Sunday, April 4, 2004

DCU Alumni Magazine Interview with Professor John Crown

The best doctors are born rather than made.

So some believe, anyway – particularly some doctors. In the case of John Crown, it might just be true.

The renowned oncologist and newly-appointed Thomas Baldwin Chair in Translational Cancer Research at DCU is having difficulty navigating his way to the main door of St. Vincent’s Hospital. He barely takes two of his long, loping strides before someone stops him: a junior doctor, asking him to look at some x-rays, or the pale-faced relative of one of his patients. He accidentally kicks over the edge of the carpet, and – without missing a beat – reaches out to grab the elbow of an elderly woman walking just behind him, and steers her safely over it.

But he’s no soft-touch. At the inaugural lecture for his new chair at DCU, he criticised every pillar of the medical establishment, from the Irish Medicines Board to at least four successive health ministers. The EU came under fire for a new directive which will limit clinical trials. And, as always, the Irish health system.

“I’ve made no secret of the fact that I think we have very bad cancer services in this country,” he says, in his typically from-the-hip manner.

“It is a shame that the Department of Health have had to be cajoled, humiliated and bullied in public into doing something about it. The disastrous health service we’ve had over the past ten to twenty years reflected a complete lack of planning on the part of the Department. It wasn’t until certain people started to make very public criticisms of the state of the cancer service that they were shamed into doing something about it. I think it’s an awful pity that that’s the way the public discourse has to work in a democracy.”
Dr John Crown, who has been awarded the Thomas Baldwin Chair in Translational Cancer Research, speaking at his inaugural lecture at DCU
Dr John Crown, you quickly learn, is rarely on message. He eschews the popular opinion in favour of the truth, however unpalatable it might be. To the undoubted chagrin of those who manage it, he’s forever shaking things up, rattling cages, exposing the chinks and cracks in our health system.

It’s a wonder, though, that he finds the time to be anything other than exhausted. In addition to his responsibilities at St. Vincent’s and DCU, he’s a founding member and leader of the Irish Clinical Oncology Research Group (ICOR); the Anglo-Celtic Oncology Group; the European Breast Cancer Dose Intensity Study; and the Irish Society of Medical Oncology.

He’s also a member of the American Society of Clinical Oncology; the American Association for Cancer Research; the New York Metropolitan Breast Cancer Group; and the European Society of Medical Oncology (ESMO). He is chair of the Breast Committee of the Irish Clinical Oncology Research Group (ICORG), and last year became the first Irish oncologist to be awarded a merit award from ESMO for his work in breast cancer research.

Oh, and he’s a father of three.

Perhaps unsurprisingly, he’s a few minutes late for our interview, arriving in a whirlwind of white lab coat and clipboard.

Can we ever win the war against cancer, I ask him.

“I think we have a different understanding of the nature of the war against cancer,” he says in the measured tones which still betray hints of his years training in the US.

“Throughout the 1950s and 1960s, and even up until the 1970s, there was an expectation that we would have a Eureka! moment when we cured cancer on the basis of some magic bullet treatment. If we could put a man on the moon, there was a feeling that if we set a single task to science – any task – it could be done within a certain amount of time. We probably exercised a certain amount of hubris in the face of nature in terms of the task we were setting out to do. Cancer is a very complex illness, and the focus of the war on cancer has changed.

“I think now there’s an appreciation that what is going to happen with some cancers is that they may be transformed into chronic illnesses. This means that people will live with them for a long – and hopefully an increasingly long period of time – without necessarily being cured. It may be a pipe-dream, but I believe we will see that happening more and more with cancer.”

The joint venture he’s currently undertaking with Professor Martin Clynes from the National Cell and Tissue Culture Centre (NCTCC) at DCU could prove pivotal in what he terms this ‘revolution’.

The establishment of a chair in translational research makes DCU the first institution in the country to give recognition to the importance of the coming together of ‘the bench’ and ‘the bedside’ – Clynes’ research and Crown’s clinical treatment.

“The essence of the cancer treatment revolution is that for a very long time there was a complete discordance between what was happening in the lab and what was happening at the bedside,” he says.

“During all that time, the treatments that we were giving to people had been developed in the lab, through no more sophisticated a method than trial and error, where we tried to unlock the mysteries of the cancer cell.

“Now we’re all biting our nails and holding our breath because in the next year or two perhaps a half dozen to a dozen new, molecularly-targeted, rational, specific, non-blunderbuss cancer treatment drugs are coming into clinical trial. And there’s a real excitement right now that we may have some new tricks up our sleeves.”

One of these potential new ‘tricks’ was developed in the lab by Martin Clynes’ team at DCU.

It’s nothing more high-tech than a standard, prescription painkilling drug, normally used to treat arthritis and sports injuries. But administered in conjunction with high dosage chemotherapy, it has had what he calls with some caution “very encouraging” results at early trial stage. Some of the patients – all of whom had cancer that had spread throughout their bodies – have gone into complete remission.

But if the EU has its way, however, such trials may be in their final days. Under new regulations, up to 80 per cent of the trials that took place over the past twenty years would now not be able to happen.

How serious are the implications of this?

“Let me put it this way,” he says. “There is not one disease that we don’t cure now that we would have cured if these regulations have been in place twenty years ago. But there are many diseases that we do cure now that we wouldn’t have cured. Much other trials we did into childhood leukaemia, for instance, would be illegal under these new regulations.”

The ICOR, which Crown formerly chaired, is spearheading what he intends to be a very noisy campaign to have the directive repealed.

But for now, he’s got other things on his mind.

“In a society where getting an appointment to see a doctor is a mammoth task, seriously ill patients have too much to contend with. I like to see patients. That’s why I became a doctor,” he says, as he disappears out the door – and reminding you that for all his gongs, and all the letters after his name, John Crown hasn’t forgotten why he got into this game.

Jennifer O’Connell is a graduate of the MA in Journalism 1998 and an assistant editor of The Sunday Business Post.

First published in the Spring 2004 issue of the DCU Alumni Magazine


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