll do. Then I went back to Boston on the bus. Forty-eight hours later, I received orders to report for active duty at NCI.
Even though I had a commission in the army, I didn't have orders to report for duty, so I still had an interval where I could accept a commission in the Public Health Service. They raced my commission through in 48 hours, FBI check and everything, and I had orders. Forty-eight hours after I went to Bethesda, I had orders to report for active duty. Then the Public Health Service sends a copy of my orders to the army, and that eliminates my army commission because the army can't give you orders if you're already serving on active duty in a military service. During the Second World War, the Public Health Service was a military service. It was part of the navy. We went in at the rank of second lieutenant. I was a Public Health Service officer, and I had orders. Forty-eight hours after I came home and told my wife about the interview, I had orders.
Lesley Brunet, MA
What did your wife think?
Emil J Freireich, MD
I had 4 days from the time I went to Bethesda until I had to go to Washington. It was total hysteria. The next 2 days we didn't sleep. First of all, I had to get all my notebooks together. I had to finish my research. I had these 2 great things I had to publish that were in the mill. I had to finish the experiments that I had done. We had to get all of our possessions together, and we didn't have any money. I got my terminal check from my $3,000 thing. I had to resign. I went through all these shenanigans. In 48 hours, we had everything we owned in my 1946 Oldsmobile, including my 5-months-pregnant wife and my 19-month-old daughter. We had everything piled in, and we drove to Washington. I had been to the NIH, so I had a notion as to how to go. We had a map, and we found Bethesda. Then we found the navy and the NIH building. This was cold turkey, with no money, no nothing. I said, "That's the building where I saw Dr. Zubrod." I pulled up there, and the guy said, "You can't park there." I said, "Well, I've got to report for active duty." He said, "You can park there." I took the elevator to Dr. Zubrod. "Reporting for active duty, sir." "Welcome aboard, Freireich. We'll get right to it. We've got an office for you, and you can start working today. Your office is on the twelfth floor." He was on the tenth floor. "You go up 2 floors. You walk down the corridor." "Yes, sir." He said, "Have you got a place to stay?" I said, "No. I was just here 2 days ago." He said, "Well, take your time. Go find a place to stay. Relax and come to work tomorrow. Take the rest of the day off." "Yes, sir." I'm really frightened. I'm just a kid. I was only 28 years old. I went up to see my office. I'm walking down the corridor, and I'm looking at the names on the doors. I come to a door, and it says "Emil Frei III." That's just like the government. They can't even spell my damn name. I walk in the door, and there's this skinny guy with no hair. I said, "Sir, you're in my office." He said, "No, no, no. What's your name?" "Freireich." "No, no. I'm Emil Frei. Your office is next door." That's how I met Tom Frei, and he was the biggest factor in my career from that day forward. That was 1955, sometime in February.
Frei said, "Well, look. You haven't got a place to stay. You go down here." He'd just arrived. He came from St. Louis with Zubrod, and he had arrived in the fall, so maybe 3 or 4 months before I did. He already had a place to live, a house that he rented, and he had a family. He had 5 children and a wife. He was about 3 years older than I am.
He said, "You go to this office, and they have a list. You find a place, and you can rent a place for a couple of days, and then you can look for a house you can rent." He said, "Why don't you come over to our house for dinner?" I said, "Great." So that was that. I went downstairs, and there's my wife in the car with the crying baby. I said, "I've got an address. We can find a place here. We go here."We found a place. It was a lady who had a basement that had been modified, and you had to walk down underground. We had this basement apartment with windows. We rented that for whatever money we had. It was furnished. I went to the Freis' house for dinner and went to work. That was NIH. Soon after that, we rented a house from a Foreign Service guy who was on assignment, and he gave it to us at a very low rate. Our salary was $5,600. We'd been making $6,000, so we were still in trouble, but we had several advantages. We had the PX. Everything was kind of cheap in Maryland. It wasn't like downtown Boston. We were out in the middle of nowhere, and the rent was low, so we made it.
Freireich, Emil J. M.D. and Brunet, Lesley W., "Chapter 04: Oncology Research at a New Hospital at the National Institutes of Health" (2001). Interview Chapters. 152.