J

J

By

Leonard Zwelling

https://www.nytimes.com/2021/02/07/science/emil-freireich-dead.html

https://cancerletter.com/articles/20210205_5/

One letter was all that was needed to know who you were talking about. Emil J Freireich died on February 1 as one of the most distinguished medical oncologists in all of history—and one of the first. In a discipline still demarcated by the lines between doctors who use surgery, radiation or drugs to treat cancer, medical oncology, the use of the drugs, is the newest sub-discipline. It was begun by visionaries at the National Cancer Institute in the mid-1950s. J Freireich was one of those at ground zero.

All of this is covered in the many tributes to his long life and many contributions to science.

file:///Users/leonardzwelling/Downloads/INTRODUCTION%20-%20version%20210207ai.pdf

My mentor Kurt W. Kohn, MD, PhD gives a terrific first-hand account of the early days of combination chemotherapy in his contribution to the NCI web site included here.

I have a very different take on J Freireich because I met him after he had become a legend.

I think my first encounter was in 1980 when I was first recruited to MD Anderson from my position at the NCI. He scared the hell out of me. He was so much bigger than life and so sure of his view of the road to the cure for cancer. His philosophy was also quite different from the more modern, post-Institutional Review Board and Belmont Report process I was taught at the NCI. I was in shock. J knew what was right for any patient, any doctor, and any young faculty. The job of the faculty was to find a new treatment for a cancer, preferably a cure. My interest was in biologically-relevant target molecules of established cancer drugs and their testing in the laboratory to understand their mechanisms of action. I never saw myself as a clinical investigator as most of the faculty of Developmental Therapeutics (J’s department) at MD Anderson did in 1980. I didn’t take the job. It would have been a bad match and the end of my career, I fear. I could never have lived up to or emulated J’s philosophy of cancer care or clinical investigation. I had just spent four years learning new lab skills and did not want to detract from a career at the bench doing clinical trials with patients.

Four years later I was recruited to MD Anderson by Dr. Irwin Krakoff, the new Head of Cancer Medicine who had, for all intents and purposes, supplanted Dr. Freireich as the leader of the chemotherapy arm of the MD Anderson. Dr. Freireich and the President of MD Anderson, Dr. Mickey LeMaistre, did not see eye to eye on almost anything. Dr. Krakoff was brought to Houston to change the direction of cancer chemotherapy research at the institution and Dr. Krakoff’s direction was in line with the way I was taught at the very NCI that Dr. Freireich had vacated in 1965. That’s when I joined MD Anderson (1984) where what I wanted to do and what Dr. Krakoff wanted me to do were one and the same.

Soon enough I caught up with Dr. Freireich again and like everyone else fell under his spell because he thought the work I had done with one of his faculty in my lab was ingenious. It wasn’t, but it was nice to hear. That’s how he got you. He used honey and he used vinegar and the combination made you want to be the best you you could be. Unlike me, J Freireich was, in fact, a genius. But more than that, he was a leader. Now we look to people like Tom Brady as exemplifying leadership and getting the people around them to be their best. J was Tom Brady long before there was a Tom Brady.

However, he and I would eventually get crossways over the rules governing clinical research. J’s view of clinical research was that every patient should be on a clinical trial and no one had to get conventional drugs that they could get elsewhere if they came to MD Anderson. I didn’t disagree, but I did demand adherence to the principles governing good clinical practice and the federal rules governing clinical research even when Dr. Freireich or his minions thought otherwise. I had risen to be Vice President for Research Administration overseeing the infrastructure governing clinical research and the adherence to those rules by all at the institution. Dr. Freireich’s colleagues did not enjoy the constraints mandated by such rules and often skirted them or frankly flouted them. That put J and me on a collision course once in a while, but that did not alter the mutual respect. After all it was my boss at the NCI, Dr. Kohn, who first told me about the exploits of Frei and Freireich and how they had invented combination chemotherapy when Dr. Kohn was a trainee at the NCI. I knew what J had done and was in awe of it. In essence he invented the discipline that gave me a career.

I will always be grateful for having known Dr. Freireich. Knowing him was a bigger than life, once in a lifetime encounter with greatness. Unlike most of the rest of us, he really was a genius. To have invented platelet harvesting and transfusions as well as curative combination chemotherapy in one lifetime is amazing. To have also trained hundreds of disciples is even more so. We will not see the likes of J Freireich again any time soon.

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