Transcripts For CSPAN2 Book Discussion On The Death Of Cance

I am the Program Director here and welcome. As a few housekeeping items please take a complement to silence your cellphone. We hear pleas to have cspan here. To pioneering on campuses is cowritten and that has received high praise. Tonight elizabeth will interview her father about his work and his personal story. The rise to the National Cancer institute becoming the director were currently the professor of medicine and then to receive got a masters degree and writes about Science Health and society. To appear in though washington post. With a psychology today and harpers bazaar. [applause] host. Thanks for coming. I have been asked to interview my father which is something i have done a lot of the most of our conversations took place over scotch but we will do our best in this format as we tried to invoke those stories and introducing my mother in the pharao. [applause] so with your journey through it people dont know which. Sold the Congress Passed with the National Cancer act the 23rd of december as a Christmas Gift to the nation. The brainchild of the very wealthy philanthropist. And it was a very controversial program. That the fda control of drugs and it was controversial and with a great influence that it will eradicate cancer with the bicentennial. The scientists believe that is true. But with your tax dollars so it is really about my check with though gore on cancer. What was she waiting for . She had a machine. And she and add a and leanders for example, and motel letter to congress. See you had this big machine with the feeling it is time to push for word in did 1969 as a keynotes their best bet i of the patient with gallbladder cancer to live in washington and work with congress stick with that one drug. To say thank you very much. And he said he will take this patient. I was cocky but not stupid. [laughter] so i took the patient and when i examined him i felt his lymph nodes under his armpits. It turned out he had lymphoma that we were working on it and we treated into remission in delhi had provided the missing link most people dont die from cancer where it starts but the secondary results in bin to treat effectively. We should say how they were connected. He was working for the American Cancer Society mary paid his salary and he was the eyes figures on the hill. And to be the guys did years on the hill and identified those that how you deal with each one is a different way. The ones he was in remission to put witnesses together to testify before congress and wrote the National Cancer act itself. In those with the congress it is very interesting. And if you describe what a contradiction of how she acted. There was nobody like mary before or since. As the National Cancer Advisory Council she would come with the coat to draped it over the chair to put her makeup on to get the impression but nothing could be further from the truth. But then i met her from the first phone call and i remember boasting to my staff. She was a very smart woman in a very logical. System of her logic is a believer and his experiences come from those visits steve began to in advance the goals in she had a machine in place but in the spring for the fox world of washington and. And then to have tenders sandwiches. And things are very carefully planned. One day i got a call she said will you come to lunch today . I said i can i am very busy today and she said barry wants you to come. Please come. So i got in my car of the late. With a government limousine in front of the house. And then to ask me to Say Something but i said who is this . And she said he is maggies driver, of the one who handled all the money. [laughter] so she had a shocked look and said he drives maggie to work every day in and around shopping but she was surrounding him to pass the budget but he never stood a chance spitting but there are many scientists and doctors now. Was very unpopular. With the implication but money doesnt buy ideas. End is to pop out. In the university once the money to go into grand. So they were unhappy in to smile at me. Id you can agree and this one. And it hasnt been very popular. But i just cannot get into my backpack but the volume by a comparison is what compelled you to go to writing for doctors . [laughter] she said it was very clever of us to chronicle what we did. The it because she made it readable. 100 billion is a lot of money. And with that language. Second i am very fortunate to become director of the Cancer Institute the biggest Cancer Center in the country to go to the leaked university. As a unique position to say that the public needed to know and we have been talking about it so that is the reason right there if you enjoyed reading its. Sun may construe it being inflammatory have you got an emails . Did anyone caution you about writing that things that you did . Divers six years ago i went out for a sabbatical and my good friend is one of the pioneers so we had lunch at the Italian Restaurant down the street. With the boisterous guy and i told him about the book and he got very serious. But instead he said people dont really need to know. But it was so a lot of character. Were you concerned of the responses you might get . But people seem surprised. Bin tell the truth. Estimate would is the hardest criticism and how you respond . Remember we were reviewed twice in the new york times. One was wonderful the other one was not fair. Believe in it wholeheartedly head with a patient named lee. And by 3. Nine months with they were like this. So oneyear and twoyear. So he suffered in the on the rabbi side he said its good. I dont think we know enough my response is you dont know e. F. And the cancer feels he dont have to do that but fix critical parts so theyre exposed to a treatment to be the hallmark of cancer. If youd do that and to get back to where you were darfur ups and eradicate cancer or give other achievements. They are understandable. Early in the books husses chapter to. Overflowing martinis because if is the ground you dont want to your bosss but these guys are your mentors civic we and said jurors should who. The sow so for the two reasons. Visually they worked very hard in and if you look you would know they were very intense. So i had to make the decision. That they were argued tuesday way as it is a privilege if he did go there it would be vietnam to be shot at. People said it is good for that reason the delicate to close the was professionally. And then to do get drunk. So how to make a decision to work on this but that power was so in in but and maybe this stories made him unfruitful comfortable and i got a note saying he loved the book and he is so proud that we work together. And is still stick in 1963 is duke were lucky were operated on. If you might survive. Then that radiotherapy was around. So that overall survival rate was 37 for all cancers combined. Chemotherapy was on the lunatic fringe. But i worked on both because of a one was the glorious people and there wasnt much excitement just testing new drugs without hope they wouldnt do much for that patient either for is the children with leukemia. He is as super dr. In seeing things happening despite the fact mmis were telling me something different. At the hematologist at the Cancer Institute and as we do that a bone marrow you have to take down the slides and we can then decides and then he would give me to say crazy with their doing. In den he says and the leukemia was committed back but in those that had this kind of approach. Sova to keep within the hostility we would cross paths and then there was a study that was a little more toxic. But we were very careful. That we may translations from the mouse i came up with a fairly complicated schedule. I did this with my first partner and jack did the bump program and i did the box. Jack is an interesting story because when i first met him we shake cans, hi how are you, where youre from, what you get it after you leave here . Jack said i wanted to be a dean. No one wanted to be a dean. So was unusual. Jack went back to boston and three years later he went to medical school and people asked what happened he just disappeared. We still stay in touch. We converted mom into mop. So my question would be what is the biggest hot obstacle to getting mop outpatient. After the first four years were pretty sure of the patient was going to recur it wouldnt reoccur in the first four years. Now we are pretty confident we hear them. But youre asking people who had never done things like this to now use the combination and if you do not believe you could curate the new are making people sick for nothing. So getting doctors to work on the schedule that you put together was very difficult. I tell a story before i was up to grand rounds and they worn to me when its coming up that they couldnt make it work. My father who worked in new york decided he was going to come so he came and set her office. Personally my data and the one after another they got up and said we cannot make it work. The implication was that i was taking the easy cases and they were taken the hard cases. The reverse was true. Somehow they thought i was fudging the data. So what do you do . Said we dont like nitrogen mustard though so we used our own drug and they put a dose and that was easy to use so this drug makes you throw up so we cut that drug in half. Another one causes nerve damage so we cut that dose. The way worked out scheduled so we could get the drug in and keep the two from going back without damaging the marrow. They threw it out the window and put another two weeks between the cycle. So i finally blew up and said why would you do this, they said outpatients come to us and we dont want them to vomit on the way home so i said to them that they could you tell the pissed patients that they could vomit and be cured or not vomit and die the disease maybe they would take a taxis. But that was the problem of getting people to stick to the dosage schedule. When i went to Memorial Hospital to give you an idea of some of the fears that people had a tackle from a local Football Team had hutchinsons disease. He was to 60 pounds and 6foot 7 they said this is crazy your not going to give that to them. So i had to go to the clinic and inject this giant with a dose because on the basis of body surface area and he had a big body surface area. So you dont give a sumo wrestler and someone his size the same dose. So i had to go in the clinic and surrounded by nurses and doctors were thinking the sky would fall over dead. We still have this problem because if you are in private practice you need regimens that you can give easily because otherwise it ties up your office and doctors look for them hopefully they are comparable regimens. In those days there is nothing but that mop program. I want to ask about the fda. You are pretty critical about the way the fda has of proved drug for Cancer Patients. [inaudible] we need the fda. They do a lot of good things and its a nowin job because if they approve drugs rapidly than half of the people criticize it for going too fast, if they go too slowly people like me criticize were going to slow. They are not approving cancer drugs. Cancer is special, its the most fatal disease and people using cancer drugs dont want to wait ten years. They tend to rely on comparing and they tend to look at survival as an endpoint what they should do is based on if its safe to early studies and if it has a biologic target, you can pick up mutations a cancer has. If it hits the target and a safe you should be approved. Most of what were talking about like mop they are done in the postmarketing. So you should give these tools and let them come up with new ways of curing cancer. The way to do that is approve them on the basis of safety hitting the target and then delegate these early trials to the Cancer Centers so do what we call phase i and phase ii studies. They could be done in the Cancer Centers in the fda could retain the right to audit which they have now. But the way it is now if you set up a protocol and someone wrote a paper on this that in some cases it takes 800 days to get a protocol through because it has to go through committees that yell then more committees. So one of the meetings i attended when i first came to my colleague who was called a society of jabbering idiots. It was chaotic. There blackboards all around and people would take a piece of chalk and was one of the most exciting meetings i ever attended and all of my years. The name is misleading. But it was a war room. You took the latest information you had and brought everyone together and you decide how are you are going to adjust the protocol. The next day you change the protocol. Now if you do that the next day might be 800 days away. So if you do what i said, at least based on the basis of safety delegate the phase one and two of the Cancer Centers you would revolutionize new drugs and it will cost less. Its actually less expensive. It would be much better, faster and better system. The fda will not do that on their own. Believe me i ran the Cancer Institute for many years, government does not want to give up power and authority it has to be squeezed out of them. It would take some interest from the congress to go there and get them to change. We need another ann landers writing letter. We dont have ann landers so we dont have mary i never went to a meeting where she was in the audience the senator congressman was speaking i would refer to her as the angel of mercy. They really loved her and she could move them to do something. But we dont have anyone at all, we, we dont have any organization that comes close to being like her. What changes that we can look for to in terms of new treatments . Many people came up and ask questions about what was in the paper recently which is exciting. The most exciting is immunotherapy. Were been looking at it for years and not making much progress except for what rick edison developed a few years ago. He did one of the most successful but it was the 1i were looking at how we could get that system to react to cancers. We didnt know why they didnt. In 1996 a dr. From a hospital in texas discovered what we call checkpoints. Receptors that could be turned down so it would not react. This this way our body protects ourselves and being attacked. So you can now develop drugs that block the checkpoint. Cancer cells are little beast and the notice if you turned on the checkpoints so now we have checkpoints and they been approved and it has changed how melanomas are treated. We now see patients with melanoma living years i may be have been cured of their disease. It is working with lung cancer, which is very difficult to treat. In fact it is working and pretty much ever cancer it has been tried in, not to the same to green. Breast cancer the Response Rate is lower but fair. So now we have chemotherapies and in the therapies, Radiation Therapy and we can and match all of these things. That is now we can engineer these cells. You can find the mutation and mike kollek did this and he took a tumor which really response to anything and found the mutation that was unique to that particular cancer and engineered the t cell to respond to it and kill it. They got responses that no one has ever seen with that particular kind of cancer. That is very personalized medicine because you have to take the tumor you have to seek sequence the genome, you have to have very suspicious sophisticated laboratories to do it. I think as time goes on ill be widely available. When less quick question, so has the cancer act performed its mandate in are we winning the war. To support research, about 70 100,000,000,000 dollars went into basic Laboratory Research. When i went in with mary she would ask that she was am going to ask a 200,000,000 dollars above the president s budget. I said merry theres nothing i can say that could justify it and she said dont worry ill only get half. Sure enough, we could have. 5,000,000 of it would go into the area i talked about, 95 we going to Laboratory Research which is fine and the way it should be at the time. So we support research to reduce the incidence coming down and likes Smoking Cessation programs have been very successful. cancer incidence are down because we can prevent polyps from going into malignancy. We reduce the incidence of many cancers and morbidity is so much less for tumors. Be an older in the field and being able to see you take blood cancer and the difference between outcome and more bidding for Breast Cancer than and now is quite enormous. Mortality rates are down. Overall 25 . This status five years old because it takes us five years to collect all the data. So when we get to measure 25 could when we get to 2015 it could be 35 . It would reduce morbidity and reduce mortality. The mistake made was in san we could do that by the centennial. But the best is yet to come. All of these things has happened with the old not even measuring the impact of immunotherapy or targeted therapies so i think we are in for an exciting time. Thank you. We have some time for questions if anyone has some. There is a microphone. I dont hear as well as i like so you would have to use a microphone. I like to ask you what you think is the role of hope in the treatment of cancer . It is very important. We have if cell had energy and pumped iron and when you die you reach entropy theres no difference between the inside and the outside of the cell. I thought patients who were not responding to treatment they gave up and died. So the ability to do this since i am going to it is very important. Motivation is a very important component of treatment. I have a patient who is treated with hodgkins disease who is alive today and when he would come back he would say to me, when i leave here i get the treatment and were in maryland and as you walk outside their two pools on either side of the door, to symbolic the healing pools of the desert. He said when i used to leave i would take my shoes and socks off and walked through the pools. Which do you think work, the pool of your treatment . And i said i would i would take all the help i could get. [laughter] thank you for your talk. My husband have esophageal cancer, he was fortunate to be operated by doctor swanson who