Chapter 05: New Chemotherapy Treatments for Breast and Cultural Challenges to Research Innovation

Chapter 05: New Chemotherapy Treatments for Breast and Cultural Challenges to Research Innovation

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Description

In this chapter, Dr. Freireich discusses his work on breast cancer chemotherapy, simultaneously reflecting on cultural trends in the United States that work against the spirit of innovation.

Identifier

FreireichEJ_2011_C05

Publication Date

10-5-2011

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 Researcher; Character, Values, Beliefs, Talents; Professional Values, Ethics, Purpose; On Research and Researchers; On Leadership; Discovery, Creativity and Innovation; Patients; Cancer and Disease; Discovery and Success; Critical Perspectives on MD Anderson

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

Tacey Ann Rosolowski, PhD:

We’ve been talking for about two hours now, would you like to stop for today?

Emil J Freireich, MD:

I have a noon meeting, but other than that I have no problem except my voice giving out. But your patience is probably giving out.

Tacey Ann Rosolowski, PhD:

0:46:2404

No. I’m good, if you want.

Emil J Freireich, MD:

And I may have to transfer more money in the bank, if my wife calls.

Tacey Ann Rosolowski, PhD:

Well, if your voice is going to hold out, let me ask you one more question, and then we can stop for today, because I will be coming back tomorrow as well. I wanted to ask you about the breast cancer clinic. That was something that was started up here at MD Anderson. The last time you were interviewed, you didn’t speak very much about that. So these were the chemotherapy trials that were being discussed. I wonder if you could talk more about that.

Emil J Freireich, MD:

Do you read National Review?

Tacey Ann Rosolowski, PhD:

No, I don’t.

Emil J Freireich, MD:

There’s a good article in National Review this last week about innovation. Our country is going through a—you know—when people are well-off, they want to protect their wealth. America is well-off. We’re going into a dark ages, as you know, not only our economy but our whole philosophy. All the innovation in the world is going on in the third world—the Japanese, the Chinese, the Indians. The Americans, we’re sitting on our fortunes. We want to control what we’ve got, so we’re getting hardening of the arteries. The ultimate expression of it is this president who is trying to make us like Europe, totally socialist. In a socialist state, you can’t tolerate anything new because you have the perfect system. So if you have the perfect system—socialism, where everything is free and run by the government—you don’t need innovation. Innovation is a threat to the status quo. So innovation occurs during periods of great stress, like after the war. That’s when NIH was created. In the post-war area was when we expanded and got all the marvelous new things.

America is going through this awful phase of hardening of the arteries. We’re totally obsessed with safety. We ruined our economy because we’re worried about clean air, so we can’t drill for oil. We have to import it from Saudi Arabia for billions of dollars. We can’t manufacture anything because it contaminates the air. We can’t develop drugs because they’re potentially dangerous. We’re totally in a regressive mode. We have to save what we’ve got. Hug the trees. Save the trees. Don’t build new trees; save the trees. Clean the environment. Don’t use energy. Don’t waste it. What does Obama say? Get your engine tuned up. Put air in your tires.

Do you remember when—? The previous Obama was a guy name Carter. When the Arabs raised the price of oil, Jimmy Carter said, “We’re going to run out of oil. There’s only so much oil.” He forgot that there was no oil before Spindletop was discovered one hundred years ago.

People who have hardened arteries have no— I have a little slide I show. When you ask people what’s going to happen in the future, the liberal will say, “Everything is going to be just like it is now—perfect,” but the science writer is going to say, “Wait a minute. We’ll be going to the moon. We’ll have planets. We’re going to have people replacing themselves and living forever. We can do anything.” There’s a big conflict of cultures, and in medicine it is horrible.

The federal government, through the FDA, has become so oppressive that the possibility of Americans discovering anything new is becoming progressively unlikely. You read about it in the papers all the time. It doesn’t take a genius to think that if you put 10,000 people in a five-billion dollar building in Rockville, Maryland, and you give them guaranteed wages and a retirement program that after twenty years you retire and a better salary than the average American citizen, for life, they’re going to do their job. Their job is safety.

Last night I was watching the EPA lady testify before Congress. You can’t have fat in the food. You can’t have sugar. We’re going to have a law against McDonald’s and God knows what else. But the FDA guys, with all this money, their careers depend on nothing ever going wrong. So I’ve got a drug that can cure cancer, right. I give a talk on this. I’m sure it will cure cancer. I have to apply to the FDA. They say, “Wow, if this drug cures cancer, it won’t do me a damn bit of good. But what if one person in a thousand dies of a stroke? I’ll be fired.” Forget it.

The government is in a position where any innovation is too dangerous to undertake. So the answer is do nothing—status quo—USA 2011. It’s a sad thing, because we were the world leader in science and technology and innovation. Now, we’re totally out of it. Americans buy BMWs, not General Motors. They went broke. Americans throw away their light bulbs and we have to use these little mercury things and kill ourselves with mercury. Everything is status quo.

Tacey Ann Rosolowski, PhD:

But the context was different when you were working with the breast cancer issues and the chemotherapy for that?

Emil J Freireich, MD:

Sure.

Tacey Ann Rosolowski, PhD:

So how was that different? What were you doing?

Emil J Freireich, MD:

Well, that occurred at a time— Do you know how the FDA got worked out today? It always occurs in crisis. I wrote a paper—I’ll give you a reprint of it—it’s called Freireich’s Laws. One of Freireich’s Laws is success breeds enormous problems. Failure is no problem. And that’s the thing; we live in a world where everybody’s happy, like Europe. If you only work four days a week and you get three months vacation and everybody’s happy and the country is going to the dogs and nothing is happening, fine. Well, anyway, we’ll get to innovation.

Breast Cancer patients are dying. Ruth Harriet Ainsworth was a breast cancer patient. In the post-war period, America was NIH, all of America was NIH. The auto industry was booming, atomic energy was booming, the petroleum industry, petrochemicals, plastics, everything was booming. The Japanese had the American culture, as you know. One of the geniuses in Japan was a guy named Hamao Umezawa. Umezawa worked for the pharmaceutical industry, and he discovered that organisms made compounds which could kill bacteria. He became the godfather of antibiotic therapy. The Japanese developed the antibiotic industry under Umezawa’s leadership. He discovered several of the antibiotics we now use today, but he made another amazing discovery. He discovered a drug called bleomycin. Bleomycin is a natural product which consists of about nine amino acids. If you purify it down to eight or seven or two, it doesn’t work, but if you put the nine, it works.

So I was in my famous NIH phase, and I got to go to Japan. I met Umezawa, and he told me about bleomycin. I said, wow, we have to have it in the US. You can’t use it in the US because it might hurt somebody. So you have to spend two decades killing innocent horses, cows, pigs, mice, guinea pigs, rats, plants, anything. Just keep busy, but don’t give it to people—FDA. Clark—wait a minute, the Japanese have treated a thousand Japanese. Oh, we do not accept foreign data. We have to kill Americans. Clark got FDA to relinquish the role that they would not accept foreign data and insisted that they accept the Japanese data, and we have bleomycin. Bleomycin was one of the drugs that cured testicular cancer, as you know. It was working, so we were on a roll. We had a new agent that worked, and we had Clark.

Along came Farmitalia in Italy. The Italians, in the post-war era, were like the Japanese. They acquired the American macho, and their drug industry discovered a drug called doxorubicin. It was simultaneously discovered by the French. These drugs are called anthracyclines, and they had extraordinary activity in a number of tumors, particularly leukemia and lymphoma. The guy sitting right behind you, see that picture? The one with the red tie is Gianni Bonadonna, and Gianni Bonadonna was working in Milan. He cooperated with Farmitalia, and he got this drug, Adriamycin, which was read. He studied patients with breast cancer. He thought it worked, so he called us and said we should study Adriamycin. You’ve got to kill monkeys, dogs, horses. Wait a minute. Bonadonna had treated 500 women—Italian women. We don’t accept—wait a minute. Bleomycin—you accepted Japanese. Okay, you can use Adriamycin. We did the first Adriamycin clinical trials in America. Ruth Ainsworth was one of the first fifteen people to get Adriamycin. And it turned out that Adriamycin is still the most important single drug for treating breast cancer.

Tacey Ann Rosolowski, PhD:

Could you describe the trials that you did with that?

Emil J Freireich, MD:

Those were the days when we didn’t have to worry. Dr. Clark was there. We just gave it to women with breast cancer, and we got sixty percent objective responses and that was it.

Tacey Ann Rosolowski, PhD:

What stage of breast cancer?

Emil J Freireich, MD:

All metastatic. They all had to have measurable disease. But then, as you already intuited, we got the same idea we got with infections. What if we gave Adriamycin to women who were poor prognosis that might get metastasis? That was the advent of Adriamycin, which is still practiced today. Adriamycin, as you know, has unpleasant side effects. They lose their hair. For women, that’s a bad thing. It also has cardiotoxicity. We had to learn to limit the dose. We did all that. One of our fellows, Jeff Gottlieb, worked that out. Daniel Von Hoff published it. So that’s a classic picture up there. That occurred at a meeting of the AACR. Paul Carbone died suddenly on a golf course. He’s the one who worked with us at the Cancer Institute, and he developed the CMF. He’s the big guy. Joe Burchenal is the guy who developed 6-MP with Hitchings and Elion and Gianni Bonadonna. He’s the guy who did all the anthracycline work.

Tacey Ann Rosolowski, PhD:

And who are the other two?

Emil J Freireich, MD:

He’s still alive. He had a stroke and was out of work for about five years. Now he’s kind of coming back, but will never be the same. He’s badly disabled.

Tacey Ann Rosolowski, PhD

Who is the other gentleman in the photo?

Emil J Freireich, MD:

Me.

Tacey Ann Rosolowski, PhD:

That’s you?

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Chapter 05: New Chemotherapy Treatments for Breast and Cultural Challenges to Research Innovation

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