Chapter 05: “The World’s Authority on Infectious Diseases”

Chapter 05: “The World’s Authority on Infectious Diseases”

Loading...

Media is loading
 

Description

In this chapter, Dr. Bodey outlines his significant contributions to medical research. He begins by discussing his work in infection control for neutropenic patients and methods for measuring microbial presence in the throat. He also highlights his pioneering research into intravenous aminoglycosides, which improved treatment options for leukemia patients. Another major contribution was his work with carbenicillin, which increased survival rates from pseudomonal infections by 75%. Publicity from this work raised awareness of advancements in infection control for cancer patients.

Dr. Bodey also discusses his collaborations with pharmaceutical companies in developing new antibiotics and chemotherapy drugs based on initial research conducted at NCI.

Identifier

BodeyG_01_20030303_C05

Publication Date

3-3-2003

City

Houston, Texas

Topics Covered

The Clinician; Care; On Care; Survivors, Survivorship; Cancer and Disease; Discovery and Success; Healing, Hope, and the Promise of Research; The Healthcare Industry; On Pharmaceutical Companies and Industry; MD Anderson Impact; MD Anderson Impact

Transcript

Gerald P. Bodey, Sr, MD:

He called me that. (laugh). Yeah. I’m certainly not the world’s authority on infectious diseases. I’m not even sure I qualify as the world’s authority on anything, but in the cancer population in particular, neutropenic patients, some people have said that I’m sort of a father of infection in neutropenic patients. I’m not sure that that’s a proper appellation for me. But the paper that I wrote on the relationship between neutrophils and infection sort of started the whole focus on infection, and that plus the causes of death study that we had done on infection was a major cause of death in those patient populations. We did a lot of investigations in this institution. I talked about the laminar airflow and the life island projects. We did all kinds of things that were somewhat innovative. I developed a sort of semi-quantitative method for measuring the floor—microbial floor in the throat. We did a semi-quantitative method for determining a concentration of organisms on the skin. We divided the skin, the whole body up into sections, and then we swabbed entire sections and cultured them and did quantitative analysis and so on. There were a lot of those little items that we were doing in an effort to determine how effective our prophylactic program was. And there are other things we did. When I came here, it was considered very dangerous to administer aminoglycosides, which are one category of antibiotic which was relied on very heavily in those days for treatment of infections. They had a side effect of muscle paralysis, and so there was a great deal of concern about giving the drugs intravenously. So you had to give them intramuscularly. Well our leukemic patients didn’t have any platelets, so if you gave them something intramuscular, they were going to bleed. So when gentamicin became available, which was actually a little before I came down here, we were actually very much interested in it, so we actually did the very first studies of the drug administered intravenously. We did pharmacokinetic studies, therapeutic studies, and so on. Now everyone uses aminoglycosides intravenously and doesn’t think anything of it. The first study of glycosides was actually done at this institution. And we did the first prospective randomized trial of antibiotic regimens in neutropenic patients before they were done anywhere.

Lesley Williams Brunet, CA:

I saw your article on sort of a historic view since The Middle Ages.

Gerald P. Bodey, Sr, MD:

Yeah. And the biggest—in the early days, the thing that was perhaps the most important of all was that somebody in the department mentioned to me that there was an article in Nature magazine, which was a general science magazine, on this new penicillin that had activity against pseudomonas. Now pseudomonas in our leukemic population was the kiss of death. If you have pseudomonas infection and you didn’t quickly go into remission and get some neutrophils, you were going to die.

Lesley Williams Brunet, CA:

Now was this before you became— this is here, or at NCI still?

Gerald P. Bodey, Sr, MD:

No. This was here. I mean, it was true there, too, but it was true here. Our major killer at that time was pseudomonas. So anyhow, you mentioned that there was this article in this journal on carbenicillin and penicillin that had activity against pseudomonas. Beecham Laboratories in England had written a paper, and so I contacted them. It just so happened that around that time they had decided they were going to start developing the marketing of their drugs in the United States. Prior to that time they had worked through Bristol-Myers. So I didn’t know at the time, but Pfizer here in the United States also had carbenicillin. I had contacted Beecham, and the medical director was from England. He was sort of an acting director while they were searching for somebody to take it on here in the United States. So he came over, and somehow I managed to convince him that this was a place for them to do some major work with carbenicillin. So they used to send this drug over in these great big round drums, come into the pharmacy, and the dose of the drug was five grams every four hours. It came in a one-gram vial. We had so many patients on that drug that we had one nurse who did nothing but mix up this drug every day. That was long before we had the kind of pharmacy we have now, so—

Lesley Williams Brunet, CA:

I was going to ask you about that.

Gerald P. Bodey, Sr, MD:

So the nurses mixed up the drugs, and they spent essentially the entire day just mixing up this carbenicillin. Well the drug was not terribly potent, but it was active against pseudomonas. At that time we didn’t have anything that was really terribly active, so about twenty percent of our patients who were neutropenic and got pseudomonas infection survived. Eighty percent of them died. So we started using carbenicillin, and it was really dramatic. It was extraordinarily dramatic. Our overall cure rate of pseudomonas infections increased seventy-five percent

Lesley Williams Brunet, CA:

That’s dramatic.

Gerald P. Bodey, Sr, MD:

It was kind of funny. Mary Jane [Sheaver], you might talk to her about this. She was working at The Houston Post at the time.

Lesley Williams Brunet, CA:

I remember seeing her articles.

Gerald P. Bodey, Sr, MD:

She called the hospital one time and said they were interested in doing some kind of an article on a new cancer drug or something. So the public relations office called me, and they asked if she was there. I said, “Well, I don’t really have anything terribly exciting about new drugs for cancer, but I do have this new antibiotic that’s very exciting.” So she came and interviewed me, and then a couple of days later, she said, “The editor decided to put this on the front page of the newspaper on Sunday morning.” So I got up and I went out Sunday morning, kind of nervous about what this was going to be, and I picked up the paper. I thought it was going to be somewhere in the bottom corner or something like that, but I didn’t see it anywhere.

Lesley Williams Brunet, CA:

18:28.3 Was there a headline?

Gerald P. Bodey, Sr, MD:

I went in the house, sat down for breakfast, and started looking through the newspaper. It was the headline on the Sunday morning newspaper.

Lesley Williams Brunet, CA:

I don't think I’ve seen that one, but I’ll look for it.

Gerald P. Bodey, Sr, MD:

Unfortunately one of my secretaries ended up throwing out all my newspaper articles without ever talking to me about it.

Lesley Williams Brunet, CA:

This happens a lot, I’m afraid.

Gerald P. Bodey, Sr, MD:

Everybody was afraid to tell me about it for about a year after it happened, so I never knew. And I just talked to Mary Jane not so long ago to see if she had a copy of it because I don’t have one anymore.

Lesley Williams Brunet, CA:

We can always get it on microfiche and microfilm and make a copy.

Gerald P. Bodey, Sr, MD:

Somebody has. Some portions of The Post are no longer, but I suppose somewhere it is.

Lesley Williams Brunet, CA:

0: The Chronicle should have it.

Gerald P. Bodey, Sr, MD:

But, I mean, I was terribly embarrassed. I sort of snuck in the back row of church that Sunday morning—(laughs).

Lesley Williams Brunet, CA:

And about what year was that?

Gerald P. Bodey, Sr, MD:

—so nobody could see me. I don't know what year it was. Probably around 1969, 1970, somewhere in there. And so then I got home, and the local TV was calling. They wanted an interview, and I wouldn’t. I was too embarrassed to do anything, but I think it was Associated Press or somebody picked this up, and it got all the way around the world, and I had a whole—

Lesley Williams Brunet, CA:

That’s why you’re the world expert on—

Gerald P. Bodey, Sr, MD:

You know, Mary Jane did an excellent job, and her article was very good and very correct. By the time I got around the world, I mean, this drug was curing acute leukemia. I can remember one morning I was awakened at four o’clock in the morning with somebody calling me from the jungles of Brazil wanting to know something about this drug that cured acute leukemia. And there were headlines, not major headlines, but the front page and the papers about this new drug that cured acute leukemia from different places in the world that ended up on my desk at some point or other. So it got a little bit more publicity than it deserved, but it had a major impact on our ability to treat our patients with chemotherapy. This threat of patients dying of pseudomonas infection was greatly reduced. So those were some of the things that we did at that time. Then that sort of started us into getting involved in new antibiotics, and that’s been one of my major activities over the course of my career.

Lesley Williams Brunet, CA:

And these— the antibiotics, these come from pharmaceutical companies primarily?

Gerald P. Bodey, Sr, MD:

Yeah.

Lesley Williams Brunet, CA:

But the chemotherapy drugs you worked on at NCI and in the early years here, they weren’t from pharmaceutical companies, were they?

Gerald P. Bodey, Sr, MD:

Most of them were not, but—

Lesley Williams Brunet, CA:

Okay. I just wanted to be—

Gerald P. Bodey, Sr, MD:

—some of them came through. For example, vincristine came through Eli Lilly, and there were a few of them that came through drug companies, but most of them were sponsored initially by NCI. Then when they reached the point of being approved by the FDA, some drug company would pick them up at that point. One of the other things that was kind of interesting—actually, we’ll forget about that because that was done before I came here.

Lesley Williams Brunet, CA:

Well, if you have insight on it, go ahead.

Gerald P. Bodey, Sr, MD:

In the early days, when I was at the NCI, patients would get fever and all. We’d send them down to the x-ray, and they’d have something wrong. The usual radiology report was that they had a leukemic infiltration in the lung. And so we did this study, an autopsy study, and it turned out that almost nobody had leukemic infiltrates, and they were all due to infections of some sort or another. So it sort of changed the radiologist. I remember a couple of years after I’d been here that a radiologist generally had made comments on the x-ray that—about the fact that this was—no, I take that back. I’d better not say that. It was a little bit more complicated. But it was a very exciting time to be involved in the development of the chemotherapy of cancer. When I went to the National Cancer Institute, I ended up spending most of my first year on the pediatric service. Taking care of little kiddies that were dying of leukemia wasn’t exactly a pleasurable experience. But Dr. Freireich had this idea of using combination chemotherapy. Everybody thought he was crazy. What were you going to give the poor patient when they had a recurrence of their disease because you knew that all the drugs first go round.

Lesley Williams Brunet, CA:

That was one of the criticisms?

Gerald P. Bodey, Sr, MD:

Well, I mean, that was the way I looked at it. I couldn’t imagine doing this because what are we going to do with these poor patients after they relapse and refuse [all the] drugs? And—

Lesley Williams Brunet, CA:

And was it—it’s hard to say if an idea is entirely one person’s, but was that his?

Gerald P. Bodey, Sr, MD:

That was Dr. Freireich’s idea. Dr. Freireich revolutionized treatment of acute leukemia in many respects. He’s a brilliant man and made tremendous contributions to acute leukemia. I don't think there’s anybody in the world who has made similar contributions to what he did in the pioneering days. One of the debates at the time that I was in the National Cancer Institute, and even in the early years here, was that justified to treat an adult with acute leukemia? Why don’t you just make them comfortable and let them die? And I mean, prominent hematologists took that position. So Dr. Freireich was really a great man. He is a great man. I mean, he made a lot of very important contributions to acute leukemia that everybody takes for granted at this point.

Lesley Williams Brunet, CA:

But age really was a factor, wasn’t it?

Gerald P. Bodey, Sr, MD:

Oh, age is a factor even today. In a substantial portion of children, acute leukemia can be cured. A small proportion, roughly around twenty percent, of adults with acute leukemia get cured, and that’s—

Lesley Williams Brunet, CA:

Stupid question, but why?

Gerald P. Bodey, Sr, MD:

Well, we don’t know completely. Different forms of leukemia. Most children have acute lymphocytic leukemia. Most adults have acute myelogenous leukemia. Age is a factor as well. Older people do less well than younger people. But at any rate, when he came up with that idea, I mean, it really disturbed me. But I guess I treated this therapy to the second patient, who was a young girl about twelve years old at the time, and she basically was cured of acute leukemia. I kept in contact with her. Unfortunately, when she got into her forties or fifties—late forties, I guess—she developed breast cancer and ended up with metastatic disease. I think she has probably passed away by this point. I kept up with her, of course, for some time. So I mean, on the one hand, it was kind of depressing all these little children getting leukemia and dying. But on the other hand, it was kind of an exciting period as well, beginning to develop therapies in adults. When Dr. Freireich came down here, we started some of our chemotherapy regimens here and began to see responses and about forty percent complete remissions in forty percent of adults, and that was pretty exciting at that time, too, because generally it was around ten percent fifteen percent.

Lesley Williams Brunet, CA:

You also worked on—I want to get the terminology right. He’s talked to me about a neutrophil situation, and you must’ve worked on that, the—

Gerald P. Bodey, Sr, MD:

The white cell transfusions?

Lesley Williams Brunet, CA:

Yeah. The blood cell transfusions, and then the—

Gerald P. Bodey, Sr, MD:

That was mainly his. I mean, he developed that program. People thought he was crazy doing that, but he developed a whole white cell program. People nowadays have forgotten about who did all the work, but he did all the pioneering work. I worked with him a little bit on that, but I was not heavily involved. There was just, I mean, so many things to be involved with, so obviously I was giving white cell transfusions to patients I was taking care of, but I wasn’t really that much involved in that aspect of therapy. But he did all the pioneering work on that. I’m sure he must’ve told you about it.

Lesley Williams Brunet, CA:

Yes. He did. I’ve also looked at a report on developmental therapeutics. I don't know if you remember, but for a while they were working on the second history of MD Anderson. I think it started around ’77, and the version I’ve seen is he finished this article in like ’80, but there was supposed to be a second book, and that was never really finished.

Gerald P. Bodey, Sr, MD:

Sometime I wrote a book on treatment of acute leukemia or—

Lesley Williams Brunet, CA:

Oh, this was a book on cancer, and all their departments wrote sections, and everybody has put in their contributions. They’ve polished it and played with it for a long time, but I guess it was one of Clark’s. Maybe they were saving it for Clark once he retired to finish a project, but it was never actually finished.

Gerald P. Bodey, Sr, MD:

Well, I just dug out an old book that’s been sitting right there, the first twenty years, and because Dr. (???) Daigle’s asked me to—I guess because everybody started to pay attention to—

Lesley Williams Brunet, CA:

Pay attention to their history?

Gerald P. Bodey, Sr, MD:

—put together something related to the Department of Medicine and its origins and so on. So I agreed to do that, but it’s—

Lesley Williams Brunet, CA:

Oh, good.

Gerald P. Bodey, Sr, MD:

He’s not thinking in terms of going into great details or anything, but just sort of—

Lesley Williams Brunet, CA:

I’ve tried to. And of course, we have a lot of good records from those early years.

Gerald P. Bodey, Sr, MD:

Oh, you do?

Lesley Williams Brunet, CA:

They’re on microfiche, but they’re—

Gerald P. Bodey, Sr, MD:

Well, maybe I need to talk to you more about some other date doing that. He’s kind of eager to have something because the department has had sort of a checkered career. I mean, so there aren’t too many people around anymore who really know its origins. In actual fact, I wasn’t in the department—the original department of medicine, so I have to rely on some of the other people who were to—

Lesley Williams Brunet, CA:

Well, I’ve actually pulled together quite a few documents because I think when I was first here, someone asked me about identifying the chairs, and then it just got simply complicated, partly because medical specialties, and it’s—

Gerald P. Bodey, Sr, MD:

Yeah. There’s a certain amount of overlap—

Lesley Williams Brunet, CA:

—a confusing tree.

Gerald P. Bodey, Sr, MD:

—between the two. Yeah. I’ll need to talk to you at some point—

Lesley Williams Brunet, CA:

But I’ll be—

Gerald P. Bodey, Sr, MD:

—before too long about that and what you have, so I don’t spend too long doing what I’ve already done.

Lesley Williams Brunet, CA:

Okay. I’d be happy to show you what I’ve done and pulled together and kind of outlined. Well we—speaking of medicine, let’s talk about how Developmental Therapeutics was—is—let’s see. What’s a good word for it? Demised? Closed?

Gerald P. Bodey, Sr, MD:

Well, there was—basically what happened was that at some point, Dr. Cliff Howe [Clifford] was the head of the department— (End of Audio 2)

Conditions Governing Access

Open

Chapter 05: “The World’s Authority on Infectious Diseases”

Share

COinS