In the days after being diagnosed with potentially inoperable brain cancer, Senator Edward M. Kennedy began crafting a strategy for his health, one not altogether different than those he's devised to pass healthcare legislation, run for president, or win regattas on Nantucket Sound.
And to lead the methodical, analytical approach, the 76-year-old senator has turned to one of his most trusted former aides, Dr. Lawrence C. Horowitz. A Yale-trained doctor who has played a role in steering medical treatment for others in the Kennedy clan, Horowitz is organizing a group of experts and former Kennedy staff members to scour medical literature and research experimental treatments to help Kennedy decide which cutting-edge cancer treatments to pursue.
"Horowitz is trying to organize all the flying objects," said Gerard Doherty, former chairman of the state Democratic Party and a longtime friend of the Kennedy family. "He's a two-fer: a medical man who . . . knows Teddy."
Doherty said Horowitz and the Kennedys are looking at a doctor at Duke University Medical Center, which has a brain tumor research center that is conducting several clinical trials on malignant glioma, the type of tumor with which Kennedy has been diagnosed. Also on the list of places where Horowitz probably would seek opinions are M.D. Anderson Cancer Center in Houston and a major brain tumor center at the University of California, San Francisco.
Horowitz devised diets for Kennedy as the senator contemplated running for president in 1984. He treated Patrick Kennedy when the 12-year-old suffered an asthma attack on a flight from Wichita, Kan., in 1980. And when Edward M. Kennedy Jr. was diagnosed with a dangerous bone cancer in his right leg, Horowitz helped the family find the innovative treatments that saved the 12-year-old boy's life.
To many in the vast network of Kennedy family members, friends, and staff members, it seemed logical that he would turn to Horowitz as the senator pursues a path similar to millions of other patients in this age of Internet information: conducting independent research in addition to consulting with a doctor.
But in this case, Kennedy's own analysis is being carried out by a deep bench of knowledgeable current and former staff members who have vast experience with medical research and bureaucracy - most of it gained through working for Kennedy himself.
"My role is to reach out to everybody everywhere - Mass. General, Brigham, anywhere across the country," said Horowitz, who since Kennedy's diagnosis has had dozens of discussions with doctors and researchers from the National Institutes of Health, the Food and Drug Administration, research hospitals, and the pharmaceutical industry.
"You try to present the range of alternatives," Horowitz said. "He discusses them; he sees the advantages and disadvantages of each decision, like any other patient would."
As a senator for 45 years and counting, Kennedy is known for a Socratic approach to legislation, organizing debates among experts to determine how to proceed - and those close to him say he will probably take a similar approach over the next few weeks to determine his course of treatment.
Any decision will ultimately be made by Kennedy and his wife, Victoria Reggie Kennedy - and will include input from doctors at Massachusetts General Hospital - but several others are said to be involved in searching for other courses of treatment, including current staff members.
Horowitz, who was once the senator's point person on healthcare and scientific research, is uniquely qualified to help Kennedy navigate the difficult path he now faces. When it comes to instructing patients in ways to manage their own medical care, Horowitz literally wrote the book. In 1988 he authored "Taking Charge of Your Medical Fate," which is a step-by-step guide to navigating the medical world to determine the best course of treatment.
It is unclear whether the options laid out by Horowitz would include searching for new specialists for treatment - and whether Kennedy would choose to leave Mass. General to receive care somewhere else. Part of the decision may depend on the results from several types of tests that Kennedy underwent two weeks ago. Kennedy's primary care physician is Mass. General's Dr. Larry Ronan, who will also be involved in deciding the course of treatment.
Horowitz declined to comment on any decisions the family may face or specifics involving Kennedy's care.
While Kennedy confronts a much greater range of possibilities to treat cancer than existed in years' past, researchers warn that none of the current therapies come close to being a cure and that advances typically add months to a cancer patient's life, not years.
In a line of former Kennedy staff members that includes a Supreme Court justice and others who have risen to the top of their fields, Horowitz has been one of the senator's most trusted aides and closest friends.
When Kennedy wanted to meet with President Mikhail Gorbachev of the Soviet Union, Horowitz greased the wheels and held dozens of meetings with senior Soviet officials in Moscow, Europe, and Washington. In the early 1990s he defended the senator against allegations that he had a serious alcohol problem, saying scars and blotches on his face are the result of basal cell skin cancer and its medical treatment.
As Kennedy weighed whether to run for president in 1984, Horowitz produced a black, loose-leaf notebook containing 60 single-spaced, typewritten pages, complete with charts and diagrams. The cover stated: "Memo to EMK from Larry. Subject: 1984. Confidential. No copies."
Horowitz, who graduated from Yale Medical School, first joined Kennedy's staff in 1972 and was staff director of the US Senate Subcommittee on Health, chaired by Kennedy, from 1977 to 1981. He was Kennedy's chief of staff from 1981 to 1986.
He now lives in California and is a medical consultant to several major corporations. Horowitz has also been a producer of 35 movies, including his first in 1986, the made-for-TV movie "The Ted Kennedy, Jr. Story." Horowitz, who also advised the family in Kara Kennedy's extraordinary battle to overcome lung cancer, has also been a trusted physician for the Kennedy family.
"Having been through cancer with my children, he's already on top of things," said Joan B. Kennedy, the senator's former wife and the mother of Kara, Ted Jr., and Patrick.
Horowitz wrote in his book that Teddy Jr. was confronted with a situation where the prognosis was poor. The response from Senator Kennedy was a swift research effort, assisted by Horowitz, that led them to experimental medical techniques - an indication of what is currently underway.
"One thing he did say to me is that as difficult as this is, it's noting compared to the feelings he had when people told him his children had cancer," Horowitz said.
"Hard as this is, it's a lot easier than hearing about your own children."
Matt Viser can be reached at firstname.lastname@example.org.