Abstract
As Dr. Saul Hertz's daughter, I read Dr. Gilbert Daniels’ “Radioactive Iodine: A Slice of History” in your March 2013 issue (1) with great interest. It is only recently that I have had the opportunity to understand the research that Dr. Daniels refers to in his article.
My father passed in 1950 when I was a young child. I was told of his pioneering work in medicine, but I had limited knowledge beyond that. Today, I appreciate his profound contribution to the diagnosis and treatment of thyroid diseases and the paradigm change it represented. Preserved in the attic of my childhood home were boxes of correspondence, the handwritten data charts of the very first series of patients treated with radioactive iodine (RAI) along with journals and newspaper articles.
Several prominent thyroid specialists and medical historians have helped to review and organize this treasure. Dr. Daniels writes, “The initial MGH [Massachusetts General Hospital] experience of treating hyperthyroidism with RAI during the early 1940s was described in two separate articles in the same 1946 issue of the Journal of the American Medical Association (JAMA)” (1). I now know why there were two articles from the same hospital demonstrating the effective medical use of RAI. Dr. Hertz's established cases began in January 1941 with his administering the first therapeutic RAI treatment. Several years later, Dr. Hertz went to serve in World War II, and Dr. Earl Chapman took over Hertz's established cases. Soon after, Dr. Chapman independently adjusted Dr. Hertz's protocol. Upon his return from serving his country, Dr. Hertz received a cold reception at MGH. He then joined Boston's Beth Israel Hospital. He was there but a short time, when he received a phone call from Morris Fishbein, editor of JAMA. “Saul,” he said, “I have a paper here from MGH by Earl Chapman and Robley Evans from the Massachusetts Institute of Technology (MIT), and they are saying they have propriety over RAI… and your name isn't even on the paper! What is going on here?” Fishbein requested that my father submit an article updating his original series of 29 patients. Consequently, both articles were published side by side in JAMA's May 1946 issue (2,3).
A reception was held at Harvard Medical School's Vanderbilt Hall, to honor 75 years since Dr. Hertz asked MIT's President Compton, “Could iodine be made radioactive artificially?” Presented was President Compton's response to Hertz's seminal question. There was further documentation of the first use of RAI as a tracer in the rabbit studies that Dr. Hertz and MIT's Dr. Arthur Roberts began in late 1937 as well as Dr. Hertz's clinical data in the development of RAI as the preferred treatment for hyperthyroidism. Of particular interest was Dr. Hertz's letter to MGH's Director, suggesting “It is a coincidence that my new research project is in cancer of the thyroid, which I believe holds the key to the problem of cancer in general.” Pulitzer Prize author Dr. Siddhartha Mukherjee spoke recently at an Aspen Institute Meeting, elaborating on the use of RAI as the first targeted cancer therapy (3). He discussed my dad's work as initiating a method of cancer treatments. Currently, there is ongoing interest in using 131I attached to other molecules for targeted therapy of certain malignancies.
Dr. Daniels' article is a remarkable review (1). The primary facts are that Saul Hertz was the first and foremost person to develop the experimental data on RAI and to apply it in the clinical setting. He spontaneously asked the seminal question to launch the research, followed by his rabbit studies demonstrating the tracer qualities of RAI. Dr. Daniels cites that “In 2012, after more than a million Graves' patients have been treated with RAI, it is now clear that the success rate is almost 100% and the response is generally a permanent one” (1,5). Dr. Mukherjee publicly thanked Dr. Hertz on behalf of the hundreds of thousands of thyroid cancer patients whose lives Dr. Hertz's discovery has saved. Let us also be grateful to the courageous children and adults who took the leap of faith to participate in research studies and to all the dedicated doctors who have carried Saul Hertz's dream forward.