[Ip-health] NYer: Buying a Cure - What business know-how can do for disease.

[Matt Price]

--
[ Picked text/plain from multipart/alternative ]
Medical philanthropies are encouraging researchers to share data and meet
deadlines.
http://www.newyorker.com/reporting/2008/01/28/080128fa_fact_groopman?printa=
ble=3Dtrue
Buying a Cure - What business know-how can do for disease.  by Jerome
Groopman<http://www.newyorker.com/search/query?query=3DauthorName:%22Jerome=
%20Groopman%22>
January 28, 2008

Last May, Kathy Giusti was in midtown Manhattan pitching her current ventur=
e
to an audience of potential investors. Giusti, a forty-eight-year-old
Harvard Business School graduate and former pharmaceutical executive,
believes that medical breakthroughs shouldn't be left to chance. In 1998,
she created the Multiple Myeloma Research Foundation, a charitable
organization dedicated to the lethal blood cancer, which afflicts more than
fifty thousand Americans and has no known cure. Most medical charities focu=
s
on increasing public awareness and on raising money to distribute to
researchers, in the hope that some of the work will lead to a new drug or a
cure; Giusti runs hers as if it were a for-profit business, expecting high
returns on the money she raises from "investors"=E2=80=94her term for
philanthropists. Her staff includes four scientists, who track myeloma
research at academic institutions around the world, advising her on which
projects are most likely to lead to new therapies for patients, and are thu=
s
the best candidates for funding. (Drug companies have typically not been
interested in developing drugs for myeloma, preferring to focus on diseases
that affect large numbers of people, for which treatments are most
profitable.) Researchers who receive money from Giusti's foundation are
required to meet strict deadlines for demonstrating progress. "We try to ge=
t
academics to work like businesspeople," she told her audience in Manhattan.
"Money gives you power to drive people's behavior."

Giusti's organization maintains a tissue bank of more than fourteen hundred
bone-marrow samples and nearly twelve hundred blood samples from patients
with myeloma, which researchers use to test novel compounds, and it helps
finance clinical trials of experimental myeloma drugs. Since 2001,
twenty-one drugs derived in part from research funded by the foundation hav=
e
entered clinical trials, and eight are currently in Phase II=E2=80=94a trac=
k record
that pharmaceutical companies would envy.

Since Giusti established her foundation, medical philanthropies that apply
business principles to their work have become increasingly common. In 2002,
Scott Johnson, a former C.E.O. of several Silicon Valley startups who
suffers from multiple sclerosis, created the Myelin Repair Foundation, with
the goal of facilitating academic research into treatments for the damaged
nerves characteristic of patients with the disease. Johnson identified five
leading M.S. researchers and persuaded them to collaborate on a research
program funded by his foundation. "The academic system is broken," Johnson
told me. "Researchers focus on publishing to get tenure. It's all about
credit for discoveries." (Johnson hopes to have a drug ready for lab testin=
g
in 2009.) Two years ago, Susan G. Komen for the Cure, the oldest and larges=
t
philanthropic organization dedicated to breast cancer, hired a new C.E.O.,
Hala Moddelmog, the former president of Church's Chicken, the fast-food
franchise. (The organization's departing C.E.O. was a former health-care
executive.) "We have followed a traditional paradigm," Moddelmog told me.
"But we believe there is a smarter way to do things." This year, Komen is
considering allocating thirty-five million dollars of its
hundred-million-dollar research budget to support a new initiative called
Promise Grants, which would require recipients to share data with one
another and to observe strict guidelines. "We need flexibility and speed to
discover new treatments and deliver them to patients," Moddelmog said.

Giusti told me that she has been contacted by several other new medical
charities, including the Lance Armstrong Foundation, which is devoted to
cancer; the Kirsch Foundation, which supports research into Waldenstr=C3=B6=
m's
macroglobulinemia, a rare blood cancer; and ABC2, which was created in 2001
by Steve Case, the co-founder of AOL, and his brother Dan Case to combat
brain cancer. (Dan Case died of the disease in 2002.) But Giusti's
aggressive approach to myeloma research has been controversial among some
academic scientists, who argue that it's unrealistic=E2=80=94even
counterproductive=E2=80=94for patients and their advocates to think that wi=
th enough
money and the right business model they can buy a cure.

Giusti's move from the pharmaceutical industry to the nonprofit world began
in December, 1995, when she was thirty-seven years old and living in Lake
Forest, Illinois. "I was on the fast track at Searle"=E2=80=94the pharmaceu=
tical
company=E2=80=94"for a leadership position," Giusti, who has short blond ha=
ir,
intense blue eyes, and an energetic voice, told me. For four years, she had
overseen the marketing of Searle's popular arthritis drugs, including
Daypro, and she was in charge of developing the strategy for selling a new
one, Celebrex. She travelled frequently, and as Christmas approached she wa=
s
exhausted and losing weight. She had an eighteen-month-old daughter, and sh=
e
and her husband, a real-estate developer, had been trying to conceive again=
.
In late December, Giusti visited her doctor, who ordered some blood tests
and referred her to a fertility specialist. "Two days after Christmas, the
doctor called and said he wanted me to come back and get the tests done
again," she recalled. She repeated the blood tests, and in early January sh=
e
received a phone message from the physician, asking to meet with her and he=
r
husband.

"I was driving back to Lake Forest from a regional sales meeting and finall=
y
reached him," Giusti said. "I was on my car phone, and I was driving, and I
said, 'Look, I know something is horribly wrong. My father was a doctor, an=
d
you wouldn't ask me to come in with my husband unless something was really
bad.' And he said, 'Well, just come in and I will talk you then.' And I
said, 'No. You need to tell me now.' I'm driving down the Kennedy Expresswa=
y
in Chicago, and this guy was telling me that I likely have myeloma. I got
home that night, and I just looked at my husband and said, 'I think that I
have cancer, and we've got to go in tomorrow morning.' " The next day, on
their way to the doctor's office, Giusti and her husband stopped at a
bookstore, where Giusti consulted a copy of "Harrison's Principles of
Internal Medicine," a textbook widely used in medical schools. "My husband
and I were sprawled out in Borders reading this medical book, and, the more
I read, I just had this huge knot in my stomach," Giusti recalled.

Myeloma is a cancer of plasma cells, which are normally found in bone marro=
w
and produce antibodies that help the body fight infections. Under a
microscope, plasma cells are easy to identify: they are robin's-egg blue an=
d
have a pale area behind the nucleus. When such cells become cancerous, they
produce excessive amounts of a single kind of antibody, called a monoclonal
protein, and release it into the blood. The malignant plasma cells can caus=
e
bone lesions, dangerously high levels of calcium in the blood, kidney
failure, and nerve damage. Since 2003, several new drugs have been approved
by the F.D.A. for treating the disease, including thalidomide, which was
linked to severe birth defects after it was prescribed as a sedative to
pregnant mothers in the nineteen-fifties and sixties, and Velcade, the firs=
t
approved drug from a class of compounds that disable a structure in plasma
cells called a proteasome, and by doing so kill the cell. Many myeloma
patients are also given bone-marrow transplants, which are thought to exten=
d
the length of remissions. Even so, the cancer cells invariably return,
evolving in such a way that they no longer respond to treatment.

Giusti had a bone-marrow transplant in 2006, and her cancer is in remission=
.
But in public presentations she describes her case as "incurable." Kenneth
Anderson, a professor at Harvard Medical School and a myeloma expert at the
Dana-Farber Cancer Institute, in Boston, recently summed up the cancer's
grim prognosis in the journal *Nature Reviews Cancer*. "In spite of
conventional and high-dose chemotherapies," he wrote, "it remains uniformly
fatal owing to intrinsic or acquired drug resistance."

The causes of myeloma are unknown, but risk factors include exposure to
radiation and pesticides, and, possibly, having close relatives with the
disease. Giusti's maternal grandfather had myeloma, and she told me that
after she received her diagnosis she realized that she could "market"
herself to researchers as an "interesting case," because she has a healthy,
identical-twin sister, Karen Andrews; she discovered that doctors were eage=
r
to compare the sisters' plasma cells. "I did searches at the Searle library
to see who was the best in myeloma in the country," Giusti said. "I needed
to meet with people at Northwestern, the University of Chicago, the
University of Arkansas, the Mayo Clinic, the Fred Hutchinson center, and
Dana-Farber. I called all the doctors, and they all called me back, because
I was smart enough to say in the message that I have an identical twin. I
knew they were thinking, She is young, she is otherwise healthy, she has an
identical twin, and she could be a fascinating research specimen. "

Giusti met with seven myeloma specialists and received contradictory advice=
.
"Some people thought I should get a transplant immediately, while others
thought that, because I was so healthy, I could potentially watch and wait,=
"
she said. Ultimately, she chose the more conservative approach, in part
because she knew that she would not be able to conceive safely while taking
the toxic drugs that are given to patients before a bone-marrow transplant.
(Nevertheless, she and her sister provided plasma cells to several
researchers.) "I put a plan together, and I went through the whole I.V.F.
program to get pregnant," Giusti said. "After two tries, nothing was
working, and I was really down in the dumps. I was, like, 'O.K., I'm dying,
and I can't get the second child.' That was when my whole life was crashing=
,
and I finally decided to try I.V.F. one more time, and my whole life change=
d
when I found out I was pregnant. At that point, I realized that nothing was
more important to me than finishing the pregnancy. We decided to move East,
because now, with two little ones and the potential of my dying=E2=80=94bac=
k then I
was supposed to live, at best, three years=E2=80=94I wanted to be where my =
twin
sister could help my husband raise the kids." In July, 1997, four months
after quitting her job at Searle, and after giving birth to a healthy boy,
Giusti moved with her family to southern Connecticut, where Andrews=E2=80=
=94who had
two children of her own=E2=80=94and Giusti's in-laws lived.

The previous summer, Giusti had attended a patient seminar in Florida
sponsored by the International Myeloma Foundation, a philanthropic
organization founded in 1990 that helps educate patients and doctors about
the disease, and sponsors frequent meetings of myeloma specialists. The
group also provides funding for research, according to the traditional
model, in which individual investigators apply to the foundation for grants=
.
"They asked me to be on the board," Giusti said of the foundation's
directors. "So I started working for them, taking on the job of writing a
business plan, because it turned out they didn't have a business plan. But
the more I was challenging them about where they are heading and what they
are doing with research and funding research, the more the I.M.F. was
getting annoyed with me. So they booted me off the board." (Susie Novis, th=
e
president of the I.M.F., disputed Giusti's account. "She never challenged u=
s
about our research funding," Novis told me. "One day, at dinner, she
mentioned to me that she was setting up her own foundation. That was a clea=
r
conflict of interest and she was asked to resign at the next board meeting.=
"
Novis added, "We don't agree with the business model." Still, she said, "We
share the same goal: to end myeloma.")

In October, 1997, Giusti and her sister held a dinner at the Hyatt Regency
hotel in Old Greenwich, Connecticut, to raise money for myeloma research.
They invited their friends in the New York area, including employees at
Time, Inc., where Karen Andrews was an in-house counsel; they raised four
hundred and fifty thousand dollars. Giusti was unsure how to distribute the
money. "I looped entrepreneurial management at business school
intentionally," she said, using Harvard slang for taking a course pass/fail=
,
"because I thought I'd never be an entrepreneur. But, if you were able to
raise that kind of money on your first event, you were meant to do bigger
and better things. And so I did. I incorporated as a 501(c)(3)"=E2=80=94the=
 I.R.S.
designation for a non-profit organization. She distributed most of the mone=
y
she had raised to researchers and used the remainder to set up her
foundation. Andrews's colleagues helped Giusti create a logo and a
letterhead, and she began to contact potential donors. "I really had to ask
for significant dollars to make the foundation happen, and at a time when
there was no proof that I could do it," she said. In 1999, Bill McKiernan, =
a
Harvard Business School classmate and the C.E.O. of an Internet company in
California, gave her a million dollars. (He has since raised two hundred
thousand more.) At the same time, Giusti was being treated by Kenneth
Anderson, at Dana-Farber, who prescribed bisphosphanates, medications that
help protect bones from deterioration.

Giusti realized that in order to accelerate the development of new myeloma
drugs, she needed to foster greater collaboration between researchers at
different academic institutions. In 2002, she decided to assemble a
consortium of scientists who would be required to submit their research
proposals to a steering committee for approval, and to publish their result=
s
jointly. In exchange, the scientists would receive access to a tissue bank
of myeloma blood cells and bone marrow, as well as administrative and
organizational support for lab tests and clinical trials. She approached
eight institutions. Four=E2=80=94the Dana-Farber Cancer Institute; the Mayo=
 Clinic
Cancer Center; the H. Lee Moffitt Cancer Center, in Tampa; and the Princess
Margaret Hospital, in Toronto=E2=80=94accepted her offer. The consortium no=
w has
thirteen members, and at least two more institutions are expected to join
this year.

Giusti figured that she needed a budget of at least three and a half millio=
n
dollars to launch the consortium, and five million dollars to sustain it. A
portion of the money would be used to pay clinical-research co=C3=B6rdinato=
rs and
data collectors, who would oversee trials of myeloma therapies at each
academic center. In 2003, Giusti approached the writer Michael Crichton, wh=
o
she knew had a family member with myeloma. Crichton gave Giusti's consortiu=
m
half a million dollars to support the creation of the tissue bank. He told
me that he admired Giusti's efforts to encourage academic researchers to
co=C3=B6perate with each other and to be accountable to donors and patients=
. "She
had gone and talked to all these people, and she was very clear about how
she intended to make them all work together," Crichton said. Giusti told hi=
m
that she was having some difficulty getting philanthropists to understand
what a tissue bank was and why it was important, he recalled. "And I
understood it, so I said I would help with that, just out of the strong
desire to see if anybody could pull it off=E2=80=94not simply to make the t=
issue
bank but to actually get these fiefdoms to work together." Crichton went on=
,
"I think there are a lot of people, in a lot of ways, who are coming to be
very dissatisfied with medical research in terms of how it's organized. I'm
guessing that the people in all these institutions must have intuited
somehow that she was in some way the wave of the future."

Since 1998, Giusti's foundation has raised $92.4 million. The consortium's
steering committee, composed of three myeloma researchers from member
institutions, advises Giusti on which experimental drugs to test in clinica=
l
trials, and her team of scientists, recruited from pharmaceutical companies=
,
evaluates the committee's decisions. In the fall of 2006, the foundation
funded lab studies of a compound called perifosine, which attacks a protein
in myeloma cells, in combination with two other drugs frequently given to
patients who have the disease. Within four months, the foundation had
launched a clinical trial of all three drugs, in collaboration with Keryx
Biopharmaceuticals, which makes perifosine. The trial is being held at four
of the consortium's centers; the foundation helped recruit patients,
assisted each center in obtaining approval from its affiliated hospital to
conduct the trial, and paid for co=C3=B6rdinators to supervise the process.=
 In
December, preliminary results were presented by a researcher at the
University of Michigan (a consortium member), at a conference of the
American Society of Hematology. As Peter Sportelli, the director of oncolog=
y
at Keryx, put it, "It's extremely unusual for experimental drugs to move
from the lab to clinical testing so quickly, and Giusti's foundation
deserves a lot of credit for spurring the process along."

In September, I visited Kenneth Anderson's laboratory at the Dana-Farber
Cancer Institute, which, during the past decade, has been awarded nearly
eight million dollars from Giusti's foundation. The laboratory occupies a
series of rooms along a narrow corridor, each crowded with incubators
containing myeloma cells, centrifuges, and tissue-culture hoods.
Postdoctoral researchers stood elbow to elbow, decanting chemical solutions
into beakers and extracting DNA and RNA from cells. One took a plastic flas=
k
from an incubator and placed it under a microscope. Cells adhered to a
matrix of human bone marrow; others floated in the culture medium. In the
nineteen-nineties, Anderson and William Dalton, a myeloma researcher at the
Moffitt Cancer Center, discovered that the behavior of myeloma cells depend=
s
on whether they stick to the matrix=E2=80=94which helps explain why it has =
been so
difficult to treat the disease. Traditionally, experimental drugs were
considered promising if they killed the floating myeloma cells, but, as
Anderson and Dalton realized, the cells' behavior changes when they are
attached to bone marrow=E2=80=94as they are in our bodies=E2=80=94and they =
frequently become
resistant to the drugs. Now experimental compounds are tested against both
freely floating and attached myeloma cells.

The day I visited the lab, researchers were screening several compounds tha=
t
interfered with the myeloma cells' proteasomes. Because Velcade, the
proteasome inhibitor recently approved by the F.D.A. for the treatment of
myeloma, can have serious side effects, including nerve damage, and often
becomes ineffective against the cancer, new proteasome inhibitors have been
developed by several biotech startup companies, and Giusti's foundation has
given Anderson's lab money to study a promising one. The lab is also testin=
g
compounds that attack other parts of myeloma cells, including enzymes calle=
d
kinases, and proteins that regulate cell survival and DNA replication.

Scientists at Giusti's foundation keep track of experimental drugs invented
by pharmaceutical and biotech companies=E2=80=94usually for the purpose of =
treating
diseases other than myeloma=E2=80=94by studying abstracts of articles in sc=
ientific
journals, and by examining patent applications, which are publicly
available. If the scientists identify a compound that they believe could be
useful in treating myeloma, the consortium approaches the drug company that
makes it, offering to cover the expense of having it tested at the
consortium's centers, and, possibly, to cover some of the overhead costs of
clinical trials. (The consortium allows the company to retain the right to
any profit from sales of the drug if it is eventually approved by the F.D.A
.)

In April, 2006, Steven Young, the executive director of the consortium,
telephoned Joe Garlich, the chief scientific officer of Semafore, a biotech
company in Indianapolis that is developing drugs to treat solid tumors, suc=
h
as those of the prostate, kidney, and breast. "It was just sort of a
courtesy call, to let us know they exist, and we really didn't think too
much about it," Garlich told me. "There's not a lot of money floating into
companies like ours, so we focussed single-mindedly on solid tumors, which
we think will be our sweet spot." Two years earlier, Semafore had filed an
application for a patent on a novel compound that blocks an enzyme called
PI3 kinase, which plays a central role in cell survival. Scientists at
Giusti's foundation speculated that the compound might be effective against
myeloma, and in June, 2006, Giusti met with Garlich, who agreed to provide
the compound, called SF1126, to the foundation. Tests at one of the
consortium's laboratories showed that the compound was very active against
the cancer.

That December, Giusti's foundation awarded Semafore a million dollars, to
cover the costs of producing SF1126 and to help subsidize a clinical trial.
(The trial is now under way.) "They bear the brunt of the cost, and it
doesn't dilute our focus, because we still maintain all our people on solid
tumors," Garlich said. "These guys aren't dummies; they look for things tha=
t
are promising, and we get to tap into all their resources=E2=80=94the tissu=
e bank,
the experts, the clinical experience."

Not all the foundation's partnerships have worked so smoothly. Giusti said
that consortium members have occasionally made "end runs" around the
foundation: after accepting its funding and taking advantage of its
experimental trials to test a compound in myeloma patients, they have
negotiated a deal with a drug company to test the compound in, say, a set o=
f
patients whose disease is more advanced. "When researchers come to the
consortium, all of the money is raised for them," Giusti said. "If they nee=
d
it, and they give us a good case for the work, they will get the funding.
And if it's a really great trial, and the company needs support, we will
find funding for the company, too. But there are companies that still go
directly to the centers. And here is where it gets ugly. Last spring, I sai=
d
to the thirteen centers, 'Here are the five trials that are most important
for us this year. Does everybody agree that we should be conducting these
five trials this year? If you do not speak now, forever hold your peace.' "
All thirteen centers said that they agreed with Giusti's choices. "Then I
found out that one of the centers is going to do a trial with a drug
company, of one of the five drugs=E2=80=94one of the most interesting ones=
=E2=80=94and they
never told me," she said. "I was furious."

One leading myeloma expert who declined to join the consortium is Bart
Barlogie, the director of the Myeloma Institute for Research and Therapy, a=
t
the University of Arkansas for Medical Sciences, in Little Rock. Among the
largest such centers in the world, Barlogie's institute, which he
established in 1989, has twenty faculty members, including seven who conduc=
t
basic research, and receives between six hundred and seven hundred new
patients every year. "I report directly to our chancellor and have quite a
number of degrees of freedom, so the usual bureaucratic bullshit I do not
have to contend with," Barlogie, a native of Germany who worked at the M. D=
.
Anderson Cancer Center for fifteen years, told me. He said that researchers
at the institute have analyzed fifty thousand chromosome samples from
myeloma patients, enabling them to identify abnormalities that may help to
predict the severity of the cancer.

"We give patients our program, which we call Total Therapy, and we throw th=
e
kitchen sink at these patients," Barlogie went on. The patients receive
chemotherapy, followed by two blood-stem-cell transplants, more
chemotherapy, and other medications=E2=80=94treatment that takes between th=
ree and
four years to complete. In 2003, Barlogie added Velcade and thalidomide to
the patients' regimen. Of two hundred and thirty-one patients treated at th=
e
institute between 1989 and 1994, fifty-four=E2=80=94about twenty-five per c=
ent=E2=80=94have
survived for more than ten years, and half of these have never experienced =
a
recurrence. (According to the National Cancer Institute, of the myeloma
patients diagnosed between 1996 and 2003, only a third were alive five year=
s
later.) "So when people come to me and say, 'Well, is myeloma curable?' I
pause and show them the consent form where we state, 'The objective is to
cure.' "

Barlogie, who is a member of the scientific advisory board of Giusti's
foundation, has argued that, by seeking to develop new drugs, her consortiu=
m
risks overlooking opportunities to make existing treatments more effective.
"The thirteen centers in the consortium do a little bit of this and a littl=
e
bit of that," he told me in August. "There are these many new drugs, and
there is the issue of whether they should all be given initially, or only
after patients enter remission. I want to continue to refine and improve on
the Total Therapy approach." He continued, "I am sort of the generalissimo
here. I don't believe in democratic rule when it comes to making medical
choices and decisions." (Despite his differences with the foundation,
Barlogie is in discussions with it to develop a protocol for treating
myeloma patients with an especially poor prognosis.)

Several researchers in the consortium also criticized the foundation's
methods, complaining that it frequently issued press releases, even when
there was no new science to promote, and arguing that Giusti's desire to
control all aspects of the drug-development process could hinder progress o=
n
the disease. "Research is not just connecting the dots," a prominent
scientist who receives funding from the foundation told me. "You need
creative latitude." Several researchers said that negotiations between thei=
r
academic institutions and the foundation had been difficult, and that Giust=
i
often took credit for discoveries that would not have been possible without
financial support from other sources as well, such as the National
Institutes of Health.

"We're still learning as we try to change the system," Giusti told me. "To
understand how to cure patients, we are going to have to break down a very
broken system. And that's not going to make us loved by everybody." She wen=
t
on, "Maybe we've been too tough. I actually thought we were not doing enoug=
h
P.R. Academic centers and the biotech industry often go out too early,
contacting media every time they do something in a mouse." Last year, for
the first time, Giusti issued report cards to each institution in the
consortium, assessing it on such criteria as how quickly it implemented
projects and completed the lab studies necessary before a compound could be
tested in patients. (Five institutions earned top grades.)

In 2005, the foundation invested six million dollars in a project to study
the myeloma genome=E2=80=94a complete record of the cancer cells' DNA=E2=80=
=94which can help
doctors determine how virulent a patient's disease is likely to be, and
which treatments might be most effective. The researchers on the project=E2=
=80=94a
collaboration between the Broad Institute, in Cambridge, which is affiliate=
d
with M.I.T. and Harvard, and the Translational Genomics Research Institute
(TGen), a non-profit organization in Arizona=E2=80=94post the genetic data =
as soon
as they are analyzed, on a Web site that is accessible to the public.
(Several academic centers, including Barlogie's, are also studying the
myeloma genome.) Under the terms of the agreement with the foundation, the
Broad Institute and TGen may not file patents on the DNA sequences they
discover, as some biotech companies have done.

Todd Golub, an oncologist, who is overseeing the myeloma-genome project at
the Broad Institute, said that he admired Giusti's pugnacity. "The notion o=
f
accountability is not omnipresent in academic research," he said. "It's
important to have transparency, integrity, follow-through, and
collaboration, regardless of where the money comes from." However, he added=
,
researchers should balance highly directed work of the kind Giusti's
foundation supports with more exploratory projects. "You need to find the
sweet spot between just lobbing money over the fence versus believing we
know everything that needs to be done," he said.

With its focus on deadlines and drug development, Giusti's approach is best
suited to a disease such as myeloma, whose basic biology is at least partly
understood. (For maladies that are still largely mysterious to doctors, suc=
h
as A.L.S.=E2=80=94also known as Lou Gehrig's disease=E2=80=94a more creativ=
e, open-ended
research model may be needed.) Kenneth Anderson, whose lab receives funding
from the N.I.H. and participates in drug studies financed by pharmaceutical
companies, said, "Myeloma now is a paradigm for new drug development,
because of partnerships that occur between academics, large pharmaceutical
companies, small biotech, the F.D.A., the National Cancer Institute, and
foundations. And, frankly, Giusti's foundation has been a catalyst that
created the urgency and awareness to make this progress possible."

Even so, he went on, "No one company or foundation has all the answers.
Those of us who are still in academia are in a unique and privileged
position, because we can study the biology. We can understand the importanc=
e
of putting good drugs together to increase the killing of the myeloma cells
and avoid the development of drug resistance. Hopefully, we can create the
urgency to work together." =E2=99=A6
  ILLUSTRATION: JOOST SWARTE
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