Customer Reviews

Dr. Folkman's War: Angiogenesis and the Struggle to Defeat Cancer

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This book clearly deserves many more than five stars.

Dr. Folkman's War contains many valuable insights including how to: Raise children to be outstanding people; be an astute observer about nature to unlock new lessons; pioneer in a new field of science; and be persistent about something important. When the history of medicine in the twentieth century is written, Dr. Judah Folkman will be considered one of the most important figures. This book is the most accessible and complete source of information about his remarkable life and accomplishments.

Dr. Folkman's research to date "has found applications in twenty-six diseases as varied as cancer, diabetic retinopathy, macular degeneration, psoriasis, arthritis, and endometriosis." "Ordinarily, researchers working in any of these fields do not communicate with each other."

Angiogenesis looks at the way that capillaries are formed in response to the body's biochemistry to help and harm health. Tumors depend on this action to get the blood supply they need to grow. Wounds also rely on a similar mechanism to grow scar tissue.

I have been following Dr. Folkman's career for over twenty-five years, and heard him speak about angiogenesis just a little over two years ago. Because I felt I was well-informed, I almost skipped this book. That would have been a major mistake on my part. Dr. Folkman's War contained much new and interesting information that helped me to better understand the lessons of Dr. Folkman's life, as well as the future implications of angiogenesis.

Unknown to me, Dr. Folkman had also played a role as an innovator in implantable pacemakers, time-released drug implants, and specialized types of heart surgery before he began his serious assault on angiogenesis.

The discoveries had their beginning in 1961 when he was a draftee in a Navy lab in Bethesda, Maryland. He noticed that tumors could not grow unless they first recruited their own capillaries to bring an increased blood supply. "Over time, he convinced himself that there had to be some way to block the growth of those blood vessels." He was right, but it took a long time before he knew any of the answers.

In brief opening comments about the book, former surgeon general C. Everett Koop, M.D. and Sc.D. observed how this new science evolved. "In the 1970s, laboratory scientists didn't believe any of it." " . . . [T]he critics' objections were hushed for good in 1989." "In the 1990s, the criticisms came chiefly from the clinical side, and the pharmaceutical companies didn't want anything to do with angiogenesis."

The story is a very heart-warming one. Dr. Folkman's father was a rabbi who asked each member of the family each night what she or he had learned that day. He also constantly implored his son to "Be a credit to your people." His father clearly thought that Dr. Folkman would also become a rabbi. Having announced his attention to become a physician, his father told him, "You can be a rabbi-like doctor." This injunction was one he took to heart, often seeking out his father's counsel on how to console the families of his patients.

His first taste of how close mortality is to all of us was when his first two children inherited cystic fibrosis. The younger of the two died, and the older one needed lots of special care to deal with infections. This probably made him a better doctor, by helping him see things more from the patients' points of view.

Space constraints keep me from discussing the book's description of how angiogenesis developed, but if you like stories about trail-blazing research, you will be amply rewarded. The key hurdles are described, along with the blind alleys that were followed. Anyone reading this will see how important it is to add new skills to the study of any new subject.

I was particularly interested in the way that press reports tended to harm the progress of angiogenesis, either by annoying other scientists, attracting hucksters, or delaying key deals with potential partners. We often think about freedom of speech being helpful, but here the case is a mixed one.

My only disappointment with the book is that it does not provide as much clinical data about the drugs under testing now as has been made public. That material would have made for fascinating reading. There are also natural substances that can cause a tumor to shrink, and clinical studies have been very successful in growing and shrinking tumors for some time.

I suspect that some member of your family will live a longer, healthier life due to future treatments soon to be available using angiogenesis. This book is a great way to learn more about the subject now, so you can encourage exploration of these experimental therapies where possibly appropriate. If anyone in your family now has cancer, this book is must reading for you!

Dr. Folkman summarized the book nicely as follows: "Success can often arrive dressed as failure." "If your idea succeeds everybody says you're persistent. If it doesn't succceed, you're stubborn."

May we all live longer and healthier lives due to the emerging medical treatments using angiogenesis . . . that were helped by Dr. Folkman's persistence!

This is the extraordinary story of an extraordinary man. Dr. Judah Folkman's approach to fighting cancer, long the subject of derision from the medical and research establishment, is finally bearing fruit. Robert Cooke writes beautifully and clearly, combining a scientific biography of Dr. Folkman with an introduction to anti-angiogenesis. Read this book- when Judah Folkman wins the Nobel Prize, you'll know all about him. (A sidebar- a Amazon customer reviewer, who pans the book, is under the impression that it is written by Dr. C. Everett Koop. It is not. He does however, write the introduction, which ends with these words, "In the end, of course, Judah Folkman's beautiful idea has triumphed over the doubters. A few still persist, but their time will come.")

I'm in med school, and I've heard a lot about Dr. Folkman, so I was curious to read why he's so mythologized. Now I know! This is an inspiring book -- it reminded me how hard you have to work, how brilliant you have to be, and how lucky you have to be just to have a CHANCE to make a huge difference. Dr. Folkman was all three. THe author does a real service, too, in explaining the history of cancer research -- not easy to do in an engaging yet substantive way.

Robert Cooke does an amazing job of rendering what could have been a dense scientific discussion of anti-angiogenesis and its role in treating cancer, into an engaging and meaningful discussion that someone without a medical background can easily understand. Cooke aptly chronicles Folkman's career ups and downs, and ably captures the doctor's frustration of being a scientist two decades ahead of his time.

The real message in this book, however, is one of triumph in the face of scorn and ridicule. That Folkman's peers - be they colleagues at Boston's Children's Hospital who sought to have him ousted from his position as Chief of Surgery or to have his laboratory closed, or the anonymous reviewers at the medical journals where he submitted his papers describing his thoughts and findings in anti-angiogenesis who refused to publish his work finding it too implausible, or the conference attendees who would simply walk out of one of his scientific lectures thinking he was a crackpot - could subject him to so much difficulty in pursuing his scientific vision speaks volumes about how we, even in this modern era when we are supposedly more open minded, have trouble dealing with a visionary. Most of us, in Folkman's shoes, would have moved on to something else.

Now that Folkman's ideas have come of age - science finally possesses the tools to validate his work and we are seeing the fruits in clinical trials around the country - I truly hope that his early critics will have the courage to acknowledge their error. As Cooke reminds us, genius can be very hard to recognize. Now that it is upon us, however, shame on those who continue to diminish it.

This book is ideal for anyone possessing a fascination with science or medicine, anyone who appreciates stories of personal triumph, or anyone who is interested in how insight can be mistaken for heresy. Furthermore, as someone whose family has been touched by cancer, I found the book to be incredibly insightful in understanding the disease. Cooke's writing is clear and concise, and the Folkman story is incredibly engaging.

When I first started reading the book I thought it was going to be more about Dr. Folkman's life and not about medicine. You quickly realize there is no difference as far as Dr. Flokman is concerned. Medicine has been his life and fortunately for us cancer research his passion. I was stunned to find out he has helped discover; cardiac pacemakers, drug release systems and a cure for an incurable childhood disease all while being a world-renowned pediatric surgeon. These life saving stories will bring tears to your eyes. All this alone would make for a great book without ever mentioning angiogenisis. However, the quest for a major cancer treatment while putting up with the critics and red tape read like a major military battle through which this man has prevailed. You will feel his passion.

The discussion of Dr. Folkman's relations with corporations and the business of medical research is another great aspect of this superb book.

Folkman is a paradox in the medical research world. He is a highly talented and committed surgeon by training - a profession ruthlessly focused on "results - now!" and often comically averse to academic molecular research. At the same time, following an early experiment during his conscription days for the navy, he set himself a path of just such academic molecular research. Part of the troubles he's had come from the cognitive dissonance that accompanies his appearance at conferences - the scientists don't want to hear a surgeon lecture to them, and neither do surgeons want a scientists to speak. In combining two disciplines he often fell between two stools.

More than that though, his focus on angiogenesis initially made no sense at all for cancer research. When he first postulated that stopping a tumour required stopping the blood vessels, he was often, and probably justifiably, laughed at. At the time, researchers were elucidating the reasons for a normal cell's conversion into a cancerous one. Painstaking molecular experiments pointed to a sequence of random mutations, whose accumulation correlated with the cancer's aggressiveness. Be it radiation, viruses or old age, the common mechanism of all these tumour causing agents was their ability to induce mutations in cells. Stop the mutations, and you stop the cancer.

Why on earth bother with the surrounding, normal, non-cancerous blood vessels?

Folkman's epiphany, and subsequent stubbornness, rests upon the experiments he performed while in the Navy. Given free reign after completing his initial assignment, he teamed up with a pathologist. They played around with tumour cultures. Growing them in petri dishes, they observed a mysterious phenomenon. Although the tumours grew aggressively once placed on a mouse' skin, they would not grow beyond 1 mm on the dishes. Comparing the tissue on the dishes with the tissue on the skin, the only difference was the presence of blood vessels in the latter.

So began Folkman's long journey. And it is a fascinating and historic journey. Along the way, he became Harvard's youngest ever Professor of Surgery. In particular, it was an appointment in Paediatric Surgery, at the Boston Children's Hospital - an appointment that shocked many, as he never been in formal Paediatric training. This was soon remedied by a personal, intensive 6-month course with the great Dr C Evert Koop himself, the father of paediatric surgery.

Later, as he struggled for funding to research his ideas, he inked a multi-million dollar research agreement with Monsanto. This made history, as the first major agreement between a commercial enterprise and Harvard - at the time, staunchly refusing such tainted money. It opened up the floodgates for many future agreements, that lay the foundation for the reality of American research today - a lucrative and productive partnership between industry and academia, that helps maintain US research the envy of the world.

Interspersed amongst this is a story of an intensely hard working young man, who attracts to his lab young researchers of similar nature. It took twenty years for his team to get the evidence the academic world needed to accept angiogenesis. But, they got it. And it's a great read to find out how.

Truly - seminal.

I have read quite a few books about the science of disease research and this is one of the best yet. Folkman's story is fascinating and Cooke tells it well. Highly recommended!

Also recommended:"Decoding Darkness" on Alzheimer's by Tanzi and Parson

Cooke is an excellent writer and biographer, and he clearly has a grasp of how scientific theories that are both useful and fruitful must challenge the conventional wisdom. Theories that meet this standard bring criticism upon the pioneer. Cooke brings out this struggle in bold relief and takes the reader right into the laboratory to gain a sense of how difficult is the task and how dedicated must be the scientist in giving birth to new wisdom for the benefit of mankind. Exquistely told. Adults will learn from this. Young readers will be inspired.

Amazing story of an incredible scientist,doctor and human being. this man has managed to accomplish so much in his lifetime and we will all benefit from his amazing work in the not too distant future. Worth a read! I am donating my copy to our local library. The writting can be laboroius at times but the story is a MUST read.