Chapter 02: Dr. Emil J Freireich and the Early Years in Departmental Therapeutics

Title

Chapter 02: Dr. Emil J Freireich and the Early Years in Departmental Therapeutics

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Identifier

GuttermanJ_01_20041201_RD_C02

Publication Date

12-1-2004

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; MD Anderson Past; Building/Transforming the Institution; Portraits; Research; Cancer and Disease; Patients; Patients, Treatment Survivors

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

Jordan Gutterman, MD

So, among the Freireich group, I mean, there was Freireich himself, and I think Frei, who I think -- but the impact, but most of their real impact, really in the sense, occurred before they came to MD Anderson. You know, the work of the NCI. I mean, it went on and on and on again back to details, but the principles. The [white's lead?], the plate, the transfusions, to stop the hemorrhaging. The intensive chemotherapy, none overlapping toxicities by different mechanisms using combination chemotherapy, really came out of Freireich's brain primarily. And working -- but there, Frei, with the relationship they had with Howard Skipper...

James S. Olson PhD

And this is the Southern...

Jordan Gutterman, MD

At the Southern Research Institute in Birmingham, and to some extent, Frank Schabel, played a key role. So there, Frei, I think -- and again, I don't know that history because I wasn't there at the NCI. So the real seminal advances, I always kind of look at this. Where were the seminal advances? They were made in the late '50s, really, in the late '50s and early '60s at the National Cancer Institute. And but, then they came here and established this really creative department. And for me personally, that was the fertile environment. It was Freireich's boldness and creativity, and some very specific things he would say to me after a meeting, having an insight, really, what turned me around. Because I had such incredible respect for his intellect. We'll come back to those specifics. So I think Freireich's impact, even on interferon in ways –

I've actually published this on the anniversary -- on his 70th birthday in 197 -- in 1997, he was born in '27. There was -- Michael [Keening?] organized a thing, and it was published in Clinical Cancer Research, the proceedings. And I tell the story in a very brief article about a meeting we had, our weekly meeting, small conference room, still there. We don't have those types of dialogues anymore. And he said Gutterman, have you noticed the patients responding to interferon, and we're getting ahead of this story. There's some common characteristic. And I said, you mean the slowly growing tumors, not the highly malignant ones. He said yeah. Why don't you -- how come you're not treating chronic myeloid leukemia and hairy cell leukemia? And I said, I'm trying, I'm trying, but I need help. And so he really helped me, twisting some people's arms. I just didn't have the time, but his insight into it really got me saying I really got to move on it. And so his impact, but we don't have that much anymore. Everything is so regimented. And we'll come back to those stories too. How clinical cancer research is done. Everything is so controlled by the pharmaceutical industry, everybody's so legalistically minded. So we don't have that freewheeling environment anymore. But we'll come back to that. I want to come back to some of these ideas. The environment that Freireich himself -- not Frei, but Freireich created, in that developmental therapeutics, where I prosper personally and benefited. And it's the reason I came here and the reason I stayed here. And it really kind of set up for what I'm doing now. But I had to arrange my own creative ways of doing things. So, they stand out. Obviously within the institute, I mean Clark, as you say, Bertner and Clark and, to some extent, LeMaistre, because of their -- I mean, LeMaistre because he was the president. Obviously are critical people.

James S. Olson PhD

How about Gehan?

Jordan Gutterman, MD

Well, he was -- Freireich was very adept at getting people to work with him who filled -- had skills. That, you know, specific skills. And biostatistics was one of those skills. Have you met Gehan?

James S. Olson PhD

We have.

Jordan Gutterman, MD

Yeah. Wonderful guy. Not very dynamic, but nice with a story of two statisticians that meet on the street. And one of them says to the other, "How is your wife?" And the other one says, "Compared to whom?"

And (laughter) -- just there's not a lot of passion there. But -- (laughter) -- just like, "she's fine," you know. Do you have to start comparing her? So, I don't know. When I hear about statisticians, it's kind of -- it's hard, you know. But Gehan was very important -- but again, I -- Gehan came, I guess, from NCI, so --

James S. Olson PhD

He did, yeah.

Jordan Gutterman, MD

-- so...

Lesley W. Brunet

Ti Li Loo.

Jordan Gutterman, MD

Yeah, Ti Li Loo, pharmacology. But he surrounded himself with these people. Bodey, with the infectious diseases, which was very critical. But, you know, Bodey was just kind of a hard-nose, very meticulous clinician who really focused on one thing, which was the way he got these people through infections with antibiotics. So he did some very important work. It's kind of not -- if you look back today, it's not molecular, but it's really good, solid, clinical stuff. Establishing principles of when do you give antibiotics? You got to give them one of those -- when that fever goes up, even if the -- and the counts are going down, because if you get behind an infection with a leukemic patient, it's too late. So, you know, there's that group of people that Freireich brought with him. So, I mean, they all played a role, no question, and they all became -- Bodey became a leader in infectious diseases with cancer patients, probably the leading person in the country. Gehan, a critical person in biostatistics, along with a few others. Loo was hard for me to really -- to judge exactly what contribution he gave. Who else? I got to think about this a little.

James S. Olson PhD

Yeah, that's fine. That's fine.

Jordan Gutterman, MD

Yeah. I'll think about it. There's others I'm forgetting, I just have to think about who would be the major players on a local or national or international scale.

Lesley W. Brunet

Yeah, just of people I've interviewed. Van Eys, you know Van Eys, I don't know how much you've worked with him. The whole thing with the whole child...

Jordan Gutterman, MD

The what?

Lesley W. Brunet

The cure, truly cured child, the whole...

James S. Olson PhD

Yeah. He had such a hard time with therapeutics, it seemed to me.

Jordan Gutterman, MD

Who?

Lesley W. Brunet

Well, it wasn't...

James S. Olson PhD

Van Eys was -- you know, I've seen some of the reports of people coming back through pediatric departments in the '80s, outside observers, and kind of saying well it's a very caring, loving department, but there wasn't a lot of advancement in the therapeutic side of it.

Jordan Gutterman, MD

There was none. There's all this tension between our department, which was right around the corner from pediatrics, and you know, Freireich's big advance occurred, Freireich and Frei, in children, with kids with ALL. And again, it was all kind of filling in the blanks, there was not a lot of passion, and so forth. So, I -- my memory -- of course I knew all these people and watched it, but there was no innovation. None. I mean, minimal. Still in pediatrics.

James S. Olson PhD

Sutow?

Jordan Gutterman, MD

Um...

Lesley W. Brunet

(inaudible)

Jordan Gutterman, MD

Yeah, he was getting near retirement. Sarcomas, right? Sutow, he did sarcoma work?

James S. Olson PhD

Did some Hodgkin's, too.

Jordan Gutterman, MD

You know, but you see the principles of Hodgkin's came out of the NCI again, because -- and there, that's an interesting story. It's not an Anderson story, but that was really -- Frei really played a more important role there than -- well, with Freireich. But the idea of combination chemotherapy for childhood leukemia started the whole thing in the late '50s and '60s. And that's where the MOPP regimen and DeVita was a fellow, so to speak, on the wards, and just was the chief investigator. But he really milked that and became famous with it, but it really was not his design. But he took an enormous amount of credit for it. Shared a Lasker Prize. But again, that's not an Anderson story. So a lot of that stuff by all these guys was going on when I got here in '71. So MOPP was just beginning in a way, you know. Late '60s. But it started in NCI -- it really came out of Frei and Freireich's pioneer -- in my opinion, Carbone and DeVita did -- and they left, so the real fame on MOPP and Hodgkin's and so forth was more centered at the NCI, because these guys had come down here. And they fought with the people who were here, the establishment, to even get combination chemotherapy, you know. A little bit in the GU with Mel Samuels, I mean, he was doing some stuff. But anyway.

Lesley W. Brunet

Let me...

END OF AUDIO FILE 1

Jordan Gutterman, MD

I mean, Bodey I respect tremendously. Again, he did establish -- because I wasn't there in the '60s when -- I mean, he published his most famous paper, I think it was 1966 in the Annals of Internal Medicine. Then when the white count is below 1500 neutrophils, you're starting to get more susceptible to infections. And when your temperature -- he just showed a linear relationship. So the lower the white count, the neutrophil count, the higher the incidence of infections. And when I came here, that's the principles you followed in these people, because when you spike a fever and your white count's 1600, you don't wait for the organism. You have to start. Because if you don't get ahead of the infection, you lose the patient. How much of that was Bodey, how much of that was Freireich driving him at the NCI to ask those questions. But again, it's the ghosting analogy. It's Freireich and Bodey or Freireich and Gehan. Without Freireich, there would have been no Gehan. Without Freireich, I think there would have been no Bodey. Bodey would have been a good infectious disease doctor. But those principles probably wouldn't have been developed without that intense chemotherapy and the need for it, because Freireich's drive to cure leukemia. So the white count's down, the neutrophils, let's figure out how to get them through the infections. The platelets are down. And he was called a murderer at the Blood Club in hematology meetings in Atlantic City, when he first reported the use of platelet transfusions from donors. Saying you're killing these people. He said, killing whom? They're going to die anyway, what are you talking about. [Redacted] But I'll think about the question of others in terms of impact. I mean, you asking me questions is the best way of doing it. What about this, what about this person, and stuff.

[Redacted]

Jordan Gutterman, MD

You know, another figure that -- again, I don't know how many of these people will come into your book. I just don't know. I mean, you put up Van Eys in there, who was kind of a figure that, I don't know.

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Chapter 02: Dr. Emil J Freireich and the Early Years in Departmental Therapeutics

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