DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE
NATIONAL INSTITUTES OF HEALTH
BETHESDA, MARYLAND 20014

December 29, 1969

 

Prof. Joshua Lederberg

Department of Genetics

Stanford University School of Medicine
Stanford, California 94305

Dear Dr. Lederberg:

Your letter of December 22 arrived just as I was about to write to
you to say that we were very much interested in your column in the
Washington Post on December 27. The headline based on your opening
sentence was excellent, as was the observation concerning the unsung
value of prevention (through a knowledge of etiology).

In answer to your questions: Birth weight is reduced by maternal
cigarette-smoking during pregnancy, but to my knowledge there has been
no satisfactory study of leukemogenesis in this regard. There is no
excess of malformations or perinatal mortality associated with cigarette
smoking--only low birth rate, as I recall.

In the October 31 issue of Science, I have a paper that gives my
thoughts on the question of intrauterine leukemogenesis (the reprints
have not arrived yet). I am troubled about the biologic plausibility
that radiation accounts for an equal increase in each form of childhood
cancer. We suspect not that each conceptus is at the same risk of
radiation leukemogenesis but that there is a subgroup of supersusceptible
fetuses or newborns. whose first encounter with a leukemogen induces the
neoplasm. We believe that the age-peak in mortality at 4 years is not
due to radiation alone, or even largely due to it. The basis for our
view is given in the enclosed reprint, along with a laboratory procedure
that has been successfully used to evaluate the potentiation of x-ray
effects by SV-40. Other agents, including experimental vaccines, may
be tested in the same fashion.

We have looked at data on leukemia in the NINDB Perinatal Study and
found only a handful of cases.

Your proposal for a graduate program in Environmental Health was
familiar to me because Dr. Lawrence E. Hinkle at Cornell proposed just
such a plan about 2 years ago to the National Institute for Environmental
Health Sciences (Dr. Paul Kotin, Director). There was great interest at
Prof. Joshua Lederberg
December 29, 1969 Page 2

that time in providing training grants to universities to conduct such
programs. Should you wish to write to Dr. Kotin about this, his address
is:

Dr. Paul Kotin

National Environmental Health
Sciences Center

P. 0. Box 12233

Research Triangle Park

North Carolina 27709

I believe that much can be done in this regard in clinical medicine
if selected medical students or junior staff members were given small
grants in return for which they would obtain from ward patients etiologically
oriented information, especially pedigrees and histories of occupational
and other environmental exposures. Much can be learned in this way at very
little expense. Participants who do well could then be encouraged to obtain
further formal training.

Sincerely,

wy _¢
: “ae é
Ee tae tA fh Lohse

Robert W. Miller, M.D.
Chief, Epidemiology Branch
National Cancer Institute

RWM :m1p