How We Do Harm by M.D. Otis Webb Brawley

Author:M.D. Otis Webb Brawley [Otis Webb Brawley, M.D., with Paul Goldberg]
Format: epub
Publisher: St . Martin’s Press

Chapter 14

How Much Protection?

THE POWER OF CANCER to kill is so fearsome that treating it naturally invites the metaphor of war. As oncologists, we crave big weapons and are eager to throw them into the field. This is our mind-set, our history, our culture. Sometimes it’s also our folly, our madness.

Some of the key strategies that still guide us can be traced to the NCI of the 1950s and 1960s, when two young doctors with strikingly similar names—Emil “J” Freireich and Emil “Tom” Frei—performed a series of experiments on children dying of acute leukemia.

The leukemia ward at NCI at the time was terrifying. The blood on the sheets was the first thing one noticed—children were routinely bleeding to death. Mortality from the disease was 100 percent.

In 1955, Freireich came up with an idea for controlling the hemorrhages: give the kids platelets. Shockingly to people who thought they understood blood, Freireich was determined to skip a step. He didn’t want to waste time on testing his theories in animals. He would go directly to the kids.

First, J tried thawed-out, previously frozen platelets. When he gave this treatment to a child, the bleeding stopped, albeit for five minutes or so. So, J decided to try fresh platelets.

Hematologists told him it was completely insane. J’s opponents made the—seemingly logical—case that if you infuse fresh platelets even once, the patient would become sensitized, which would render the intervention impossible in the future.

J transfused platelets without formal consent, without protocols, without approval of any board responsible for monitoring ethics and safety; indeed, he did it without any formal safeguards. This was 1955. The concept of “informed consent” did not fully enter medicine until years later. At that time, doctors still knew best, and no forms were required. (Even drugs were still being approved based on their “purity.” Proof of effectiveness was not needed.) If you owned a white coat, you could pursue your hunches.

No one knows how well these children and their parents understood the experiments and the risks. Did the scientists conducting the experiments tell the kids or their parents that they had no earthly idea what was about to happen? Did Freireich and Frei even understand that they had no rational way to predict the outcome? It seems that at best the doctors explained how excited they were about their hypothesis, and permission would follow. What else was there to do? These were desperate parents of dying children.

Fortunately, this time skeptics in the hematology establishment were wrong and J’s approach worked. When leukemia patients were given fresh platelets, their bleeding stopped.

After finding a way to stop the bleeding, Freireich and Frei came up with another wild idea: combine all the drugs that were at the time used to treat the disease. They used four drugs: vincristine, amethopterin, mercaptopurine, and prednisone, abbreviated as VAMP. This regimen was a witch’s brew, a combination of nasty drugs, each with a different mechanism of action and different side effects. They wanted to administer it at a maximum

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