Chapter 09 : The Ideal Patient

Title

Chapter 09 : The Ideal Patient

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Identifier

GuttermanJ_02_20060518_C09

Publication Date

5-18-2006

Publisher

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

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Clinical Provider; Fiscal Realities in Healthcare; On Pharmaceutical Companies and Industry; The Business of MD Anderson -- The Institution and Finances; Definitions, Explanations, Translations; Cancer and Disease; Understanding Cancer, the History of Science, Cancer Research; Donations, Gifts, Contributions; Fundraising, Philanthropy, Donations, Volunteers; On Philanthropy and Volunteerism

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

Lesley W. Brunet:

We're going to end with '81, and I'll probably pick up a few pieces.

Jordan Gutterman, MD:

So a year later, we're raising this money. We're starting to think of new -- now we're getting more money, so we're getting more interferons, so I began to think about more diseases. So we start organizing some studies. Meanwhile -- the pure interferons. So it's always more than one track. There's always several tracks coming. We had to prepare for the first pure interferon, which was beyond exciting. And I was thinking this is going to be the great nirvana, because here's pure protein. Pure interferons. It's going to be like insulin. No side effects. All the side effects we were seeing, which was fatigue and fever, you know, exactly what you do as you get the flu, are going to be gone. So, I'll finish with this, and I'm pretty well spent. So I was in the clinic seeing a patient, her name was [Redacted]. Very public. With lymphoma. Very attractive, what, mid-40s lady with lymphoma in the clinic, and I, in the old station -- near the library. An area you just walk past every day, you know. If you just go straight out of the library, past the elevators, and you get to the first -- not the first corner, by the men's room. Not by the elevator, but the first one, there's an elevator here going there. That area was our clinic. I was there on the -- there's physics offices there. Seeing a patient. And someone said John Burns from -- I actually went upstairs. John Burns is on the phone upstairs, my office called. So actually, somebody ran upstairs to the seventh floor, same little office. And he said we've been approved by the FDA to start clinical studies with pure interferon. So I guess you need to start looking for a patient. And he said, just remember, this is going to get a lot of attention, and I remember Hubert Humphrey was getting -- who I met with Mary -- was getting a lot of publicity with his bald head and stuff. And I said OK. And I walk back in the [Redacted] room and I think, oh my god. The perfect patient. She's intelligent, well spoken. We were looking for a new therapy. We knew it works in lymphoma. I'm thinking -- so I said, she said, seemed like a call. And I said, yeah, we just got -- and she knew about interferon. In fact, we've been talking about going on interferon, and I said that the FDA has just approved us for the first pure interferon, and she said "Can I be your guinea pig?" And I said you bet you can. So that was it. No, no, excuse me. She didn't say that. "Can I be your poster girl?" That's what she said. Can I be your poster girl. I said yes.

Lesley W. Brunet:

And I guess you had permission to use her picture.

Jordan Gutterman, MD:

Yeah. And she was attractive in every way. You know, she just was -- photographed well, well spoken.

Lesley W. Brunet:

Her picture's in my brochure.

Jordan Gutterman, MD:

Yeah. Yeah. And the whole scenario -- now I was beginning to get the vision of Mary. No, you know, you think ahead -- like a chess game? You're at ten steps, you know.

Lesley W. Brunet:

I don't play chess, I'm sorry.

Jordan Gutterman, MD:

What's that?

Lesley W. Brunet:

I don't play chess.

Jordan Gutterman, MD:

OK. But you know, in chess, you have to think ahead five steps and six -- you have to have a strategy. These guys can think. I can't do it. I can play the game, but I don't play the game. Or in bridge, and all. You have to know steps ahead. Anyway. So I was beginning to do -- I think I always did this to some extent, I wouldn't be -- have been even where I was or convinced -- impressed Mary, you know. But now I was beginning to play the game too, (laughter) you know. Particularly since I was being beat up about turning down, you know, you don't want the first patient with interferon to be somebody, you know, moribund in bed, bald-headed, jaundiced, you know, that type of thing. And she was the perfect candidate, because she was healthy. She had the right disease. And she was well-spoken and she wanted to be the patient. So, you know, I played the whole game -- I mean, it wasn't a game. Excuse me, I shouldn't say that. But I wanted to choose a patient that would represent a new idea of a non-chemotherapeutic compound. And it was totally legitimate, I mean. We couldn't -- I mean, the protocol -- she fit the protocol, I mean, obviously. This was not a volunteer -- although I was accused, by the way, of hiring a model to get the first (laughter) I had everything happen. Oh yeah. People came down on me. "Hey Gutterman, how'd you hire that model for the patient and lying about her disease?" I mean, people said that stuff in the elevator to me.

Lesley W. Brunet:

You said she had lymphoma?

Jordan Gutterman, MD:

Nodular -- yeah, nodular lymphoma. Mmhmm. She didn't want -- she had to have some chemo, and didn't respond that well to it. And she just was one of these naturalists who didn't want a whole lot of chemo, or a whole lot of -- she loved the idea of interferon. Which did work on her up to a point. So I could see that she was going to be the ideal patient. So, without going through the specifics, you know, we did a lot of work in the first two weeks of January. She, in fact, was the first patient, and we injected her. And I had a trip planned to Santa Rosa, California, to a hospital to give a talk, which I didn't do very often. It's just -- it was already scheduled. So my colleague, Dr. Cassada, who was just barely worked with me, it turned out prescient, because he's the one that agreed to work on hairy cell leukemia, because I needed doctors to work on new diseases with the natural stuff. See, we had these strategies going on. And she was feeling perfect, and she gets the treatment. I didn't expect anything to happen. She was an outpatient. And about two hours after the treatment, I -- we were watching her, monitoring her very carefully. She said -- because FDA was very uptight. She (inaudible) chilly. Got a little headache. And I said, really? And then she really spiked the fever. So I remember calling Dr. Burns, the VP of research, and Pestka, the guy that just got the -- actually, it was Pestka. Both of them, both of them. I was scared out of my mind, I mean, I don't know. Recombinant protein...

Lesley W. Brunet:

(overlapping conversation; inaudible)

Jordan Gutterman, MD:

Exactly. (laughter) I mean, jeez. And I said, there must be an endotoxin -- an endotoxin is the outside wall of Gram-negative bacteria. Sid, who's been on the arrogant side, he said absolutely not. (inaudible) company, there's no endotoxin, there's no -- you may have contaminated it, but there was none in the vial. So I said, oh my god. Why -- of course, interferon is pyrogenic, it's causing fever. That's what -- when you get a flu, you release interferon, and all the side effects we see is due to interferon. And that was historical for me, personally. I've never written about it, because we were the first to inject a purified protein like this, a cytokine. That, in fact, simulates the side effects of a disease. I mean, that was quite a privilege -- and I recognized it on that afternoon, prior to my trip, that we were seeing history in action, because no one had the technology to ever inject a pure protein outside of insulin, which was synthesized, and it's a hormone, so it didn't cause fever, but this would be classified as a cytokine, a defense hormone, that part of the defense is to induce fever because bacteria and other viruses don't do well in a higher temperature, so evolution created these side effects, which in fact help the host. And we couldn't ever test that before, nor at least did I -- none of us ever talked about that, or did we predict it. So it was not a contaminate. It was, in fact, what pure...

Lesley W. Brunet:

How long did it take you to figure that out? Same day?

Jordan Gutterman, MD:

Oh yeah, oh yeah. I mean, when they said there was no endotoxin, I finally woke up and I said, well, it's -- oh my god. Of course. I mean, and when you went down to talk to her, she said I just feel achey all over, and I must be getting the flu. And that's what -- when -- I think she said, I think I'm getting the flu, and I'm thinking, oh my god, you are getting the flu, so to speak. You're getting exactly what you do with the flu, you're releasing interferon. (laughter) So we put her in the hospital, and I went to the airport, and I called them at the airport, and when I got to California, she leveled off, and I kept track of her during the night, sort of. But she kind of leveled off. And the protocol was the same dose given twice a week, so we had 72 hours before we had to repeat the dose. And... END OF FILE

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Chapter 09 : The Ideal Patient

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