August 2010: An obituary in the New York Times described Henry Kaplan, MD, who served as chair of radiology from 1948 to 1972, as the physician and scientist most credited with “transforming Hodgkin’s disease from a hopeless form of cancer to one of the most curable.” Oncologist and professor of medicine emeritus Charlotte Jacobs, MD, [Stanford University] has written a biography about him, Henry Kaplan and the Story of Hodgkin’s Disease. She discussed the book with Krista Conger, a science writer in Office of Communication & Public Affairs [at Stanford University].
- Why write a biography? Jacobs: I got hooked on biographies in elementary school, reading as many as I could devour. Like much of the public, I am interested in other people’s lives — how an individual succeeded, failed, made choices, coped with crises, loved. So when I studied creative writing, I was drawn to biography. The biographer’s onus is to paint a picture of the real person, and that takes a great deal of detective work — finding out all one can through interviews, letters, personal notes — and then putting it into a narrative. Kaplan’s achievements initially attracted me, but it was his uniqueness and flaws that kept me engaged for years. I found his story and that of his family, colleagues and friends compelling.
I wrote this book for the knowledgeable public. I didn’t put MD by my name because this is not a medical book. It is the life of a fascinating man, with relevant medical history and patient stories.
- What makes Kaplan such an important, interesting and also surprising subject for a biography?
Jacobs: Henry Kaplan (1918-1984) ranks as one of the foremost physician-scientists in the history of cancer medicine. A radiation oncologist, he co-invented the linear accelerator to treat cancer and is responsible, in large part, for the cure of Hodgkin’s disease. A gifted scientist racing against a friend, Robert Gallo, he was one of the first to discover a cancer-causing virus. He used a novel technique — a science writer likened it to the development of a steam engine — to develop one of the first monoclonal antibodies to treat cancer. And he was a dedicated, caring physician, who approached each patient as a human being rather than a medical problem.
My book is a dual drama — the biography of this renowned man and the history of Hodgkin’s disease, the malignancy he set out to cure. In the 1950s, when he began his work, Hodgkin’s disease was considered a hopeless condition. Today almost ninety percent of patients survive, in large part because of his work. He not only co-invented the first medical linear accelerator in the western hemisphere, but he also set the standards for its use. He formed a multidisciplinary group of specialists to treat cancer—a model used at most cancer centers today. He and oncologist Saul Rosenberg, MD, ushered in the era of modern clinical trials with their studies. His influence extended beyond Hodgkin’s disease; he changed the way cancer is treated.
He was a multifaceted, enigmatic man, called a “saint’ by some, a “malignant son-of-a-bitch” by others. Several of his closest associates, his brother and his son couldn’t reconcile the man who touched patients with tenderness with the man who devastated them with sharp words.
I knew of the infamous fights with colleagues but not about the humanitarian efforts that imperiled him. He rarely told reporters or even his colleagues about his international efforts to aid physician-researchers. His wife referred to this as his “quiet conviction.” In 1978, he led a boycott against the International Cancer Congress, held in Buenos Aires, in order to draw attention to the desaparecidos, the thousands of Argentineans who had simply disappeared in what was termed the “dirty war.”
Had he been an Argentine scientist, he would have been tortured and executed. He risked his life traveling to Argentina to try to save scientists who constituted a significant number of the disappeared.
- What lessons about scientific and medical breakthroughs — what it takes to achieve them — does Kaplan’s story offer?
Jacobs: Within the framework of Kaplan’s life and the story of Hodgkin’s disease, my book draws attention to broader issues of scientific discovery: the inherent tribulations, the role of chance, the politics of investigation and patients as pioneers.
Medical discoveries require creativity combined with fortitude. The path to curing Hodgkin’s disease was not easy, leaving controversy in the wake of every innovation.
When Kaplan subjected patients to exploratory surgery to determine how Hodgkin’s disease spread, he was accused of performing “living autopsies.” When he devised total lymphoid irradiation to treat all lymph node groups, he was denounced for “burning bodies.” And when he combined radiotherapy and chemotherapy, many questioned his sanity.
The role of serendipity in science cannot be overlooked. Researchers conceived of chemotherapy while studying the aftermath of gas warfare. Kaplan envisioned the linear accelerator to treat cancer when he overheard a cocktail party conversation about a new atom smasher, being designed on campus, which could accelerate atoms to produce high-energy radiation. A forthright man, Kaplan rarely compromised. He risked his reputation when, as an advisor for President Nixon’s National Cancer Act, he defied a group of influential philanthropists and politicians to save the National Cancer Institute from decimation.
The book underscores the importance of clinical trials in testing novel therapies. With progressively improving cure rates can come unanticipated toxicities. Understanding and mitigating them are as important as finding positive results. Trials couldn’t be conducted or progress made without the patients who serve as pioneers in discovering new therapies. Individual patient cases are used in my book to illustrate successes and failures.
- What personal traits made him a great scientist?
Jacobs: At the core of Henry Kaplan’s being lay a passion — a passion to cure cancer. It pushed him to persist despite failures. It helped him weather the storm of criticisms that followed in the wake of almost every one of his innovations. He called cancer his “Moby Dick,” and he set out to annihilate it. Obsessed with curing cancer, he was driven by every new patient, distressed by every death.
Kaplan was intoxicated by science. In the laboratory, he felt exhilarated solving problems. But they had to have relevance to patients. One of the first translational scientists, he took questions from the clinic to the lab and the findings from his laboratory back to the clinic.
He had what I call an ill-fated love affair with Stanford. In 1948, when he first came to the medical school in San Francisco, it was undistinguished. Radiology was considered a service unit, housed in a far corner of an outdated hospital. But he could see beyond the hanging wires and chipped paint. At Stanford, he saw a place where he could create his ideal of an academic radiology department. He was a major proponent of the school’s move to the main campus, and he helped recruit a cadre of brilliant scientists. Before long, he built the country’s foremost radiation therapy department, and the medical school was being mentioned in the same breath with Harvard.
In these efforts, Kaplan fought hard. His fights with deans and his sharp tongue became legendary. His single-mindedness blunted his insight into the hearts and minds of many colleagues, alienating them and isolating him. In the end, this proved to be a liability, especially when it came to fulfilling his dream of building a cancer center at Stanford.
- So what’s your next book?
Jacobs: I am currently working on a biography of Jonas Salk. When a waiting world learned on April 12, 1955, that the Salk vaccine could prevent poliomyelitis, Jonas Salk became a hero almost overnight.
Two aspects of his story intrigue me: Born in a New York tenement, humble in manner, he had all the makings of a twentieth-century icon. His discovery catapulted him into a world of celebrity from which he could never extricate himself. Why was this man, who was beloved by the public, shunned by the scientific community, the one group whose adulation he craved? Having reached acclaim at age forty, Salk had half a lifetime to try to reinvent himself. Was he successful?
To date, no one has written his formal biography. His archives have been closed to the public.