dr Donald Pinkel, a pediatrician who developed an aggressive treatment for childhood leukemia in the early 1960s that turned the disease from a virtual death sentence into one that nearly every patient survives, died Wednesday at his home in San Luis Obispo, California . He was 95.
His son John Pinkel confirmed the death.
Acute lymphocytic leukemia, a cancer that blankets the body with misshapen white blood cells, was once the leading cause of death in children in the United States between the ages of 3 and 15, causing about 2,000 deaths annually. It had a 96% mortality rate – and doctors say that number may have been low because the remaining 4% of cases were likely misdiagnosed.
When Donald Pinkel began his research as a pediatrician in Buffalo in the 1950s, there were already several drugs that could bring the disease into remission. But the cancer almost always returned. Doctors would then try a different drug, only to get the same results.
“At the time, the idea with ALL was to try and extend life in comfort — it was,” Pinkel told Smithsonian Magazine in 2016. “We called it ‘palliation’. No one thought you would “cure” anyone. That was almost a forbidden word.”
In 1961, shortly after moving to the newly established St. Jude Children’s Hospital in Memphis, Tennessee – he was its CEO, medical director and first associate – he took a radically different path. Instead of using one drug or treatment at once, he would use them all, pushing patients’ bodies to their limits in the hope that the cancer would die first.
“Dr. Pinkel and my father shared the same unyielding hope and were equally brave in their determination that childhood leukemia could be defeated,” said actress Marlo Thomas, whose father, comedian and actor Danny Thomas, founded St. Jude, in a statement.
Pinkel combined multiple chemotherapy drugs to try to put the disease into remission. When patients were healthy enough, he and his team bombarded their skulls with radiation and injected drugs directly into their spines, targeting spots where Pinkel suspected the cancer was hiding during remission.
This would go on for months, even years. Children would lose their hair, their appetites. Some died. But in 1968, Pinkel’s therapy, which he called Total Therapy, achieved remarkable results: Of 31 patients in one study, 20 were in complete remission after 3 1/2 years.
A decade later, after further refinements of the protocol, the five-year survival rate was up to 80%. Today, still using Pinkel’s Framework, it’s 94%.
“He really is the man who cured leukemia,” James Downing, current president of St. Jude, said in a telephone interview.
Donald Paul Pinkel was born on September 7, 1926 in Buffalo, New York. His father, Lawrence, was a hardware salesman, and his mother, Anne (Richardson) Pinkel, was a homemaker.
Donald Pinkel enlisted in the Navy in 1944 and went to Cornell University as part of the service’s V-12 program, which gave college courses to promising recruits. There he developed an interest in biology and medicine; After returning home and graduating from Canisius College, Buffalo in 1947, he went straight to the medical school at what is now the University of Buffalo, and covered some of the costs by joining the Army Reserve Medical Command.
He quickly found his calling in paediatrics and specifically in the field of childhood cancer. At the time, it was considered a lost cause — a field of research so desolate that one mentor said he was giving up his career.
Pinkel insisted, earned his medical degree in 1951 and held a number of residencies and fellowships in pediatrics and oncology throughout the Northeast. He was preparing for another fellowship in New York City when he was drafted into the Army and sent to a military hospital outside of Boston.
A polio epidemic was in full swing in the area, and Pinkel, overworked as the hospital’s only pediatrician, soon contracted the disease himself. It took him a year to recover – coincidentally, just as Jonas Salk’s new polio vaccine was launched, turning what was once a scourge of childhood into a largely preventable disease.
Pinkel dreamed of doing the same with leukemia. He worked with famed oncologist Sidney Farber in Boston, then returned to Buffalo, where he opened a pediatric unit at the Roswell Park Cancer Institute (now Roswell Park Comprehensive Cancer Center) and worked with James Holland, another cancer research pioneer.
One day in 1961, Pinkel received a phone call asking if he was interested in a position as director of St. Jude. At a time of emotional and professional need, Thomas had prayed to St. Jude, the patron saint of hopeless cases, for help. When he recovered, he decided to build a hospital to help children in similar dire emergencies.
Pinkel was sick of the cold, wet Buffalo winters, but he wasn’t sure about what was on offer; Memphis was a segregated Southern city, and many in the medical community said Thomas’s status as a television comedian made the idea difficult to take seriously.
Despite this, he met with several members of the hospital board and was impressed. They, like him, believed in focusing their efforts on childhood cancer and they agreed that the hospital should be needs-blind and that both its staff and its patient population should be completely desegregated.
Pinkel drove to Memphis in his Volkswagen Beetle and found a hole in the ground where the hospital would one day be. He made himself an integral part of the planning process and called, among other things, for the hospital to have integrated bathrooms.
He also insisted on as much common space as possible, including a single cafeteria for everyone – doctors, scientists and administrators – to encourage creative cross-pollination. He also opened the cafeteria to patients and their families to give staff a visual reminder of their shared mission.
“It was a civil rights culture,” said Jackie Dulle, one of his first executive assistants, in a phone interview. “He wanted everyone to be equal.”
With the blessing of Thomas and the support of the board, Pinkel hired the best researchers and physicians he could find and attracted them to his bold vision and progressive St. Jude culture. His wife, Marita (Donovan) Pinkel, would help by hosting recruits at her home and lobbying for them at dinner.
This marriage ended in divorce. Along with his son John, Pinkel is survived by his second wife, Cathryn Howarth; six daughters: Rebecca Amthor, Nancy Pinkel, Mary Pinkel, Noelle Greene, Sara Pinkel and Ruth Pinkel; two more sons: Thomas and Michael; his sister Eileen Pinkel; 16 grandchildren; and five great-grandchildren. Another son, Christopher, predeceased him.
Pinkel and his team had early success with their Total Therapy approach, but kept the results unpublished until the late 1960s to ensure the data were solid. When he published his findings, however, he was met with skepticism, even ridicule; Other doctors said he was cruel to give hope to patients and their families in the face of a disease everyone knew was incurable.
But after he invited some of his most prominent critics to visit the hospital, they changed their minds; One of them, Alvin Mauer of Cincinnati Children’s Hospital, took over the presidency from St. Jude when Pinkel left.
During their studies, Pinkel and his colleagues noticed something odd: The children from low-income families, most of them black, tended to do worse than children from higher-income families. After an investigation, they concluded that pervasive malnutrition was to blame.
Pinkel helped launch a program to provide families with supplementary food. These efforts provided the model for the federal government’s special nutritional supplement program for women, infants and children, known as WIC.
But those efforts brought Pinkel into conflict with some in the city’s white leadership, who felt they gave Memphis a bad name. Several of the hospital’s donors threatened to withdraw support if he proceeded.
Pinkel left St. Jude in 1973. He later worked in children’s hospitals in Wisconsin, California, Pennsylvania and Texas before retiring in 1994. He moved to San Luis Obispo to be near some of his children and later taught as an adjunct at California Polytechnic University.
Pinkel won most of the major awards in the medical field. In 2017, St. Jude named its new research tower after him, a testament to his perseverance in the face of what everyone else deemed an impossible task.
“I’m a very stubborn person,” Pinkel told the Smithsonian. “A trainer once told me, ‘Never run from a fight — the farther you run, the harder it is to fight back.'”