Promise and Progress - Humble Guy
Date: April 1, 2007
Reflections on the decade and a half at the helm of one of the world's greatest cancer centers and the years leading up to it.
There are a lot of different adjectives that could be used to describe Dr. Martin Abeloff:
Brilliant clinician—He brought breast cancer therapy into the oncology clinic at Johns Hopkins, headed ASCO, the world’s leading organization of clinical oncologists, chaired the FDA oncology drug advisory board, served as a member of the NCI advisory board. He was a pioneer in translational research and worked diligently to make sure that doctors, not insurance company executives, decided who could be treated with experimental cancer therapies.
Leader—After serving as chief of medical oncology, he became thesecond director of the Cancer Center. He secured funding for a state-of-the-art clinical facility and two cutting-edge cancer research buildings, creating a campus for cancer research and care at Johns Hopkins. He brought together all of the disciplines involved in the prevention, diagnosis, treatment and supportive care of cancer to wage a formidable assault against the many diseases that are called cancer and secured the largest single gift to JHU.
Mentor—The list of talented clinicians and investigators who creditDr. Abeloff with their success are too long to mention. Among them is breast cancer program director Nancy Davidson, the newly elected president of the American Society of Clinical Oncology and herself a recognized national leader in breast cancer research and treatment.
Well rounded—He is the Cancer Center director by day, a music lover by night. Dr. Abeloff’s knowledge of art, music and literature is impressive. Under his leadership, the Art of Healing Program was established, boasting a collection of museum-quality artwork to decorate the clinical building as well as a concert-hall quality music program.
Knowledgeable—He can cite cancerrelated facts and statistics and all things Kimmel Cancer Center without hesitation.
Family man—For 40 years, he has been the devoted husband to Diane, whom he credits with too many things to mention, including instilling his love of art. He is the proud father of Elisa and Jennifer and a doting grandfather to Helen, Aaron, and Lily. As director, he is as supportive and respectful of his faculty and staffs’ roles as mothers and fathers and husbands and wives as he is of their professional roles.
But the word that probably best describes him is humble—so humble, in fact, that the citing of the aforementioned qualities would most surely make him quite uncomfortable. It is perhaps his most admirable quality of all and one that he likely gained long before he came to Johns Hopkins
Growing up in Schuylkill County, Pennsylvania, in the small coal-mining town of Shenandoah, most high school students could scarcely imagine going to college, much less medical school. But Martin Abeloff had been inspired, however subtly, from a young age. It was a convergence of several defining moments that cemented, by age 16, Abeloff’s desire to be a doctor and to specialize in cancer.
His father had always been interested in medicine, but it wasn’t feasible for him to go to medical school. Instead he became a pharmacist and owned the town’s apothecary and soda fountain. Abeloff spent much of his childhood in the store, working side by side with his mother and father. He dished ice cream and conversation with a lot of people, perhaps contributing to the six-foot-four man’s down-to-earth personality and skill as a communicator. He is as comfortable—and comforting—speaking with a multimillion dollar donor about cancer treatment and research progress as he is talking with patients and families about a promising new therapy.
Sports were a great diversion in the hardworking blue-collar town, with frequent talk about Philadelphia-based teams and players. In the Abeloff household, though, there was a different hero. William Dameshek, one of the world’s most renowned and revered hematologists and a pioneer in the treatment of hematologic cancers, was a relative of his mother and to the young Abeloff, he was larger than life and a frequent topic of conversation. “In my home, medicine was held in high regard,” he says. “When you talked about medicine, my parents’ faces lit up.”
While he says his mother never directly tried to persuade him to become a doctor, she was an influence in his decision. When he was just 12, she was diagnosed with breast cancer. In the 1950s, the standard course of treatment was an invasive and debilitating operation known as radical mastectomy, which meant surgically removing the entire breast, the underlying muscle as well as substantial tissue from the armpit. One memory remains very clear for him. As part of her recovery, his mother had to do exercises to regain strength and movement in her arm. He recalls observing her as she struggled in pain to regain mobility by sliding her arm up the wall and above her head. It is this memory, and the patients he treated, that taught Abeloff early on that the real impact of cancer was much greater than its daunting statistics. “Therapies have been lengthy, toxic, and disfiguring,” he says, “adding to the amount of suffering that a patient and family endures.”
Abeloff’s concern for the caring of cancer patients, body and soul, is apparent throughout the Center, from the comforting artwork on the walls to the depth of the medical and scientific programs he has put into place, and it is what many say makes him a healer in the truest sense of the word.
This quality, too, was probably learned at a young age, and formed, in part, by John Gunther’s Death Be Not Proud. The book was Gunther’s personal and moving chronicle of his son’s battle and ultimate death from brain cancer at just 17. Writing in 1949, Gunther told about the mystery and chaos that was cancer, but also poignantly described his young son’s courage and good spiritin the face of this menacing cancer. For Abeloff, the physical and emotional components of cancer would remain inextricably entwined. “You simply can’t treat cancer without paying attention to the psychological and social aspects of the disease,” he says.
This understanding is reflected in the breadth of his body of work over the last 35 years. Yes, there are the pathology studies, the drug trials, and biomarker research, but there are also psychological studies of cancer patients. Abeloff has a gift for seeing the complete picture—how each piece of the cancer research and treatment puzzle fit together and how even one missing piece, whether it is scientific or humanistic, can detract from the the ultimate ability to help patients. The truth is, say colleagues, that Abeloff recognized the value of interdisciplinary clinical and laboratory research long before he had the opportunity to put it into place at the Kimmel Cancer Center. This vision surely was what helped him rise from unlikely Johns Hopkins medical school candidate to head of one of the institution’s premier departments.
A Hopkins Man
Abeloff’s path to Johns Hopkins was not as certain as his path to medicine. There weren’t many colleges paying attention to high schoolers in Shenandoah, but Abeloff received interest from Franklin and Marshall in nearby Lancaster. The college had a good premedical program, and at the time, it was the biggest step this small-town boy and his family were prepared to take.
Abeloff spent two years at Franklin and Marshall, but longed for a more stimulating environment. A roommate told him about an accelerated program at Johns Hopkins. “I knew of the Hopkins reputation, but I had no connections and was not optimistic,” recalls Abeloff. He received an interview, an intimidating one at that, with a committee of faculty and administrators looming large from across a conference table. “I don’t think Franklin and Marshall was on the list of colleges they were looking to for candidates,” quips Abeloff. “I really didn’t expect to get in, but about two weeks later that big envelope arrived.” He was in.
In 1961, he entered what was called the 2-5 accelerated program at The Johns Hopkins School of Medicine. “Coming here was exactly what I needed, but I never intended to stay beyond medical school,” he says.
He mentioned to then-Dean of Students Julius Krevans that he was interested in cancer research. Krevans sent him to see researcher Dr. Albert Owens who had a novel idea that cancer could be treated with drugs, and with a small group ofresearchers, he was working to prove it. Among them was bone marrow transplant pioneer George Santos. Owens sent Abeloff to work in Santos’ lab at Baltimore City Hospitals.
Abeloff studied with many of the founders of the field of oncology at Hopkins and other stellar medical institutions. Likely, the most significant for him was his clerkship at Tufts- New England Medical Center on the service of his childhood hero William Dameshek. But, arguably the most significant influence was Diane Kaufman, an Art as Applied to Medicine student at the School of Medicine he met at Johns Hopkins and married during his internship in 1967.
Abeloff interned in medicine at the University of Chicago and returned for cancer research training to the Baltimore Cancer Research Center at Wyman Park, a branch of the NCI. The lure of Boston was great, so Abeloff did his residency at the Beth Israel Hospital and a hematology fellowship at New England Medical Center.
In 1972, however, Baltimore beckoned him again. Talk of an oncology center at Hopkins was beginning, and he returned as a fellow in the fledgling department of oncology. His salary was $18,000, which even by 1972 standards wasn’t much. But it was an exciting time in the emerging field, and Johns Hopkins was on the forefront as one of the first medical institutions in the country to build a center focused solely on the treatment and research of cancer. Abeloff believed this was a place that could make a difference in the management of cancer and decided to stay. “Diane and I never would have predicted we would end up staying in Baltimore,” he says, “but it has been a great home for us.”
The Early Days in the Under the Door Clinic
Cancer was a mysterious disease. No one knew what caused it, and often patients seemed to go from healthy to sick to dead in a short amount of time. With a lack of any real body of knowledge about the disease but a growing number of cases, the public imagination ran wild and people feared it like the black plague.
Recognition of these new specialists called oncologists was just beginning. There were a few surgeons who were treating cancer patients with chemotherapy, but the medical oncology clinic was a new idea at Hopkins. Abeloff was on the front lines as one of the first foot soldiers in what would soon be classified as the “war on cancer,” as they simultaneously tried to figure out what caused it and what drugs might stop it. “There was an urgency about this disease that demanded a merging of laboratory and clinic,” he says. “In many ways, cancer became the impetus for translational medicine as we know it today.”
The Oncology Center, which is what the first Johns Hopkins cancer treatment and research facility was called, had not yet been built, and Abeloff and other oncologists saw patients in a clinic set up in the Carnegie Building. Abeloff called it the Under the Door Clinic. “I would be sitting in my office reviewing the chart of the patient I was about to see, and inevitably a note would be passed under the door,” explains Abeloff. “My father doesn’t know he has cancer,” was the typical message. The notes referred to different family members, but they were all basically the same, warning Abeloff not to let on to the patient that he or she had cancer.
Of course, Abeloff could not treat patients without being honest with them, and more often than not, he found that they already knew; saying it out loud freed them to talk about it. “Many patients felt guilty, as if it was their fault they had cancer,” he says. “This blaming-the-patient mindset was common at the time and added to the stigma of the disease. I’m happy to say we have, for the most part, gotten beyond that today.” In fact, he adds, one cannot talk about advances made against cancer without recognizing the forceful but thoughtful activism of patients that raised public awareness and made it possible to talk freely about breasts, colons, and prostates.
In the cancer research laboratories at Hopkins, most investigators were focusing on leukemia research and bone marrow transplant. Abeloff, who decided to be a clinical investigator, but had done most of his training in blood-forming cancers, was now seeing patients with lung, breast, colon, and other cancers. “There were no cancer-specific specialists in those days. We saw them all,” says Abeloff. His first clinical research, interestingly enough, was not on breast cancer, the disease for which he is revered as a world-class expert, but rather on another type of cancer —small cell lung cancer.
Small cell lung cancer, an aggressive form of lung cancer, was unlike most solid tumors. It could not be treated surgically. Drug and radiation therapy was patients’ only hope. He began a collaboration with another young investigator, David Ettinger, also interested in developing medical therapies to combat this cancer. Rounding out the team was endocrinologist Stephen Baylin. Together they developed the first translational lung cancer program. During the 1980s, Abeloff shifted his focus to breast cancer and new responsibilities as chief of medical oncology, but Ettinger and Baylin remain to this day focused on the treatment and research of lung cancer.
Turning Research into Results
“What we have learned about the cancer cell in the laboratory has been very important in teaching us about cancer’s weaknesses,” says Abeloff, “but the real gains are made when we can take these laboratory findings and use them to improve the treatment and life of patients with cancer. And this is an area where our scientists have excelled. I don’t think there’s any institution in the world that has an edge on us."
It is only when speaking about the talented teams that have come together in the Kimmel Cancer Center that Abeloff shows even the vaguest hint of immodesty.
“Our investigators and clinicians have spanned the boundaries of academic departments and medical disciplines to battle this complex group of 100 to 200 diseases,” he says. The last 15 years, he adds have seen many new developments in cancer— gene testing, vaccines, targeted therapies, new screening tests, new prevention methods and combinations of all of these approaches—that have significantly diminished the disease’s capacity to affect the quality and length of a person’s life.
“Even patients with advanced disease are benefiting like never before with new therapies that don’t cure the cancer but keep it in check, giving them many years of good life,” says Abeloff. “Breast cancer is a perfect example. From 1972, when I saw my first breast cancer patient, to 2007, the progress made against this disease has been impressive. It is a good model for how one makes progress against a common epithelial cancer. We are curing more patients. Those we don’t cure are spending more time symptom free, and the reality is that it is getting better all of the time.”
Despite the successes, significant challenges remain, he says. Research against some of the most lethal forms of cancer, like those of the brain and pancreas, has seen only modest gains. And, though survivorship has risen exponentially, incidence is also increasing with an aging population. It is unlikely that this trend will change any time soon.
Still, Abeloff remains optimistic. He anticipates that within the next decade we will see an even greater increase in the translation of research to the bedside. He is particularly excited about advances in cancer prevention and control. “We are poised to do so much scientifically in this area,” he says. “This is the next step in the continuum of cancer management, and there are an array of interventions possible, from lifestyle and behavioral interventions to non-toxic medical interventions.”
As Abeloff departs as director of the one the world’s most renowned cancer centers, many accolades are certain to be bestowed on him. His ability to—after conquering funding hurdles and other delays—bring about the construction of three cancer facilities, merge varied and diverse departments to form a comprehensive cancer center, bring together faculty that earned the Center the nickname of “research powerhouse” are just a few. But, true to form, Abeloff remains humble. “What has been most satisfying to me has been the opportunity to participate in patient care,” he says.
“When I hear a brain cancer patient tell me that the Kimmel Cancer Center was the only place that gave him any hope, or another patient say that we ‘fixed the unfixable,’ then I know I have set the right course.”