Honoring a pioneer in curing cancer
Thank you Greenwich Hospital, Yale’s Smilow Cancer Center, Greenwich Endocrine Group and to the Town of Greenwich for celebrating radioactive drugs in curing cancer and much more.
Greenwich First Selectman Fred Camillo has proclaimed March 31, 2021 as the “Dr. Saul Hertz Nuclear Medicine/ Radiopharmaceutical Day.” On March 31, 1941 Dr. Saul Hertz, charged across the bridge over the Charles River from Massachusetts Institute of Technology (MIT), with a flask of radioactive iodine (RAI) from the newly operating MIT cyclotron. There was no time to lose. A patient named Elizabeth D. was waiting, at Massachusetts General Hospital (MGH), no doubt a little nervously, for a completely new treatment for hyperthyroidism, difficult and dangerous condition. She was going to be asked to swallow radiation. Saul Hertz administered the very first treatment of a radionuclide, RAI, that became the first targeted and gold standard of precision oncology that cures cancer.
Although there had been a few attempts previously to treat bone metastases with internal radiation, that Monday, effectively marked the beginnings of treatments with radioactive drugs. It also ushered in the dawn of dosimetry, a way to determine a safe and effective dose, as Hertz’s collaborator a young Arthur Roberts with his new Ph.D. took measurements of uptake with a Geiger counter clicking merrily away by the patient’s neck. Elizabeth’s urine was collected to find that 20 percent of the radioactivity was passed through. This was a positive sign that the radiation was going where it was needed. Elizabeth’s thyroid shrank after the first treatment, that showed Dr. Hertz’s idea would work.
“This auspicious day laid the foundations for one of the most successful treatments not just in thyroid disease, but in medicine,” British Institute of Cancer expert Glenn Flux, Ph.D., said.
It is all the more remarkable for the speed at which a major scientific breakthrough that began with Saul Hertz’s idea of the medical uses of RAI, to the laboratory studies and made its way to a successful and enduring treatment extending the lives of countless generations of patients worldwide.
Radioiodine (RAI) a radioactive drug is used to diagnose and treat thyroid cancer and conditions. Radioiodine in the form of Iodine-125( I-125) seeds are used to treat prostate cancer. The same type of I- 125 seed is used in breast cancer surgery to detect the cancerous cells so that the surgeon can enhance the success of the surgery. Greenwich Hospital uses radioactive drugs to diagnose heart and neurological conditions. Positron emission tomography (PET) scans check for diseases. The scan uses a special dye containing radioactive tracers.
Radionuclides are the technological backbone for much of the biomedical research being done today. They are used to identify how genes work, and the research on AIDS depended upon their use. Monoclonal antibodies, which are produced in the laboratory and engineered to bind to a specific protein on a patient’s tumor cells, can be labeled with radionuclides. When such labeled antibodies are injected into a patient, they bind to the tumor cells, which are then killed by the attached radioactive nuclide, but the nearby normal cells are spared.
Saul Hertz overcame many challenges to bring his lifesaving research to fruition. He was an outsider at a time of restrictions and quotas for minorities. In the 1940s discrimination played out in educational and medical institutions. Dr. Hertz had come to the Massachusetts General Hospital (MGH) in 1931 and was appointed the director of the MGH thyroid unit. He was not paid or allowed on the staff as was customary at that time, for outsiders (particularly Jews and Catholics — there were no women). Economic pressures of the health care system created challenges to the acceptance of the RAI that was a less expensive treatment. Questionable ethics regarding medical publication as well as false information created fear of the use of a nuclear medicine. A world war shut down normal daily life, just as the pandemic has done today. Dr. Hertz’s first clinical trials were interrupted when he became an officer in the U.S. Navy during World War II. Dr. Hertz confronted these stumbling blocks creatively and with a “never give up” approach.
Dr. Saul Hertz's prediction that radionuclides, “would hold the key to the larger problem of cancer in general,” may just be the best hope for diagnosing and treating cancer successfully. Yes, radioactive iodine (RAI) has been used for decades to diagnose and treat thyroid cancer, the first and Gold Standard of precision targeted oncology. Today’s “theranostics,” a term that is a combination of “therapy” and “diagnosis” is utilized in the treatment of neuroendocrine tumors (Steve Jobs suffered from such a tumor). Liver cancer, brain tumors and leukemia are responsive to this targeted approach.
Let us be grateful to Dr. Saul Hertz as well as to the dedicated support staffs and professionals who are keeping us safe and healthy.