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Radiophosphorus Therapy for Polycythemia Vera

HEFNER: Given what you know, your social and political sensitivities, are any experiments from that 1950 era-the radioactive iron, the treatment of breast cancer, radiophosphorus-are there any of those experiments, [which you] say to yourself, "That was a little in the gray area"?
GOFMAN: Well, let's take the radiophosphorus first. I made some radioactive nuclides of yttrium [that] we tested in John's clinic. Nobody who came to that clinic, to my knowledge, came as an experimental subject without knowing. These were people who had a serious disease, knew just what was being done, and wanted it.

You may have heard some criticisms of John Lawrence's radiophosphorus therapy. Some people said he killed people; I think that's unfair and false. I [will] tell you what the situation was. The disorder that was John Lawrence's great success was polycythemia vera, which he treated with radiophosphorus.

Treating those people [with] radiation was not a new idea. Radiation had been used to treat polycythemia for decades before John Lawrence came on this scene. But they used either radium or x rays. Now that's just a fact. So, John thought, "Well, if these people are making too many red cells and radiophosphorous goes to the bone marrow and the spleen," (organs involved in the making red cells), "maybe that will work better [than] or at least as well as external x rays or radium." That's the history of it.

So if anybody says that John Lawrence introduced radiation in the treatment of polycythemia vera, that's a falsehood-an out-and-out lie. John Lawrence was giving radiophosphorus and it turned out to be a very good way of managing these people who would otherwise be treated elsewhere with x rays or radium.

Now, what was worrisome, however, with anyone [treated with either] radium, x rays, or John Lawrence's 32P, was th[at] some of the people with polycythemia vera after x years, where x could mean 5 or 10 or 15 years, went into a new phase of their disease where they became leukemic. Some of the critics of radiation treatment of polycythemia vera said radioactivity made them become leukemic.

When I came to Berkeley and worked in John's clinic for those first couple of years, with us in the clinic was a young doctor by the name of Robert Rosenthal. Robert Rosenthal's father, Nathan Rosenthal, was one of the great hematologists[26] of this country in New York. When Robert was with us there, Nathan Rosenthal visited occasionally. One afternoon, I remember, John called us all together and we were going to talk about polycythemia vera and the conversion to leukemia and this whole question of whether the radioactivity was causing the leukemia. Nathan Rosenthal, by that point as one of the world's leading hematologists with about 40 years' experience, said, "You know, I've treated polycythemia vera for over 40 years" (or some number like that!). He said, "It doesn't matter what you do." One of the treatments at the time was venapuncturing with repeated bloodletting.[27] "Whatever you treat them with," he said, "eventually, if they don't have a stroke from the polycythemia vera, if you can control that, [if you] make them live longer without a stroke by cutting the red cells, they'll all end up with leukemia. It's got not a damn thing to do with the treatment."

John felt very much relieved by that. There are still people who say that the radiophosphorus caused the leukemia. I don't know whether a decent study has yet been done to ascertain whether they're [right] or not. It's just as clear as crystal in my mind [and I am] amazed, that he said, "They'll all end up with leukemia no matter what the treatment."

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