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

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

Book Review: A Modern Odyssey of Medical Innovation
Summary: 5 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!

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