Survival: A Medical Memoir: From Drug Discovery to Clinical Cancer Trials by Lorne J. Brandes (review)

A hematologist-oncologist, L.J. Brandes, who has made a successful career in both laboratory and clinical medicine in Winnipeg, Manitoba, gives a first-hand account of failure in medical science. Despite its predominantly progressive discourse, medicine for Brandes is replete with ill success that must be recognized in its own right. In his book, Brandes provides insights into what is usually happening to an idea of a clinician-investigator as it passes through a theoretical formulation, an experimental testing, and a series of clinical trials. This passage has innumerable twists and turns, ups and downs, which reflect the complexities of medical history. According to Brandes, advances in medicine occur through incremental understanding of fundamental life processes, such as the genesis and development of cancer. This understanding is both reasoned from medical sciences and divined serendipitously. A new method to treat human cancer that Brandes devised in the last quarter of the twentieth century was a result of scientifically informed serendipity; however, transformation of a therapeutic theory into a novel anticancer drug was uncertain.

Survival: A Medical Memoir elaborately relates a personal story coupled with the history of drug development. Brandes uses the theme of survival not only to narrate a human drama of cancer patients, but also to tell how a clinician-investigator persists in turning a scientific discovery into a potentially useful treatment, regardless of the odds. A chemical substance, DPPE, reaches the level of clinical application as an anti-cancer agent through a winding path: from the laboratories to the patent offices, the pharmaceutical companies, the regulatory agencies, and, eventually, the hospitals. Brandes masterfully explains the planning and the performance of pharmacological experiments with rodents and draws the reader's attention to the problem-ridden process of animal–human translation in testing investigational agents. In doing so, the author spells out major side effects of different chemotherapies and what causes them. No less interesting are the author's simple explanations of the transitions from animals to humans in drug experimentation, especially in terms of dosage and non-linearity of therapeutic effects.

It is instructive for a medical historian to trace interactions of the clinician-investigator with the drug regulatory agencies in Canada, the Bureau of Human Prescription Drugs, and the Food and Drug Administration in the United States. Brandes manages well to give a taste of dealings with government bureaucracies. What is even more revealing to the reader is the role of pharmaceutical business in dictating which drugs become available to the consumer. The author casts some light on the changing research and development strategies employed by drug corporations. For instance, Brandes explicates a deepening relationship between Big Pharma – Bristol-Myers Squibb, Burroughs Wellcome, Eli Lilly – and North American universities in the 1980s and 1990s. Representatives of pharmaceutical giants were "touring various Canadian universities" on the lookout for drug development opportunities and innovations that were commercially attractive (99). As the author sardonically interpreted one of the corporate messages, "we are Eli Lilly. … We will buy you off for a small amount of funding, which we know you badly need, and will control you through legally-binding agreements. You will publish only after we approve any manuscript you write. For all these things, you and the University of Manitoba should be eternally thankful" (109). Against this corporate culture, Brandes and his colleagues struggled to get a potential anti-cancer agent off the ground. Through trials and tribulations they succeeded in giving DPPE a fair test in randomized controlled clinical studies.

The reader will find quite enlightening the parts of the book discussing how a newly made DPPE progressed from a pilot investigation in patients with advanced cancer to, much later than anticipated, a large-scale double-blind randomized trial. Brandes rightly asserts that "there is no such thing as a totally safe drug" and clarifies his point lucidly, even referring to the antidepressant Prozac (151). In this respect, the author pays...