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Dr. William Nelson recently was named director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. Nelson, a professor of oncology, specializes in the treatment and research of prostate cancer. He is also a leader in translational research, which means using basic scientific research and laboratory studies to find solutions for patients, such as cancer treatments.
Q: Tell me a little about your background. I understand you didn’t intend to become a doctor, you were going to be a lawyer?
A: I don’t even think I had thought through it that carefully. The area I grew up was near St. Louis in Missouri. I was a reasonably good student, but I also kicked soccer balls, and the area I grew up in was to American soccer what Baltimore is to lacrosse.
So it didn’t get me into college but that was the dominant decision tree of where I went to school and at that time the Ivy League had the best soccer league.
Someone in your business, strangely enough in a related business, loomed large on why I went to the school I went to. He was a guy from my high school and was a senior when I was a freshman. He was also a scholar-athlete and had gone to Yale college and I knew him. His name is Stone Phillips [now of Dateline NBC]. He was doing fairly well there, and he was always nice to me, and that did make a difference as to why I went to [Yale].
I ended up majoring in chemistry and worked as a laboratory technician. I trained in medicine and medical oncology, and that is the place where experimental therapy has been. There is abundant evidence that the best-quality treatment you can get is on a clinical trial. It’s been shown over and over again. We don’t treat these diseases as well as we need to. Cancers in general, we are not as good as we need to be [at treating them].
Q: Why?
A: We are working on it, but the state of the art to my taste isn’t good enough. Until we get rid of all these diseases, there is plenty to do.
Q: You discovered the most common genome alteration in prostate cancer. How does the study of genomics fit into how the cancers aren’t treated well enough?
A: What enabled me to do that is something that is very difficult to do in private practice medicine, which is to focus specifically on prostate cancer.
What we did in the laboratory is we stumbled across what is still the most common mistake the genome makes. If you sort of look at the corruption of the cancer genome, that is one of the great stories of this genomic age.
What we learned is the cancer genome is quite extensively corrupted. Every type of thing that can be wrong often is. It’s a major avenue toward what will ultimately be a generation of diagnostic tests.
Q: So you are using this information to diagnose the cancer?
A: In the product development cycle, that is where it’s headed, and it’s getting very close. We try to make discoveries that might fuel that. We are not in the business of product development.
Right now what we have tried to do is pursue research in three different directions — new biomarkers [which are substances sometimes found in the blood or tissues that may signal a certain type of cancer is in the body], discovering new treatments, and trying to learn more and more about the biological processes that drive them.
Q: Knowing how complex cancers are, does some of the research translate across the board to all cancers?
A: We are approaching a junction of the sort of vectors you describe. Obviously there are many reasons breast cancer is not prostate cancer is not lung cancer, but having said that, it is also becoming clear that as we learn about the hardwiring normal cells use to stay alive there are some thematic functions that are corrupted in cancer cells that are shared.
Q: Why are we still seeing high cancer rates?
A: We are making progress. The death rates are going down and even in the last few years we have beaten the demographic trends. That’s the alarming part. We are having a greater fraction of the population reaching cancer-prominent ages, and so there is going to be more cases, per se.
And so the question almost becomes, at what point does it swamp the whole health care system?
The other thing that not many people are watching is the worldwide cancer burden, which is already in excess of AIDS, tuberculosis and malaria. As lifespans get longer you can put a serious gloom-and-doom scenario here.
The other way to look at it is when the United States of America shows up in some part of the world, we usually seem to be welcome. We are going to have to help them out. It is sort of a moral obligation. If we can solve the cancer problem, we should.
With this genome business and the insights into the way cancer works at that level, in a sophisticated way, this does present an extraordinarily large number of opportunities.
Age: 50
Job: Director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and a professor of oncology, urology, pharmacology, medicine, pathology and radiation oncology.
Hometown: Born in Philadelphia and raised in Town and Country, Mo.
Current home: Baltimore
Family:Divorced, two children: Kate, 21, a senior at Yale; and Sara, 17, a senior in high school
Education: Bachelor’s degree in chemistry from Yale University where played soccer; medical degree and Ph.D. training at Johns Hopkins University School of Medicine and completed an Internal Medicine residency training and medical oncology fellowship at Johns Hopkins Hospital
Education: Bachelor’s degree in chemistry from Yale University where played soccer; medical degree and Ph.D. training at Johns Hopkins University School of Medicine and completed an Internal Medicine residency training and medical oncology fellowship at Johns Hopkins Hospital.
Hobbies: Music, soccer
Currently reading: “The Cold War: A New History” by John Gaddis
Philosophy: “It is amazing what you can accomplish if you do not care who gets the credit.” – Harry S. Truman
