Magic + Medicine =
by Maryann Brinley
Barton Kamen, MD, PhD, professor of pediatrics and pharmacology, Robert Wood Johnson Medical School
rom a classic doctor’s black bag stashed beneath his desk at The Cancer Institute of New Jersey (CINJ), Barton Kamen, MD, PhD, pulls out a couple of magic tricks. He’s quite serious. There is no laughing here. Now you see the scarf. Now you don’t. Even when asked to give up a secret, this Robert Wood Johnson Medical School (RWJMS) professor of pediatrics and pharmacology, and chief of the division of pediatric hematology/oncology, is not telling. Playful but resolute, Kamen incorporates these magician’s props into his life as a pediatric cancer specialist just as if they were real medical tools. Not in league with a chemotherapeutic agent, stethoscope or thermometer, of course, they are the “ice breakers,” he explains, which help to engage children’s senses and break down their defenses and fears.
Yet, this bag of tricks is just a small part of Kamen’s magic. Walk through the CINJ halls with the man himself, especially into the pediatric clinic on the second floor, and you sense another kind of magic in his passionately personal approach to caring for kids with cancer. “I went into pediatrics because I didn’t want to take care of anybody bigger than me,” he jokes. “I like kids, and cancer is an intricate problem in pediatrics. Mother Nature is very good at solving problems. Especially when you look at human beings from the perspective of the genome, you can see how she checks, rechecks and most of the time, eliminates problems. But we’ve got about three billion bases in the DNA of each cell, which translates into a huge chance of something going wrong developmentally. It’s clear that some pediatric cancers are caused by genetic mutations.” From 12,000 to 13,000 children are diagnosed with cancer each year, far less than the adult figure of a million and a half new cancer cases annually, but still too many for Kamen.
Born into a playfully inventive family, the pediatric oncologist is the oldest of four children. His parents, who are still alive, are colorful, creative artists and teachers, he says, who encouraged them to explore and follow through on whatever they found curious or interesting. One brother is a talented
musician. Another is a world-renowned inventor. His sister, a very successful businesswoman, also enjoys sitting down at the piano. “I grew up in a household where we did everything ourselves. We were a self-contained unit,” Kamen adds. “If the house needed to be painted, we painted it. If it needed plumbing, we did it ourselves. I was pretty lucky having such remarkable parents. They still think the four of us are all cool. We have jobs and are pretty productive members of society,” he laughs. “Nobody has been arrested.”
In a family of high overachievers, this, of course, is the kind of understatement
typical of Kamen’s humor. Other parents might not have gone along with a basement full of rats but this was a home where freedom of expression reigned. The rats, 150 to 200 in a vivarium, belonged to him when he was in high school. Always interested in laboratory experiments, he even had an operating room.
His younger brother Dean, creator of the famous Segway personal transportation system, was inducted into the National Inventors Hall of Fame last year. “But not for the Segway,” Kamen explains. Reaching back to a shelf behind his desk, the oncologist pulls down a small rectangular device. “It’s a pump, the very first portable pump,” he says. “What most people don’t know is that my brother got into the Hall of Fame because he was solving a problem. You don’t invent things. You solve problems.”
The story of this pump began when Kamen was working towards his MD/PhD degrees and then doing his residency during the early 1970s. “I said to my brother, ‘Boy, I wish I had something smaller than the huge Harvard infusion pump,’ which was bigger than some of the patients and certainly the animals we were studying.” Though Dean was just a college undergraduate at the time, he devised the first wearable infusion pump, known as the AutoSyringe, which could be used to treat kids with thalassemia and iron overload. The pump could also meet needs in chemotherapy, pain therapy, neonatology and endocrinology. “In fact, it was one of the iron overloaded patients, who developed diabetes, who first used the pump for continuous insulin delivery. This began the use of this type of device for kids with difficult to manage diabetes,” he says.
It’s one of those original models that sits on Kamen’s crowded shelf. “I’m proud of the fact that I was involved. Remember this was a time when there were no oral time-release capsules, no patches, no catheters and the whole approach to pain was different. You could use the pump for subcutaneous morphine to be administered at home.” Kids didn’t need to remain hospitalized as long. “This piece of hardware allowed us to practice better medicine.”
That same insatiable search for answers and practicality led Kamen to the
remarkable discovery that the DM (dextromethorphan) in ordinary cough medicine, as well as the caffeine (a methylxanthine), could reverse some types of neurotoxicity experienced by children undergoing chemotherapy. Kamen had wanted to know why some drugs made youngsters lethargic and caused learning problems. His research has led to the effective use of these drugs for some kids with acute neurotoxic side effects of some types of chemotherapy. His work has also led to the re-investigation of a very old drug initially used in the 1940s to treat some children with leukemia.
Kamen is one of the few pediatric oncologists to be named an American Cancer Society Clinical Research Professor. He has published more than 200 papers and chapters, and is editor-in-chief of a pediatric hematology/oncology journal. Lately, his research interests have even branched off into Alzheimer’s disease and neural tube defects because of the neurotoxic similarities to chemotherapy’s side effects.
When he arrived at UMDNJ six years ago, there were three pediatric cancer
specialists treating 20 to 30 new children a year. “We have eight doctors now and I’m trying to recruit a ninth. There were 5,000 plus clinic visits last year and we have become a major force in pediatric cancer care in New Jersey.”
What really excites Kamen are his faculty recruits, or the “young-uns” he’s hired. “I feel like a parent to them,” says this husband and father of a 14-year-old daughter. Careers, he points out, can be measured by patients treated, grants received, or papers written. At this stage of his own career, he likes to point to his
protégés: the clinicians and researchers he has mentored and who are developing their own novel therapies.
Approximately 70 percent of childhood cancers now have curative therapy available. To achieve these numbers, “we take big risks,” he points out. Long-term survival and quality of life have also become more important. Medicine has changed. Parents of sick children come in much more knowledgeable, having “googled” their way to his office looking for only the best science can offer. “Treating kids can be difficult because we always have to ask, ‘What’s the price of the cure?’” For instance, “When I started doing this, back in 1975, I learned how to treat teenagers with Hodgkins disease using a full dose of radiation and a full dose of chemotherapy. That approach left the child with a high risk of breast cancer or cardiac problems later.”
Reminders of Kamen’s patients are all over his walls. Pointing to one photo, he explains. “Yes, that’s me in the tuxedo,” escorting a former patient down a runway in a fashion fund-raiser held several years ago in Dallas at Nordstrom’s department store. “She could have walked down with Troy Aikman of the Dallas Cowboys or anybody. But she was 16 or 17 at the time and asked me to come back to Dallas to do it. Yes, me,” Kamen says. Moving to
another shot, he adds, “And here she is just two months ago on her wedding day in Colorado.” A beautiful bride, this girl was one of Kamen’s first metastatic bone cancer patients when she was just 14 to 15 years old. He also treasures a little book a kindergarten girl made for her favorite
doctor when she was very sick. “Look at this,” he says, turning the pages. “When you treat kids for cancer, you begin a
long-term relationship.” The young woman is now a college graduate and a staff writer for a local newspaper.
Always on a quest to solve problems, especially those at the bedside of children — “where the most important issues in medicine are identified”— Kamen believes he is practicing in a specialty unlike any other. “We build relationships. A lot of children are treated for months and months and even afterwards, we worry about them and see them for years.” When asked what he might do when confronting the tears of a mother, he answers, “I’d cry with her. I can’t take care of kids and not be human. I don’t believe in keeping professional
distance. I just don’t.” And therein lies the magic of Kamen’s best medicine. In fact, look up the definition of magic: “the use of means … that are believed to have
supernatural powers to produce or prevent a particular result (as in … death or
healing).” A magician is someone who is “able to produce startling and amazing effects.”
“I like to think I give kids life,” Kamen says. And that is no trick.