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Authors: Harry Stein
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endured. The descriptions of the trials being performed at the ACF were more than just fascinating; after his introduction to the place, they were invigorating. This was what mattered, not all the personality conflicts and petty bureaucratic maneuverings. Those came with every job everywhere. But only at the ACF was it possible to do this kind of remarkable work.
The protocols were the heart and soul of the ACF, the very reason for its existence and wondrous reputation. For a young doctor, studying them was a chance to explore the thinking of the greatest minds in the field, to have the very future of cancer medicine laid out before him.
Each of the thirty-six protocol proposals ran at least twenty-five pages and was loaded with the kind of obscure language and arcane detail that would quickly put off anyone outside the field. But to Dan, every one was like a chapter of an epic detective story. For it suggested a new approach to the age-old mystery of cancer; a plausible theory about why and how malignant cells grow and change as they do; a daring hypothesis about how this or that drug might have an impact where nothing had ever worked before.
Logan was not surprised by the number of compounds that had demonstrated activity against malignancy—at least in a test tube or a rat. Too, he was prepared for the staggering variety of problems that remained in almost every instance, most involving the complex issue of toxicity: fully a third of the trials focused on mechanisms for targeting tumor cells while leaving surrounding healthy cells intact. But what did take him aback, what he had never before fully grasped, was how many of the most promising drugs had in some form been known to scientists for decades. It was just that, among the hundreds of thousands of compounds available, with more being developed every day, their potential uses had never before been fathomed, let alone tested; no one, until now, having made the essential leaps of logic and imagination.
Logan found himself absorbed even by the specifics of patient eligibility, daily treatment plans, and statistical analyses of data. Able to see the desperate human beings beyond the cold numbers, he understood that a change of just a few percentage points in the survival rates represented the lives of thousands of individuals and the well-being of countless families.
The next morning, Reston caught the bounce in Logan’s step as soon as he saw him approaching the administration building lobby.
“Who’d
you
sleep with?”
Logan laughed. “I have the feeling I’m not going to be sleeping with anyone for a long time—unless I find someone who gets turned on by randomized trials in Hodgkin’s disease.”
“Ah, you’ve been going through the protocols.…”
Logan nodded. “God, some of the stuff that’s being done around here!”
“I know,” smiled Reston. “Amazing, isn’t it?”
“I mean, I’m reading this stuff and thinking,
What the hell do these people need me for?
”
“We went through that yesterday with Larsen—to do the scut work.” He snickered. “But don’t give me any ofthat false-modesty crap. You’re thinking the same thing I am:
How soon before
I
get to run a protocol of my own?
”
Logan smiled. “Me? I’m a humble junior associate, I accept my station in life.”
“Like hell.”
“At least for public consumption.” He glanced around the busy lobby. “Look, seriously, that kind of talk’s not going to do either of us any good.”
“Logan, they know we’re ambitious. Ambition is part of what they were after when they brought us here.”
“
Controlled
ambition. Ambition in the service of the greater good.”
Reston nodded. “You’re right. The first order of business”—his voice dropped slightly—“is figuring out which of the senior guys to try and get as a godfather.”
“Reston, you’re really out of your mind, you know that?”
“What are you, blind, deaf, and dumb or just pretending to be? You
The protocols were the heart and soul of the ACF, the very reason for its existence and wondrous reputation. For a young doctor, studying them was a chance to explore the thinking of the greatest minds in the field, to have the very future of cancer medicine laid out before him.
Each of the thirty-six protocol proposals ran at least twenty-five pages and was loaded with the kind of obscure language and arcane detail that would quickly put off anyone outside the field. But to Dan, every one was like a chapter of an epic detective story. For it suggested a new approach to the age-old mystery of cancer; a plausible theory about why and how malignant cells grow and change as they do; a daring hypothesis about how this or that drug might have an impact where nothing had ever worked before.
Logan was not surprised by the number of compounds that had demonstrated activity against malignancy—at least in a test tube or a rat. Too, he was prepared for the staggering variety of problems that remained in almost every instance, most involving the complex issue of toxicity: fully a third of the trials focused on mechanisms for targeting tumor cells while leaving surrounding healthy cells intact. But what did take him aback, what he had never before fully grasped, was how many of the most promising drugs had in some form been known to scientists for decades. It was just that, among the hundreds of thousands of compounds available, with more being developed every day, their potential uses had never before been fathomed, let alone tested; no one, until now, having made the essential leaps of logic and imagination.
Logan found himself absorbed even by the specifics of patient eligibility, daily treatment plans, and statistical analyses of data. Able to see the desperate human beings beyond the cold numbers, he understood that a change of just a few percentage points in the survival rates represented the lives of thousands of individuals and the well-being of countless families.
The next morning, Reston caught the bounce in Logan’s step as soon as he saw him approaching the administration building lobby.
“Who’d
you
sleep with?”
Logan laughed. “I have the feeling I’m not going to be sleeping with anyone for a long time—unless I find someone who gets turned on by randomized trials in Hodgkin’s disease.”
“Ah, you’ve been going through the protocols.…”
Logan nodded. “God, some of the stuff that’s being done around here!”
“I know,” smiled Reston. “Amazing, isn’t it?”
“I mean, I’m reading this stuff and thinking,
What the hell do these people need me for?
”
“We went through that yesterday with Larsen—to do the scut work.” He snickered. “But don’t give me any ofthat false-modesty crap. You’re thinking the same thing I am:
How soon before
I
get to run a protocol of my own?
”
Logan smiled. “Me? I’m a humble junior associate, I accept my station in life.”
“Like hell.”
“At least for public consumption.” He glanced around the busy lobby. “Look, seriously, that kind of talk’s not going to do either of us any good.”
“Logan, they know we’re ambitious. Ambition is part of what they were after when they brought us here.”
“
Controlled
ambition. Ambition in the service of the greater good.”
Reston nodded. “You’re right. The first order of business”—his voice dropped slightly—“is figuring out which of the senior guys to try and get as a godfather.”
“Reston, you’re really out of your mind, you know that?”
“What are you, blind, deaf, and dumb or just pretending to be? You