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Baruch Blumberg, Hepatitis B And Hepatoma

Major universities compete about the number of Nobel laureates that are among their alumni. If you are ever on “Final Jeopardy,” Harvard is far and away No. 1.

How about among U.S. yeshivot or Jewish day schools? Which one leads in Nobel laureates among its alumni? Was it Yeshiva Rambam or BTA, my schools in Brooklyn? The answer is the Yeshiva of Flatbush, with two—not exactly Bronx High School of Science, the national leader, but very creditable. (Which other yeshiva has a Nobel laureate alumnus? Please feel free to submit a letter to the Link with the school and Laureate’s names, especially if you have an anecdote. Answer will appear here a few articles from now.)

Actually, both Nobel Prize winners were contemporaries and attended only the elementary school at Flatbush: Eric Kandel won for his work in neurosciences and is currently a university professor at Columbia. Baruch Blumberg went to Far Rockaway High School, served in World War II, and graduated from Union College. He then earned his medical degree from Columbia’s College of Physicians and Surgeons, where he did his residency in medicine, and went to Oxford for doctoral work in biochemistry. He went to the National Institutes of Health for several years and then to a faculty position at Fox Chase Cancer Center in Philadelphia, where he did his main research work.

In the 1950s, hepatitis was a fairly common disease that was understood to be spread by an infectious agent. If one contracted the disease, it would result in a constellation of symptoms that include fatigue, loss of appetite and jaundice, which would last a few weeks and end when the body developed immunity to the virus, similar to most viral infections. However, some of those infected remained carriers of the virus, with chronic infections that were not apparent to healthcare workers or themselves. Thus, they could pass these viruses along to others through blood products by transfusions or through needles. Similar to HIV 2-3 decades later, this made blood product transfusions, an important part of surgery or other medical interventions, a dangerous procedure.

Blumberg collected blood and serum from people from many ethnic groups worldwide, looking for how they varied. In 1963, he discovered in the serum of an Australian Aborigine an unexpected antigen (a molecule that evokes an immune response, usually an antibody) that turned out to be part of the hepatitis B virus. (There are multiple forms of viral hepatitis: A, B, C, etc.). This became known as the Australia antigen and became a serum marker for hepatitis B, the most common and virulent form of hepatitis. Blumberg led its development into a screening test that could be used to screen blood products prior to transfusion, transforming the entire blood banking and blood transfusion process. While he held the patent on this test, he made it freely available so the test could be widely usable.

If this were all that Blumberg accomplished, I would say, “Dayenu.” But it would not earn a place in a column on cancer.

It turns out that hepatocellular carcinoma (HCC), primary liver cancer, is one of the most common cancers in the world. Its etiology is from severe chronic liver damage, known as cirrhosis. Many things can damage the liver and cause cirrhosis, and then cirrhosis can lead to HCC. In certain parts of the world, notably the Far East, this pathway most frequently originates from hepatitis B infection, with persistent chronic infection leading to cirrhosis and then to HCC. While this did not occur as commonly in the U.S. and the West, there is a so-called hepatoma belt in the Far East and Africa where this occurs. As a consequence, HCC is the No. 1 cancer in Taiwan and other countries within this hepatoma belt and one of the leading causes of cancer worldwide.

At Fox Chase, Blumberg separated the Australia antigen particle from the hepatitis virus and, with his collaborators, utilized it as an antigen to create a vaccine for hepatitis B. A similar vaccine was later produced by genetic engineering at Merck and became widely distributed starting around 1982. As a result, hepatitis B has now largely disappeared in the United States.

This vaccine is now considered the first cancer vaccine. Since it is generally administered to infants/children, it is still too early to see the full impact of its use on the incidence rate of HCC in the Far East. Nonetheless, since its widespread mass administration started in 1985 in Taiwan, the rates of HCC in those under age 35 have decreased by over 95%. And hepatitis B-associated HCC is now a rarity in the U.S.

It would be difficult to name a Nobel laureate whose work has had more direct impact on cancer than Blumberg. It has been said that he probably prevented more cancer deaths than anyone in history. He was quoted in a New York Times interview as saying that he went into medicine to save lives and was deeply affected by the dictum “He who saves a single life, it is as if he has saved the entire world.” He often also gave credit to relying on Talmudic logic in his scientific research. Blumberg attended a weekly Talmud shiur in Philadelphia most of his life.


Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.

This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.

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