Lessons after the death of a scientist

Noon on January 15, 2008. That big man who suddenly yesterday has deadJudah Folkman, a few years ago ran to say he was alive.

Boston, November 12, 2006. At a meeting of the American Association for Cancer Research (AACR), from the stage of the immense dimly lit room, a lanky man speaks to us affectionately, with a quiet passion, attentive to the thousand scientists already what each slide should tell. He has us in his grip, fascinated with his science and his charisma. We all just burst out laughing, with that laugh of complicit and authentic happiness, the one that only people and exceptional findings provoke in scientific congresses.

Folkman has just told us: “Hearing that I ran to the microphone to make it clear that he was alive.” And we all burst out laughing. Because the anecdote he has just told us is deep and funny (I tell it two paragraphs below), and because it culminates a dazzling presentation. During it, Folkman has displayed the findings of several decades of prodigious research: in his slides he has shown graphs and diagrams, quantitative results, interpretations and ideas… and real patients on the verge of death.

Several decades ago, Folkman and others rediscovered that tumors grow tiny blood vessels to nourish themselves. His work founded a new field of research and a new class of drugs, anti-angiogenic therapy: drugs that inhibit the growth of new blood vessels. Some experts disdained his studies. Occupational hazards. Tenacious, bold, creative, he and his team continued to investigate.

The anecdote that Folkman had just told us that November 12 is this: “A few months ago,” he said, “I was in another congress, among the listeners, while a doctor from an institution other than ours presented the results of his studies , which confirmed and expanded those of our team. The audience was amazed. Then beside me a stranger murmured in wonder: ‘If only Folkman were alive to see it!’ Our laugh. “I immediately ran to the microphone to make it clear that he was alive,” he continued. And after our new laughs, he added: “Luckily for me, there was a good colleague next to the microphone who told me: ‘Sit down and keep your mouth shut, Judah, you’re going to spoil everything’”. More laughs.

The anecdote may seem trivial or presumptuous if we do not attend, first, to the plain tone with which Folkman related it. And second, especially, because it was part of a complex and precious presentation, with exquisite attention to the facts that he had observed for years in his observational and experimental studies, both on the bench in the laboratory and in real patients.

During his professional life many times his wishes, ideas and hypotheses collided with his observations, contradicted by studies designed and analyzed in a merciless way: only the clinical course of the patients matters. A culture key in the culture of the 20th and 21st centuries.

These ideas are resurfacing now, when fortunately some discover that studies must be done in reality, in populations real. So many years ago that epidemiology and clinical specialties make. Better every time. With dialectical causal views between studies in laboratories, in medical centers and in populations, between mechanistic analyzes and pragmatists. Impressive advances and deficits that we have experienced during the pandemic. How much progress is possible!

But today, January 15, 2008, Folkman’s speech is far from me. I’ve been immersed in writing a scientific article for a while. Happy and tired, I glance at the email. And that’s when Folkman’s death hits me inexplicably. Leo: “Judah Folkman, MD, Professor of Pediatric Surgery and Cell Biology at Harvard Medical School, died suddenly this January 14, 2008. He was 74 years old. Dr. Folkman’s seminal discovery that cutting off the blood supply to a cancerous tumor inhibited its growth and ability to spread revolutionized the treatment of cancer and macular degeneration. Today, several drugs are approved…”.

The recognition of the obituary is precise: no path that a medical researcher undertakes is more arduous than the one that starts from the immense fragmentation of biology data and wants to cure the complex disease of a human being. There are many hopes for a cure, some in good faith, others with little scientific foundation.

At the same AACR meeting, Professor Michael Sporn said: “The Human Genome Project is intellectually bankrupt when it comes to offering solutions to patients.” The phrase may or may not be taken literally: after the outbreak of the genomic bubble, the bankruptcy of many companies was not only intellectual, scientific and ethical but also literal: economic. Sporn asked us to be less accommodating and more creatives. That we achieve more clinically and socially relevant findings.

In 1998 Folkman himself had said: “It’s only in mice.” He was referring to experiments of his that had caused a sensation after a Article in the New York Times, which explained how two drugs that Folkman had developed eradicated tumors in these experimental animals. With elemental honesty, Folkman wanted to avoid extrapolating his sick findings in mice that had yet to be tested in people. In the Times article, none other than James Watson, Nobel laureate for his proposal on the structure of DNA, proclaimed: “Judah is going to cure cancer in two years.” A hyperbole still all too common today.

It’s getting late, I have to rush out. On the way I think: why does the death of someone you only heard once hit you? Because of its ethical and scientific, human height? I tell myself that the same can happen to any citizen interested in culture.

Yes, I am just one more citizen who lives the history of his time. And then I feel an unexpected gratitude: thank you, Judah, for those decades of struggle, for your insolent creativity, for your discoveries and mistakes, and for those happy laughs that we who make a living with one of the best jobs in the world enjoy so much. .

Michael Porta He is a doctor, a researcher at the Hospital del Mar Medical Research Institute and a professor of public health at the Autonomous University of Barcelona. author of Nearby epidemiology (Triacastela), the book from which this article is adapted.

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