USCF - MOUNT ZION CANCER CENTER Memorandum To: Chancellor Joseph B. Martin, M.D. Box 0402 From: Mack Roach, III, M.D. Assistant Professor of Radiation Oncology Re: Personal Statement as a Member of the Ad Hoc Committee on Radiation Experiments In Humans: Radiotherapy, Clinical Research and Hysteria Date: January 23, 1995 This personal statement was prepared to formally amplify "a voice" that I believe is buried in the conclusions reached by this task force. This "voice" is simple but loud. This voice is the voice of reason that arises from attempting to put my self into the shoes of the physicians who are at the heart of the allegations that we are forced to address. This voice provides a different perspective on interpreting the body of information which I had the opportunity to review as a member of this Ad Hoc committee. Why do I think it is easy for me to put myself into their shoes? I am a Radiation Oncologist and, like them, I to am actively involved in clinical research attempting to improve the outcome for cancer patients using radiation. The clinicians at the core of the allegations were among the pioneers who provided much of the information which forms the basis for how many of us use radiation today. As such, it is my general impression that, ultimately, almost all of the work that was done byu these researchers was done because they were actively looking for ways to improve the outcome of cancer patients. The fact that the federal government was interested in the hazards associated with exposure to radiation does not change what and who these individuals were. They were simply medical doctors interested in the medical applications of radiation. That they were in a position to do the sorts of research that was requested by the federal government was a reflection of their expertise. Their expertise grew out of their demonstrated commitment to and appreciation for the power of radiation to improve the quantity and quality of life for cancer patients. Despite the negative attitudes which typically follow mere mention of the word "radiation", it is now well established that radiation is the single most active agent in the treatment of cancer. As a reflection of this truth, roughly one-half of all cancer patients will receive radiation treatment of cancer. As a reflection of this truth, one-half od all cancer patients will receive radiation treatment in their lifetime. This fact is remarkable, particularly because of the plethora of chemotherapeutic agents which are now 1 widely available for the treatment of cancer. In contrast, in the 1940's there was essentially no effective chemotherapy. With this fact in mind, it is not surprising that there was quite a bit of enthusiasm for the medical applications of radiation. Since then, literally millions of lives have been saved because of the medical uses of radiation. Although most of the major prospective randomized clinical trials establishing the valuable role of radiation for medical applications began in the 1960's, it was work completed in the 40's and 50's that made future applications possible. In order to better understand the attitudes and beliefs of the medical workers during the time that the plutonium experiments occurred it is useful to briefly review the clinical applications of radiation at that time. The primary management of malignant conditions has been tied to the use of radiation for approximately 100 years. In 1895, Roentgen first described x-rays. By 1899, the first patient with skin cancer was cured with radiation and with 10 years radiation was used to treat cancer of the prostate as well as other cancers. Table 1 summarizes a few of the significant moments in the history of the therapeutic applications of radiation. In time, radiotherapy became, and continues to be, a mainstay of treatment for cancers from numerous sites with both curative and palliative intent as is summarized in Table 2. The proliferation and the widespread use of radiation in the early years was astounding. In the early days men, women and children were treated with radiation for such benign conditions as acne, "ring worms", warts, tonsillitis, enlargements of the thymus and "athletes foot". Radiation was also used for a number of bizarre purposes such as measuring foot size. These widespread applications were not undertaken with the desire to do harm but rather reflects the lack of understanding of the true nature of the risks and benefits of radiation during that time period. The pioneers of the 1940's were largely responsible for providing the foundations of knowledge for the clinical applications of radiation. The fact that a large number of the patients injected with radioisotopes at USCF had sarcomatous bone tumor strongly suggests that their research was ultimately guided by interest in medial application and, as such, did not violate any ethical standards or guidelines of the time. I believe that all of the patients were informed. They had to know that they were part of an experiment otherwise it would have been impossible to follow them as carefully as they were followed. To assume 50 years later that they were unaware and that the physicians injected them against their wishes is an insult to their intelligence as well as to the integrity of the physicians. Why would physicians experiment on patients against their knowledge when they could easily get volunteers? It makes no sense. Although in retrospect the practice habits of the time appear crude, so too it is likely that 50 years from now approaches. Let us be fair to the memories of clinicians who sought to improve our lots and not let the words "radiation and human experimentation" bring forth images of Dr. Frankenstein or Chernobyl. Rather we should be able to visualize the millions of people whose lives have been improved or saved due to the clinical application of radiation. cc: Roy Filly, M.D. Chairman, Ad Hoc Committee Via FAX 476-9803 2 Table 1 A Chronologic History of Using Radiation in Humans for 100 years (1895-1990'2) YEAR SIGNIFICANT EVENTS 1895 Wilhelm Conrad Roentgen discovered x-rays 1896 Henri Becquerel discovers radioactivity of uranium 1898 Marie and Pierre Curie discover polonium and radium 1899 First cancer patients treated 1900 P. Curie describes alpha (a) and beta (b) particles and radiation made widely available 1900 Hand held radiological equipment used without protection for the patient or doctor 1920 Kingery describes the "saturation method" for defining the normal tissue tolerance to radiation 1940 MacMillian and Abelson discover plutonium 1941- USCF>300 patients treated with P32, Stronium 89, 1965 radioactive Phos., radiogold and/or total body radiation for CLL, breast cancer, Hodgkin's Disease, acute leukemia and lymphosarcomas 1946 Cal-2 with incurable stage of bone cancer injected with Plutonium prior to surgery 1946 "Manhattan Project" becomes Atomic Energy Commission made radioactive nuclides available for medical, industrial and scientific research. 300 shipments the first year!! 1947 CAL-3 diagnosised as having a form of bone cancer, injected with Plutonium prior to surgery to assess whether it was taken up preferentially by the tumor 1949-63 UCSF Radiological Laboratory - Research establishing uses of radioactive iodine, for thyroid cancer and basic work on the medical use of Neutrons 1968 Radiation prolongs survival from lung cancer in patients who are unresectable 1970's Radiation cures large number of patients with Hodgkin's Disease (Stanford Trials) 1970-80 Radiation allows breast conservation for women without reducing survival 1980's Radiation + Chemo prolongs survival for rectal cancer 1980's Radiation + Chemo prolongs survival for small cell lung cancer 1980's Radiation + Chemo prolongs survival for non-small cell lung cancer 1980's Radiation + Chemo prolongs survival for rectal cancer Table 2 Summary of Common Therapeutic Uses of Radiation in 1995 Tumor Site Common Types of Radiation Used Impact of Radiation Skin Cancers External beam irradiation and Curative radioactive implants Brain Tumors External beam irradiation and Curative or radioactive implants palliative Head & neck External beam irradiation and Curative cancers radioactive implants (mouth & throat) Lung Cancer External beam irradiation Curative or palliative Breast Cancer External beam irradiation Curative or palliative Hodgkin's External beam irradiation Curative or and non- palliative hodgkin's lymphomas Cancer of the External beam irradiation Curative or esophagus palliative Cancer of the External beam irradiation Curative or rectum palliative Adjunctive with surgery Cancer of the External beam irradiation and Curative or prostate/ radioactive implants pallative bladder Cancer of the External beam irradiation Curative testis Cancers of the External beam irradiation and Curative or female radioactive implants pallative reproductive organs Leukemia's External beam irradiation Curative (total body for bone marrow transplanta- tion) Sarcomas External beam irradiation and Adjunctive with radioactive implants surgery Bone External beam/strontium-89 Palliative metastasis 2