Chapter 13: Getting to Work, Diving into Controversy, and Studies of POMP

Title

Chapter 13: Getting to Work, Diving into Controversy, and Studies of POMP

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Description

In this chapter, Dr. Freireich talks about the difficulties of treating children, getting fired as head of Pediatrics, and being put in charge of Leukemia.

Identifier

FreireicEJ_02_20010730_C13

Publication Date

7-30-2001

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Researcher; Overview; Definitions, Explanations, Translations; Discovery, Creativity and Innovation; Discovery and Success; On Research and Researchers; The Professional at Work; MD Anderson Culture; Working Environment; Growth and/or Change; Leadership; Obstacles, Challenges; Institutional Politics; Controversy; Critical Perspectives on MD Anderson; MD Anderson History; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; Patients, Treatment, Survivors

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Chapter 13: Getting to Work, Diving into Controversy, and Studies of POMPA: The Researcher;

CodesA: The Researcher; A: Overview; A: Definitions, Explanations, Translations; C: Discovery, Creativity and Innovation; C: Discovery and Success; D: On Research and Researchers; C: Professional Practice; C: The Professional at Work; B: MD Anderson Culture; B: Working Environment; B: Growth and/or Change; C: Leadership; D: On Leadership; B: Obstacles, Challenges; B: Institutional Politics; B: Controversy; B: Critical Perspectives on MD Anderson; B: MD Anderson History; B: MD Anderson Snapshot; D: Understanding Cancer, the History of Science, Cancer Research; D: The History of Health Care, Patient Care; D: Technology and R&D; C: Patients; C: Patients, Treatment, Survivors;

Emil J Freireich, MD

I started making rounds on Pediatrics, and the first day I went around, I said, "I have just claimed that we can cure leukemia with this VAMP." Dr. Sullivan said, "Dr. Freireich, we don't give our children vincristine. It's too toxic." Dr. Sutow said, "Anything you say, Margaret." Dr. Taylor just did compassion. Pat Sullivan ran Pediatrics with an iron hand. Grant Taylor worked for Pat Sullivan, and Sullivan ran the show. I said, "I'll tell you what we'll do. We're going to recruit Myron Karon, who worked for us at the Cancer Institute." He was on sabbatical in France. Karon agreed to come, and he brought with him 2 PhD's that he met in France. One was Grady Saunders, who is still here, and the other one is his wife, Priscilla, who is now retired. So Karon came with these 2, and they set up Applied Molecular Biology.

They trained with Manod, who was the first guy to work out all the genetic code. They were into molecular biology, and we knew that was the future. So we had a section in DT, Applied Molecular Biology. Karon is a pediatrician. I was getting along with Pat. We were bumpy, but we didn't have any major collisions.

Lesley Brunet, MA

Did she do a research program on vincristine?

Emil J Freireich, MD

Sure. She became famous for vincristine.

Lesley Brunet, MA

Did you have to convince her to do that?

Emil J Freireich, MD

More than convince. Dr. Karon arrived, and I said, "Look, here's Pediatrics. Grant Taylor's the boss. Pat Sullivan is a bit of a pain, but let's get going." Karon started making rounds. Now, Karon was not diplomatic like me. He had done a study at the Cancer Institute on how children react to fatal illness. He did this study with a psychologist. He interviewed children and parents, and then looked at how they fared, and he proved for the first time that children have to be treated like adults. They have to know about their disease, and the parents have to be treated like parents. He came in, and he found this pediatric service. When we made rounds, you'd see parents sitting in the room with their children who were bleeding, infected, and vomiting. They lived with their children in these rooms. They had a bed for the parents. Dr. Karon came to me, and he said, "This is intolerable. We're torturing the parents. What happens when a child is sick is you say, 'Okay. He comes to the hospital. Now the doctors are in charge. You go home and rest. We'll take care of the baby. We take care of the vomiting and the bleeding and the dying, and you cry, but you don't have to sit in the room while they're being tortured. You don't have to hold their hands while you're doing a bone marrow and all that.'" Dr. Sullivan said, "We cannot change the way we run the service." So after about 2 months, we received a memo from Dr. Taylor. "Dr. Karon can no longer see children on Pediatrics."

Lesley Brunet, MA

That was a big deal for parents to be able to stay with their children. Until you said that, I thought it was something favorable.

Emil J Freireich, MD

It's horrible. It's torture for the children. Children don't like to suffer when their parents are there. It's horrible for the parents. It's horrible for the staff. You can't do anything. You can't treat the children when the parents are there. Who's in charge? You tell a kid who's 2 years old, "You have to get your blood drawn." Who's supposed to protect him from pain? His parents are, so he doesn't know what to do. Parents are supposed to protect him, and they're standing there and want to torture him. The doctor's got a white coat. He's supposed to do that. When the kids are treated properly, the parents should not be there. Now the child understands. "Parents are not here to protect me. Doctor is here to help me. If it hurts, it's his responsibility." It's clear. That's the only way to take care of children, and it's proven quantitatively, by interviews, by cooperation, by how long they live, and how well the treatment goes.

Lesley Brunet, MA

I'll bet that was a real battle.

Emil J Freireich, MD

Karon was fired.

Lesley Brunet, MA

He was completely fired or fired from Pediatrics?

Emil J Freireich, MD

He was fired from Pediatrics. Well, he's a pediatrician. What's he going to do? He took care of adults with leukemia for a while. Of course, he immediately started looking for a job, and he went to UCLA, where he was head of Pediatrics at Children's Hospital and was an enormous success. He died tragically at the age of 35 of a stroke, shortly thereafter. When Karon was fired, I was fired. We had a confrontation with Dr. Clark. Dr. Taylor said, "We love Dr. Freireich, and we want his advice. But he can't be in charge of taking care of the children, because he's not certified in pediatrics." So I wrote to the board, and I said, "I have cured childhood leukemia. I have run the best leukemia pediatric service in the world for 10 years. I think I should be certified as a pediatrician." They wrote back, "You can be certified if you take a 2-year residency." Dr. Clark said, "Well, Freireich, you can make rounds and give advice, but you're not in charge of Pediatrics anymore." Pediatrics was taken out of DT. So we have no hospital, no medical school, no children, no Pediatrics, no nothing. Things are not going well. Let's work on adults. We went over to the Shamrock and drank with Cliff Howe and Shullenberger one night. We went to their house, and we went to their office. I had no referrals; none, zero. So I went to Dr. Howe, and I said, "Dr. Howe, I had discovered this treatment at the Cancer Institute called POMP. It's an adaptation of the VAMP study. We had 60 percent responses in adults with acute leukemia. Nobody in the world has done that. I've written a paper. I need to have referrals. When a doctor calls with a patient with acute leukemia, you have to refer them to me." "No problem."

Lesley Brunet, MA

Dr. Howe said this?

Emil J Freireich, MD

Yes. I went back in the medical record room with Eleanor MacDonald, and in the previous 10 years, they had had 100 patients with leukemia referred here, 10 a year. I'd been here 2 months and didn't get any. I didn't think anything of that. Maybe that's all they get. Nobody knows I'm here. I'm famous. I've written papers. I've got prizes. I can treat leukemia. Finally, I got my first patient. [redacted] He went to the literature, he discovered Freireich, and he found out he was here. He walked into my office and said, "I have leukemia. I want you to be my doctor." My first patient was self-referred. I had a patient. I think his name was [redacted] or something like that. I had this new treatment, informed consent, POMP. This is a disease that is 100 percent fatal; median survival is 6 to 8 weeks. It had 99 percent mortality in 11 months. We're going to try something new. Good idea. Okay, now I've got a patient. What's next? Well, I have to have platelets. Where am I going to get that? There's no blood bank. There are no platelets. Dr. Shullenberger ran the hematology lab, not Lab Medicine. If you wrote out a slip for a platelet count, Dr. Shullenberger sent back a platelet count, something that didn't make any sense. So I went to his lab, and I talked to the technicians. "How do you do your platelet counts?" Well, they were doing the Dameshek method, which is the method that Dr. Brecher had proved was ineffective in 1954. This is 1965. He's only a decade behind. "You're doing the Dameshek method? That is not acceptable for my patients. We have to use the Brecher-Cronkite method." "Well, we don't know how to do that. We don't have a phase microscope. We don't have any equipment. Sorry." So we wrote a grant, and we got money. We bought a phase microscope, hired a technician, and we did platelet counts in my little lab. Now we knew what the platelet count was. The next problem was we had to get platelets. Where are you going to do that? Well, I discovered this system. I published. I'm getting prizes. We just have to do platelet apheresis, but who's going to do that? No one is going to do it. Dr. Clark gave me a little kitchen that wasn't being used, put in a bed, and we started collecting platelets.

Before we started in 1955, when you treated leukemia, you judged it based on blood alone. I learned to do bone marrow aspiration from Charles P. Emerson, who was the first person in the United States to do bone marrow aspiration, when I was a fellow in Boston. I knew how to do bone marrows. We published a paper that if you have normal blood and still have leukemia in the marrow, your survival is no different than if you didn't have treatment. In order to get prolongation of remission, you had to get a normal bone marrow. So I treated my patient. The blood was okay, but I needed a bone marrow.

Who does the bone marrows? Dr. Shullenberger. How does he do bone marrows? He puts the bone marrow in a hematocrit tube and spins it down and measures the buffy coat. That was unacceptable. The way we do bone marrows is we make a smear, and we get clot section, and we quantitate the cellularity of the bone marrow. Who's going to do that? Not Shullenberger.John Shively was working in Pathology under Dr. Russell, so I went to Dr. Shively and said, "You know, it's wrong for this clinical guy to be doing hematology. We ought to do it in Lab Medicine." So we started Lab Medicine. They learned how to do the Brecher-Cronkite method. They did platelet counts. Anyone in the hospital could order it. They set up a little pheresis area. They began to collect platelets. More importantly, when I did a bone marrow on my patients, I wrote, "Do not send to Dr. Shullenberger's lab. Send to Dr. Shively in Pathology." He gave me a bone marrow report. The nurses hated me.

Now, you can understand that Shullenberger didn't think I was strictly his ally. We were now in '66. We were moving ahead. So Pediatrics hates me, Shullenberger hates me, and Howe hates me. How about Alexanian? He's in my department, right? We had a meeting. Dr. Grant Taylor had founded the Southwest Oncology Cooperative Group. He asked Dr. Frei to be the chair, and Dr. Frei asked me to chair the leukemia group. We had a grant that we competed for, and then we had a meeting with Dr. Taylor. Dr. Alexanian said, "I think I should be the PI on this leukemia grant, not Freireich, because I was here when he came." I said, "That's unacceptable to me. It's either me or nothing." So I became head of the leukemia thing, and Alexanian also hated me.

Chapter 13: Getting to Work, Diving into Controversy, and Studies of POMP

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