Chapter 07: Evolution of Medical Practices in Neoplasms and Drug Therapy
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Description
In this chapter, Dr. Bodey highlights innovations in cancer treatment in relation to anti-cancer drugs. Antibiotics, such as anthracyclines and actinomycin D, being used as anti-tumor agents, are more commonplace. An increase in pharmaceuticals in cancer care led to increased committee work and Dr. Bodey served on the Pharmacy and Therapeutics Committee. He briefly discusses some changes to dispensing drugs to patients – including having nurses administering medications instead of doctors and moving to a centralized pharmacy on campus.
Identifier
BodeyG_01_20030303_C07
Publication Date
3-3-2003
City
Houston, Texas
Interview Session
Gerald P. Bodey, Sr, MD , Oral History Interview, March 03, 2003
Topics Covered
The Administrator; Working Environment; Care; On Care; Growth and/or Change; Devices, Drugs, Procedures; Discovery and Success
Transcript
Lesley Williams Brunet, CA:
You were talking about the intravenous drugs—giving drugs intravenously—and you talked about the number of individual units. But there were also problems with giving drugs intravenously, weren’t there? I mean, some of the drugs— Gerald P. Bodey, Sr, MD The biggest problem we had with doing that—I mean, I mentioned the aminoglycoside problem. That was really the only problem about giving a drug. With some drugs, some of the cancer therapeutic agents, you had to be careful about because they were vesicles, and they caused local damage if you didn’t get it into the vein. So the biggest problem in the leukemic population was simply having a vein because in those days, it was thought to be dangerous to use catheters. And these people had no neutrophils, so we had just plain, straight IV needles. Over a period of time, the patient would run out of veins. I can remember one time that we had a patient that needed an IV started, a little girl—this was back when I was at NCI—and I spent two hours on the poor child. I had to give her a platelet transfusion, and she had no veins left. I finally found something, got something started, and that took two hours. Eventually they began to start using catheters, and that made a big difference. And, of course, I’d say there were problems because most of the time when we were giving cancer chemotherapy, we were using just regular needles. There were some of these drugs like vincristine, Adriamycin, and so on where if they got under the skin, they caused big-time trouble, and a lot of that has been eliminated by the use of catheters.
Lesley Williams Brunet, CA:
Because some drugs were better given intra-arteri— Gerald P. Bodey, Sr, MD That’s not done routinely. There are certain diseases where they do perfusions, like melanoma in the leg, and I don't know if they’re still doing that. They used to do it. But I mean, there are occasions when arterial therapy is used, but generally speaking, it’s all, you know, given intravenously.
Lesley Williams Brunet, CA:
One thing I want to talk about, and I admit I don’t completely understand it. When you were at NCI, and I guess the early years down here, the use of the antibiotics as really anti-cancer drugs—? Gerald P. Bodey, Sr, MD I’m sorry. Antibiotics as anti-cancer drugs?
Lesley Williams Brunet, CA:
Yeah. Were there ever any? I’ve been reading some of this— Gerald P. Bodey, Sr, MD See, you have to understand what an antibiotic is. People use that term antibiotic very loosely. Specifically antibiotics are drugs that are produced by microorganisms that have activity against other microorganisms, so that’s an antibiotic. So penicillins were first found by accident actually. An investigator, Dr. Alexander Fleming, looked to have some Petri dishes he would grow on an organism. I think it was Staph aureus or something. And they got contaminated with his fungus, penicillin, and he noticed where the Penicillium was growing, the Staph aureus wasn’t growing. That was the beginning of developing antibiotics. There were other bacterial agents that are not antibiotics, like fluconazole for fungal infections, that’s not an antibiotic. The first antibacterial agents actually were the sulfonamides, and they came out of the IG pharm and dye industry in Germany. But at any rate, an antibiotic specifically— and penicillin is a prime example—aminoglycoside is also. There are some anti-tumor agents that are also antibiotics.
Lesley Williams Brunet, CA:
That’s what I’m thinking of, so that’s where I’m confused. Gerald P. Bodey, Sr, MD Yeah. The anthracycline drugs, like Adriamycin. They’re derivatives of antibiotics.
Lesley Williams Brunet, CA:
Bleomycin. Gerald P. Bodey, Sr, MD Actinomycin D is an antibiotic. What else is there? There are several others. And most anti-cancer drugs are synthetic chemical agents, but there are a few of them that are antibiotics.
Lesley Williams Brunet, CA:
Okay. I’m going to go through some more. I know we’re concentrating mostly on the early years, up until the ‘80s, not so much later. That’s where I’ve been going slowly through the records from the beginning to the end, and I’m not at the end yet. One thing I’m picking up is that in interviews, I’m not always getting enough about faculty members’ committee work. Gerald P. Bodey, Sr, MD Committee work? I don’t even know that I have all of that information.
Lesley Williams Brunet, CA:
Well, I don’t have all of your committee work either, but I do want to, if not now, maybe at another time— Gerald P. Bodey, Sr, MD I kind of need more a list of them—
Lesley Williams Brunet, CA:
And, I don’t have—we can always— Gerald P. Bodey, Sr, MD — in the institution. I don’t even see them on this thing. I served on—I don’t remember all the committees that I’ve served on.
Lesley Williams Brunet, CA:
I guess you’ve been on the infectious disease committee. Gerald P. Bodey, Sr, MD Well, I was on the pharmacy and therapeutics committee off and on. For most of the time I was here, I was on the infection control committee off and on, and I was on the medical liability committee. I was on the faculty classification committee quite a few times. I don't know. I’d have to get my CV. I don't think I have a copy of it.
Lesley Williams Brunet, CA:
Well, we can always come back and— Gerald P. Bodey, Sr, MD This is the same thing. Oh. Here we go. Maybe this. It’s a short one. Are you sure you want to talk about this?
Lesley Williams Brunet, CA:
Well, they’re obviously sort of important, and this is sort of a hidden, behind-the-scenes role, and yet it’s very important. Gerald P. Bodey, Sr, MD Yeah. I was on the cancer clinic—I think what you need to do is get a copy of this from my secretary. I’ve been on the cancer clinical research advisory grant advisory committee, the chaplaincy committee, the clinical conference program committee, the clinical laboratory review committee, conducted care committee, medical staff, faculty classification committee, infection control, institutional research grant committee, investigational new drug committee, physician referral service benefits committee, professional liability committee, research committee, so on.
Lesley Williams Brunet, CA:
.1 I guess I should say, of all your committee work, what stands out most in your memory? Gerald P. Bodey, Sr, MD Well, pharmacy and therapeutics committee. That was something I was very much interested in because of my interest both in cancer chemotherapy and antibiotics and so on. So that was to me an important committee, and I served off and on during most of my career. I was a chairman and a vice chairman several times, so that was an important committee. I would say that one of the activities that I was involved in that was very important to me was that once in a while there would be some kind of touchy problem about some physician who did something that was considered potentially harmful to a patient, or somebody got an overdose by mistake, and that sort of thing. Before they organized a liability committee, they would conduct investigations into the particular case, and for some reason, I have seemed to be chosen to serve on several of those occasions either as a chairman or one of the members of committee. That was always a challenge because you wanted to be fair in your assessment and understanding that the physician didn’t do anything intentional but made a mistake. So that was to me a very important activity, and I really tried very hard to be fair to everybody in that kind of an investigation. [Redacted]
Lesley Williams Brunet, CA:
Actually of the things I’ve seen of the pharmacy and therapeutics committee were to work on procedures, especially with dispensing medication. Whether the nurses or the physicians dispensed medication, it was one interesting thing I did see. An early nurse said that the nurses were giving chemotherapy drugs, and then it seemed like the physicians then had to give those, especially investigational drugs. Now, you know, things have switched around, and now nurses are taking that role. Gerald P. Bodey, Sr, MD Of course, the pharmacy plays a major role, and at that time, only one person was mixing up drugs and all that sort of thing. Now it’s handled by the pharmacy instead of on the ward, so it’s changed quite dramatically. But the one thing that’s pretty unique, not so much anymore as it used to be about cancer drugs, is they have a low therapeutic index. So if you make a mistake and give the wrong dose, the consequences of that are going to be a lot greater than, say, if you gave a wrong dose of an antibiotic. For most antibiotics, it wouldn’t matter. It’s all right for a single dose. But a single dose of a cancer drug can make a difference whether a patient lives or dies.
Lesley Williams Brunet, CA:
Where the effective dose is very close to the toxic dose. Gerald P. Bodey, Sr, MD Well, the therapeutic index is the relationship between the effective dose and the toxic.
Lesley Williams Brunet, CA:
The toxic. Oh, okay. Let’s see. You were also involved in the international arena? I noticed some international antimicrobial therapy project group. Were you involved at all in that?
Recommended Citation
Bodey, Gerald P. MD and Brunet, Lesley W., "Chapter 07: Evolution of Medical Practices in Neoplasms and Drug Therapy" (2003). Interview Chapters. 982.
https://openworks.mdanderson.org/mchv_interviewchapters/982
Conditions Governing Access
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