A springboard for acclaim

Scientists: What the patients don't see: Struggling researchers dependent on the trials for career advancement.

November 11, 2001|By Julie Bell | Julie Bell,SUN STAFF

It took years of work and one gut-wrenching leap of faith for Dr. Adam Dicker to arrive at this spot. Standing in an exhibition hall in front of a poster summarizing the cancer research he helped lead, he was one of a select group of scientists chosen to present findings at an international conference.

His poster presented results of the world's first experiment combining radiation with Angiostatin, an investigational drug being developed by EntreMed Inc. of Rockville, in humans. More than 200 scientists who submitted their research for the chance to make a similar presentation at the conference in Miami Beach's Fountainebleau Hilton Resort were turned away.

But a lingering impatience weighed on Dicker. As a reward for his work, he had won the privilege of patrolling a carpeted patch of floor smaller than a first-base coach's box, greeting passing scientists for two hours. Like salesmen lined up at a trade show, other selected researchers were doing the same.

Theirs was a sideshow to the convention's center-stage attraction, the prestigious plenary sessions in the Grand Ballroom.

There, where a handful of scientific stars addressed audiences of 2,400 at a crack, is where Dicker hoped to one day earn the right to speak.

"I may be an up-and-comer," said Dicker, a radiation oncologist at Thomas Jefferson University Hospital in Philadelphia, "but I'm not a major player."

He clearly has a plan to become one. A key part of his strategy involves overseeing the human testing of new, nontoxic cancer drugs, including EntreMed's Angiostatin. Dicker is one of the top investigators overseeing tests of the drug in Thomas Jefferson patients who also are undergoing radiation.

Cancer patients taking experimental drugs are often grasping at a last chance for life. Many don't realize that doctors overseeing human tests of such drugs are also engaged in a fierce struggle - for scientific acclaim and career advancement.

Clinical trials, which are the tests on people required by the Food and Drug Administration, are the only vehicle through which new drugs are determined safe and effective enough to market. Without the trials, drugs such as Gleevec - approved in May after bringing leukemia patients back from the brink of death - wouldn't exist.

But doing trials depends on the driven doctors who design and run them, people willing to take on far more work than physicians who don't. The ambitious investigators can set themselves on a path to international prominence by supervising trials of groundbreaking new drugs. But doctors who pick drugs that flop may lead lives of professional obscurity. Even a successful drug that fellow scientists view as a dull, incremental advance may not do much for a career.

"We all want treatments to work, because we want to help patients and be at the forefront of something," said Dr. Jonathan D. Cheng, a cancer researcher at Fox Chase Cancer Center in Philadelphia who has studied patients' attitudes in human tests. "I don't think patients have any understanding of these issues: the promotions or scientific accolades one might receive from a clinical trial."

Dicker describes the criteria that investigators use to identify trials worth pursuing in this way: "It's novelty. It's promise. It's ego."

While star scientists work in spacious, well-staffed labs at prestigious universities and may have grants totaling millions of dollars, much of the country's cancer research - and experimental treatment of patients - is done by scientists like Dicker at lesser-known institutions. He scrapes for money by applying for a succession of smaller grants, lobbies pharmaceutical companies for drugs and financial backing to do laboratory experiments and constantly looks for colleagues with whom he can collaborate to save money and speed results.

His sole, permanently assigned staff person is a department secretary he shares with others.

He doesn't want it to be that way forever. Several years ago, dejected by the slow pace of his research into tumors' resistance to chemotherapy and radiation, Dicker made a bold decision. He dumped that research and gave up the money.

He turned instead to an emerging field some saw as fringe science, one on which EntreMed executives had bet the company. In it, scientists were trying to halt cancer with drugs that attacked the growth of tumor-feeding blood vessels. They thought they could do so without side effects.

Dicker thought the new ideas might transform cancer care, and he wanted to help.

"Why are you doing this?" Dicker remembers his department chairman asking him. "This is a little soft."

He was in his late 30s. The decision would make or break his career, and he knew it.

The right project

Dicker learned the value of choosing the right science project in the fifth grade. For a school fair, he built a model of a hovercraft with his father's help. It didn't win. "Do an experiment," someone said snidely. "Don't build a model."

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