Dr. Emil Jay Freireich: The inspiring story of a Jewish underdog

Widely regarded as the father of modern leukemia therapy, today let’s look at the inspiring story of Dr. Emil Jay Freireich, whose never say die attitude, determination, and scientific breakthroughs helped bring cure for leukemia. 

Dr. Emil Jay Freireich was fired seven times over the course of his career. But if it weren’t for his persistence, we wouldn’t have a cure for leukemia today. 

Doctor Emil Jay Freireich faced an almost insurmountable task when he took on the medical industry giants of the 1950s to develop new cancer treatments. In many ways, it was like David taking on Goliath.

Childhood leukemia in those days was considered a death sentence. There was no cure.

“When they came to the hospital, 90 % of the kids would be dead in six weeks,” Freireich said.

Leukemia is a type of cancer that affects the blood and bone marrow, resulting in severe bleeding. Children would bleed from their eyes, nose, ears, skin, intestines, and urine, as well as vomit blood. 

It was nothing short of a slaughterhouse, as Dr. Freireich, fondly called “Jay,” describes it later. It was every parent’s worst nightmare!

Today leukemia has a cure rate of more than 90 percent.

A Biography of Dr. Emil Jay Freireich

Emil Jay Freireich was born into a poor family in Chicago on March 16, 1927. His Jewish parents were immigrants from Hungary and ran a restaurant there in Chicago.

As if being poor wasn’t bad enough, but going through the stock market crash of 1929 just made matters worse. They lost everything. It was in the early days of the Great Depression when his father committed suicide. Emil Jay Freireich was then two.

With no money left to survive, his mother took up a job at a ‘sweatshop,’ sowing hats. She made two cents a day. She didn’t speak much English either. Life was difficult, and I assume they must have been pretty desperate.

A ‘sweatshop’ or a ‘sweat factory’ is a crowded workplace with poor or socially unacceptable working conditions, where mostly women and children work long hours for very low pay. The term was first used in the late 19th century to describe the dangerous and grueling conditions in textile factories.

Unable to take time out from work, his mother soon became an absent figure in his life. But she couldn’t just leave her two-year-old and a five-year-old alone. So she hired an Irish maid to care for them — who became like a mother to these two kids, whom Jay fondly adored.

When Jay was nine, seven years after the death of his own father, his mother remarried. She married a Hungarian man who had himself lost his wife and had a son through her. It was a marriage of convenience sort of; she wanted somebody in her life, and he wanted someone to take care of his son. 

This didn’t go down well with Jay. He never liked his stepfather, who, according to him, was a bitter and shriveled guy. 

So they got married, and Jay’s mom left the sweatshop to be a stay-at-home mom to look after the kids. 

After moving back home, his mom could no longer afford the Irish maid. So they let her go — this incident had a profound effect on young Jay’s mind, and he never forgave his mother for that. The Irish maid was like a mother to him, whom he dearly adored. Now he had no one in his life.

Growing up in poverty during the Great Depression, Jay spent his days on the street, sometimes stealing or getting into fights. He wasn’t close to his sister either, who he considered more of a disciplinarian than a friend. He neither liked his mother, who was an angry woman, nor his stepfather, who Jay later describes as an “ugly guy who brought this stepbrother, who got half of everything he used to get…”

On the other hand, Jay knew nothing about his own biological father. His mother never spoke a word about him to Jay. 

Read: 25 Life Lessons For Young Adults. No. 19 Will Surprise You!

Schooling and Education of Dr. Emil Jay Freireich

When Jay was nine, he had a bad case of tonsillitis. The local physician — Dr. Rosenbloom, came to remove his inflamed tonsils.

Dr. Rosenbloom was a gentleman — dignified and kind and wore a suit and a tie — a perfect role model for young Jay. 

You see, Jay lived in a poor neighborhood, a place where ragged people lived. Everyone who Jay knew was either a woman or, if it was a man, he was dirty.

Young Jay made up his mind. He wanted to be a doctor, just like Dr. Rosenbloom! He was ten then.

Jay did reasonably well at school. And in high school, his teacher took a shine to him. He told him, “Jay, you need to go to college.”

What must I do to get into a college? Jay asked

“Well, If you could get 25 dollars, you could make it!” his teacher said.

Mind you, this was way back in 1942, when people weren’t well off as they are today in America. There was no way he could afford that kind of money.

But nevertheless, he told his mom that he wanted to go to college and wanted 25 dollars. A couple of days later, his mom came back to him with the money.

And believe it or not, as luck would have it, she managed to get that money from another Hungarian lady whose husband died and left her some money. She gave that money to Jay’s mom.

Life in college

Students back then who normally went to medical schools were from upper-middle-class families. They were polished and sophisticated gentlemen. Not so, Jay. He was rough around the edges and came across as downright rude and arrogant — in moments of special emphasis, he had this habit of shouting and pounding his fists across the table to put his point across. So that is Jay for you, in short!

Given his nature, even his wife refused when Jay first asked her out on a date.

Navigating the Tumultuous Career of Emil Jay Freireich

Emil Jay Freireich had a very shaky career — he was, over the course of his lifetime, fired seven times from his job!

He started his career as a Research Associate in hematology in Boston. 

He was then later drafted into the army, and he chose to complete his military service at the National Cancer Institute in Washington, DC.

He was, by all standards, a brilliant and dedicated student. But even though he was hard-working, he was never more than a step away from being fired from his job. 

He had a very bad temper, lacked patience, and had no gentleness in him whatsoever. He was the type of guy his colleagues would invite home for dinner, but he’d somehow, knowingly or unknowingly, would end up insulting their wives… recalled one of his former colleagues.

Another coworker recalls, “during one of Jay’s visits to the ward, he came across a routine error made by one of his medical residents, because of which the patient died.” 

(But later, it was discovered it wasn’t because of the error)

Jay yelled at him in front of the entire staff and patients and called him a murderer. The poor guy just broke down and cried!

The reason why most of us do not yell “murderer” at someone is because we empathize with their mistakes, having committed some ourselves. When we make mistakes, there is always someone there to hold our hands and guide us and tell us, “it’s okay”. That support gives us a model, how to feel for others. But during Freireich’s formative years, everyone he knew either abandoned him or died, and his bleak childhood only left him with pain and anger. So, he didn’t know how to show sympathy because no one had ever shown it to him.

Weathering Storms and Soaring to the Top

At the National Cancer Institute, Emil Jay Freireich was assigned to the children’s leukemia ward on the second floor of the main building. His boss Dr. Zubrod would come once a week to check on his patients and how they were doing. Their job was to find a cure for cancer.

As I mentioned earlier, childhood leukemia was one of the most terrifying cancers. Children would hardly survive it. Since the doctors found it extremely difficult to control the bleeding, there was blood everywhere. The floor looked like an abattoir, so much so that even the parents were afraid to get in. And if the child bled from the nose or mouth, they couldn’t eat or swallow. They’d gag and vomit more blood. The doctors, too, did not last too long in that ward, such was the situation. The visuals completely destroyed their psychology.

But for Freireich, he was never depressed. Unlike other doctors, who could but only sympathize with parents, Freireich never sat with a parent and cried about their child. Perhaps, he’d have cried if it was his own child, but with other parents, his relationship remained that of a doctor and patient, never being emotionally involved in their emotions.

The first breakthrough in childhood leukemia research

Jay teamed up with another doctor named Tom Frei. Together they discovered that leukemia was destroying the children’s ability to make platelets (a type of blood cell that makes your blood clot when you are injured or bruised). 

Without platelets, their blood couldn’t clot, which was causing profuse bleeding among his patients. So the whole idea was, why not give fresh platelets to children, this way, they’d be able to control the bleeding in the first place. Back then, it was a radical idea — but one of his bosses, Dr. George Brecher, was skeptical.

Dr. Breecher, an expert in hematology, thought otherwise. In his calculations, the number of platelets seemed normal. But Dr. Jay was adamant, he was very sure Dr. Breecher wasn’t counting the platelets correctly. So he devised his own complicated procedure to calculate the number of platelets and zeroed in on a sophisticated methodology that showed platelets were really low, and to him, the connection was clear — the children needed fresh platelets if at all they had a chance to survive, and they needed that in huge doses.

It’s one thing to discover a new methodology and another to get clearance from medical boards. The NCI blood bank refused to give Dr. Jay and Dr. Tom Frei fresh blood for transfusions. It was against regulations. 

Freireich pounded on the table with his fists, “you’re gonna kill the people!” 

At work, you have gotta be careful who you say that kind of a thing to, and Freireich, so to speak, was yelling at the management. Man, he was someone who wore his heart up his sleeves and gave a piece of his mind to them..!

Since the NCI refused to give him fresh blood, Dr. Jay recruited blood donors. One of his patient’s father was a pastor who mobilized 20 members of his church’s congregation to donate blood.

Now the blood transfusions in the 1950s weren’t done how it is done now. The standard operating procedures back then were steel needles, rubber tubes, and glass bottles. But that blood stuck to those surfaces, causing loss of platelets!

So Freireich, yet again, decided to bypass the standard operating procedures of the NCI. He decided to switch to a brand-new technology of silicone needles and plastic bags. This technology prevented blood from sticking to the surface and the loss of platelets. 

Not to make the hospital management sound like the villain or criticize their standard operating procedures, but why the hospital had not yet adapted to the new technology was because the new technology was risky. If you didn’t do the transfusions right, you could risk heart failure in children…

Dr. Berlin, the then Director of NCI, said to Jay, “You’re insane ..If you keep doing these transfusions, I may have to gonna fire you”

But Jay pressed on… If he couldn’t do it, he didn’t want to work there anymore!

Guess what, the bleeding stopped!

Read more about my other blogs here.

The second breakthrough…The children are anyways gonna die, so why not try it out?”

The work Dr. Jay had done to stop the bleeding was a breakthrough. It now meant that the children could be kept long alive to treat the underlying cause of the problem,. I.e., leukemia itself!

But leukemia was an even harder problem than bleeding. There were just a handful of drugs known to show some effect against the disease — 6 – MP, methotrexate, and prednisone! Each of these drugs had a different chemical pathway to killing cancer cells — why this is important, you’ll know in a little while.

Now each of these three drugs was very toxic and therefore was given only in limited doses, and never as a “cocktail” like how they do it in modern times! That was the standard operating procedure back then.

Since they were given in limited doses, these drugs were only able to wipe out only some of the cancerous cells, not all. But a week or two later, the cancer was back again, this time with a roar. 

It was just a vicious cycle. This treatment only delayed pain and death and nothing more so, to simply put it.

Cometh the hour cometh the man…! Just as he was born out of his mother’s womb with clenched fists ready to pick on a fight, Dr. Jay was ready to take on the medical industry giants of his time!

Together with Dr. Frei and one James Holland, decided — if the drugs weren’t killing enough cancer cells, shouldn’t we make the treatment more aggressive?

“Why not combine the three drugs together?” they discussed among themselves.

Dr. Jay then stumbled upon another drug, the fourth one with promising results. It was called vincristine, a drug derived from the periwinkle plant. Someone had brought it from the Eli Lilly drug company to the NCI for researchers to study. No one knew much about it, but Dr. Jay decided to try it out — “My gut feeling is it’s gonna work! The children are anyways gonna die, so why not try it out?”

So Dr. Jay and Dr. Frei tried this drug on children who no longer responded to other drugs — it showed signs of improvement!

But it was not like they had an easy going, given how little they knew about vincristine, its side effects, and its consequences. There was a lot of trial and error method involved in figuring out the dose and combination of drugs before they could get any substantial results. Some children got paralyzed, and others got into comas. In fact, of the first fourteen children, two actually died. It was never easy! But nevertheless, they finally started making some progress. The results seemed positive!

So Frei and Freireich went to the medical board of the NCI and sought permission to try all four drugs together. They met Dr. Carl Moore, a senior hematologist on the board, and proposed — “Sir, we’d like to try all four drugs together,” they said.

But their proposal struck Dr. Carl as being outrageous! 

“It’s unethical”, he said and declined their proposal.

But Dr. Frei and Dr. Jay were desperate… So they went to their own boss Dr. Zubrod, the same guy with who they had fought a war about the platelets controversy. He had only reluctantly approved the vincristine experiment, and now they want to try all four drugs together?? Insane!

Dr. Zubrod was responsible for what happened on the second floor, and just imagine if something went wrong, he’d be hauled before a congressional committee. Can you imagine? Saying yes, to Dr. Jay was like saying yes to the end of his career and the possibility of spending the rest of his life in prison!

He had his own reservations. He wasn’t going to allow two renegade researchers who were experimenting with a cocktail of drugs on five and six-year-olds that too in a government hospital to do something of that sort, definitely not under his watch and definitely not when Dr. Jay was involved.

But Dr. Frei and Dr. Freireich pressed on. And let’s agree, by now, even Dr. Zubrod was beginning to feel the winds of history stirring, he could see a breakthrough coming through. It’s not like he was a villain. He, too, wanted a cure for leukemia, but just not in the way Dr. Jay wanted it — he reluctantly gave in to their demands!

Cancer these days is routinely treated with a cocktail of drugs, but in the 1960s, it was unheard of. The drugs considered to treat cancer in those days were considered too dangerous, let alone a combination of drugs. But it was Dr. Jay and his team who first tried a combination of drugs to treat cancer. They were the pioneers.

What Dr. Jay and Dr. Frei were doing was so controversial that even their subordinates and other junior doctors refused to be a part of it! They thought Dr. Jay was insane — “he is tinkering with the protocol,” they said.

But guess what!!!

The treatment worked. Patient number two recovered, and so did the next child and the child after him. 

But there was a small problem. 

The cancer wasn’t completely gone. The cancerous cells kept coming back. 

In fact, 12 of 13 kids that were given chemo relapsed.

The VAMP regimen — the four-drug chemotherapy combination

So Dr. Freireich decided there’s only one way to deal with this — “we are going to treat them every month, for a year.”

If people thought Dr. Jay was crazy before, now they thought he was completely mad!

These were kids who seemed completely normal, completely recovered, walking around, playing football, but here was Dr. Jay telling their parents to bring them to the hospital, to make them sick again??? 

For their parents, it was agony. They were told, “for your child to have a chance at all in life, you gotta bring them back for chemotherapy,”…repeatedly, even to the brink of death, given the nature of chemotherapy in those days — sounds painful, but it was necessary!

You see in those days, antibiotics were never given in combination like how it’s given these days. 

So in a way, what Dr. Freireich was asking his clinical associates to do was heretical so to say — injecting kids were a combination of drugs, administering certain antibiotics into spine (which they had been told should never be administered in the spinal fluid).

Since nobody wanted to do what Emil Jay Freireich was doing, he had to do it all by himself — mixing the drugs, injecting them, doing blood counts, measuring the bleeding, doing the bone marrows etc.

His colleagues thought he was completely nuts. He was made fun of and insulted, especially by the guys from Havard. It was awful. Just imagine the pain of going through such humiliation at work..Dr. Jay carried the weight of it all! 

Sometimes he gave in to the pressure and said things that would get him into trouble or insult someone, and Dr. Frei would have to come running to smooth things over.

Did Dr. Jay really care what people thought of him?

Maybe, but not enough to stop him from what he really thought was right!

The cure 

In 1965, Dr. Jay and Dr. Frei published a book titled “Progress and perspectives in the chemotherapy of acute leukemia.”

They had together successfully found a cure for childhood leukemia. Today the cure rate for this cancer is more than 90 percent! 

Today the number of children who have been saved by the efforts of Dr. Jay and Dr. Frei and the doctors and researchers who have followed in their footsteps is in the many, many thousands!

Mrs. Freireich

Dr. Emil Jay Freireich was married to a soft-spoken nurse named Haroldine Cunningham, so different in nature to Dr. Jay.

Back then, when they were not dating, he asked her out. But since Jay was outspoken and came across as aggressive, she refused.

One day Haroldine went to meet her aunt in a suburb of Chicago, and the phone rang. It was Dr. Jay. “I’m here,” he said. He was calling from the train station.

She only decided to meet him because Jay was very persistent, probably just meet and get done with it, hoping that he wouldn’t bother her again!

This was in the early 1950’s and have been married since then.

“I see the man. I see his needs,” she said.

“She is the first person who ever loved me, she’s my angel from heaven. She found me. I think she detected something in me that could be nourished. I defer to her in all things. She keeps me going every day,” he said about her.

Regarded as a pioneer in the treatment of cancer and chemotherapy and often as the father of modern leukemia therapy passed away the ripe age of 94 on February 1, 2021.

A thought to ponder on from the life of Dr. Emil Jay Freireich

Success they say comes at a price — and for some individuals, that cost may be early childhood trauma, loss, dyslexia, poverty, and other challenges. While these experiences are certainly not something any parent would wish upon their child, there is evidence to suggest that those who have overcome adversity can develop important skills and unique perspectives that can help them succeed in various areas of life. As a society, we should consider whether we need people who have emerged from trauma and acknowledge the strength and resilience that can come from overcoming adversity. It is important that we provide support and resources for those who have experienced trauma to help them overcome their challenges and achieve their full potential.

References:

David and Goliath, Malcolm Gladwell.. Buy the book here.