Dr. Folkman’s War

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The Book of the Week is “Dr. Folkman’s War, Angiogenesis and the Struggle to Defeat Cancer” by Robert Cooke, published in 2001.

In the 1970’s, Judah Folkman was a competent surgeon and a very popular professor at Harvard Medical School, but his first love was medical research. He hypothesized about why and how a tumor grows. He inferred that blood vessels grow toward a tumor, but was unable to provide proof for a very long time. He was ostracized for having this radical idea, so he had difficulty attracting enthusiastic graduate students to assist him, and with getting funding for his research.

Traditionally, university medical studies in laboratories had been funded by government grants. Profiteering from patents and medical products resulting from research was considered sleazy in scientific circles. In 1974, Harvard broke the taboo and partnered with the large, profit-making organization called Monsanto.

Even after receiving generous funding, Dr. Folkman worked around the clock simply because making new medical discoveries requires months or years of blood, sweat and tears. The materials required to do experiments can be expensive, messy, odorous and pose unanticipated problems. For a while, Folkman’s lab was working with vast quantities of cow and shark meat (and other obscure, problematic materials) because the animals’ cartilage contains no blood vessels.

Even after the doctor’s studies yielded exciting breakthroughs, media articles influenced the medical community and the public in ways that were harmful to Folkman’s research operations. There were even accusations of fraud against him. It turned out that in his team’s haste to treat cancer patients, many errors were made. Time was of the essence, and procedures for organized data collection were lacking. Folkman wasn’t deliberately trying to deceive anyone.

Folkman was a rare bird in that he was quite altruistic with his time and talents. His patience and persistence allowed him to ignore his detractors and the naysayers (most of whom were jealous). He eventually acquired an area of expertise that not only spawned a new way of thinking about cancer treatment, but also led to treatments for other medical conditions, and whole new industries, including biotech. He also helped shatter a myth in cancer treatment. But this additional idea of Folkman’s still might not be fully accepted in oncology circles (due to GREED), even two decades after the writing of this book.

This is what he learned: The approach to cancer-drug delivery to a tumor of:

“low [dosage] and slow [buildup over the long-term]” was shown to be superior to

“might makes right” and come in with guns blazing; in the past, it was hoped that immediate, large doses would eliminate the tumor before metastasis, and before the patient died from the deaths of too many healthy cells that were also killed in the process.

In other words: The patient’s treatment should begin with a low drug dosage, and if that proves ineffective, increase the dosage gradually until it is effective. Folkman’s experiences with patients showed that that was the successful way to go, and he even saw a few miraculous cures.

Read the book to learn many more details on Folkman’s trials and tribulations and the reasons for them, and what transpired when he finally found vindication.