The trouble started when her speech ended, and the first doctor raised his hand.
It was the mid-1980s, and Dr. Anne Kessinger had grown used to flying from Omaha to medical conferences around the globe.
She had grown used to presenting her team's data, the data that showed that the University of Nebraska Medical Center had successfully withdrawn healthy bone marrow stem cells from the blood of 10 cancer patients. The data that showed you could regrow a cancer patient's destroyed bone marrow using this technique.
The data that could — and eventually would — help change the way we fight cancer.
There was just one problem: That doctor raising his hand.
He didn't buy it. Neither did the guy sitting beside him. Neither did this country's prestigious medical centers and its preeminent medical journals.
For a half-century they had known it was impossible to harvest bone marrow from the blood cells of humans. This knowledge was enshrined in textbooks, confirmed by widely read journal articles, taken as truth by generations of successful American doctors and researchers.
Kessinger and her medical center in Nebraska were wrong. They had to be wrong.
And so when Kessinger finished her presentation, the first doctor would raise his hand and ask a skeptical question, and then another would follow with an even more skeptical question, and another, and another, and before long, it had stopped being a Q-and-A and had turned into something else.
“The questions were so, uh, impassioned, that the moderator would sometimes have to ask the guy to sit down,” says Kessinger now. “You couldn't really fuss at them — it was something they had been taught all their lives. They just couldn't believe it.
“It's very, very hard to overcome dogma.”
A small group of Omaha doctors, researchers, lab technicians, nurses and very sick patients ignored that dogma in the early 1980s. Together they made bone marrow transplants infinitely less painful. They made bone marrow transplants possible even in patients whose cancer had seeped into their bones.
This innovation in cancer research began, as so many innovations do, with a simple yet audacious thought: Do we really need to do things as we've always done them?
Three decades ago, autologous bone marrow transplants happened only one way.
A doctor would put a patient under general anesthetic, take a giant needle and jab it into the patient's pelvic or hip bone. The doctor would extract a tiny amount of bone marrow, move the needle and jab again. And again. And again. Maybe 100 times. Maybe 300.
“It used to take me an hour,” Kessinger says.
This bone marrow extraction was crucial, because leading oncologists, including the med center's Dr. James Armitage, had pioneered intense chemotherapy that was successfully treating cancers such as lymphoma.
But the high-intensity radiation or chemotherapy also destroyed the patient's bone marrow, necessitating a bone marrow transplant.
The med center would often extract healthy bone marrow from the patient, freeze it, do the chemotherapy and then give the healthy bone marrow back to the patient.
As you might imagine, the extraction process — the several hundred jabs with a long needle — wasn't fun. Even worse, this new, high-intensity treatment couldn't necessarily be used on patients who had no “good” bone marrow left to transplant.
Which prompted the Nebraska doctors' audacious thought: Are we sure we can't capture these cells from the blood?
Kessinger knew that bone marrow stem cells had been proven to circulate in the bloodstreams of rats, baboons and dogs. But the medical textbooks said bone marrow stem cells didn't circulate in the blood cells of healthy humans. Even worse, two leading medical centers had recently tried and failed to pull bone marrow out of blood cells and transplant it into cancer patients.
But the NU med center researchers didn't buy the common wisdom or accept the previous failed efforts.
The med center researchers managed to persuade their bosses — and an internal review board — to OK a clinical trial.
The Red Cross volunteered a machine used to collect blood.
Ten patients volunteered their bodies.
“Imagine making that decision,” Kessinger says. “Do I want to do something that's never been done before?”
Crucially, the med center tweaked its trial, making it different from the two earlier, unsuccessful ones. They pulled blood out of the patient over and over, froze it, and reinserted what they hoped were the bone marrow stem cells all at the same time.
The results for the first patient came back: It worked. The patient's bone marrow returned.
And it worked for the second patient in the trial, and the third, and the fourth.
After 10, Kessinger and others published the med center's data.
That's when they ran into the brick wall of the medical establishment.
Some believed the med center had misread its results. Some believed that the patients' healthy bone marrow was regrowing by itself.
Kessinger kept going to conferences, presenting the numbers and fighting through the Q-and-A sessions that turned into interrogations.
“I didn't feel frustrated,” she says now. “I just kept trying to convince people.”
Slowly, the questions grew less heated, more inquisitive. Oh-so-slowly, the ripple from Nebraska became a wave.
Researchers in Europe and Asia produced similar results from similar clinical trials. The small group began to hold its own conferences, including one in Omaha.
And the med center did a second study, which helped to prove beyond a reasonable doubt that its first study was accurate.
Today, bone marrow taken from a patient is almost always taken from the patient's blood. The extraction procedure is now routine enough that it's sometimes done in an outpatient clinic.
Kessinger still works as a med center doctor. She lives in Scribner, an hour northwest of Omaha. At the end of her interview, I ask for her age, which is standard journalistic procedure. None of your business, she replies.
She is similarly hard-nosed about what she and her colleagues did 30 years ago.
Every doctor, every lab technician, every nurse does something during his or her career to help a patient. That is just what doctors do, she says. “It's a job.”
The patients are always the heroes, she stresses to me again and again.
The lesson here, if there is a lesson, isn't much about medicine, anyway, she thinks. It's about going left when everyone else is going right.
It's about asking a new question and finding a new answer and standing up for it in the face of the withering status quo.
“Sometimes you have to work to overcome dogma,” Kessinger says. “You have to do that in other fields. You have to do that in life. That's what we did. And the rest is history, I guess.”
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