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Grisham, neurosurgeon beam attention on focused ultrasound

On the conference table near where Dr. Neal F. Kassell sat was a gray, life-size, anatomically correct model of the human brain.

For more than 50 years, the University of Virginia neurosurgeon has studied and operated on this most vital human organ. Best-selling author John Grisham sat nearby signing copies of a thin novella he considers the most important book he has written.

The title of the work, which is being given away for free, is “The Tumor.” It contains a wealth of information about an emerging medical technology — focused ultrasound — that is already saving lives, and has the potential to revolutionize medical therapy in the near future.

The 47-page handbook also reveals something about using fame as a force for good. The two leading men in their chosen professions recently got together at the Focused Ultrasound Foundation in Charlottesville to talk about the book and the promising technology behind it.

The first part of the book tells the story of the end-of-life march of a happily married 35-year-old banker with three young children. The golf ball-sized glioblastoma tumor that has formed on his brain will kill him within a year.

The second half of the book tells the story of the young father 10 years in the future. It’s 2025, and the painless, non-invasive and relatively inexpensive focused ultrasound therapy that can eradicate the tumor is available. After a short outpatient procedure, he goes home to enjoy many more years of life.

“I’m not being Pollyanna when I say focused ultrasound could be as big and revolutionary to therapy as MR [magnetic resonance] scanning was to diagnoses,” Kassell said. “So it’s huge, but it’s where MR was 30 years ago.

“This is a very, very big deal, but there’s an enormous amount of work that needs to be done to get it across the finish line. One of the major impediments is lack of awareness.

“Everybody needs to know about focused ultrasound, whether it’s the patient, their doctor, the insurance companies. There’s no single thing that could have been done that would be better than this book in terms of raising awareness and moving the field forward.”

Kassell and Grisham have been friends and neighbors for years. The physician was quick to make it clear that the idea for the free book was Grisham’s alone.

“Neal and I started talking about this probably three years ago,” said Grisham, whose books have sold more than 275 million copies and have been translated into 42 languages. “He talks with people about these kinds of things almost every day, so he has seen his share of misery and suffering.

“Neal had a son-in-law who was a 39-year-old veterinarian in Philadelphia with two kids. He was diagnosed with a glioblastoma, and he lasted 11 or 12 months.

“For a long time, Neal carried that X-ray in his wallet to show people. You think about things like that, and you hope in some small way this book can help.”

An anonymous donor covered the total cost of the book’s printing, publication and distribution. So far, about 300,000 hard copies and downloads have been ordered.

A few months ago, Grisham sent a copy of the book and a personal letter to Jeff Bezos, founder and CEO of In the letter, he explained what he was trying to do with the book, and asked Bezos for his help in making it available for free on Amazon.

Bezos immediately signed on and, according to Grisham, has been “a great help,” in the endeavor. The same has been true of Doubleday, which has published all of Grisham’s more than 30 books.

“What I write is what I aspire to call a high level of popular, commercial fiction,” said Grisham, who stepped in Thursday on short notice to fill in as luncheon speaker for the Virginia Festival of the Book. “First and foremost, it’s entertainment.

“ ‘The Tumor’ is far different, because it has the potential of helping a technology advance that one day may save or prolong millions of lives. What focused ultrasound might be able to do one day is fascinating, and we hope that awareness leads to an increase in funding and donations to move the research forward.”

Focused ultrasound uses ultrasonic energy beams to destroy diseased tissue. Kassell learned about it 11 years ago when he was looking for a way to treat brain tumors either that were in locations too dangerous to operate on, or that had proved refractory to surgery, radiation and drug therapy.

“I was thinking about this a lot, and couldn’t come up with anything,” Kassell said. “Serendipitously, in August 11 years ago, I was operating on a patient with an aneurysm.

“Our neuroanesthesiologist wasn’t there and, instead, we had a cardiac anesthesiologist. He said he had been doing these interesting studies using ultrasound and microbubbles to measure blood flow in the heart. He thought it could work in the brain, and suggested I try that.

“So we started a research project to measure blood flow in the brain with microbubbles and ultrasound. I’ll never forget driving home from the hospital one day when the light bulb went off in my head.”

Kassell’s flash of insight suggested that ultrasound, plus or minus the microbubbles, could be used to treat these difficult tumors. The epiphany led to the creation of UVa’s Focused Ultrasound Center and the Focused Ultrasound Foundation.

Worldwide, there are now more than 225 research sites conducting clinical trials using this technology for tumors of the brain, breast, pancreas and liver, as well as for Parkinson’s disease, arthritis and hypertension.

It recently was announced that the Virginia state budget will provide $4 million for ultrasound technology to treat cancer and other diseases at UVa. Kassell said this is a $1 million increase from the $3 million that has been received from the state in the past two biennia.

As helpful as these funds are, Kassell said $8 million is needed every year to keep the research up to speed at the university. He estimates that, worldwide, $750 million has been invested so far in the development of this technology.

“When we got started with our research 10 years ago, there were three ways that focused ultrasound could affect tissue,” Kassell said. “Today, there are 18 different ways — including enhancing the immune response for cancer, which is a big, big deal.

“Ten years ago, there were five manufacturers in this field, and now there are 36. They’re almost all small companies, and none of them are profitable, so they will need more investment as time goes on.

“The other important thing we’re trying to figure out is how focused ultrasound fits in with the cancer moon shot initiative that’s being run by Vice President [Joe] Biden.”

Kassell said that UVa is one of the leading sites for technical research and the development of ultrasound technology, particularly on the imaging part of it. Currently, there are clinical trials for use of this therapy for essential tremor, uterine fibroids, prostate cancer and soon epilepsy.

“The research for using this technology to treat brain tumors is very early,” Kassell said. “But the clinical trial that’s going to lead to the FDA’s [Food and Drug Administration] approval of this for essential tremor has been completed, and we’re hopeful that the FDA will approve that by the end of the year.

“So far, we’ve spent almost $70 million. That money has come from fabulous individuals who have given amounts from $25 to more than $15 million.

“The research I have been doing since 1962 has been good, but it affects in the thousands of patients a year. With further lab research and clinical trials, this has the potential, if it works out, to affect hundreds of thousands or millions of people a year.”

At this point, Kassell and Grisham are only joking about a sequel to “The Tumor.”

“I can’t ever imagine writing another free book,” Grisham said with smile. “With free books, I’m one and done.

“But as fast as the technology is going, who knows? For example, last fall, after I finished the book, the FDA approved this technology for prostate cancer.

“One thing I’ve learned in the last 25 years is that you can never predict where a story is going to come from. It can slap you in the face the first thing in the morning, or you can chase one for five years and not get it.”

Last May, Grisham and Kassell were sitting at the conference table with a number of other board members of the Focused Ultrasound Foundation. The neurosurgeon called it “a scary moment.”

“We had all these presentations right here in this room, and John got his head down and he’s scribbling away,” Kassell said. “A number of the directors were thinking, ‘This doesn’t look good. It looks like we’ve lost John, because he’s doodling.’

“What he was doing was writing the book.”

To support or learn more about focused ultrasound, or to download a copy of “The Tumor,” visit

David A. Maurer is a features writer for The Daily Progress. Contact him at (434) 978-7244 or