Who was Sidney Farber?
Sidney Farber, MD
A Career Driven by the Power of an Idea
The light seemed never to go out. Nine, ten o'clock at night, passersby on Binney Street would see it gleaming from the top floor of the Jimmy Fund Building and know: Dr. Farber is at work.
To an extent that still makes colleagues marvel, Sidney Farber, M.D., put his life in the service of a single, powerful idea. Associates didn't need to know whether the light in his office signified that he was reviewing the results of a clinical trial, preparing for an appearance before Congress or discussing a new fundraiser with the Red Sox - there was never any doubt about the ultimate aim of his efforts. Farber was convinced that the only thing standing between science and a cure for cancer was forceful, diligent research, sufficient funding and the national will to bring it about.
It was a conviction that he had a unique right to hold. At an age when other physicians and scientists were just settling into their careers, Farber had done something so unexpected that its announcement had been met with as much incredulity as celebration. He had achieved the first clinical remission with chemotherapy ever reported for childhood leukemia.
Taking on leukemia
It was the mid-1940s. Farber was a pathologist at Children's Hospital. Medicine was poised for a post-war boom in research that would, for the first time, give science the upper hand over many diseases. For children and adults with leukemia, however, the prognosis was the same as it had been when the disease was first described in 1845: death, often painful, usually within weeks of diagnosis.
Leukemia had almost become a symbol of medicine's embarrassed impotence in the face of dreaded disease. There was essentially nothing, other than a brief respite with cortisone therapy, that doctors could offer young leukemia patients.
Farber felt differently. Leukemia is a disease of the white blood cell-making tissue of the bone marrow. Studies during World War II had shown that pernicious anemia and tropical anemia - both caused when bone marrow fills with immature cells called blast cells - could be cured relatively easily. Give vitamin B12 to a patient with pernicious anemia, or folic acid to a patient with tropical anemia, and, researchers found, the problem would be completely corrected.
Farber believed a similar solution could be discovered for leukemia. He knew that folic acid stimulates the growth and maturation of bone marrow. If a drug could be found that chemically blocks folic acid, he reasoned, it would shut down the production of the abnormal marrow associated with leukemia. As luck would have it, the pharmaceutical manufacturer Lederle was testing just such a drug, called Aminopterin. In November 1947, Farber tried the drug on a group of 16 children who were seriously ill with leukemia. Temporary remissions were achieved in 10 of them.
Farber reported these results in the June 3, 1948, issue of the New England Journal of Medicine. It would be gratifying to report that the findings were met with the acclaim and acceptance they deserved. Such are the vanities of science, however, that researchers' reactions would be better characterized as disbelief and outrage.
Part of the reason was cultural. In the entire history of medicine, no drug had ever been proven effective against non-solid tumors (those that are spread through the body and cannot be removed surgically). Futility was taken as a sign of impossibility. Part of the reason for the chilly reception, surely, was personal: for a young pathologist who worked in a hospital basement laboratory with little in the way of funds, staff or scientific equipment to make a discovery of such magnitude was considered unforgivably presumptuous.
The reaction among practicing physicians and pediatricians, however, was quite different. Calls, telegrams and letters poured in from practitioners throughout New England and, later, the rest of the country, asking for help or advice. Farber answered each one personally.
Such was the start of the institution that this year is marking its 50th anniversary. It was not - by a long shot - the last of the feathers that Farber would ruffle or the outstanding accomplishments he would make.
Beginnings: medicine and the Variety Club
Sidney Farber was born in 1903 in Buffalo, N.Y., the third oldest of 14 children. He graduated from the University of Buffalo in 1923 and took his first year of medical school at the Universities of Heidelberg and Freiberg in Germany. He entered Harvard Medical School as a second-year student and graduated with the class of 1927.
After graduate training in pathology at Peter Bent Brigham Hospital (the predecessor of Brigham and Women's Hospital), he was appointed a resident pathologist at Children's Hospital and assistant in pathology at Harvard Medical School in 1928. In 1929, he became the first full-time pathologist to be based at Children's Hopsital.
It is not definitively known why Farber chose to specialize in children's cancer. His brother Darwin believes it to have been the experience of having seen so many young people die of the disease during his early years at Children's Hospital - and of medicine's then helplessness to alleviate such suffering.
The publication of Farber's groundbreaking New England Journal of Medicine study came at a propitious moment in history. The war having recently ended, the leaders of the motion picture industry were flush with wealth - movie-making having been one of the few immensely profitable industries during the war years. When leaders of the Variety Club of New England - a charitable organization formed by members of the entertainment community - sought a local scientist whose work offered a promising venue for financial support, they were directed to Farber.
The club established the Children's Cancer Research Foundation and began funding the small outpatient clinic Farber had opened at Children's Hospital. The foundation's "defining moment" came on the evening of May 22, 1948, when the radio program "Truth or Consequences" introduced the nation to a young cancer patient named "Jimmy" being treated at the clinic. (Farber, determined to protect his young patients from exploitation, insisted that the boy be known only as "Jimmy." In a newspaper interview more than 20 years later, Farber related that "The program representative went through our little clinic and chose a fine-looking 12-year-old boy. Then they insisted they needed a name. I said, in desperation, 'Well, call him Jimmy!' and that's how the title came about - 'Jimmy,' you see, is any child with cancer.")
The broadcast netted nearly a quarter of a million dollars for the Variety Club of New England Children's Cancer Research Foundation, which was renamed the Jimmy Fund for succinctness' sake. Those funds and others made possible the construction of the four-story Jimmy Fund Building on Binney Street, which opened in 1952 at a cost of $1.47 million. What would later become the Sidney Farber Cancer Institute had a state-of-the-art home for laboratories, offices and the newly created Jimmy Fund Clinic.
Formal, but kind
The entire Institute staff in those early years numbered only a few hundred. Longtime staff members remember Farber as a dignified man of formal, confident bearing, but who, with children, had a grandfatherly gentleness that was irresistible. Colleagues describe a figure with a subtle, sometimes sly sense of humor, an immense capacity for work, and an ability to shift from imposing to cajoling to confiding as the situation demanded.
At more than six feet tall, impeccably dressed in custom-made suits with four-button vests, Farber was very visibly in command of the Institute. Though American through and through, he conveyed a sense of European stateliness: When he walked into a room, whether to deliver a lecture at Harvard Medical School or confer with colleagues, those in attendance would stand. He never demanded such a show of respect; his manner made it implicit.
His office was the picture of uncluttered efficiency. His desk, broad and clear except for whatever papers he was using at the time, was embellished only by a green marble statuette of a raven with glittering red eyes. The bird, with its head turned questingly up, symbolized hope, Farber often said. "Whenever a member of my staff, or the parents of a patient, feel despondent, I ask them to study it and I think it helps them. There is much strength and beauty in it," he wrote in an article in 1971.
Farber's formality did not distance him from the staff, every one of whom he knew by name. "Dr. Farber created an aura about him, but a kindly one," says Antoinette Pieroni, who was the Institute's first full-time social worker and is now a volunteer. "He didn't call people by their first names - I was always Miss Pieroni - and he spoke very deliberately. He had a very dry sense of humor, too, I remember."
Farber took visionary action
In many respects, Farber was far ahead of his time. Pieroni recalls that when she was hired as the Institute's social worker, Farber told her she was to make rounds with the medical staff every morning and see every new patient in the clinic. Such regular contact between patient and social worker was unheard-of at the time. Today, it is standard practice everywhere.
In the area of clinical care, one of Farber's innovations was something that sounds as if it could have come out of today's headlines. "He came up with the idea of what is now called 'total care,'" says former Institute President David G. Nathan, M.D., who began working with Farber at Children's Hospital in the early 1960s. "He decided that all services for the patient and family - clinical care, nutrition, social work, counseling - should be provided in one place. All decisions should be made as a team. Everyone involved in caregiving should plan the treatment together." That such an idea should have been conceived by a pathologist - a physician not formally trained in clinical care - only made it more unlikely, not less revolutionary.
Like the discovery of the effectiveness of chemotherapy, not all of Farber's advances were uncritically embraced by the medical community. In the mid-1950s, he persuaded Children's Hospital to give him an entire inpatient floor on which to put his principles into practice. The hospital agreed, and it has become the model for pediatric cancer care around the world.
Moving cancer to the national arena
Throughout the 1950s and '60s, Farber continued to make advances in cancer research, notably the 1955 discovery that the antibiotic actinomycin D and radiation therapy could produce remission in Wilms' tumor, a pediatric cancer of the kidneys. And it was during this period that he took his persuasive powers to a national stage.
Beginning in the early 1950s, and continuing until his death in 1973, Farber became a star presenter at Congressional hearings on appropriations for cancer research. Animated, with a flair for the dramatic anecdote and poignant case history, Farber made a compelling speaker. He was not given to understatement, nor did he take refuge in half-hearted vagueness. "He would tell the senators and representatives that a new treatment looks so promising that an investment of federal support was crucial to bringing down the death rate from cancer," says an admirer, Emil Frei III, M.D., who succeeded Farber as Institute director upon Farber's death.
"He was a medical diplomat," says Farber's brother, Darwin. "He saw that if cancer was going to be conquered, it would require a concerted national effort and a major funding commitment by Congress."
He was astonishingly successful. With Mary Woodard Lasker, a longtime advocate of biomedical research, famed surgeon Michael DeBakey, Senator Lister Hill of Alabama and Congressman John Fogarty of Rhode Island, Farber led a massive expansion in federal spending for cancer research. Between 1957 and 1967, the annual budget of the National Cancer Institute, the government's primary funding arm for cancer study, jumped from $48 million to $176 million.
Meanwhile, Farber was working to expand the Institute's clinical services to adults. "Dr. Farber would say that, in cancer, the child is the father to the man," Frei remarks. "Progress in cancer research at the clinical level almost always occurs in pediatrics first. Many of the treatments we now have for adults are based on what we learned with pediatric patients." In 1969, the Institute's charter was expanded to provide services to patients of all ages.
Farber was unsuccessful in his effort to recreate at Brigham and Women's Hospital an adult version of the cancer inpatient unit he'd built at Children's Hospital, so he opened one at the Institute itself.
Farber was always reluctant to forecast a date by which cancer would be cured. "Any man who predicts a date for discovery is no longer a scientist," he said in a 1971 newspaper article. "We have a solid basis of accomplishment in research and treatment to permit controlled optimism and expectation of rapid progress."
His carefully chosen words belie the fact that the "cure date," whenever it comes, was brought immeasurably closer by the accomplishments he made.
