Mike Milken spent a year beating prostate cancer. He spent
the next decade shaking up cancer research. Now thousands
of men are living longer—and leaders everywhere are
taking notice.
By Cora Daniels
The image on the oversized screen behind the podium was
of a giant malignant tumor. The discussion was about prognostic
indicators—doctorspeak for how much longer people
with such tumors had to live. The prognosis wasn't good,
with life expectancy measured in months, not years. The
presenter's manner was cold, but it didn't matter: This
was no hospital bedside but a roomful of physicians, gathered
for a seminar on prostate cancer at Houston's prestigious
M.D. Anderson Cancer Center. In the third row sat a tall,
slight, unimposing man. The top of his middle-aged head
no longer had hair; his eyebrows were thin. His nametag
read dr. robert hackel, and all he could think about was
how enormous the tumor looked onscreen. A tumor just like
his own.
When the speaker, Donald Coffey, an esteemed prostate cancer
expert from Johns Hopkins, was finished, Hackel made his
way to the front. For 25 minutes he grilled Coffey on his
presentation, asking technical questions about the research
and its therapeutic implications. At what should have been
the end of a friendly exchange between colleagues, Hackel
turned to Coffey and said, "I am Mike Milken. I want
to be cured."
Coffey knew the name. It was 1993, and Michael Milken, the
once-highflying junk-bond wizard had, a few years earlier,
been a familiar face in the newspapers because of his high-profile
indictment on securities violations. Only two weeks before,
in fact, Milken—now wearing a phony ID badge with
his middle name and father-in-law's surname—had been
released from prison, having served 22 months. Coffey was
surprised not just by who his questioner was, but by the
fact that he wasn't a doctor. His toupee gone and his toothy
grin somewhat modulated, Milken seemed more like a veteran
lab scientist than a desperate patient. He knew much about
the biology of cancer.
It was only when Milken began to speak rapturously about
turning prostate cancer research on its head and starting
"a Manhattan Project for cancer" that the financier
sounded a bit naive. A real physician would have known better,
thought Coffey. "The truth was, at the time, there
was so little research—or anything else—going
on in the field [of prostate cancer], it was as if Milken
was speaking in tongues," he says. Still, the good
doctor listened politely.
Eleven years later many others are listening too. That's
because Milken has, in fact, turned the cancer establishment
upside down. In the time it normally takes a big pharmaceutical
company to bring a single new drug to market, Milken has
managed to raise the profile of prostate cancer significantly,
increase funding dramatically to fight the disease, spur
innovative research, attract new people to the field, get
myriad drugs into clinical trials, and, dare we say, speed
up science. Milken's philanthropy, the Prostate Cancer Foundation,
formerly called CaP Cure, has raised $210 million from its
founding in 1993 through 2003 (the latest audited figures),
making it the world's largest private sponsor of prostate
cancer research.
That all-fronts effort, say numerous experts interviewed
by FORTUNE, has been a significant factor in reducing deaths
and suffering from the disease. The progress on this bottom
line, in fact, has been stunning. In 1993 some 34,900 Americans
died of prostate cancer; this year the figure is estimated
to be 29,900, despite the fact that the population has grown
11% since then. That translates to a 24% drop in per capita
death rates. (The National Cancer Institute, which adjusts
its figures to minimize the effects of the aging population,
calculates the decline at 26%.) What makes the improvement
all the more remarkable is that the incidence of prostate
cancer rises markedly with age—70% of cases are diagnosed
in men over 65, for example. And today there are 1.6 million
more men over 65 than there were ten years ago. Indeed,
the drop in the prostate cancer death rate is four times
the decline in overall cancer rates during the past decade
Cancer researchers, clinicians, and patient advocates rarely
speak with one voice on any subject related to the disease.
They fight over funding priorities; they squabble over treatment
options; they joust over the relevance of biological discoveries.
But virtually everyone agrees that Milken deserves an enormous
share of the credit for the progress made against this major
killer. "Mike's done more for prostate cancer research
than anyone in America," says one of the nation's best-known
prostate surgeons, Patrick Walsh, head of urology at Johns
Hopkins. Across the country Mike Glode, a medical oncologist
at the University of Colorado Cancer Center, doesn't even
wait for the question. After hearing an offhand mention
of the name, Glode offers, "Milken has done more to
raise the visibility of prostate cancer than anyone else
in the country." Phrases like "done more,"
"led the fight," and "saving lives"
are thrown around with conviction. And almost nobody mentions
his past.
"Michael Milken changed the culture of [medical] research,"
says Andrew von Eschenbach, director of the National Cancer
Institute. "He created a sense of urgency that focused
on results and shortened the timeline. It took a business
mindset to shake things up. What he's done is now the model."
The Milken model, in a nutshell, is to stimulate research
by drastically cutting the wait time for grant money, to
flood the field with fast cash, to fund therapy-driven ideas
rather than basic science, to hold researchers he funds
accountable for results, and to demand collaboration across
disciplines and among institutions, private industry, and
academia. This philanthropic paradigm is spreading. The
Juvenile Diabetes Research Foundation and the Cystic Fibrosis
Foundation have each sought Milken's advice to juice up
their grant-funding mechanisms. The Lustgarten Foundation
for Pancreatic Cancer Research has directly modeled its
research process after that of the PCF. And charities such
as Project ALS, which fights Lou Gehrig's disease, and Michael
J. Fox's foundation for Parkinson's, without consulting
Milken's organization, have followed its lead by offering
fast cash in exchange for collaborative research.
To be sure, Milken isn't the only business figure who has
had a major impact on medicine. A growing cadre of the rich
and powerful is embracing so-called venture philanthropy
in the global fight against disease. Rather than just writing
hefty annual checks to old-line charities, they are bringing
their problem-solving skills and natural-born impatience
to the fight (see How Big Givers Are Shaping Other Quests
for Cures </fortune/articles/0,15114,782018,00.html>).
Bill Gates is spending more than $100 million to rid the
world of malaria—and expects weekly e-mail progress
reports from the scientists he funds. Lee Iacocca's foundation
has been aggressive in finding and supporting some of the
most creative diabetes research. Says Iacocca, who lost
his wife to complications of diabetes 20 years ago: "I
was going to spend a lot on [diabetes] education, but I
changed my mind because what I really want is to lick this
disease—I want a cure." Increasingly, says Stacy
Palmer, editor of The Chronicle of Philanthropy, business-world
donors have gotten fed up with the slow, tradition-bound
world of medical research, where scientific breakthroughs
can take decades to become treatments that people can use.
These givers expect concrete results for their cash. They
demand a return on investment.
None of these savvy donors, however, seems to have had a
bigger ROI than Mike Milken. Indeed, when it comes to medical
research, the old junk-bond king has rewritten the rules
of investment.
Rudolph Giuliani is on the phone. The former New York City
mayor and current GOP darling is gushing: "No one was
really paying attention to prostate cancer before Milken.
He is a pioneer and really created a movement," says
Hizzoner. Then his voice hushes a bit as if to reveal a
secret: "You know, we have a history."
Everyone knows the history. Giuliani, of course, the onetime
prosecutor, got famous by putting Milken behind bars.
In the 1980s Milken was one of the most powerful men on
Wall Street. He virtually created the market for the high-yield
debt securities known as junk bonds. From behind an infamous
X-shaped desk in Beverly Hills he dominated the market,
matching the companies that issued the bonds with the banks
and institutions that bought them. Milken amassed an enormous
fortune as he built the firm he worked for, Drexel Burnham
Lambert, into a powerhouse. To companies that couldn't find
financing anywhere else, including small firms and minority
businesses, he was a visionary. But the new financing had
another effect, fueling a wave of hostile takeovers and
mergers. Often, in this frenzy of corporate raiding, employees
of older, struggling companies would suddenly find themselves
out of a job. continued
And then, just as suddenly, it was Milken who was out of
a job. A crusading prosecutor named Giuliani descended on
Wall Street, promising to root out corruption. The first
to go down was Ivan Boesky, a top arbitrageur who pleaded
guilty to insider trading in 1986. Boesky fingered Milken,
who four years later pleaded guilty to six counts of securities
violations related to market manipulation. Milken served
nearly two years in prison, paid some $600 million in fines
and penalties (plus hundreds of millions more in civil settlements),
and was banned from the securities business for life. Not
since the days of J.P. Morgan had any financier left so
deep a mark on corporate America or stirred so many conflicting
passions of support and contempt.
Some two decades after that rise and fall, it is hard to
square Milken with the image of the legend. His presence
is so understated that it seems almost wispy—he emanates
what, for want of a better word, seems like contentment.
Yes, he can still captivate a room, but he does it with
a kind of buoyancy rather than overpowering charisma. He
can come across as both relaxed and deeply passionate in
the same breath. He still has a finger in a few businesses—but
even there, his known ventures are of a lighter genre, having
to do with education, wellness programs, and nutrition.
He and his family have a large passive investment in LeapFrog
Enterprises, for example, which makes educational toys.
(The stock has dropped about 63% in the past 12 months.)
Milken is notably reserved about his other public-company
holdings.
His for-profit ventures, in fact, are the one topic that
Milken seems loath to discuss. Otherwise, he is the Energizer
bunny of talk. Milken has been known to speak, intelligently
and off the cuff, for hours on subjects of personal interest—yoga,
nutrition, cancer. In one interview with FORTUNE, he discoursed
for four hours, barely pausing to catch his breath, and
stopped only when an assistant yanked him away. "The
day he came into my life it was like I hitched myself to
the tail of a comet," says Stuart "Skip"
Holden of Cedars-Sinai Medical Center, who became Milken's
urologist 11 years ago and is now among his closest friends.
"He is exhausting—physically, mentally, and emotionally
exhausting."
It was cancer that reunited Milken with his old nemesis
Giuliani. In 2000, soon after New York City's mayor was
diagnosed with prostate cancer, he and Milken exchanged
calls (they say they can't remember who dialed first). Milken
offered health-care guidance and nutritional tips. They
became fast friends. "He knew more than any doctor,"
says Giuliani. "I realize now that I didn't know him
then. The man I now know is able to do tremendous things.
He took the tremendous talent he had in business and is
using it to fight prostate cancer. What more could you ask
for?"
Milken has shared the same kind of foxhole camaraderie with
an alpha list of fellow prostate cancer survivors: Senator
John Kerry, News Corp. chairman Rupert Murdoch, Intel chairman
Andy Grove, New York Yankees manager Joe Torre, General
Norman Schwarzkopf, former Senate leader Bob Dole, and numerous
others. For many prominent men, Milken is one of the first
connections made after hearing they have the disease. And
to hear the men talk about that first call, Milken seems
to know just what to say. "He took the scare out of
cancer for me," says Torre, now a close Milken friend
Six-time Tour de France champion Lance Armstrong, who in
1996 was diagnosed with an aggressive form of testicular
cancer that had spread to the lungs and brain and who would
later make a miraculous recovery, also holds deep admiration
for Milken and what he has been able to accomplish. Armstrong
met Milken at a luncheon in 1997—the same year he
launched his own charitable group, the Lance Armstrong Foundation,
to raise awareness about issues related to cancer survivorship.
(The two argue jokingly over whose colored wrist band has
been a more successful fundraising gimmick. Armstrong's
foundation has sold 22 million neon-yellow livestrong bracelets,
raising an equal number of dollars for charity. Milken's
blue band has been worn by major league baseball players
every June since 1996 for PCF's Home Run Challenge, an event
that has raised more than $20 million for cancer research.)
When Milken learned he had cancer in 1993, he had been home
from prison only a few days. The disease had just killed
his friend Time Warner chairman Steve Ross, so Milken asked
his doctor during a checkup for a PSA test. The test measures
a protein called prostate-specific antigen that is produced
by both normal and malignant prostate cells. Very little
of the protein leaks out of a healthy gland, so an elevated
PSA (normal readings for most men range from zero to four)
can be a red flag that warrants follow-up examination and
often a biopsy. (To complicate matters further, some men
have cancer despite low PSA readings. See box,"What
You Need to Know About Prostate Cancer.")
The doctor told Milken, then 46, that he was too young for
prostate cancer to be a threat and declined to give him
the PSA test. Milken insisted: "Humor me—I can
afford it." The test came back with a PSA level of
24. A biopsy revealed the worst. An MRI and other scans
showed that the cancer had spread to his lymph nodes, though
not yet to his bones. Surgery was unlikely to remove all
the cancer. "He went around to all the best-known medical
facilities in the country," remembers his wife, Lori,
who has known Milken since the seventh grade. (He proposed
their senior year in college in the front seat of his Ford
Falcon.) "He talked to everyone, and his options were
so limited," she says. Milken was given less than 18
months to live. One doctor told him to get his finances
in order—it was the end. Two weeks later Milken showed
up at the conference in Houston.
Back then, prostate cancer was a medical backwater. Cancer
research, like any academic field, has its hot topics where
all the government and private research money tends to go.
And while prostate cancer is fairly common—one in
six American men will eventually develop it—the field
got little attention and even less funding during the 1980s
and early 1990s. "I've been in this a long time, and
there was just nothing going on," says Holden. "We
were," he adds, pausing to find the word, "struggling."
George Wilding, director of the University of Wisconsin
Comprehensive Cancer Center, calls the academic environment
then "dismal, dismal, dismal." When Wilding, a
medical oncologist, left breast cancer research in 1988
to study prostate cancer at Wisconsin, the National Cancer
Institute awarded only a handful of research grants related
to the disease, he says. Things stayed that way for years.
For newly minted MDs and Ph.D.s, studying prostate cancer
was risking career suicide. "When I realized there
was so little funding for prostate cancer, all I could think
was that maybe, scientifically and career-wise, I'd made
a mistake," says Wilding. Von Eschenbach, a longtime
practicing urologist at M.D. Anderson before his appointment
to the NCI in 2000, has a similar memory: "We were
this quiet corner no one wanted to be associated with."
It wasn't that the cancer community didn't care that tens
of thousands of men were dying. Oddly, the problem was nearly
the opposite: People diagnosed with prostate cancer often
took a long time to succumb to it. While the cancer spreads
quickly in some—predominantly younger—men, others
get the disease late in life and die from other causes before
the malignancy has a chance to spread. Ironically, such
long periods of latency make research difficult and major
breakthroughs few and far between.
The extraordinary variance in outcome also led to markedly
different approaches to treatment. Clinicians argued ferociously
about who was a candidate for radical surgery, or radiation,
or "medical castration" with hormone injections,
or combinations thereof. There was almost no agreement on
a course of therapy—or whether even to treat some
cancers.
With little money available, the field could not attract
young physician-scientists to energize research and parse
the clinical data. And without exciting research advances,
it was hard to attract more money. The study of prostate
cancer had virtually stalled. "People were afraid to
try anything," says Howard Scher, chief of genitourinary
oncology at Memorial Sloan-Kettering Cancer Center in New
York City. "There was such nihilism in the field."
Adding to the cloud was the frustrating reality that the
grant process took years. Applying for federal money had
become a science unto itself. Proposals for NCI research
funds to study a disease are ranked by a committee of top
researchers in the field. But too often in the early 1990s
even prostate cancer projects that scored well in the vetting
process still fell short when the time came for actual funding.
In 1990, for example, there were six times as many grants
awarded for the study of breast cancer as there were for
prostate cancer. "We were starving to death before
Mike came along," says Coffey.
Another major barrier was public awareness. The disease
had no spokesman—no face. By the early 1990s, in contrast,
women had turned breast cancer into a powerful social and
political movement. Women with the disease, including former
First Lady Betty Ford, were going public with their diagnoses
and successfully stirring up support, awareness, and funding.
For men with prostate cancer, the story couldn't have been
more different. They hid. The disease, which seemed to suggest
some black mark on a man's virility and sexual prowess,
was not something one discussed publicly. (When Andy Grove
candidly detailed his own bout with prostate cancer in a
May 1996 FORTUNE article—, the personal revelations
struck a powerful chord with readers.) Sickness was seen
as a weakness.
Milken told his doctors at Cedars-Sinai Hospital that he
wanted an aggressive course of treatment to clear any malignant
cells from his lymph nodes and prevent their spread to the
bones. That meant hormone therapy, which consists of giving
patients estrogen or an "anti-androgen" drug—both
of which interfere with the production of testosterone,
a male hormone that prostate cancer cells require to proliferate.
For months Milken took two pills three times a day, plus
a monthly injection. When that was over, he underwent eight
weeks of radiation therapy. On his own Milken decided to
change his diet radically to one virtually devoid of fat.
And as a supplement to Western medicine, he added meditation,
sesame-oil massages, aromatherapy (he believes that certain
aromas can invigorate the body's immune system), and yoga.
"No one had embraced the force, as George Lucas would
refer to it. Mind over matter—so I immediately set
out on that path too," says Milken, only half-jokingly.
"I didn't want to discount anything." His PSA
soon dropped to zero. He was in remission.
"I believe ...," begins Milken, sitting at a giant
conference room table in his foundation's sleek Santa Monica,
Calif., offices. Before he can finish the thought, he is
interrupted by Gus, his personal chef. Dressed in white
chef's gear, minus hat, Gus brings him a deep-red pomegranate-flavored
soy shake atop a small silver tray. A self-proclaimed former
junk-food addict, Milken is now obsessed with nutrition.
He starts each morning with a shake—a mix of antioxidants
including brewed green tea, lemon zest, vitamin E, and a
micronutrient called genistein that is found in some soybeans—and
insists that everyone should try it. (It tastes like fruity
foam.) Rupert Murdoch is supposedly hooked on the shakes
now, and Joe Torre drinks one in the fifth inning of every
Yankees game. The recipe is culled from nutritional and
cancer research, often conducted by scientists the PCF has
funded.
After a swig of the shake, Milken continues: "I believe
the person who waits for 110% of the facts to be in and
all the information is a person who is probably not alive—because
it's too late for him. A lot of businesspeople have been
forced to make decisions without 100% or perfect information
but based on what they know. I worked in a field where ten
seconds was a long decision process. Either you're buying
the securities or you're not. Either you're selling them
or you're not. Now people said, 'Well, gosh, that's a short
period of time,' and I say, 'No, it's not.' I've prepared
my entire life to make that decision. I think getting off
that inertia of making a decision qualifies well in building
something."
Inertia is exactly what Milken found with the cancer community
in the early 1990s: Researchers were swimming in data and
theories, but nobody acted. Milken traced much of the paralysis
to the government-funding mechanisms that fuel scientific
discovery. The process of getting research grants is convoluted
and counterproductive. Just gathering enough data and background
research to apply for an NCI grant can take a year or more.
(The applications and supporting data often run hundreds
of pages.) Add another year for the government's review
process. And throw in another year, perhaps—depending
on the federal budget cycle—to allocate the money.
At the end of the ordeal, funded researchers are locked
into their proposed study topic. Trouble is, in three years
science has often passed the ideas by.
Great "investment" opportunities—investments
in science that could pay off in lives saved—were
being lost. Milken, who'd already donated millions of dollars
since 1982 through his medical and educational philanthropy,
the Milken Family Foundation, realized that "just giving
money was no longer enough." What the cancer establishment
really needed was a completely different approach for generating
promising research.
The answer, he decided, was to streamline the grant application
process. So the PCF put out an open call to cancer scientists
to submit their most innovative and unconventional proposals.
"We asked people to give us ideas they dream about
rather than the safe ones that they thought they could get
funding for," says Howard Soule, the PCF's chief scientist,
who oversees the grant process. Better yet, it wasn't going
to take long to apply—the form was only five pages
long. The reward was something few cancer scientists had
ever known. If approved, they'd see the money—outright
gifts ranging from $75,000 to $150,000—in 90 days.
There was a catch, however. Scientists who received PCF
money had to learn to share. The lone requirement of the
gifts was that the beneficiaries had to present their findings
at Milken's annual scientific meeting before their peers,
competing institutions, and even private industry—and
they had to do it in one year's time, often before they'd
had a chance to publish the findings in a medical journal
or to patent a new compound. It was a rule that many researchers,
forever protective of their ideas and experimental data,
initially balked at. The PCF received only 85 grant applications
the first year. But in a time of strained federal budgets,
the chance for funding proved too good to pass up. Doctors
and scientists began applying in droves. By 1994 there were
200 applications, and a year later the PCF was getting 600
grant requests. "We weren't used to sharing,"
says Eric Klein, head of the urology department at the Cleveland
Clinic. "Milken really fundamentally changed things.
[PCF] funding is now a badge that people wear proudly."
The fast cash and long leash have not only proved to be
a researcher's dream but also are getting results for people
suffering from cancer. In 1998, Julian Adams, a chemist,
had what he thought was a good discovery—a proteasome
inhibitor that he suspected could kill cancer cells. But
ProScript, the cash-strapped biotech company where he was
a researcher, was on the verge of going under, so he was
desperately hunting for funding. "I had a theory and
no clinical data. A lot of people thought I was crazy,"
admits Adams. "But sometimes ideas need to be tested
instead of finding reasons to kill them."
His research caught the attention of renowned prostate cancer
specialist Christopher Logothetis at M.D. Anderson. After
teaming up, the researchers met with Milken and Soule in
spring 1998. "They got it—there was no convincing,"
says Adams.
Sixty days later they had a check in hand for $75,000, enough
to fund a small Phase 1 clinical trial. (The PCF does not
award grants to scientists in private industry, so Adams
worked out of Logothetis's lab.) By October 1999 the researchers
began to test the agent in cancer patients. Five years after
PCF's initial funding, Adams's proteasome inhibitor, now
called Velcade, was approved by the FDA for use in multiple
myeloma, a cancer of the blood, and U.S. trials evaluating
the combination of Velcade and chemotherapy for advanced
prostate cancer are underway. "That PCF funding was
pivotal," says Adams. "The drug might have been
shelved like so many drugs. But we started a whole clinical
program an entire year sooner than we thought. It kept our
company alive and probably saved the drug." (That extra
year allowed ProScript to be acquired by Millennium Pharmaceuticals,
which used the clinical trial to secure long-term research
funding for Velcade.)
Because the Prostate Cancer Foundation prefers to focus
on initial funding, its money has touched some 1,100 projects,
which means it has a piece, even if a small one, of most
of the substantial work going on in prostate cancer today.
If the PCF were to own the projects it has been affiliated
with over the past decade, the products that have resulted
from research it has funded would make the foundation the
third-largest biotech company in the world, analysts say.
But Milken's group, unlike either drug-company or even academic
sponsors, keeps nothing. "We weren't looking to build
a company. We were looking to solve the problem," says
Milken. "Our goal is to go out of business."
Cancer is caused, it is thought, when critical genes involved
in the cell division cycle are mutated, throwing cellular
development out of whack. Cells not only ignore their instructions
to die at appropriate times, but also fail to do the jobs
they have evolved to do. In the early stages it is often
hard to tell that anything is wrong. Most cases of prostate
cancer, for example, produce no symptoms. (A tumorous gland
can become abnormally firm, but that is generally detected
only by a doctor doing a digital rectal exam, or DRE.) That
silent quality can be its deadliest. If prostate cancer
is unchecked, it can—though it doesn't always—spread
to more vital organs, including the lymph nodes and bone.
In Milken's case, the cancer had been caught just in time—by
a fluke. (His doctors say it could come back; in patients
who undergo hormone therapy the cancer often returns as
much as ten or 15 years later.) But too many other men weren't
even conscious of the threat. Here, the paramount problem
wasn't the sclerotic pace of research, but a lack of public
awareness. Even worse, those most at risk—African-American
men—often have no idea that they are 65% more likely
to develop prostate cancer than white men. They are also
twice as likely to die from the disease.
Milken knew exactly how to get attention. Just weeks after
finishing his own treatment, he flew to Washington and knocked
at the door of Kweisi Mfume, who was then an outspoken Congressman
from Maryland and head of the Congressional Black Caucus.
Milken had never met Mfume. But when the two men sat together
in Mfume's office in the Rayburn building, Milken made his
pitch for political support for his fledgling cancer foundation.
He was so impassioned that the Congressman, who is now president
of the NAACP, worried that the financier was going to "break
down into tears at any moment," he says. Milken concedes
as much: "Mfume told me he had to say yes because he
didn't want me crying in his office," says Milken with
a laugh. "I admit it, I am passionate. But when you're
passionate you can do anything."
Over the next several years Milken did whatever it took
to put prostate cancer on the public's radar. In late 1993
he hosted a gala in the U.S. Capitol Building and invited
powerful members of Congress and celebrities to mingle with
leading doctors and researchers. The idea was to make prostate
cancer research "sexy." And it was so popular
that it became an annual star-studded affair. (Last year's
gala at the Waldorf-Astoria, hosted by Whoopi Goldberg,
included a private concert by Cher, attracted 1,100 people,
and raised more than $5 million.)
In large measure, Milken was doing what he always did—working
his connections and pulling the levers of power to get things
done. In the world of medical research, such moves had a
surprisingly dynamic effect. Lee Hood, for one, could barely
believe it.
Hood was a leading molecular biologist at the University
of Washington in Seattle, who, among other achievements,
had invented the DNA-sequencing machine—a device critical
to the mapping of the human genome. And in 1995 he was one
of many researchers searching for a gene related to prostate
cancer. (A few years earlier the first gene connected to
breast cancer had been discovered.) The easiest way to narrow
down the universe of possible culprits—there are an
estimated 20,000 to 25,000 human genes—was to study
the families of men suffering from the disease. Tracking
down families willing to be studied, however, was difficult
and time-consuming. It had taken ten years for Johns Hopkins
to recruit a mere 90 families on a similar hunt related
to prostate cancer heredity.
When Milken heard about the problem Hood's group faced,
he nonchalantly suggested that the researchers just go on
CNN and make their case. There was a collective "Yeah,
right" whisper among the researchers. "It was
ridiculous," Hood remembers thinking. "Who ever
heard of going on a program like Larry King and making an
appeal for a disease?" But then, Milken was partly
responsible for CNN's very existence, since Ted Turner had
used junk bonds in the 1980s to fund Turner Broadcasting
and its all-news network. That same year Milken had served
as a consultant to Turner when he sold his company to Time
Warner, a deal that had made founder Turner billions of
dollars richer and a vice chairman. Getting airtime on CNN?
To Milken that sounded possible.
So after Milken made some calls, the researchers, as Hood
says, "got dressed up and had an hour on Larry King."
The entire show was devoted to prostate cancer and included
an interview with newly diagnosed Norman Schwarzkopf; the
general appeared as a favor to his friend Milken. When the
show asked for study volunteers, more than 3,000 people
called in. In just three weeks researchers succeeded in
building a sample of 300 qualified families. "Michael
is always thinking creatively," says Hood, sounding
like a convert. "He transformed how you do research
in the field of prostate cancer and how you think about
aggressively going after a disease. It has been a real revolution."
After analyzing the DNA from those families recruited from
the Larry King show, scientists have been able to identify
a few genes that appear to be involved in the development
of prostate cancer. Treatments related to this discovery,
however, are at best years away. (In 2000, inspired by Milken's
collaborative approach, Hood left the University of Washington
to found the Institute for Systems Biology, a group of biologists,
mathematicians, chemists, and technology experts who are
working together to study how genes can be used to prevent
disease.)
As much as can be done with the participation of human study
subjects, most cancer research involves spending hours looking
at cells under a microscope. The cells, put onto slides,
come from tissue specimens—that is, from ultrathin
slices of tumors. Amazingly, though, in the mid-1990s there
was no standard procedure for gathering, categorizing, and
storing human tissue specimens. None of the cancer centers,
government labs, or universities had ever bothered to set
up a protocol. Milken couldn't believe it. So in 1995, PCF
held what it grandly called a "Tissue Bank Summit"
with four of the leading prostate cancer research hubs:
M.D. Anderson, Dana Farber Cancer Institute in Boston, the
University of Washington, and Washington University in St.
Louis. The four centers (joined later by the University
of Michigan) not only came up with common rules regarding
the specimens but also agreed to coordinate efforts
The next step was getting big medical institutions to work
together in setting up major clinical trials that often
require the participation of hundreds or even thousands
of patients. The PCF brought eight leading centers into
a therapy consortium and provided lots of funding ($3.2
million in the latest year). Milken also enlisted Oracle
CEO Larry Ellison to link (for free) the computer systems
of the participating hospitals so that researchers could
check on patient data across institutions. Again Milken's
lone rule applied: The hospitals would have to share what
they learned with one another. It was a no-brainer of an
idea. Only thing is, nobody had ever done it before.
2. In that same busy 1995, Milken had another major brainstorm.
He noticed that, astoundingly, no one had ever tried to
harness the enormous political power of the millions of
Americans with cancer and their families. So he began to
pull every lever he could to generate a mammoth march on
Washington. Organizing the march would take him and other
cancer advocates a full three years. There were many hundreds
of cancer organizations to pull together, from giant charities
like the American Cancer Society to smaller advocacy groups
to specialized medical societies—all agitating for
their own research agendas. The march became an effort to
get this fragmented community to speak with one voice.
Milken and Sidney Kimmel, chairman of the Jones Apparel
Group, donated most of the estimated $10 million it took
to pull off the 1998 event, which included demonstrations
in 200 cities. Six hundred organizations joined the effort,
and more than 150,000 cancer survivors converged on the
Washington Mall. Against doctors' orders, King Hussein of
Jordan, who would lose his battle against cancer within
the month, flew from the Mayo Clinic to take part in the
march but ended up too sick to leave the VIP tent. His wife,
Queen Noor, spoke to marchers instead.
The 1998 march is credited with ushering in a period of
expansive funding for cancer research. In the five years
since, Congress has increased funding of the NCI by nearly
70%.
It takes a long, twisting drive up Mount Rose to get from
the Reno airport to the Hyatt Regency on the shores of Lake
Tahoe, 6,800 feet above sea level. Winter weather always
comes early to this famed Nevada hideaway, and when it does
heavy snow packs the banks of the highway and ice freezes
the pavement. Scientists, it seems, get a little giddy at
this elevation.
In October hundreds of them gathered here for the PCF's
scientific retreat, an annual confab of heady science talk
and mingling, focused on the newest of the new in prostate
cancer. If there is one gauge of Milken's reception in the
cancer community, it is this invitation-only event, which
top doctors and scientists rarely decline and which drug
company emissaries fall all over themselves to attend. There
are so many back-to-back-to-back presentations in the four-day
lineup that the organizers have squeezed out all the bathroom
breaks. A urologist joked this year that prostate cancer
researchers have been evolutionarily "selected"
based on the size of their bladders.
Some top doctors clearly wanted to rub elbows with Aaron
Ciechanover, the Israeli researcher who had just won the
2004 Nobel Prize in chemistry for his work on the way human
cells break down protein—and whose research has been
funded by the PCF since 2002. Some shimmied over to Intel
chairman Andy Grove. (In past years Nobel Prize-winning
economist Gary Becker was the celeb du jour—the guest
list invariably includes top thinkers from nonscientific
disciplines.) But the biggest draw is Milken himself. He
has become a godfather of sorts, and the retreat has become
a medical reincarnation of his annual Predator's Ball, the
lavish deal-spinning Beverly Hills dinner he hosted during
his reign as the junk-bond king.
Discussions often grow lively as speakers are grilled by
peers and competitors. Somehow, say many veteran attendees,
the meeting elicits an energy that other research gatherings
don't. The marathon sessions are standing room only, and
few of the scientists seem to realize that one of the most
beautiful views in America—snow-blanketed mountains
surrounding a prehistoric lake—is just on the other
side of the window shades. "It is fantastic. I had
tears in my eyes the first time I went," says Adams,
who has attended several times since Velcade's PCF grant
in 1998. "It is like this think tank where you can
meet all the right people. You can't help but feel this
urgency and go back to the laboratory and work even harder."
2. Milken himself seems to feel this urgency on an ever-growing
number of fronts. He doesn't get much sleep, his wife, Lori,
says, because the telephone is always ringing. "People
call him all the time with their medical problems—not
just for prostate cancer, but other diseases or other types
of problems," says Lori. "He takes everyone's
calls."
Milken's latest push is to have medical records unsealed
(names would be replaced with numerical codes to protect
patients' privacy) so that researchers can cull for trends
among millions of medical histories. Currently a slate of
regulations called HIPAA, enacted by Congress in the mid-1990s
to protect patient privacy, makes such a practice impossible.
(Indeed, the rules are so imposing that it can be difficult
for doctors running clinical trials to gather information
even from their own willing patients.)
Stripping medical records of patient names, however, and
then streaming the information into a giant medical database
is one obvious and inexpensive way to let doctors and scientists
search for common markers of disease. To Milken, who once
used historical stock market data archives to broaden his
understanding of debt financing, the concept is again a
no-brainer. Forget prostate cancer—just imagine what
that could mean to all medical research!
That's the kind of extrapolation he's been making far more
often these days. Last year Milken launched a Washington,
D.C., think tank called FasterCures, whose aim is to accelerate
the search for medical cures to all major diseases by examining
(and, if necessary, changing) public policy, government
regulation, and weaknesses in technology that might be holding
up science. For starters, the organization is focusing on
regulatory and cultural bottlenecks related to five common
diseases—Alzheimer's, breast cancer, epilepsy, prostate
cancer, and juvenile diabetes. The notion is to take lessons
learned in these "case studies" and apply them
to all medicine. Milken recruited Gregory Simon, who was
chief domestic advisor to Vice President Al Gore on economic,
science, and technology issues, to FasterCures, and has
brought other big thinkers to the board—including
Nobel laureates Becker and David Baltimore, president of
the California Institute of Technology. And to give himself
more time to devote to this latest passion, Milken has handed
over day-to-day oversight of the PCF to Leslie Michelson,
who recently ran Acurian, a company that recruits patients
for clinical trials.
If Milken's work with prostate cancer is any indication,
the path to faster cures everywhere is almost devilishly
simple. There are four key elements: Improve the technology
("If we give cancer researchers the same kinds of tools
that technology companies employ, we can find a cure faster,"
he says); rewrite the dumb policy; let scientists think
big thoughts instead of spending their days begging for
money; and, finally, require everyone to share what he's
learned along the way. "I kind of view it as a relay
race, with four runners," he says. "Everyone thinks
of these types of things as sequential, and my thought was,
Why can't we just start all four relay runners simultaneously?
Maybe the fourth runner is only walking, and the second
runner is sprinting, and the third is jogging. But at least
get them all going."
Get them all going indeed
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