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physical state from 2 to 4 weeks or 2 years, why could not it be for 20 years? That is what we ask ourselves.
It would seem that the greatest jump would be to get the first remissions-get the establishment of these abnormal cells back to normal again, and I really believe the studies that are being made at Memorial in New York, where there are these many new synthetic agents being made chemically, and we in our own laboratory have synthesized over 250 chemicals with radioactive isotopes with the aid of our own cyclotron and of course the work that is going on at Oak Ridge, we have some 20 of those that have in our preliminary studies with animal tumors given promise enough for trial in the human. So, we are going on with clinical studies very shortly with those in order to approach it from the metabolic point of view, from the chemical point of view and from the isotope point of view—the three main roads down which research is moving with an increase in tempo, I believe that not only will we have these acute leukemias back within 2 years, but I hope we will be able to see them indefinitely remitted. It is no worse now to have a chronic lekemia than a mild case of diabetes or arthritis. We can control leukemia--chronic leukemia-in 90 percent of the cases and they usually die of something else.
Mr. DOLLIVER. What are the measures which you take in leukemia?
Dr. Doan. Do you mean the acute? There is a different approach to each, and as to whether it is a metabolic or the cancerous condition. We have studied that matter very intensively. In the 1,600 consecutive cases of leukemia that I have personally seen within the last 20 years, we think only 400 of those, or 25 percent, are true malignancies in terms of a malignant disease. The others are metabolic, or they come under the category of pernicious anemia, which was thought to be a cancer to start with. It is a deficiency disease, and many of the chronic leukemias have the same characteristics for white cells, and yet we know as much about what it takes to mature a young white cell to maturity as we know about red cells. With vitamin B12 and folic acid we will have the answer to chronic leukemia. We do not have to study and solve the problem of malignant diseases to cure the so-called leukemia. So that is the approach there.
If we get a mild overproduction of cells, as in chronic leukemia, we have to use a supressive or destructive agent if we cannot control it by the metabolic activities. We are looking for an enzymatic material much like insulin is for diabetes, and if we get that we should be well on our way. We believe the enzymes that are necessary to break down proteins for body synthesis, which gradually decrease in their productivity just as the material necessary to prepare red muscle meat for red-cell generation needs to be supplied. When we have that, then these cells will mature, and we are on the road to that with the aminol acids and the various enzymes that break down proteins to aminol acids and fatty acids to get a better understanding of what is necessary for these cells.
If that does not help, then we have to use mild suppressive agents such as deep X-ray, if it is in small doses, of radioactive phosphorus, P32, which is very effective in very chronic types of conditions. We have cured chronic leukemia as long as 20 years with mild radiation or radioactive phosphorus.
There are other chemicals which we can use. One of the other mild suppressives which will differentially suppress the abnormality of the white cells without destroying other cells—and that is the criteria of an agent that will specifically depress a cell that has a little more stimulus than a cell which does not, is the folic acid. In the acute leukemia, of course, as you have already heard, the folic-acid antagonists are very effective in the acute sarcoma.
The new purine which which was shared with us in the early days in the work which has been done by Dr. Rhoads has added markedly to our armament in the acute leukemia cases, and a still further new unit has been made available within the last 6 weeks. So with cortisone, with ACTH, with folic acid, with nitrogen mustard, and with these new agents, any one of which may be specific for a short time for an individual but not in the same individual from time to time, we can prolong the life and usefulness of many of these patients, both children and adults, for matters of months or of a few years.
It simply means, from the standpoint of trying to say so, that the progress made in this field, I think, is as great today and is as promising as the antibiotics in the field of infectious diseases. I feel just that way, and I have been right close to it for 30 years.
The CHAIRMAN. Doctor, your presence has indeed been very encouraging. You speak with a note of optimism that we are glad to hear, because, after all, while these studies are interesting from the standpoint of detailed information that is provided, after all, what we are seeking is something that will alleviate the condition so far as the public is concerned.
When you speak as you do here today, it is very encouraging, because it is really observable that you have optimism which is an optimism and belief that is not based on pollyanna optimism, but optimism based upon studies which you have made in long contact with the problem. You are able to look ahead and speak in the optimistic way that you do.
The presentation which you have made suggests that chemistry and physics and biology and all the biosciences are all assuming partnership with the doctors in the modern attack on disease. I think it is very fortunate that in your activities you can have a combination of these working together, so to speak, which promise the results that enable you to be optimistic.
We certainly are indeed indebted to you for your appearance here today. What you have stated adds very materially to what we have heard on Friday and Saturday of last week. It gives the committee additional encouragement to press on when men of your standing come here voluntarily as you have and give us the benefit of the information that you have gained through years of study, and years of activity. At times undoubtedly you have been discouraged and at other times you have been encouraged, all of which goes to make up the experience that brings you here today and gives us your optimistic view which you have expressed. We are indeed grateful to
you. Ďr. Doan. May I just add that even as we have been cooperating with other agencies in funds, so every unit of research-each research group across this country is as close as the telephone, and time and again we have had from our laboratory communications to others and they to us, and the great thing in this free country of ours is that not only is there an interchange of financial support, but the information which one group gets on the Pacific coast, that group on the east coast also receives. It is just as quickly flashed as was the football game on Saturday from California to us and as the baseball game which is now going on in New York to us. So, we are in an age when every combined effort, you and ourselves combined, are going to solve this problem, I am sure, in the best interest of humanity. Thank you.
The CHAIRMAN. We thank you that you included this committee in what you hope will be the ultimate results.
Dr. Doan. I certainly do.
Mr. HESELTON. Doctor, several times there have been references to isotopes and you made reference to it. I am sorry you did not explain what that is. I would like to have a brief description of what it is.
Dr. Doan. Radioactive istopes are produced in the uranium pile or in the cyclotron. In 1939 or 1940 Ernest Laurence in California established a large cyclotron that was able to crack the atom and produce certain elements that had radioactivity. Following this, John Laurence, his brother, went from Yale with a man trained in my department, to California and gave the very first product of the new large cyclotron there to a human patient with radioactive phosphorus. That is an element that during the first 14 days of its creation loses one-half of its radioactivity, whereas radium may have years or millions of years of activity.
This is a temporary activity that is given for radioactivity and phosphorus is metabolized by bones, and in leukemia the overgrowth of cells is largely in the bone marrow. Therefore, this phosphorus, just as it metabolized with calcium in making the skeleton, is deposited in the skeleton and bombards like a machinegun those cells near it which are growing at an abnormal pace. Well, by adjusting the dosage of the ammunition, like putting a brake band on and putting a brake just so tight, will just slow that process down so that the person who is being overburdened by too active a process, will be brought down to normal, we have to reline the brake bands with a little more of this radioactive phosphorus.
Then, came cobalt-60, which is a radioactive cobalt, which has a 5year life and can be used much less as the radium, but can be substituted as a gamma-ray treatment for use in cancer that cannot be removed. Then, we come to radioactive gold, which is the least tarnishing of metals—one one that is least radioactive. Now, we can make gold which has two and one-half days' life of radioactivity in nylon thread and when one gets a tumor that cannot be removed surgically because it involves a main blood vessel, one can sew into that tissue these little bits of radioactive gold with an exact dosage. So, if we are wise enough to know just what the dose for that given unit is, it is like the electric chair. You try to get just the cells that are still cancerous out just like we do an abnormal member of societyget him out before he cuts other people out. That has been developed to a high stage, both cobalt and gold isotopes. This is material that is inert material which is placed in the pile at Oak Ridge, brought to our laboratories then by air and are produced there and used. We have had over 100 patients that we have used this supplement of
radioactive gold seed, which is a real advance in adding to surgery. We all admit if you can cut out a cancer,
that is gone, but if you cannot get to it, now we have a way of getting right to the seedright to the place where it is. If you leave the gold in, it is all right. If you can have gold in your mouth, we can have gold in your tissue. It does not cause a reaction, or you can put in the threads and pull them out after a week or two. That is a development which adds to the facilities of the surgeon in handling growths, which is what we are after.
There are two methods of approach : What is the cause of it? Let us take the question of cancer. That is one method and that is the basic research. What is it that gets wrong with cells that make them behave as do some people in society? Well, we are trying to find that out. Once you get a cell of that kind in the body or a group of cells, how can we get rid of them without the knife or with these radioactive isotopes? So, the radioactive isotopes are elements that have been made radioactive with fairly regular lengths of life. Then, we have the gamma ray and that is what we want for cancer. That can be brought in close contact with the enemy and those cells threatening to take over. They represent a tremendous asset to the surgeon and make it possible for him to go one step farther in prolonging the useful life of an individual. When you have a tumor where there is a main vessel where he cannot go farther without disturbing something else, then you sew these in.
Now, it is possible by seeing the type of cell under the microscope and knowing what its sensity is, to figure a dose which is pretty accurate and getting increasingly more accurate, and being able to place it within a pinpoint of where it should be, knowing the susceptibility and cell type with which you are dealing, by seeing it and then bringing these things to bear, we will have a tremendous prolonging of life in a lot of people where we do not actually eliminate surgically the cancer.
The CHAIRMAN. Thank you, Doctor.
Doctor, again thank you on behalf of the committee for your willingness to come here, and having offered to us as a witness your testimony and experience. It has been very beneficial to us in the work we are striving to do. We feel greatly indebted to you.
Dr. Doan. Thank you for the privilege, Mr. Chairman.
Mr. PRIEST. I would like to concur with the chairman, Doctor, and also express an additional appreciation for the leadership whích I think you have given at Ohio State in developing a balanced program between State and the Federal Government.
Dr. Doan. Good.
Mr. PRIEST. I think you have been a leader in that field and have done a terrifically important job that needs to be done, and I want to express that appreciation,
Dr. Doan. Thank you. We are very proud of it.
I do not know how to express, as we bring to a close these hearings on cancer, the great degree of gratification that comes to us to realize the progress that is being made by means of research. It certainly gives promise for the future in a way that is most encouraging. It is particularly gratifying to see the extent of the work on this disease, and no doubt it will prove equally true of other diseases we will study, when we realize the extent of time and effort that is being put forth by individuals who cannot be actuated by any other motive than to do something that will prove helpful to their fellow man.
Certainly I have not been able to observe, nor do I expect to be able to see, that the monetary returns, which will come to the individuals who are doing this work are in any way a compensation for the benefits that their work will give to humanity in general. Therefore, I have great respect, and I wish it were possible for me to express in better words our appreciation to you who have appeared here this morning for the splendid work which you are doing and directing in these different activities in which we are engaged.
I can only say that the future has promise, great promise, as you proceed with your work. While it may be tedious and a day in itself will not reveal much progress, yet as you do look back over what you have been able to accomplish and have that as a basis for what you will do in the future I think you can take great courage and be inspired to carry on that we will come to those things that will prove worthwhile and will be for the benefit of humanity in general.
We thank you, Doctor. You have headed up this panel in a very fine way, and those who have been with you have assisted in a way that cannot help but be very productive in the work of this committee and our objective, which we hope to obtain. Dr. BUGHER. Thank you, sir. The CHAIRMAN. We are adjourned. (The following tables were submitted for the record:)