A Foreign Country

A Foreign Country

George W. Sledge, MD, FASCO

Jul 18, 2011
My son Daniel is a political scientist at the University of Texas at Arlington (am I really old enough to have a son who is an Assistant Professor?) and has been visiting with us this summer. His work focuses on the development of the American public health system, so we are able to converse with each other, the Venn diagrams of our interests overlapping just enough to be comprehensible to each other. Among the books he brought home was the Annual Report of the Surgeon General of the Public Health Service for the fiscal year 1941. I found it interesting reading.

We tend to date cancer research from Richard Nixon’s “War on Cancer” declaration and are now some 40 years from the time when fighting cancer finally became identified as a great national priority. But the National Cancer Institute (NCI) of course preceded the War on Cancer, being created by an act of Congress in 1937. By 1941 it was a growing concern, as the Surgeon General’s report suggests.

But it certainly wasn’t anyone’s idea of a national priority. To give you some sense of how important they thought cancer was, the report devotes two pages to “Plague Control” and two short paragraphs to “Cancer Control.” The NCI was already funding peer-reviewed research, though the amounts of the “grants-in-aid” recommended were tiny, ranging from $500 to LSU for photographic and art work to $16,800 to the Chicago Tumor Institute to study radiotherapy of radioresistant forms of cancers of the mouth, pharynx, and larynx. Though the sums were small, the pay line was spectacular, with 15 of 33 applications recommended for funding: we should be so lucky.

You can already see, in those grants, the faint outlines of the future of cancer research. There is $600 to study “urinary gonadotrophic hormone coincident with testicular neoplasms” (biomarker research; and a biomarker that is still in use seven decades later). The University of California gets big bucks (over 26 grand in two grants) to study the cutting-edge cyclotron-based technology of fast neutron therapy. Jackson Labs (still in existence) receives $15,000 to support research in the genetics of cancer, presumably using the mouse models created there. The report notes that “Much effort was directed toward the solution of the fundamental question: Why does cancerous tissue differ from normal tissue?” Still working on that one.

There are already, in 1941, mouse models for breast cancer, hepatoma, sarcoma, melanoma, and leukemia. I always find it curious that the mouse models preceded permanent cell lines. The report is fascinating for what it doesn’t discuss. Lung cancer, already beginning to burgeon in incidence, gets little play, and cigarette-induced disease receives only one sentence’s mention, an attempt to build a mouse model system. Not surprising: the NCI was way behind the curve on tars and nicotine, and would be late to that fight.

And in regard to therapy, there is one tantalizing sentence: “A large number of synthetic chemicals have been tested for therapeutic activity in various types of animal cancers.” It would take World War II, and a ship filled with poison gas exploding in the harbor at Naples, to move chemotherapy forward into the clinic. And though the Surgeon General’s report has a section devoted to chemotherapy, in 1941 the word lacked its current association with cancer. The Division of Chemotherapy, established that very year, focused its efforts on antimalarials, antituberculous drugs, and sulfa drugs. How many of my ID colleagues think of their antibiotics of choice as chemotherapeutics? As the novelist L.P. Hartley said, "The past is a foreign country: they do things differently there."

It makes you wonder: how will we look, 70 years on? What questions will our grandchildren be wresting with in 2081? What new technologies are patiently waiting to be born? Assuming that the human race has not destroyed itself through inaction and stupidity, will they, as we, and as our predecessors 70 years ago, still be studying the same problems? Or will cancer join the diseases of the past, historically interesting but rarely seen, and when seen rapidly eliminated? “Mrs. Jones, we found ten cancer cells in your kidney; the nanos took care of it and reported it to our computer.” We can only hope.

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Comments

Elizabeth F. Connelly, DO

Jul, 21 2011 10:51 PM

A friend of mine with uveal melanoma with liver mets told me today that as of July 1, several major insurance carriers have decided not to cover palliative therapies such as immunoembolic hepatic therapies or ipilimumab therapy for patients with "orphan diseases" because of the absence of data showing survival benefit. Can anyone verify and clarify this?

Zhong Meikangshi

Aug, 22 2011 3:52 AM

for the cancer treatment, our scientists havent stop their steps, so until now, the scientist found another treatment to treat with the cancer patiets, and this treatment will not cause so much side-effects, also can help the patients recover their body after their chemotherapy or radiotherapy, the treatment is IMMUNOTHERAPY, it is a new therapy, maybe seldom people know it deeply, so if anyone want to know it, you can find the website for more information about it, the website is:www.cancertherapychina.com


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