Larry Norton loves what he does. He just wishes there were a little less of it.
As head of solid tumor oncology at New York’s Memorial Sloan-Kettering Cancer Center, and medical director of that institution’s Evelyn Lauder Breast Center, Norton, 52, spends his time tending to patients and supervising care at one of the nation’s top cancer centers. He also sits on the National Cancer Advisory Board, is president of the National Alliance of Breast Cancer Organizations, chairs the Breast Committee at the Cancer and Leukemia Group B (a consortium of hospitals doing research in cancer) and is running for president of the American Society of Clinical Oncology.
Then there are the medical and scientific journals he reads to keep up with the latest advances, and the hundreds of unsolicited referrals he receives each day from cancer patients or their physicians, desperately seeking help and advice. Norton admits it can all get overwhelming.
“I’m not complaining, though,” he said. “I could obviously give up stuff. But I don’t want to give up anything because everything I’m doing is, I think, converging on a cure for cancer.”
A cure for cancer?
“I think this is the last millennium, maybe the last century, of cancer,” Norton asserted late last year. “Every day we’re learning so much more about this disease.
“I predict that a little girl born today will not have to worry about breast cancer.”
A breathtaking prediction, but, coming from this earnest breast cancer specialist, somehow believable. Maybe it’s the quiet enthusiasm he radiates when he talks about the current research at Memorial Sloan-Kettering, the development of a vaccine that might spur the body’s own immune system to root out cancer cells and destroy them.
“Every cancer cell has something on its surface that’s abnormal,” he explained. Ordinarily the body’s immune system would recognize that abnormality and destroy the cell. Unfortunately, cancer cells are so similar to other cells in the body that the body’s self-protective mechanism kicks in. “The body says, `There’s something abnormal about that cell, but it’s my cell, so I’d better leave it alone,”‘ Norton said.
A vaccine would work by flagging the abnormal cancer cell so that the body could identify it as foreign and attack it with antibodies. Norton and his colleagues are developing a vaccine that can attack up to eight different cancer cells at once. “I’m very excited about it,” he said. And, he added, this is only one of many promising lines of research. “I’m excited about a lot of things.”
If Norton is right and a cure for cancer is just around the corner, no small part will be due to the single-minded efforts of this publicity-shy father of two, who not only refused to talk about his family (“I don’t think it’s fair to them,” he said) but also firmly deflected all personal questions, relentlessly steering the interview back to his work. Although Norton has received press attention for treating such high-profile patients as Linda McCartney, he believes one of his greatest contributions to the fight against cancer has been largely unacknowledged: his work as a “translator” of pure science into clinical applications.
“The best laboratory scientists have to have total intellectual freedom,” he explained. “You never want to take basic science and say you have to be relevant in your work. Here at Memorial Sloan-Kettering Cancer Center, we have some of the best basic scientists in the world who are studying what fascinates them. But within a few yards of where they work, there are people who are very sick with cancer. Scientists owe them something.”
Here’s where “translators” such as Norton step in, scanning the field of pure science for discoveries that might carry the seeds of new and better treatments for cancer patients. Once these discoveries are identified, Norton then helps organize further research in the area. If the research pans out, he may then help spread the word about the new treatments to clinicians working directly with patients. “Talk to the scientists, talk to the clinicians, take care of patients, organize research — there’s no definition of that kind of work,” he said.
By way of analogy, he pointed to the poems that New York City authorities post in the subways for the benefit of commuters. “None of these poets sat down and said, `I’m going to write a poem that they can put up in a subway system,’ ” he said. “You need somebody who can read the poetry, pick out what works for the subways and put it up on the walls. That’s a translational person.”
Unfortunately, he added, it is not a role that society has identified or rewarded. “With all the activities I do, if you added up the dollar amounts I’m responsible for — at Memorial, Cancer and Leukemia Group B, the National Alliance of Breast Cancer organizations — I run a large multifaceted corporation. I should have the appropriate staff to handle it, but nobody who does this particular job has that kind of staff.”
For instance, he points to the 500 e-mails he receives a day. “How does one answer 500 e-mails?” he said. “It isn’t possible.”
“And I’m not unique,” he emphasized. “There are a lot of us in the country who are all in the same situation. We all talk and commiserate.”
Although he added that Memorial Sloan-Kettering had been “fantastic” about supporting his “translational” work, many of his colleagues in less supportive institutions are “really struggling.” One of Norton’s passions is to give this work a job definition so the people able to bridge the gap between science and patient care could be recognized and supported.
Bridging this gap came naturally to Norton, who said he began his career as a research scientist but felt a “calling” to patient care.
“There is something almost magical about meeting the patient and examining her,” he said. “There have been circumstances where excellent doctors have presented a case to me and I’ve sort of formulated an approach, and then I meet the patient and shake hands and my approach gets thrown out for a totally different approach,” he said. “And then if I physically examine them, even if I don’t find anything, I often I will even modify that approach.”
The difference, Norton said, is in what he can sense and learn about the patient as an individual.
“I like to say that every part of a medical consultation is two things — biology and everything else.” The “everything else,” he explained, includes the patient’s personality, life goals, social support and spiritual values.
“I am religious,” said Norton, a practicing Conservative Jew. “I do believe in God. I do believe in divine intervention. And I think there’s more to phenomena than the mechanistic explanations of it.
“If you follow a religion carefully — you’re a good person, you care for your family, you give back to the community, you have confidence in the future . . . — if you do all these things, the odds are that good will emerge from your life,” he said. “There’s no guarantee, but the odds are in your favor.”
Similarly, Norton believes that when faced with a devastating illness like breast cancer, there are ways an individual can handle the situation that will maximize the chances for recovery.
“It’s having optimism, it’s having enthusiasm, it’s being cooperative, not necessarily passive, but cooperative,” he explained. “These are all things that individuals can do to optimize the chances of good things happening in any medical situation.
“I counsel people who are sick to go to the doctor and just say, `What do I have to do to get better? Just tell me what I have to do to get better.’ You may not want to do it, but at least you have the information to make the decision that’s right for you.”
