Chapter 27: The Development of the ALZA Infusion Pump
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Description
In this chapter, Dr. Freireich talks about the development of the ALZA infusion pump.
Identifier
FreireicEJ_04_20010813_C27
Publication Date
8-13-2001
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Emil J Freireich, MD, August 13, 2001, Oral History Interview
Topics Covered
The Researcher; Overview; Definitions, Explanations, Translations; The Professional at Work; Patients, Treatment, Survivors; Ethics; Cancer and Disease; Discovery and Success; MD Anderson History; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; On Texas and Texans; Personal Background
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Lesley Brunet, MA
Let's talk a little more about the infusion pump. I saw some correspondence about ALZA.
Emil J Freireich, MD
Yes. It's a wonderful story. Everybody who gets outpatient chemotherapy now uses the ALZA pump. ALZA stands for Alex Zaffaroni. Alex Zaffaroni was an entrepreneur who discovered some kind of a steroid cream that was good for the skin, and it made a lot of money. So he got this money, and he was one of those guys who didn't like doing nothing. He decided he wanted to do something good for medicine, so he founded a company, and it was named after him. I'm not sure what his overall mission was, but one of the goals of the company was to develop devices for pharmacology. Alex Zaffaroni was a pharmacologist. He said, "Look, if we have medicines like insulin and hormones and things, we don't want this kind of stuff. We ought to have a device that could deliver pharmaceuticals on a continuous basis." So he started this company, and he hired a young engineer, Dick Buckles. Dick Buckles must have been 42 or 43 when he started to work on this problem. If you were going to approach this problem, you'd approach it the way anyone would. You would get some kind of a syringe, you'd develop some kind of a clock motor that would push the syringe, and you'd have an infusion device. It may have been just a year or 2 ago that I threw it out, but I have the first one we did.
Lesley Brunet, MA
The first device?
Emil J Freireich, MD
Yes. I kept it for many years. I keep little trinkets like that, like my written records. The company was based in California. He went around the country. He started working with people. He went to scientific meetings. He knew DT. I had a reputation by that time. I can't recall the year. He appeared in my office with a young lady who was a nurse, who is still a good friend. We wanted to do this thing. We had a fellow who worked on this, and he's the senior author of the paper, Joe Bottino. He's in practice in New York now. But McCredie was the big mover on this project. He said he wanted to test this syringe device for continuous infusion. We had been working on ARA-C pharmacology with Bill Plunkett, and we knew that ARA-C worked best if you maintained the level, because if you did this kind of thing, it wasn't as effective. So we were very interested. So we said, "Okay. This is fine. But the first problem is if we want to give a continuous infusion over 10 days, how do you get access to the vein?" He said he had discovered a company in Dallas, I think, that had made catheters that were plastic and could remain permanently implanted for long periods of time, but they couldn't find anyone to study it. Would we do it? Absolutely. This company came out with these catheters, and we began to study them. Initially they were long lines that were put in the antecubital vein and threaded up, and then you took an x-ray. We still do it. The material in the catheters has improved, and the size of the catheters has improved. A lot has improved. The early, primitive ones had lots of problems. We worked with these catheters and then with IVs. Then we learned how to do subclavians. So the catheters seemed to be working reasonably well. They were clotting, and we had some problems. Now we had to evaluate his pump. So we started with these little pumps. You used to strap them on your arm. I even have a picture of me holding one of these on my arm. You strapped it on your arm, and you wore it under your suit coat, and you had a continuous infusion. Finally, Buckles discovered a guy who had the most brilliant idea. That was the balloon, and that's what we use today. Instead of a mechanical device, what we're going to do is we're going to put in a piece of plastic, a balloon, and we're going to load the balloon with kinetic energy. So you have no energy source. It doesn't require a motor or an engine. It has no heat sensitivity. Everything works. That was the first ALZA pump, which was commercially done. Then it was bought by Abbott Laboratories, and now everybody uses one. You load the pump by blowing up the balloon. Then you hook it up, and the balloon collapses and shoots the stuff in. You get a new balloon every day, and that's how we treat our outpatients with their catheters.Tragically, before the project ended, Dick Buckles developed lymphoma and died. We treated him for lymphoma. He had an excellent response, but it was short-lived, and he died; he transformed. He was a young guy. He was only 45.
Lesley Brunet, MA
What did you do then?
Emil J Freireich, MD
By then it was commercial. You'd just buy them. We did it all in DT. The nurses hated us, but eventually they realized they had to do it, and everybody did it.
Lesley Brunet, MA
They hated you because it was creating more work or changing the system?
Emil J Freireich, MD
It's hard for people to learn new things.
Lesley Brunet, MA
Was there ever opposition to development of the whole device and program?
Emil J Freireich, MD
Not really. People are always concerned about innovation. There's always the potential for harm. Catheters are going to clot. You get a pulmonary embolism. These people are going to die. You have to flush them with heparin. Sometimes they get occluded. Sometimes they come out and go up here, and they get strokes. So there's always resistance to innovation.
Lesley Brunet, MA
But this was a big innovation in terms of the outpatient.
Emil J Freireich, MD
It was terrific innovation. It revolutionized care in the country.
Lesley Brunet, MA
Didn't outpatient care really boom here?
Emil J Freireich, MD
It boomed all over the country. It was Dick Buckles. All we did was the clinical stuff. The gal who worked for ALZA is still doing this as a career. Her name is Suzanne Herbst. She's the president of the Association for Vascular Access. She recently visited me. Her father developed leukemia, and I helped treat him. He did very well for about 10 years, and then he died of a stroke. So the world is full of challenges.
Lesley Brunet, MA
Does it seem like a lot of people associated with MD Anderson also get cancer? Is that just an external kind of view?
Emil J Freireich, MD
You have to think of it in probabilities. Cancer is the leading cause of death over the age of 60. So since lifespan is getting longer, the probability that we'll all die of cancer goes up every year.
Lesley Brunet, MA
That's a little frightening.
Emil J Freireich, MD
Well, I always look at the full and empty part. It's really gratifying that we live long enough to get cancer. We used to all die of cardiovascular disease. There's a 30 percent reduction in cardiovascular mortality every 10 years. Look at me. In '87, I was dead. This is '01, fourteen years later.
Lesley Brunet, MA
That's pretty good.
Emil J Freireich, MD
I've had open-heart surgery and a bypass and a fake vessel. It's amazing what they can do.
Lesley Brunet, MA
I think you came from hearty stock.
Emil J Freireich, MD
My mother lived a long time, but my father didn't live very long. My wife is hearty.
Lesley Brunet, MA
She keeps you going?
Emil J Freireich, MD
Oh, she's hearty. She is a tough thing. She keeps me going.
Lesley Brunet, MA
That's good.
Emil J Freireich, MD
Yes, I'm very lucky to have her.
Lesley Brunet, MA
That's always nice to hear.
Emil J Freireich, MD
Yes. I'm square. That's the thing. I have no vices. I have no hobbies. I don't play bridge.
Lesley Brunet, MA
You have no hobbies at all?
Emil J Freireich, MD
No hobbies at all.
Lesley Brunet, MA
Well, you can't retire.
Emil J Freireich, MD
I tried. I've been on vacation for 3 days, and when I went to work today Deanie said, "See? You can't even stay home for 3 days." No, I can't retire. Well, I could retire, but it would be difficult for me.
Lesley Brunet, MA
No hobbies? No golf?
Emil J Freireich, MD
No golf, no nothing. No tennis. No jogging.
Lesley Brunet, MA
Your wife wants you to keep going to work, too, I bet.
Emil J Freireich, MD
Yes, she loves me out of the house. She gets sick and tired of me. She runs the house, and I run my office. I'm totally square. As I told you, I always follow the rules. I never cheat. I never steal. I'm just one of those unusual people that don't know what to do.
Recommended Citation
Freireich, Emil J. MD and Brunet, Lesley W., "Chapter 27: The Development of the ALZA Infusion Pump" (2001). Interview Chapters. 175.
https://openworks.mdanderson.org/mchv_interviewchapters/175
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