James F. Holland, MD; Kathy D. Miller, MD


June 24, 2014

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Kathy D. Miller, MD: Hi. I am Kathy Miller, Associate Professor of Medicine at the Indiana University School of Medicine in Indianapolis. Welcome to a very special Medscape Oncology Profile. This year marks the 50th anniversary of the American Society of Clinical Oncology (ASCO), and with me today is someone who has been an active participant in the Society and in the field of oncology for much of that time. Please welcome Dr. James F. Holland, Distinguished Professor of Neoplastic Diseases at the Mount Sinai Medical Center in New York, and President of ASCO from 1976 to 1977. Welcome, Dr. Holland.

James F. Holland, MD: Thank you.

Dr. Miller: Fifty years is a good time to look back at the birth of ASCO and where the society has been during that time. Do you remember when ASCO started? In those early days, did you think it would ever be the society it is now?

Dr. Holland: I remember when it started, and no, I did not think it would get to its present level of extreme value. It started small, like everything. But we have to pay attention to the concept that a small group of dedicated people is the only thing in the world that ever has changed things, and ASCO has changed things. It was American and now it's international. It is the biggest of the medical societies. It has a focus that encompasses not only the concept of taking care of patients but is also beginning to understand "what is cancer?"

Dr. Miller: You let it slip before we started recording that you were a little skeptical in the beginning as to whether ASCO was worthwhile.

Dr. Holland: It certainly didn't seem worthwhile, but I understood later that it did have an impact. I started before there was the specialty of medical oncology. I was taught by Alfred Gellhorn, MD, a magnificent human being who was interested in cancer at Columbia University, where I was an intern at Presbyterian Hospital. I became involved in his activities and evolved into an oncologist before there was oncology.

An Unexpected Path to Oncology

Dr. Miller: How did you become interested in the field in those early days?

Dr. Holland: I treated a 4-year-old girl -- named Jennifer -- who had acute leukemia with aminopterin, and she went into remission and it was fantastic. But that came a little later. I went into the Army after I finished my residency and had to stay in during the Korean War, because President Truman extended everybody’s tour. I had to write back to the Chair of Medicine that I wouldn't be back on the first of July, which is when the medical staff rotation occurs. He wrote back to me, saying, "I can't save a place for you because I need the house staff to take care of patients, but we have opened a new cancer hospital called Francis Delafield, run by Columbia, paid for by the City of New York. I'll put you there and when somebody drops out for tuberculosis or psychiatric reasons, as they always do, I'll call you back."

I left the Army, not on the first of July but around the 30th of September, and treated a 4-year-old girl who had acute leukemia (under the supervision of Alfred Gellhorn), and she went into remission. When the Chair of Medicine called me back, I said, "Thank you. I think I'll stay."

Dr. Miller: Did they lose a resident from psychiatric illness or tuberculosis?

Dr. Holland: It was tuberculosis. A friend of mine, who had Hodgkin disease, then developed tuberculosis. In those days the phrase was "tuberculosis follows Hodgkin disease (because of radiotherapy and immunodepression) like a shadow." Things have evolved enormously since then. Tuberculosis is no longer a significant problem in the population of patients without HIV. I worked with children with acute leukemia for many years, and it is now mostly a curable disease. Oncology has evolved enormously.

Enchanted by Humanism and Science

Dr. Miller: When you think about the Society and the meeting today, is there anything from this year's meeting that surprised you or caught your eye?

Dr. Holland: Absolutely. Cliff Hudis, MD, gave a marvelous talk[1] as President, filled with passion related to social justice. There are so many people in the world who are dying from cancer, who don't have access to some of the treatments that ASCO pioneers.

They made the wonderful choice of asking Lee Hood, MD, PhD, an eminent scientist, to give a talk.[2] He was able to demonstrate, to my amazement, how we can eradicate cancer with concepts that were enormously different from what the ordinary speaker describes. It was almost enchanting to hear this man, who could visualize how we could make a major series of advances in cancer -- in understanding its causes and how to eradicate them. It was an order of magnitude different from other scientists I have heard speak.

Neglected Concept: Cancer as a Virus Infection

Dr. Miller: Is there an area of the field that you think we have neglected, that doesn't get the attention that it should?

Dr. Holland: Yes. My colleagues and I now are working on a human mammary tumor virus that is 90%-95% identical to the mouse mammary tumor virus (MMTV). It is in human breast cancer and in human lymphomas and passed in human milk. All of this represents exactly the same biology that is in the mouse. In parts of the world -- in Asia, where cancer of the breast is uncommon, and in the West, where breast cancer is common -- there are different species of mice. The mice in Asia have very little MMTV, and the mice in the West have a lot of MMTV.

We have undoubtedly, in my view, picked up that virus from the mouse, and 40% of breast cancers in American women have the virus. Very few people believe this, unfortunately. However, we have demonstrated, to my satisfaction and to the satisfaction of several other scientists, that it is indeed real -- it's not contamination.

If we can prove that breast cancer is a virus infection in 40% of women, it will make a difference. Maybe we will begin to look at lung cancer, bowel cancer, and other cancers and see whether we are activating viruses with tobacco smoke, which is a perfectly reasonable concept. This keeps me alert and active.

Overcoming Our Intellectual Default

Dr. Miller: When you think about the history of the field and the history of ASCO, is there something that we have gotten wrong, where ASCO missed an opportunity?

Dr. Holland: I don't think ASCO has, but physicians in general often rely on what they were taught in medical school: "Don't bother me with the facts, I know what the situation is." That is an intellectual default in all of us; we believe what we believe and it almost becomes an article of faith. Some are not as open-minded as science demands.

So in my view, are we making good progress? You bet. Do we have some impediments along the way? Of course.

Dr. Miller: I think I know the answer to this, because your passion is obvious. If you were starting out today, do you still follow oncology or do you take the offer for the internship?

Dr. Holland: Oncology is the field of medicine that has the most potential, because we know so little and so much needs to be known. That is why Lee Hood's talk was so amazing to me. He could encompass concepts and methods to advance the field. I persuade all the young folks that I have access to that this is the field they should join. My wife is a psychiatrist and I'm a physician, and among our children we have 3 lawyers, 1 physician, 1 physician's assistant, and 1 businesswoman. We must have done something wrong.

This is an exciting time. It's a wonderful opportunity for people to make a big impact on a group of diseases. Not a disease, but a group of diseases that are the most feared. If you make a mistake, patients die. But if you do it right, we will be able to save them. I have had the satisfaction of being able to save a lot of people with cancer over the years, because I have been at it a long time.

Dr. Miller: Dr. Holland, thank you so much for joining us. You have been an inspiration to generations of physicians and you continue to inspire us.

Dr. Holland: You are very kind to say that.

Dr. Miller: Thank you for joining us for this Medscape Oncology profile. This is Kathy Miller, reporting from ASCO 2014.


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