Expert Commentary: Stuart Diamond, Editor-in-Chief - 6/19/2009

Some questions are striking to me: why was immunotherapeutic treatments so out of fashion with mainstream medicine – when today it is considered one of the most promising therapeutic frontiers?  And why was chemotherapeutic and radiological research so dominant for the first part of the 20th century? Why weren’t research scientists exploring this approach to curing cancer?

One answer:  the Flexner Report. The report was written by Abraham Flexner in 1910 for the Carnegie Foundation.  The report was a commentary of the state of medical education at the time. It criticized the fact that there were too many medical schools, many of which were substandard.  At the time of the Report, many medical schools were private schools operated more for profit than for education. And the medical profession itself was as populated by snake-oil salesman as by legitimate physicians.  Flexner’s report triggered reforms throughout the field of medicine. Medical school standards were dramatically raised, setting admissions standards, requiring basic training in the sciences, and requiring clinical experience. When the report was issued there were 155 medical schools in the country. By 1935 only 66 schools survived the reform.

These reforms helped set high professional medical standards, improving the quality of medical care throughout the nation. As important as the reforms were, there is a growing acknowledgement that a great deal of good medicine may have been shunted to the side. For one, medical schools became all male and all white. Before the report the healing profession included men and women of all races and ethnicity -- a “standard” whose wall was broken but a few decades ago. Other orphaned agendas were the victims of a narrowing focus of interest into only “approved’ areas of research.

At the turn of the last century, science was excited by the new technologies, Madam’s Curie’s X-rays revealed the internal structures of the body, making the invisible visible. (The deadly consequences of radiation were just beginning to be discovered.) And organic chemistry was the new conceptual model of how the body worked. Thus radiation therapy and chemotherapy became the focus of research. And anything based on folk medicine, tried and true remedies of the ages, were often dismissed as minimally effective, or worse, superstitions.  Thus many babies were thrown out with the bath water. Immunotherapy, using the bodies’ own natural defenses, was associated with “alternative” treatments – a suspect sideshow to the main thrust of 20th medical research.

All well and good – except the modern miracles of many radiological and chemotherapeutic therapies had their limits. In cancer, the therapies worked, but too often with devastating side effects.  It wasn’t until the 1970s, when “mainstream” medical researchers began to explore new ways to harness the bodies’ natural immunotherapeutic responses in battling cancer.

It wasn’t until 1975 that Georges Kohler, Cesar Milstein  and Niels Kaj Jerne developed the  first Monoclonal Antibodies. They won the Nobel Prize in Medicine in 1984. A story of the ebb and flow of how we see the world affects our lives – for both good and for ill.