I was thrilled in particular by a portion of Dr. Frei’s address, wherein he described two types of clinical cancer researchers, namely “investigators” vs “discoverers.”
—Larry Weisenthal, MD, PhD
I have read with interest the recent tributes to Emil “Tom” Frei III, MD, who passed away in April. I was backstage at the ASCO Annual Meeting in 1981, when Dr. Frei was giving his Karnofsky acceptance address. I had a slide presentation at the combined ASCO/American Association for Cancer Research (AACR) meeting, which followed immediately thereafter. Back then, the ASCO and AACR meetings were held during the same week, at the same venue. The ASCO meeting was held on the first 3 days, with the AACR meeting following.
On the afternoon of the final day of the ASCO meeting and on the first day of the AACR meeting, there was a combined ASCO/AACR session, which consisted of about 10 papers felt to be of interest to both ASCO and AACR membership (papers that today would be broadly considered “translational research”). This session followed immediately after the Karnofsky address. I recall the venue as having an actual stage, with a curtained-off waiting area, from where I watched the speech.
Two Types of Researchers
I was thrilled in particular by a portion of Dr. Frei’s address, wherein he described two types of clinical cancer researchers, namely “investigators” vs “discoverers.” The investigators proceed in a very orderly fashion, are esteemed by their peers, typically succeed (at least in answering the often rather ordinary question being addressed by their work), but produce, at most, single-step advances and don’t create new paradigms. Discoverers, on the other hand, follow a path of inquiry that often seems disordered, tend not to be esteemed by their peers, often fail, but, on occasions where they do succeed, produce multistep advances and create new paradigms. Dr. Frei’s point was that the clinical oncology research establishment would be well advised to be more supportive of the work of discoverers.
Since that 1981 speech, the best example of discovery-oriented clinical research of which I am aware comes from gastroenterology—the central role of bacterial infection (Helicobactor pylori) in peptic ulcer disease. We’ve had some breakthroughs of lesser magnitude in oncology: anti-HER2 treatment of breast cancer, anti-CD20 in lymphatic neoplasms, tyrosine kinase inhibitors, and so forth. But I think that Dr. Frei’s exhortation to be more supportive of “discoverer”-type researchers has never been acknowledged, much less embraced. When his Karnofsky address was subsequently published in the journal Cancer, there was only passing mention of the investigator vs discoverer concept, which had been a major point in the address itself, and this point didn’t even appear in the abstract.1
Encouraging Would-be Discoverers
If anyone ever wished to honor Dr. Frei with some type of ASCO award to be presented in his name, it might be, for example, an award for the most creative discovery-oriented research presented at the previous year’s ASCO Annual Meeting. This might focus more attention on the need for more out-of-the-box thinking, in a world where investigators control the peer-review pipeline, investigators beget more investigators, and there are decreasing opportunities for would-be discoverers.
Note that the “Emil Frei Award” would be different from the usual awards, which require confirmation through years of follow-up work. As Dr. Frei pointed out that discoverers often fail, what is honored is a potentially breakthrough idea, supported by credible pilot data. One important purpose of the award would be to focus attention on the new idea so that it will receive scrutiny and early confirmation or refutation. The fact that the work would attract such scrutiny should serve to discourage fraud and encourage the would-be discoverer to have reasonable certainty that he or she is on a sound path. ■
—Larry Weisenthal, MD, PhD
Huntington Beach, California
Disclosure: Dr. Weisenthal reported no potential conflicts of interest.
1. Frei E 3rd: Clinical cancer research: An embattled species. Cancer 50:1979-1992, 1982.