Stanley Order, MD, FASTRO
Question: I am Gustavo Montana, chair of the ASTRO History Committee, and I have the pleasure to interview Stanley Order, a long-time friend and distinguished colleague. I’ll be interviewing Stanley with Moody Wharam, also a friend and colleague. Moody worked with Stanley very closely and knows him very well. I will start with the very simple question: Stan where you were you born? Also tell us about your family, your background, where you did you get your undergraduate and graduate degrees?
Dr. Order: I was born in Vienna, Austria. My father was studying medicine at the University of Vienna. Due to what went on in Europe at that time, my mother ran out of Vienna in 1935, in order to escape the Nazis. And my father graduated a year later and was still able to get out. I was raised in Philadelphia, where my father practiced general medicine, and my sister got an education and became a radiation oncologist as well. So the family consisted of the mother, the father and the two children who were both radiation oncologists. And my mother was an artist to top everything off.
Question: Yes, we know about your sister as well. But where did you go for your undergraduate and graduate education?
Dr. Order: I went to Central High, which was famous for its education at that time and has its reunion, actually, this month. And after Central High, I went to Albright College, and when I finished Albright College I went to Tufts Medical School.
Question: Maybe we should back up a little bit. Were you destined to be a physician?
Dr. Order: Well, in the home environment that I had, both my sister and I felt that we had to be physicians and really never considered much else. I certainly didn't have any other career in mind.
Question: Now, Stanley, I see you went to do your internship in Indiana, is that correct?
Dr. Order: Yes. I went there because it was a rotating internship, and you had several months in every specialty -- surgery, OB/GYN, etcetera -- and during my obstetric/gynecology rotation, the resident got hepatitis, and I had to assist in all the deliveries. At that time, I was thinking about OB/GYN, but I was more enamored with going to Harvard in pathology, which follows at the Peter Bent Brigham Hospital.
Question: Stan, when did you meet Mary?
Dr. Order: Actually, prior to medical school, we got married, and we went to medical school together. She worked in the department of pharmacology, while I was a student.
Question: Oh, goodness. I didn't know that you married so early in life and to a wonderful person, we might add.
Dr. Order: We have been married 54 years, so we've had a pretty good marriage. And we raised three children. And then, following, in medical school and internship and a year residency, I was in the Berry Plan, so the Army drafted me, and Dr. Dammin, who was the head of pathology at Harvard, sent me to the burn unit where I was chief of experiential studies and pathology for two years, during which I wrote about the conversion of second degree burns to third-degree or full-thickness by bacteria and also wrote a monograph called “The Burn Wound, Covering the Whole Approach to Topical Chemotherapy in Burns.”
Question: Where was that institute?
Dr. Order: Fort Sam Houston in Texas.
Question: So you were one of the pioneers in the modern treatment of burns, is that correct?
Dr. Order: Yes, it is. We were not alone. Once we announced topical chemotherapy, the University of Michigan, Ann Arbor, took it up with silver nitrate. We were doing it with sulfamylon, and, today, I was actually treated recently with sulfa silvedine which is the marriage of the two products, and it's used in burn therapy today.
Question: And that was after one year of a standard pathology residency, correct?
Dr. Order: Right.
Question: Okay. So at some point, you came back and resumed your residency, and also learned about radiation oncology. So tell us about the rest of your training. It must have been a three-year residency in pathology, is that right?
Dr. Order: No. What happened, when I was in pathology at the Peter Bent Brigham Hospital, Luther Brady was professor at Harvard and gave talks about cancer and was so impressive that I decided that I would join in that field. And I got a fellowship to Yale, which was a four-year fellowship and that's how I got to Yale.
Question: And that's where you and I met.
Dr. Order: Yes.
Question: So did you begin your fellowship when you got out of the army?
Dr. Order: Yes, I was out of the Army, right. After the two years in the Army, I did a four-year fellowship at Yale. During the fellowship, I would say there were two prominent events. One was that after Kligerman had me reconstruct tumors using tomography instead, we did not have CAT scans in those days, so we did X-ray tomographs sequentially through a tumor and lined it up in a model system of glass where one could now see the tumor in 3-D. Unfortunately, Dr. Kligerman was ahead of his time but never named the process, even though he taught it, of three-dimensional reconstruction and tumor imaging.
Question: That's fascinating, Stan. That was way, way ahead of the time.
Dr. Order: Yes, it was. He was far in advance in that. And because of my interest in immunology when I was in the service, I got a program with Dr. Byron Waksman, the professor of immunology. And what we worked on was the transplantation of F1 hybrid marrow into a parent that had been irradiated. And the way we traced the cells to see how they repopulated the lymphoid system was to use an antibody, and that introduced me into the fact that antibodies could be used both for tissue recognition as well as cancer recognition. In cancer, it's simply an exaggeration of the normal protein or marker of the particular tissue, even though at that time everybody wanted the markers to be totally unique for cancer. But that did not turn out to be the truth.
Question: So, Stan, remind me. When were monoclonal antibodies discovered? --
Dr. Order: Well, I was going to get to that. When I then entered Harvard, the Joint Center, and joined Dr. Montana at the Deaconess Hospital, monoclonal antibody was discovered during those years at Harvard. At Harvard, several events were unique at the Deaconess. I was given the laboratory at the Shields Warren, and a Dr. Robert Knapp wanted to become the Baker professor of gynecology, but it required laboratory experience, and he chose my lab to work in. We developed a model of ovarian cancer, which he dissected, and we produced an antibody to treat the cancer and put it in remission. And then we purified the antibody later using a sephadex column, and that introduced me to the whole idea of antibody therapy potentially in humans. At the same time, we were getting spleens for staging in Hodgkin’s disease, and the tumor in the spleen was used to immunize rabbits and produce an antibody. Dr. Stanley Chism, a resident at that time, won an award for electrophoresis of the antigen in Hodgkin’s disease. We then described the fast- and slow-migrating antigens from the production of Hodgkin’s tumor in rabbits. And armed with that, Dr. Knapp became the Baker professor, so that was successful. I was then given the position at Johns Hopkins, and Dr. Wharam joined me in the effort to convert the department from two antiquated cobalts to five linear accelerators, a cobalt unit and two simulators. So we made real progress by very diligent work during those years.
Question: Stan, let's go back a minute to the Joint Center. Gus Montana was there. Who was the chairman at that time?
Dr. Order: Samuel Hellman. Sam Hellman had come from Yale, and he brought a few people with him. But before we go into that -- and we will come back to what we were talking about -- I just want to say just a few words about Dr. Kligerman, Klig. He was such an important person in our life, in my life, and certainly it sounds like in yours as well. Well, he was a dynamic teacher, ahead of the field, recognizing 3-D images, three-dimensional treatment of the image and restricting the beam to that image. All of that has since been named and unfortunately, Dr. Kligerman didn't name it. He practiced and taught it. We all benefited from that knowledge. I mean, this was in the pre-CAT-scan era when there were no CAT scans, but there was tomography with X-ray. That was not commonly done in those days, but Dr. Kligerman carried that out. He also had the vision to send me to Dr. Waksman for training in immunology since I was interested in that, and that was a unique experience as well. Dr. Waksman, in my opinion, was the most broadly educated professor I had ever met.
Question: Was he a physician or MD/PhD or what? What was he?
Dr. Order: He was an MD, and his father was Selman Waksman, the Nobel Laureate for streptomycin. And he played the harpsichord, knew all the literature backwards and forwards. He would invite a professor to come and speak to us about immunology, and before the professor was finished, he would ask him five penetrating questions that no one thought of but him. And that was the kind of professor he was. One story I recall, which is a lot of fun, he asked me in an experiment I was reviewing what kind of mouse was it? And I replied one with a tail and four legs. And he said, no, that wasn't what I was supposed to learn. Go home and read “The Biology of the Laboratory Mouse” and report back when you've finished the book. The book is enormous. I read the book, and when I came back I realized that there were strains of mice, inbred strains, and these inbred strains were critical to cancer research. And from then on, I knew mice by their real name C3H/FEBJ, etcetera. And that was a real education. And the other students with Waksman said I should have gotten a PhD from him, but I didn't want to start with a language. I had enough burden with radiation oncology and immunology, simultaneously.
Question: Stan tell us about Kligerman as a clinician. He must have had some influence on you.
Dr. Order: Yes. He not only examined patients well, but he would do some interesting things like there was a patient who was able to eat but didn't like the food. He went out to a delicatessen, got the food, and brought it back for the patient and said he was the only professor to do that and to this day I find that true.
Question: He not only stimulated you with his research, but with your research and supported you in that, but also taught a lot of us that the patients come first. Never forgotten.
Dr. Order: Sure. During those years with Sam Hellman, while I was at Yale, I wrote a paper on “The Quality of Life Following Whole-Brain Irradiation for Brain Metastasis.” At that time, there was no Red Journal. It was published in Radiology, so it has never been quoted. But what I showed in that particular paper was the cumulative rate of improvement over the cumulative survival as a cumulative index. In other words, it told you how long the patient benefited and how long he was alive. And, unfortunately, that was never carried on, because it was in Radiology, and not the Red Journal which later, when it was formed, was the main journal for our specialty. So at that point, I went to Hopkins with Dr. Wharam and we worked on various things. At Hopkins, we had all kinds of unique experiences. Among them, we had a whole-body radiation program for bone marrow transplantation. I was to meet Dr. Donald Thomas, who visited the department and we became friends because we had a mutual interest, not only in medicine, but also in angling. And I was able to fish with the Nobel Laureate in Alaska, North Carolina, and the Chesapeake Bay. So those were unique fun experiences, not professional science. However, we also went to Dr. Thomas' department and published the dosimetry on his whole-body radiation that he did for bone marrow transplant and that was a unique experience. Also, we began the work on the anti-ferritin antibody. Ferritin had now been established as one of the major antigens in the Warren Laboratory at Harvard. Another Nobel Laureate won it for the immune genes, but it was in his lab that we were able to produce ferritin as the main component in the antibodies. And with that anti-ferritin in the body, we treated some end-stage Hodgkin’s when they had had failed all conventional therapies at that time. And we did obtain some remissions. More interestingly, I knew that liver cancer synthesized and secreted ferritin and went on to develop a hepatoma program and learned many new things. For example, there are three kinds of liver cancer. There are cancers that produce alpha-fetoprotein, found in Orientals. There is a liver cancer that does not produce alpha-fetoprotein, found mainly in Europeans. Then there is a fibrolamellar hepatoma that is found in young people and very resistant to surgery. We treated all of those in Phase I/II studies and demonstrated that the non-alpha-fetoprotein tumors, AFP negative, would respond to antibody therapy to the point where one could carry out surgery and we had some cures.
Question: It's worth remarking, I think, Stan, and for Gus' benefit that at the height of that program, Stan would see as many as five to eight hepatoma patients per week -- unprecedented. And they came from around the world.
Dr. Order: That's true. And one of the patients who came from China said what would I like for him to bring for me? And I thought it was a joke, but I said an Oriental rug just to say something. And lo and behold, when he arrived to be treated, I had an Oriental rug.
Question: A beautiful one, I'm sure. I want to take you back to the Yale days and mention a fellow resident, not very well-known but brilliant,-- Jim Fisher. Probably you got to know him pretty well.
Dr. Order: Oh, yes.
Question: Can you say a few words about Jim? He is, unfortunately, no longer with us.
Dr. Order: Oh, did he pass?
Question: Yes. He died suddenly.
Dr. Order: I didn't know that. Jim Fisher was an exceedingly bright person who had worked on nuclear magnetic resonance before he took the fellowship in radiation oncology. And Jim was bright in everything that you could mention. And I got to know him, because one could follow what he said and learn. And he was really the format person when Dr. Hellman had left the Yale residency, and he took over Yale when Dr. Kligerman left. He was a brilliant guy.
Question: He was not very well-known in our field. Also, this may be an opportunity to say a few words about Sam. He had so much to do with your career, the early part of your career, Sam Hellman.
Dr. Order: Well, Sam Hellman, no question, was a pioneer in breast irradiation for definitive management after lumpectomy. Unfortunately, it was done at a single institution, and later in history it was randomized and studied at many institutions.
Question: Stan, it's also worth noting in those days I think there was no RTOG. There was no easy mechanism to take an idea into a broader context.
Dr. Order: Yeah, that's true. I mean, the facts are there was no Red Journal, there was no RTOG, there was no CAT scanning in the beginning of my career.
Question: And there were no accelerators either.
Dr. Order: And the accelerator -- we had an accelerator in Yale. So when I went to Yale, we already had a linear accelerator.
Question: And it was the second linear accelerator.
Dr. Order: And I might mention one other thing. Dr. Wharam and I collected phrases of the essence of radiation oncology from some of the professors and put them on plaques, and I'd like to mention three of them -- Dr. Henry Kaplan, of Stanford, who had helped develop the linear accelerator, said that the most essential element of being a radiation oncologist is the judgment that goes with being a good physician. And Dr. Rubin, who is still alive, the founder of the Red Journal, said the first decision in cancer treatment must be multidisciplinary and right. There is seldom a second chance for survival. And finally, Dr. Simon Kramer, of Jefferson, who is no longer with us, the founder of RTOG, who stated that the challenge for radiation oncologists is to be a skilled oncologist who understands and interprets the disease process and all body systems. He must be a consultant's consultant. And these three men were certainly the foundation of modern radiation oncology with their contributions—accelerator, Red Journal and cooperative group.
Question: When I visited your department I was very impressed with the plaques with quotes from very notable people you had in the conference room.
Dr. Order: Of course, the wonderful thing about it is, although two of the men are no longer with us, that the essence of what they believe is expressed in those statements.
Question: Well, now I'd like to go back to your career. You were talking about the hepatomas, the different kinds of hepatomas and about the number of patients that came from all over the world to seek treatment at your facility.
Dr. Order: I got invited throughout the Orient which was a lovely experience. I was invited to China twice and the first time I had a unique experience. I came off of the plane in Shanghai, not knowing what the Professor Tang looked like. And a man waved from a balcony and I presumed that he was waving at me, and I waved back. But when I got out into the area where you can meet the people, he was waving to somebody else and I didn't know what Professor Tang looked like. At that moment, I spotted a young lady closing a book with my name on it and I was then able to get to Professor Tang. And I had a wonderful time. He had made antibodies and had tested them. He made antibodies directly from the liver cancer and he made antibodies like we did from the Hodgkin’s disease and published the fact that the anti-Hodgkin’s antibody, the anti-ferritin, was more effective than the other antibodies. And he published it in a journal. I was actually editor for a journal called Antibody, Immunoconjugates and Radiopharmaceuticals. And he published that study in that journal, which I ran for a couple of years. Monoclonal antibody in the meantime had taken off all over the world, and today you can pick up a New England Journal and find a monoclonal antibody active in some disease process. One of the saddest things was that in order to patent a drug, you must first patent it and then publish -- not publish and then patent. If you publish it, the patent process is lost, so none of the discoveries that I made at that time could be patented because they were all published first. However, I got to visit China, Japan, Korea, Australia and talked about liver cancer in those countries, particularly in the Orient where they have such a high incidence of liver cancer. And that was also a nice thing in my career to visit these countries. As a hobby, I would learn one paragraph in their language and give the first paragraph of introduction in the Korean, Japanese or Chinese. In China, though, I backed off because I found the language so difficult that I was afraid to utilize it.
Question: Yes, It is very obvious that you are gifted for languages.
Dr. Order: Well, it was a very interesting thing and it honored the country that you're in when you give something in their language as a recognition of their role in society. So that was also another thing. And then I had a young resident, Dr. Robert Rostock, and he took a whole variety of experimental liver cancers and studied them for what produced ferritin. And the ferritin-producing one he treated with anti-ferritin and got good results and won the resident award from ASTRO for his work. And that was also a pleasure to have residents win awards for different work in immunology. And then toward the end of my stay at Hopkins, I was anticipating going to New Jersey where I started an institute for systemic therapy. And a discovery that was made from that institute was that macro-aggregated albumin prior to colloidal P32 would make the colloidal P32 a permanent implant. And I began treating patients with that combination in pancreatic cancer, and we published Phase I which revealed doses as high as one million centigray. Out of that experience, there were two long-term survivors -- one for two years who succumbed to another disease, and one for ten years who relapsed ten years later with a second pancreatic cancer. And I don't know if that represented a recovery of the primary cancer or a new induction of a secondary cancer. I never could figure it out, but he got ten years of good life and the biomarker CA 19-9 was normal during those ten years.
Question: Stan, can we go back to Hopkins for a moment? Clearly, Hopkins was in the dark ages of radiotherapy when you came, and there were people who almost resisted some of your ideas. So I wonder if you would comment on some of the people at Hopkins that were helpful friends of the department or people who were your supporters, we weren't a department, we were a division. I think of Don Coffey, for example.
Dr. Order: Well, medical oncology enjoyed the finances that radiation oncology brought to the oncology center. We were a national center. Dr. Albert Owens was the major force in developing radiation oncology as a specialty. And Dr. Fisher of Yale told me that he had told Dr. Owens to be a national cancer center he had to have radiation oncology at a sophisticated level.
Question: Thanks, Stan. Just for the sake of the person who is going to be writing this down, you said that Al Owens was something like one of the major developers of radiation oncology. I think you meant medical oncology.
Dr. Order: No, he didn't develop the radiation oncology. He brought the people in to develop it and had the foresight to say that it was a specialty that was needed. I would not describe what we had because it would be too damaging.
Question: Dark ages.
Question: What are names -- you mentioned Dr. Jim Fisher?
Dr. Order: Yes, it was Jim Fisher, of Yale, who told me that he had told Albert Owens to develop radiation oncology if he wanted a national cancer center.
Question: Was anyone in particular outside of our division, Stan, that you want to cite as helpful or influential?
Dr. Order: Well, I can't think of his name at the moment, but the one in urology, you'll recall his name.
Question: You mean Don Coffey or do you mean Pat Walsh?
Dr. Order: Don Coffey. Don Coffey at one point in the radiation oncology history became head of the oncology center in the period of a couple of years, and during that time everything flourished under his guidance. And he was a remarkable, and is a remarkable individual, who understood the broad business of medical oncology, radiation oncology and general science. So he was an outstanding individual that I would cite.
Question: He is an exceptional speaker, very engaging.
Dr. Order: Yes.
Question: You had him as keynote speaker at ASTRO when you were president.
Dr. Order: Well, I will talk about ASTRO next. At ASTRO when I became president, I felt there was one thing missing in the ASTRO meetings. There was no cultural event. And I thought that Art Buchwald would give a seminar at ASTRO and bring a cultural event to the meeting, which he did and he was outstanding. And Art Buchwald, a couple of years ago, was put in hospice to die, but he didn't die. He lived an extra year and wrote a book with his typical humor that “It's Too Soon to Say Good-bye”, the title of the book. And he states that he dreamed he was flying to heaven and asked the stewardess, "Are there frequent flyer miles for the flight?" And she replied, "No, it's one way." So Art Buchwald was a real experience at ASTRO and for the general meeting.
Question: Thank you for having invited him to speak. So while we are on the subject of the society of which you were president in 1988, do you have any thoughts about ASTRO?
Dr. Order: Yes. I think they should have a cultural event at the meeting every year, and the cultural event, chosen by the leadership. The event should be cultural outside of the general radiation oncology to emphasize that being a physician requires culture. We all go to college before we go to medical school, and the reason is cultural and we certainly should continue that in ASTRO. And I know some of the presidents who followed did do that, but not all of them. And I think that's important to have a cultural event at ASTRO.
Question: While we are on this topic, you played a very important role in the Red Journal. Do you have any comments about it?
Dr. Order: Well, I think Dr. Rubin who founded it is an exceptional individual, and I was present at his retirement in which we roasted Dr. Rubin, and I said he was the only professor I knew who had two chairs and a sandwich named after him. And Phil got a big charge out of that particular statement. And the Red Journal has certainly done a service for radiation oncology, giving it a venue for expression in the field. But now there are so many radiation oncologists, they're making a second journal to be distributed about clinical radiation oncology.
Question: Practical Radiation Oncology, yes.
Dr. Order: Yes.
Question: There's another one at Stanford, the new one, a Journal of Radiation Oncology (JRO). It's a Luther Brady journal. It's brand new.
Dr. Order: Yes.
Question: I'd just want to see if Stan has any other comments about his time at Hopkins. He mentioned Don Coffey. Stanley took the program from the dark ages to a modern department with linear accelerators and everything that was available at the time. And also projected it onto the national scene, both by virtue of the publications and the science, but also by bringing scientists from elsewhere to Hopkins. So we became nationally and internationally recognized in a very, very brief amount of time.
Dr. Order: Well, I'd like to continue with when I left New Jersey and went to New York. It was in New York I made a significant finding and that was I was using Cisplatin intra-arterially in hepatomas -- liver cancer. And they were getting better responses at one-third of the dose given intravenously. And so I radio-labeled the Cisplatin and studied its distribution to find out that when you gave it intra-arterially, it deposited right away in the tumor, and there was very little effluent outside of the tumor. And so with that discovery, I patented radioactive Cisplatin as a therapy because it produced Auger electrons. One radiated the platinum and then made the drug Cisplatin. I had a Phase I/II study ready to launch, but I had given the patent to the department that had hired me, and they got in an internal fight between the lawyers and the study was never done. But the study was to look at escalating doses of radioactive Cisplatin in liver cancer, substituting the radioactivity for the non-radioactive in order to get the patient in remission and to study the radiation. I was only able to give 1 millicurie of Cisplatin because of the law that required the formal study which was never done. But that sort of ended my career as a final episode of discoveries. So I had finished with macroaggregated albumin and colloidal P32 as an implant and also radioactive Cisplatin in therapy. And then I would add one thing. My own thing in the plaques was a resident without the literature is a ship without a compass. And I believe that still holds true today.
Question: Stan, my memory is that it was a resident not questioned is like a ship without a compass. That's the actual quote.
Dr. Order: Yes, well, it shows my age. But anyway, that's the sum and substance of it all. And then in the latter years I had health problems. One of them was prostate cancer and I had the seed implant, and I will tell you that as a therapist looking back on it, that is a very benign procedure and it's one day and was pleasant and my PSAs are all normal. And so that was an effective treatment in my case. And that's where I would end my career. That's enough.
Question: You've given significant, important and personal testimony for the treatment for prostate cancer that sometimes is overlooked.
Dr. Order: Well, I had seed implant and beam on top of it because of the grade of tumor, and beam is not as comfortable as a seed implant in one day. And they published subsequently the fact that if they made the dose high enough, they could even do high-grade tumors with good results. And as a person looking out for the public in what they should know, having the experience, I would say it's a very pleasant therapy considering the magnitude of its approach.
Question: Okay. Stanley, unless Moody has something else to ask you about this, I would like to talk about the awards and honors you have received.
Dr. Order: I got the Simon Kramer Award, I got the Red Star in China which was a significant award. I considered the Willard and Lillian Hackerman professorship at Hopkins, a personal award, which has also now translated to other professors who lead the department. So those are the significant ones that I can recall.
Question: Well, you have two honorary degrees.
Dr. Order: Well, that's an interesting business. I had given a talk in radiation oncology for ministers at Hopkins, and one of the ministers was a power at Elizabethtown College. And he got them to invite me to give the commencement at Elizabethtown College following Three Mile Island. And I gave that commencement, but during the course of it I asked the president of the class, "What did you think about the radiation exposure?" And he said, "The radiation vacation was wonderful." So it shows you how serious the event was taken by the students. And it never really proved to be the extravaganza that the public was told in the media, because there was very little exposure of anyone to anything of significance. Following that, my college heard that I gave the commencement at Elizabethtown, and they called me up and said would I give the commencement there? And when I told them I wasn't willing to write the speech twice, they said, "Give the same speech. No one here heard it." And so I did. In fact, I ended the speech with an Art Buchwald story and Art had said, "I'm not against America, but when Richard Nixon resigned, the only military action I saw was a cop directing traffic on Pennsylvania Avenue." And when I was at Albright College and finished the speech, I told them, "Not bad for a kid from Albright College."
Question: I have a remark, a memory actually. One of the things that Stan always did was he had a morning teaching conference with the residents, which was rigorous, and Stan will always encourage or maybe tell the residents to write down the data that supported the utility of radiotherapy in a given disease. And I bring that up because one of the current buzz words is evidence-based therapy. Well, Stan was on to the importance of evidence-based therapy, in 1975, when I got to know him. Do you want to comment about that, Stan? Had you done that at Yale? Where did you sort of learn that teaching technique?
Dr. Order: No, it sort of evolved on its own. One of the things that I found was a resident would read something but not necessarily go into the profound nature of the subject. And that I learned from Byron Waksman when he asked me what kind of mouse it was. I would ask, what kind of radiation is it? How is it implied? What is the evidence that supports it? And that kind of thinking I was taught by Byron Waksman.
Question: Yes, as I think back about you, Stan, we've talked a lot today about your creativity which is manifested in many ways and recognized around the world with your research. I think also one of the things that sustained you through those tough years that I knew you at Hopkins, apart from your family, was your sense of humor.
Dr. Order: Well, I appreciate that. There was enough to laugh about. The story I remember best was Dr. Heysel was president of the hospital and the university and called me into his office to ask what did I think of radiation oncology at Hopkins? And I said it had no way to go but up. He then tossed me football off his desk and said, "Around here we play ball," and I said, "Yes, but the ball must have air in it in order to function," meaning that you had to have real accelerators and not cobalt machines.
Question: Of all of the things you have accomplished, what do you consider to be the most significant one and what has given you the most satisfaction?
Dr. Order: Well, the radio-labeled antibody which was in advance of the monoclonals, and it was very satisfying to go from the laboratory to the clinic and to see patients who were remitted and then surgically resected for cure, and that was very satisfying. It was taking an experience from the laboratory and bringing it to the clinic, and I like that more than any other business in radiation oncology. And the worldwide exposure and interaction in the other countries was also very positive and a positive experience for me. But I enjoyed everything we did in radiation oncology. I enjoyed the specialty, I enjoyed the opportunity in some diseases to treat for a cure. And I think that's the most satisfying element -- the cured patient -- better than palliation and only achievable in certain malignancies.
Question: So if you were to put a statement on a plaque, obviously, a brief statement, do you have one in mind?
Dr. Order: Well, I told you the one about the residents and the compass. That would be the one I would use.
Question: One I remember that Stan said -- and I'm saying it from memory now, so I have to think about how to get it straight -- Stan made a comment that he put on a plaque that technical excellence in radiation therapy is a standard, but compassion is what distinguishes a physician. Am I quoting you correctly?
Dr. Order: Absolutely. And the reason I said that is because you can be enamored with the technical business of radiation oncology and forget the fact that you're supporting a human through one of the trying episodes of his life. And compassion is something that is not taught. It must come from within the person itself.
Question: I would like to mention again your sister, Susha, a very accomplished radiation oncologist?
Dr. Order: Well, my sister always said that she was known as my sister, not for herself. However, she practiced beautiful radiation oncology, was very compassionate, had followed the tradition that my father had in his general practice and deserved recognition on her own. Because I had become somewhat prominent, she felt the pressure of my prominence which was unfortunate. Otherwise, it was delightful having a sister in radiation oncology.
Question: Now, we mention your devoted wife, Mary. She has been by your side for many years.
Dr. Order: Fifty-four years. And to tolerate me for 54 years is an accomplishment.
Question: It's an accomplishment and speaks for the person that she is.
Dr. Order: Sure. I have no hesitancy about her contribution to my life.
Question: I wonder, Stan, if you would reflect on how the handlebar mustache was received at Hopkins.
Dr. Order: Ah, well, that was fun.
Question: It's your sense of humor.
Dr. Order: The handlebar mustache, when I lectured in Scandinavia, they thought I was a Norseman, and at Hopkins, the patients felt a negative pressure from the mustache, and I shaved it. And when I shaved it, the dean told me it was brilliant because they all got to know me with the mustache and then had to re-learn me without the mustache. And it's interesting how symbolism thrives in our interrelationships.
Question: Well, there is one more thing that I will bring up—do you have any thoughts about the direction of health care in the United States or the lack of direction or whatever way you want to look at it.
Dr. Order: Having recent hospitalizations, I know what's happening in medicine. The resident and the senior physician taking care of me had 16 patients in intensive care at the same time due to financial pressure that is being created. And the business of somehow restricting medical cost is something that needs to be done and, eventually, will be done as the amount of expenditure for medicine increases beyond reason, which is close to where it is now. And some of the services that one receives are not necessarily good. For example, I have home medical care in which I must now see my physician every three months and have a nurse see me monthly when there's no problem, and Medicare is paying for all that. And if I tell them not to do it, it's a rule. And the business of rules in medicine is destructive to the patient/physician relationships. And I see that happening, and it's very sad. And I don't have an answer for the problem, but I recognize the problem. The problem is too much pressure, too much orientation to monetary gains and not to the essence of physical practice.
Question: Well, we want to thank you, Stanley, for allowing us to interview you.
Dr. Order: I was born in Vienna, Austria. My father was studying medicine at the University of Vienna. Due to what went on in Europe at that time, my mother ran out of Vienna in 1935, in order to escape the Nazis. And my father graduated a year later and was still able to get out. I was raised in Philadelphia, where my father practiced general medicine, and my sister got an education and became a radiation oncologist as well. So the family consisted of the mother, the father and the two children who were both radiation oncologists. And my mother was an artist to top everything off.
Question: Yes, we know about your sister as well. But where did you go for your undergraduate and graduate education?
Dr. Order: I went to Central High, which was famous for its education at that time and has its reunion, actually, this month. And after Central High, I went to Albright College, and when I finished Albright College I went to Tufts Medical School.
Question: Maybe we should back up a little bit. Were you destined to be a physician?
Dr. Order: Well, in the home environment that I had, both my sister and I felt that we had to be physicians and really never considered much else. I certainly didn't have any other career in mind.
Question: Now, Stanley, I see you went to do your internship in Indiana, is that correct?
Dr. Order: Yes. I went there because it was a rotating internship, and you had several months in every specialty -- surgery, OB/GYN, etcetera -- and during my obstetric/gynecology rotation, the resident got hepatitis, and I had to assist in all the deliveries. At that time, I was thinking about OB/GYN, but I was more enamored with going to Harvard in pathology, which follows at the Peter Bent Brigham Hospital.
Question: Stan, when did you meet Mary?
Dr. Order: Actually, prior to medical school, we got married, and we went to medical school together. She worked in the department of pharmacology, while I was a student.
Question: Oh, goodness. I didn't know that you married so early in life and to a wonderful person, we might add.
Dr. Order: We have been married 54 years, so we've had a pretty good marriage. And we raised three children. And then, following, in medical school and internship and a year residency, I was in the Berry Plan, so the Army drafted me, and Dr. Dammin, who was the head of pathology at Harvard, sent me to the burn unit where I was chief of experiential studies and pathology for two years, during which I wrote about the conversion of second degree burns to third-degree or full-thickness by bacteria and also wrote a monograph called “The Burn Wound, Covering the Whole Approach to Topical Chemotherapy in Burns.”
Question: Where was that institute?
Dr. Order: Fort Sam Houston in Texas.
Question: So you were one of the pioneers in the modern treatment of burns, is that correct?
Dr. Order: Yes, it is. We were not alone. Once we announced topical chemotherapy, the University of Michigan, Ann Arbor, took it up with silver nitrate. We were doing it with sulfamylon, and, today, I was actually treated recently with sulfa silvedine which is the marriage of the two products, and it's used in burn therapy today.
Question: And that was after one year of a standard pathology residency, correct?
Dr. Order: Right.
Question: Okay. So at some point, you came back and resumed your residency, and also learned about radiation oncology. So tell us about the rest of your training. It must have been a three-year residency in pathology, is that right?
Dr. Order: No. What happened, when I was in pathology at the Peter Bent Brigham Hospital, Luther Brady was professor at Harvard and gave talks about cancer and was so impressive that I decided that I would join in that field. And I got a fellowship to Yale, which was a four-year fellowship and that's how I got to Yale.
Question: And that's where you and I met.
Dr. Order: Yes.
Question: So did you begin your fellowship when you got out of the army?
Dr. Order: Yes, I was out of the Army, right. After the two years in the Army, I did a four-year fellowship at Yale. During the fellowship, I would say there were two prominent events. One was that after Kligerman had me reconstruct tumors using tomography instead, we did not have CAT scans in those days, so we did X-ray tomographs sequentially through a tumor and lined it up in a model system of glass where one could now see the tumor in 3-D. Unfortunately, Dr. Kligerman was ahead of his time but never named the process, even though he taught it, of three-dimensional reconstruction and tumor imaging.
Question: That's fascinating, Stan. That was way, way ahead of the time.
Dr. Order: Yes, it was. He was far in advance in that. And because of my interest in immunology when I was in the service, I got a program with Dr. Byron Waksman, the professor of immunology. And what we worked on was the transplantation of F1 hybrid marrow into a parent that had been irradiated. And the way we traced the cells to see how they repopulated the lymphoid system was to use an antibody, and that introduced me into the fact that antibodies could be used both for tissue recognition as well as cancer recognition. In cancer, it's simply an exaggeration of the normal protein or marker of the particular tissue, even though at that time everybody wanted the markers to be totally unique for cancer. But that did not turn out to be the truth.
Question: So, Stan, remind me. When were monoclonal antibodies discovered? --
Dr. Order: Well, I was going to get to that. When I then entered Harvard, the Joint Center, and joined Dr. Montana at the Deaconess Hospital, monoclonal antibody was discovered during those years at Harvard. At Harvard, several events were unique at the Deaconess. I was given the laboratory at the Shields Warren, and a Dr. Robert Knapp wanted to become the Baker professor of gynecology, but it required laboratory experience, and he chose my lab to work in. We developed a model of ovarian cancer, which he dissected, and we produced an antibody to treat the cancer and put it in remission. And then we purified the antibody later using a sephadex column, and that introduced me to the whole idea of antibody therapy potentially in humans. At the same time, we were getting spleens for staging in Hodgkin’s disease, and the tumor in the spleen was used to immunize rabbits and produce an antibody. Dr. Stanley Chism, a resident at that time, won an award for electrophoresis of the antigen in Hodgkin’s disease. We then described the fast- and slow-migrating antigens from the production of Hodgkin’s tumor in rabbits. And armed with that, Dr. Knapp became the Baker professor, so that was successful. I was then given the position at Johns Hopkins, and Dr. Wharam joined me in the effort to convert the department from two antiquated cobalts to five linear accelerators, a cobalt unit and two simulators. So we made real progress by very diligent work during those years.
Question: Stan, let's go back a minute to the Joint Center. Gus Montana was there. Who was the chairman at that time?
Dr. Order: Samuel Hellman. Sam Hellman had come from Yale, and he brought a few people with him. But before we go into that -- and we will come back to what we were talking about -- I just want to say just a few words about Dr. Kligerman, Klig. He was such an important person in our life, in my life, and certainly it sounds like in yours as well. Well, he was a dynamic teacher, ahead of the field, recognizing 3-D images, three-dimensional treatment of the image and restricting the beam to that image. All of that has since been named and unfortunately, Dr. Kligerman didn't name it. He practiced and taught it. We all benefited from that knowledge. I mean, this was in the pre-CAT-scan era when there were no CAT scans, but there was tomography with X-ray. That was not commonly done in those days, but Dr. Kligerman carried that out. He also had the vision to send me to Dr. Waksman for training in immunology since I was interested in that, and that was a unique experience as well. Dr. Waksman, in my opinion, was the most broadly educated professor I had ever met.
Question: Was he a physician or MD/PhD or what? What was he?
Dr. Order: He was an MD, and his father was Selman Waksman, the Nobel Laureate for streptomycin. And he played the harpsichord, knew all the literature backwards and forwards. He would invite a professor to come and speak to us about immunology, and before the professor was finished, he would ask him five penetrating questions that no one thought of but him. And that was the kind of professor he was. One story I recall, which is a lot of fun, he asked me in an experiment I was reviewing what kind of mouse was it? And I replied one with a tail and four legs. And he said, no, that wasn't what I was supposed to learn. Go home and read “The Biology of the Laboratory Mouse” and report back when you've finished the book. The book is enormous. I read the book, and when I came back I realized that there were strains of mice, inbred strains, and these inbred strains were critical to cancer research. And from then on, I knew mice by their real name C3H/FEBJ, etcetera. And that was a real education. And the other students with Waksman said I should have gotten a PhD from him, but I didn't want to start with a language. I had enough burden with radiation oncology and immunology, simultaneously.
Question: Stan tell us about Kligerman as a clinician. He must have had some influence on you.
Dr. Order: Yes. He not only examined patients well, but he would do some interesting things like there was a patient who was able to eat but didn't like the food. He went out to a delicatessen, got the food, and brought it back for the patient and said he was the only professor to do that and to this day I find that true.
Question: He not only stimulated you with his research, but with your research and supported you in that, but also taught a lot of us that the patients come first. Never forgotten.
Dr. Order: Sure. During those years with Sam Hellman, while I was at Yale, I wrote a paper on “The Quality of Life Following Whole-Brain Irradiation for Brain Metastasis.” At that time, there was no Red Journal. It was published in Radiology, so it has never been quoted. But what I showed in that particular paper was the cumulative rate of improvement over the cumulative survival as a cumulative index. In other words, it told you how long the patient benefited and how long he was alive. And, unfortunately, that was never carried on, because it was in Radiology, and not the Red Journal which later, when it was formed, was the main journal for our specialty. So at that point, I went to Hopkins with Dr. Wharam and we worked on various things. At Hopkins, we had all kinds of unique experiences. Among them, we had a whole-body radiation program for bone marrow transplantation. I was to meet Dr. Donald Thomas, who visited the department and we became friends because we had a mutual interest, not only in medicine, but also in angling. And I was able to fish with the Nobel Laureate in Alaska, North Carolina, and the Chesapeake Bay. So those were unique fun experiences, not professional science. However, we also went to Dr. Thomas' department and published the dosimetry on his whole-body radiation that he did for bone marrow transplant and that was a unique experience. Also, we began the work on the anti-ferritin antibody. Ferritin had now been established as one of the major antigens in the Warren Laboratory at Harvard. Another Nobel Laureate won it for the immune genes, but it was in his lab that we were able to produce ferritin as the main component in the antibodies. And with that anti-ferritin in the body, we treated some end-stage Hodgkin’s when they had had failed all conventional therapies at that time. And we did obtain some remissions. More interestingly, I knew that liver cancer synthesized and secreted ferritin and went on to develop a hepatoma program and learned many new things. For example, there are three kinds of liver cancer. There are cancers that produce alpha-fetoprotein, found in Orientals. There is a liver cancer that does not produce alpha-fetoprotein, found mainly in Europeans. Then there is a fibrolamellar hepatoma that is found in young people and very resistant to surgery. We treated all of those in Phase I/II studies and demonstrated that the non-alpha-fetoprotein tumors, AFP negative, would respond to antibody therapy to the point where one could carry out surgery and we had some cures.
Question: It's worth remarking, I think, Stan, and for Gus' benefit that at the height of that program, Stan would see as many as five to eight hepatoma patients per week -- unprecedented. And they came from around the world.
Dr. Order: That's true. And one of the patients who came from China said what would I like for him to bring for me? And I thought it was a joke, but I said an Oriental rug just to say something. And lo and behold, when he arrived to be treated, I had an Oriental rug.
Question: A beautiful one, I'm sure. I want to take you back to the Yale days and mention a fellow resident, not very well-known but brilliant,-- Jim Fisher. Probably you got to know him pretty well.
Dr. Order: Oh, yes.
Question: Can you say a few words about Jim? He is, unfortunately, no longer with us.
Dr. Order: Oh, did he pass?
Question: Yes. He died suddenly.
Dr. Order: I didn't know that. Jim Fisher was an exceedingly bright person who had worked on nuclear magnetic resonance before he took the fellowship in radiation oncology. And Jim was bright in everything that you could mention. And I got to know him, because one could follow what he said and learn. And he was really the format person when Dr. Hellman had left the Yale residency, and he took over Yale when Dr. Kligerman left. He was a brilliant guy.
Question: He was not very well-known in our field. Also, this may be an opportunity to say a few words about Sam. He had so much to do with your career, the early part of your career, Sam Hellman.
Dr. Order: Well, Sam Hellman, no question, was a pioneer in breast irradiation for definitive management after lumpectomy. Unfortunately, it was done at a single institution, and later in history it was randomized and studied at many institutions.
Question: Stan, it's also worth noting in those days I think there was no RTOG. There was no easy mechanism to take an idea into a broader context.
Dr. Order: Yeah, that's true. I mean, the facts are there was no Red Journal, there was no RTOG, there was no CAT scanning in the beginning of my career.
Question: And there were no accelerators either.
Dr. Order: And the accelerator -- we had an accelerator in Yale. So when I went to Yale, we already had a linear accelerator.
Question: And it was the second linear accelerator.
Dr. Order: And I might mention one other thing. Dr. Wharam and I collected phrases of the essence of radiation oncology from some of the professors and put them on plaques, and I'd like to mention three of them -- Dr. Henry Kaplan, of Stanford, who had helped develop the linear accelerator, said that the most essential element of being a radiation oncologist is the judgment that goes with being a good physician. And Dr. Rubin, who is still alive, the founder of the Red Journal, said the first decision in cancer treatment must be multidisciplinary and right. There is seldom a second chance for survival. And finally, Dr. Simon Kramer, of Jefferson, who is no longer with us, the founder of RTOG, who stated that the challenge for radiation oncologists is to be a skilled oncologist who understands and interprets the disease process and all body systems. He must be a consultant's consultant. And these three men were certainly the foundation of modern radiation oncology with their contributions—accelerator, Red Journal and cooperative group.
Question: When I visited your department I was very impressed with the plaques with quotes from very notable people you had in the conference room.
Dr. Order: Of course, the wonderful thing about it is, although two of the men are no longer with us, that the essence of what they believe is expressed in those statements.
Question: Well, now I'd like to go back to your career. You were talking about the hepatomas, the different kinds of hepatomas and about the number of patients that came from all over the world to seek treatment at your facility.
Dr. Order: I got invited throughout the Orient which was a lovely experience. I was invited to China twice and the first time I had a unique experience. I came off of the plane in Shanghai, not knowing what the Professor Tang looked like. And a man waved from a balcony and I presumed that he was waving at me, and I waved back. But when I got out into the area where you can meet the people, he was waving to somebody else and I didn't know what Professor Tang looked like. At that moment, I spotted a young lady closing a book with my name on it and I was then able to get to Professor Tang. And I had a wonderful time. He had made antibodies and had tested them. He made antibodies directly from the liver cancer and he made antibodies like we did from the Hodgkin’s disease and published the fact that the anti-Hodgkin’s antibody, the anti-ferritin, was more effective than the other antibodies. And he published it in a journal. I was actually editor for a journal called Antibody, Immunoconjugates and Radiopharmaceuticals. And he published that study in that journal, which I ran for a couple of years. Monoclonal antibody in the meantime had taken off all over the world, and today you can pick up a New England Journal and find a monoclonal antibody active in some disease process. One of the saddest things was that in order to patent a drug, you must first patent it and then publish -- not publish and then patent. If you publish it, the patent process is lost, so none of the discoveries that I made at that time could be patented because they were all published first. However, I got to visit China, Japan, Korea, Australia and talked about liver cancer in those countries, particularly in the Orient where they have such a high incidence of liver cancer. And that was also a nice thing in my career to visit these countries. As a hobby, I would learn one paragraph in their language and give the first paragraph of introduction in the Korean, Japanese or Chinese. In China, though, I backed off because I found the language so difficult that I was afraid to utilize it.
Question: Yes, It is very obvious that you are gifted for languages.
Dr. Order: Well, it was a very interesting thing and it honored the country that you're in when you give something in their language as a recognition of their role in society. So that was also another thing. And then I had a young resident, Dr. Robert Rostock, and he took a whole variety of experimental liver cancers and studied them for what produced ferritin. And the ferritin-producing one he treated with anti-ferritin and got good results and won the resident award from ASTRO for his work. And that was also a pleasure to have residents win awards for different work in immunology. And then toward the end of my stay at Hopkins, I was anticipating going to New Jersey where I started an institute for systemic therapy. And a discovery that was made from that institute was that macro-aggregated albumin prior to colloidal P32 would make the colloidal P32 a permanent implant. And I began treating patients with that combination in pancreatic cancer, and we published Phase I which revealed doses as high as one million centigray. Out of that experience, there were two long-term survivors -- one for two years who succumbed to another disease, and one for ten years who relapsed ten years later with a second pancreatic cancer. And I don't know if that represented a recovery of the primary cancer or a new induction of a secondary cancer. I never could figure it out, but he got ten years of good life and the biomarker CA 19-9 was normal during those ten years.
Question: Stan, can we go back to Hopkins for a moment? Clearly, Hopkins was in the dark ages of radiotherapy when you came, and there were people who almost resisted some of your ideas. So I wonder if you would comment on some of the people at Hopkins that were helpful friends of the department or people who were your supporters, we weren't a department, we were a division. I think of Don Coffey, for example.
Dr. Order: Well, medical oncology enjoyed the finances that radiation oncology brought to the oncology center. We were a national center. Dr. Albert Owens was the major force in developing radiation oncology as a specialty. And Dr. Fisher of Yale told me that he had told Dr. Owens to be a national cancer center he had to have radiation oncology at a sophisticated level.
Question: Thanks, Stan. Just for the sake of the person who is going to be writing this down, you said that Al Owens was something like one of the major developers of radiation oncology. I think you meant medical oncology.
Dr. Order: No, he didn't develop the radiation oncology. He brought the people in to develop it and had the foresight to say that it was a specialty that was needed. I would not describe what we had because it would be too damaging.
Question: Dark ages.
Question: What are names -- you mentioned Dr. Jim Fisher?
Dr. Order: Yes, it was Jim Fisher, of Yale, who told me that he had told Albert Owens to develop radiation oncology if he wanted a national cancer center.
Question: Was anyone in particular outside of our division, Stan, that you want to cite as helpful or influential?
Dr. Order: Well, I can't think of his name at the moment, but the one in urology, you'll recall his name.
Question: You mean Don Coffey or do you mean Pat Walsh?
Dr. Order: Don Coffey. Don Coffey at one point in the radiation oncology history became head of the oncology center in the period of a couple of years, and during that time everything flourished under his guidance. And he was a remarkable, and is a remarkable individual, who understood the broad business of medical oncology, radiation oncology and general science. So he was an outstanding individual that I would cite.
Question: He is an exceptional speaker, very engaging.
Dr. Order: Yes.
Question: You had him as keynote speaker at ASTRO when you were president.
Dr. Order: Well, I will talk about ASTRO next. At ASTRO when I became president, I felt there was one thing missing in the ASTRO meetings. There was no cultural event. And I thought that Art Buchwald would give a seminar at ASTRO and bring a cultural event to the meeting, which he did and he was outstanding. And Art Buchwald, a couple of years ago, was put in hospice to die, but he didn't die. He lived an extra year and wrote a book with his typical humor that “It's Too Soon to Say Good-bye”, the title of the book. And he states that he dreamed he was flying to heaven and asked the stewardess, "Are there frequent flyer miles for the flight?" And she replied, "No, it's one way." So Art Buchwald was a real experience at ASTRO and for the general meeting.
Question: Thank you for having invited him to speak. So while we are on the subject of the society of which you were president in 1988, do you have any thoughts about ASTRO?
Dr. Order: Yes. I think they should have a cultural event at the meeting every year, and the cultural event, chosen by the leadership. The event should be cultural outside of the general radiation oncology to emphasize that being a physician requires culture. We all go to college before we go to medical school, and the reason is cultural and we certainly should continue that in ASTRO. And I know some of the presidents who followed did do that, but not all of them. And I think that's important to have a cultural event at ASTRO.
Question: While we are on this topic, you played a very important role in the Red Journal. Do you have any comments about it?
Dr. Order: Well, I think Dr. Rubin who founded it is an exceptional individual, and I was present at his retirement in which we roasted Dr. Rubin, and I said he was the only professor I knew who had two chairs and a sandwich named after him. And Phil got a big charge out of that particular statement. And the Red Journal has certainly done a service for radiation oncology, giving it a venue for expression in the field. But now there are so many radiation oncologists, they're making a second journal to be distributed about clinical radiation oncology.
Question: Practical Radiation Oncology, yes.
Dr. Order: Yes.
Question: There's another one at Stanford, the new one, a Journal of Radiation Oncology (JRO). It's a Luther Brady journal. It's brand new.
Dr. Order: Yes.
Question: I'd just want to see if Stan has any other comments about his time at Hopkins. He mentioned Don Coffey. Stanley took the program from the dark ages to a modern department with linear accelerators and everything that was available at the time. And also projected it onto the national scene, both by virtue of the publications and the science, but also by bringing scientists from elsewhere to Hopkins. So we became nationally and internationally recognized in a very, very brief amount of time.
Dr. Order: Well, I'd like to continue with when I left New Jersey and went to New York. It was in New York I made a significant finding and that was I was using Cisplatin intra-arterially in hepatomas -- liver cancer. And they were getting better responses at one-third of the dose given intravenously. And so I radio-labeled the Cisplatin and studied its distribution to find out that when you gave it intra-arterially, it deposited right away in the tumor, and there was very little effluent outside of the tumor. And so with that discovery, I patented radioactive Cisplatin as a therapy because it produced Auger electrons. One radiated the platinum and then made the drug Cisplatin. I had a Phase I/II study ready to launch, but I had given the patent to the department that had hired me, and they got in an internal fight between the lawyers and the study was never done. But the study was to look at escalating doses of radioactive Cisplatin in liver cancer, substituting the radioactivity for the non-radioactive in order to get the patient in remission and to study the radiation. I was only able to give 1 millicurie of Cisplatin because of the law that required the formal study which was never done. But that sort of ended my career as a final episode of discoveries. So I had finished with macroaggregated albumin and colloidal P32 as an implant and also radioactive Cisplatin in therapy. And then I would add one thing. My own thing in the plaques was a resident without the literature is a ship without a compass. And I believe that still holds true today.
Question: Stan, my memory is that it was a resident not questioned is like a ship without a compass. That's the actual quote.
Dr. Order: Yes, well, it shows my age. But anyway, that's the sum and substance of it all. And then in the latter years I had health problems. One of them was prostate cancer and I had the seed implant, and I will tell you that as a therapist looking back on it, that is a very benign procedure and it's one day and was pleasant and my PSAs are all normal. And so that was an effective treatment in my case. And that's where I would end my career. That's enough.
Question: You've given significant, important and personal testimony for the treatment for prostate cancer that sometimes is overlooked.
Dr. Order: Well, I had seed implant and beam on top of it because of the grade of tumor, and beam is not as comfortable as a seed implant in one day. And they published subsequently the fact that if they made the dose high enough, they could even do high-grade tumors with good results. And as a person looking out for the public in what they should know, having the experience, I would say it's a very pleasant therapy considering the magnitude of its approach.
Question: Okay. Stanley, unless Moody has something else to ask you about this, I would like to talk about the awards and honors you have received.
Dr. Order: I got the Simon Kramer Award, I got the Red Star in China which was a significant award. I considered the Willard and Lillian Hackerman professorship at Hopkins, a personal award, which has also now translated to other professors who lead the department. So those are the significant ones that I can recall.
Question: Well, you have two honorary degrees.
Dr. Order: Well, that's an interesting business. I had given a talk in radiation oncology for ministers at Hopkins, and one of the ministers was a power at Elizabethtown College. And he got them to invite me to give the commencement at Elizabethtown College following Three Mile Island. And I gave that commencement, but during the course of it I asked the president of the class, "What did you think about the radiation exposure?" And he said, "The radiation vacation was wonderful." So it shows you how serious the event was taken by the students. And it never really proved to be the extravaganza that the public was told in the media, because there was very little exposure of anyone to anything of significance. Following that, my college heard that I gave the commencement at Elizabethtown, and they called me up and said would I give the commencement there? And when I told them I wasn't willing to write the speech twice, they said, "Give the same speech. No one here heard it." And so I did. In fact, I ended the speech with an Art Buchwald story and Art had said, "I'm not against America, but when Richard Nixon resigned, the only military action I saw was a cop directing traffic on Pennsylvania Avenue." And when I was at Albright College and finished the speech, I told them, "Not bad for a kid from Albright College."
Question: I have a remark, a memory actually. One of the things that Stan always did was he had a morning teaching conference with the residents, which was rigorous, and Stan will always encourage or maybe tell the residents to write down the data that supported the utility of radiotherapy in a given disease. And I bring that up because one of the current buzz words is evidence-based therapy. Well, Stan was on to the importance of evidence-based therapy, in 1975, when I got to know him. Do you want to comment about that, Stan? Had you done that at Yale? Where did you sort of learn that teaching technique?
Dr. Order: No, it sort of evolved on its own. One of the things that I found was a resident would read something but not necessarily go into the profound nature of the subject. And that I learned from Byron Waksman when he asked me what kind of mouse it was. I would ask, what kind of radiation is it? How is it implied? What is the evidence that supports it? And that kind of thinking I was taught by Byron Waksman.
Question: Yes, as I think back about you, Stan, we've talked a lot today about your creativity which is manifested in many ways and recognized around the world with your research. I think also one of the things that sustained you through those tough years that I knew you at Hopkins, apart from your family, was your sense of humor.
Dr. Order: Well, I appreciate that. There was enough to laugh about. The story I remember best was Dr. Heysel was president of the hospital and the university and called me into his office to ask what did I think of radiation oncology at Hopkins? And I said it had no way to go but up. He then tossed me football off his desk and said, "Around here we play ball," and I said, "Yes, but the ball must have air in it in order to function," meaning that you had to have real accelerators and not cobalt machines.
Question: Of all of the things you have accomplished, what do you consider to be the most significant one and what has given you the most satisfaction?
Dr. Order: Well, the radio-labeled antibody which was in advance of the monoclonals, and it was very satisfying to go from the laboratory to the clinic and to see patients who were remitted and then surgically resected for cure, and that was very satisfying. It was taking an experience from the laboratory and bringing it to the clinic, and I like that more than any other business in radiation oncology. And the worldwide exposure and interaction in the other countries was also very positive and a positive experience for me. But I enjoyed everything we did in radiation oncology. I enjoyed the specialty, I enjoyed the opportunity in some diseases to treat for a cure. And I think that's the most satisfying element -- the cured patient -- better than palliation and only achievable in certain malignancies.
Question: So if you were to put a statement on a plaque, obviously, a brief statement, do you have one in mind?
Dr. Order: Well, I told you the one about the residents and the compass. That would be the one I would use.
Question: One I remember that Stan said -- and I'm saying it from memory now, so I have to think about how to get it straight -- Stan made a comment that he put on a plaque that technical excellence in radiation therapy is a standard, but compassion is what distinguishes a physician. Am I quoting you correctly?
Dr. Order: Absolutely. And the reason I said that is because you can be enamored with the technical business of radiation oncology and forget the fact that you're supporting a human through one of the trying episodes of his life. And compassion is something that is not taught. It must come from within the person itself.
Question: I would like to mention again your sister, Susha, a very accomplished radiation oncologist?
Dr. Order: Well, my sister always said that she was known as my sister, not for herself. However, she practiced beautiful radiation oncology, was very compassionate, had followed the tradition that my father had in his general practice and deserved recognition on her own. Because I had become somewhat prominent, she felt the pressure of my prominence which was unfortunate. Otherwise, it was delightful having a sister in radiation oncology.
Question: Now, we mention your devoted wife, Mary. She has been by your side for many years.
Dr. Order: Fifty-four years. And to tolerate me for 54 years is an accomplishment.
Question: It's an accomplishment and speaks for the person that she is.
Dr. Order: Sure. I have no hesitancy about her contribution to my life.
Question: I wonder, Stan, if you would reflect on how the handlebar mustache was received at Hopkins.
Dr. Order: Ah, well, that was fun.
Question: It's your sense of humor.
Dr. Order: The handlebar mustache, when I lectured in Scandinavia, they thought I was a Norseman, and at Hopkins, the patients felt a negative pressure from the mustache, and I shaved it. And when I shaved it, the dean told me it was brilliant because they all got to know me with the mustache and then had to re-learn me without the mustache. And it's interesting how symbolism thrives in our interrelationships.
Question: Well, there is one more thing that I will bring up—do you have any thoughts about the direction of health care in the United States or the lack of direction or whatever way you want to look at it.
Dr. Order: Having recent hospitalizations, I know what's happening in medicine. The resident and the senior physician taking care of me had 16 patients in intensive care at the same time due to financial pressure that is being created. And the business of somehow restricting medical cost is something that needs to be done and, eventually, will be done as the amount of expenditure for medicine increases beyond reason, which is close to where it is now. And some of the services that one receives are not necessarily good. For example, I have home medical care in which I must now see my physician every three months and have a nurse see me monthly when there's no problem, and Medicare is paying for all that. And if I tell them not to do it, it's a rule. And the business of rules in medicine is destructive to the patient/physician relationships. And I see that happening, and it's very sad. And I don't have an answer for the problem, but I recognize the problem. The problem is too much pressure, too much orientation to monetary gains and not to the essence of physical practice.
Question: Well, we want to thank you, Stanley, for allowing us to interview you.
