Chapter 2: MD Anderson Culture and Faculty: In Transition with a New Administration
Files
Description
Dr. Kleinerman offers observations on how the culture of MD Anderson has been changing since the arrival of MD Anderson’s fourth president, Dr. Ronald DePinho. She sets context by describing the impact of a change instituted by Dr. John Mendelsohn, M.D. [Oral History Interview]: requiring faculty to derive 30% of their salaries from grants, with this rising under the new administration.
She discusses concerns that the institution is no longer distributing value equally between basic science research, clinical research, teaching and mentoring. She also fears the loss of a “special atmosphere” of collaboration and collegiality as well as innovation that the older system fostered. She demonstrates the support for innovation using her own innovative study of immune-therapy in children, an atmosphere that allowed her to conduct research impossible at the NCI.
Dr. Kleinerman next explains that today the institution is more rigid and rule-governed, with a strong focus on genomics.
Identifier
KleinermanES_01_20140521_C02
Publication Date
5-21-2014
City
Houston, Texas
Interview Session
Eugenie Kleinerman, MD, Oral History Interview, May 21, 2014
Topics Covered
The University of Texas MD Anderson Cancer Center - Institutional ChangeCritical Perspectives on MD Anderson On Research and Researchers MD Anderson Culture Institutional Politics On Research and Researchers MD Anderson Culture Institutional Politics The Researcher MD Anderson Impact Discovery, Creativity and Innovation
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
How would you characterize that philosophy [of the new administration] and what impact is that having on the culture of MD Anderson?
Eugenie Kleinerman, MD:
Okay. So, for example, when I first came here, if you were a laboratory investigator, you did not have to put your salary on grants. You were encouraged to write grants, but that allowed you the freedom to put—I don’t want to say crazy ideas, but ideas that were outside of the mainstream. And getting an RO1 NIH grant—and I sit on study sections, so I know the process—it’s very difficult to get a grant on something that is outside the box, really innovative. Now they have innovative awards where you don’t have a lot of preliminary data. So because people weren’t afraid that they weren’t going to be able to get money to support their salary, it was freeing, so you could write things that were not necessarily in the mainstream, and oftentimes it hit. So there was no pressure about if I don’t do what everybody thinks is the important thought process, that you would not be able to maintain your position. So that changed with Dr. Mendelsohn. He mandated that 30 percent of your salary, if you were basic science, had to go on grants. You know, and I think to some extent, that’s good, because obviously there are people who take advantage of the situation and they say, “I don’t have to have my salary on grants, so I’m just going to not be as productive as I could be.” I mean, so I thought that was fine. Now it’s moved up to 40 percent, and I think that the goal, at least the message that I feel I’m getting, and many of my faculty have validated that that’s how they feel, too, that your value is in how much grant funding you bring in and how many papers you write to Cell and Nature and Science, which are top journals. But those may not be the important journals for the things that we do, for the things that we’re good at. For example, in pediatrics, our journals are Pediatric Blood & Cancer, the pediatric-focused oncology journals, and those are never going to have the impact factor that Cell, Nature, Science does. But the research that we do will never get published there, but the research that we do can make an impact on patient care, a real impact on patient care, not just here’s a pathway and we can exploit this for the development of targeted therapy. No, no, no, no. What we do is, okay, we have this, now we’re going to actually treat patients. And I am very concerned that we will lose that balance. I think you need to have both, but I really think that we’re losing the perspective of valuing people for their innovativeness in clinical research, for their excellence in teaching, for their passion in mentoring, and I don’t feel that there really is an appreciation for how much that takes and that that should have equal importance.
Tacey Ann Rosolowski, PhD:
I can see how, given that perspective of the faculty, that’s actually taking the institution away from the mission.
Eugenie Kleinerman, MD:
I’m concerned that it will. I don’t think it has yet, but I am concerned. I think it has somewhat because people are leaving, but I am concerned that we’re going to lose the special atmosphere that I experienced when I came here, which was one of collaboration, collegiality. It wasn’t “You’re in the ‘in’ crowd, and you’re not.” I’m very concerned we’re going to lose that. I’m very concerned. When I first came here, nobody was keeping score about how many patients you saw and how many patients I saw, and, “If I let you see that patient, then it’s going to take away from me.” It was “What’s best for the patient?” Not to say that we’ve lost that, but I’m very concerned, as you start to keep score, that people are going to, as is human nature, say, “Well, I’d better protect my territory, myself.”
Tacey Ann Rosolowski, PhD:
Over and over again when I’ve interviewed people, they’ve referred to R. Lee Clark’s system of setting things up so that there wasn’t a territoriality, and so from what you’re telling me that there’s a sense that that’s very much in danger.
Eugenie Kleinerman, MD:
Yes, yes. He was a visionary, an absolute visionary. And if you compare the culture here and the culture at Memorial Sloan Kettering, the culture that he set up here was everybody’s on salary, so it’s not like you’re going to make more money if you refer somebody, you work with somebody, you give them your time, you collaborate. It created this collaborative environment where the focus was the patient and the family and doing what’s best for the individual patient, not, “Well, I don’t want to refer. I’m a neurosurgeon, and I don’t want to refer this to a radiotherapist,” and this is extreme, “because I’d rather take out the tumor than have him, because that’s going to reflect on my salary or my resources or whatever.” So he created this. That’s why I’m saying MD Anderson was so far ahead of its time. We were the first institution really to have multidisciplinary care, and everybody’s trying to duplicate us. And so what are we doing? We’re reverting to trying to go to the measures that everybody else did, is doing in terms of keeping score and grants and RO1s and SPORES and, you know, Nobel Prizes and papers in Nature, Cell, and Science. I think we’re just losing our way. I’m concerned we’re really going to lose our way.
Tacey Ann Rosolowski, PhD:
Thank you for that evaluation. I just finished up interviewing Dr. Keating [Oral History Interview] yesterday and—
Eugenie Kleinerman, MD:
His daughter’s in my department.
Tacey Ann Rosolowski, PhD:
Oh, okay. That’s neat. If I’m remembering correctly, her name Anna Franklin.
Eugenie Kleinerman, MD:
Anna Franklin. Right, right.
Tacey Ann Rosolowski, PhD:
Anna Franklin. And he [Dr. Michael Keating] was telling me about the first years when he arrived in the seventies where it was kind of the golden age of that spirit that R. Lee Clark set in place, as you just described it. And not only was there an enormous impact for patients, but there was this very fertile ground for collaboration, of course, in research in this critical period when there were entirely new disciplines being formed. So the question I wanted to ask you, kind of in follow-up, was now even though there’s such a focus on team science and translational, do you feel that this movement of culture at MD Anderson in a slightly different direction is changing a little bit the practice of research at the institution?
Eugenie Kleinerman, MD:
Oh, yes, I do.
Tacey Ann Rosolowski, PhD:
How so?
Eugenie Kleinerman, MD:
I do. When I first came here, and that was probably ten—I came in 1984. I don’t know when Dr. Keating came, but it was at least ten years after he did.
Tacey Ann Rosolowski, PhD:
Seventy-four.
Eugenie Kleinerman, MD:
No idea was too crazy. If it made sense and, you know, there was a safety, no idea was too crazy. I was the first—probably one of the first people to use immunotherapy in children. I had this idea that osteosarcoma that usually metastasizes to the lung where you can excise the tumor, but it comes back, looking at what we had done before, chemotherapy only took us a certain route, and once a patient failed chemotherapy, taking out the lesion and using a different chemotherapy did nothing to change the overall survival. So I had been in immune-therapy, so I said, “Let’s try it here.” You can take out the tumor, you only have a small number of tumor cells left, that’s where immune-therapy’s effective. But at the time, the standard was you have this new therapy, you treat it with the tumor in place, and you see if the tumor shrinks. But I knew from my work with Dr. Fidler that the immune-therapy could never take care of bulky tumors, so why would you design a clinical trial knowing that your therapy can’t work in that setting? So what I did is I designed a trial where I took out the tumor and treated with the immune-therapy and I said, “Let’s look at the time to relapse,” knowing that most kids relapse within a year. Could we extend the disease for survival? Could we improve in the overall survival? So I designed a totally new way of doing a Phase 2 trial. It was easily accepted here. People said, “Oh, yeah, I see the rationale. I see what you’re saying. Absolutely.” My adult colleagues in sarcoma knew that sarcomas recur in the lung, and you take them out, and it’s a very short time. They thought that end parameter was fine. And I did the trial here. I couldn’t have done it at NCI, I knew I couldn’t, because that was my concept, and that’s why I left. I’m from Duke University, I love Duke University, but I for sure know it wouldn’t go over there, because that was not—so at MD Anderson it was a very fertile working ground where you could come up with these ideas that were a little bit off the beaten path but rational, and put it into the clinic, and people were supportive. When my Phase 2 trial was completed and it showed to be effective, I was asked, because one of the patients that was referred to me was from a physician from New Jersey and he was on one of the cooperative groups, the Pediatric Oncology Group. There were two cooperative groups at the time: the Pediatric Oncology Group and the Children’s Cancer Study Group. He said, “You know, this girl was going to die and you really saved her, and look how many other patients you’ve saved. We need to put this is a Phase 3 trial, in newly diagnosed patients. Come to the Pediatric Oncology Group. Present your idea. I want to do a national trial.” I went there. The head of the Bone Tumor Strategy Group did not like the idea and torpedoed it. I came back very depressed, and I talked to Josh and he said, “This is ridiculous. Let’s talk to Irv Krakoff,” who was the head of Cancer Medicine at the time. So we talked to Irv Krakoff, and he said, “I’m not going to take this lying down. I’m going to invite—I know Joe Simone. I know Jerry Rosen. I know all these experts in sarcoma. I’m going to invite them here, and you’re going to present the data, and we’re going to see if we can help you move forward somewhere else besides the Pediatric Oncology Group.” This was a man—I was not his faculty. I was Pediatrics. He was head of Cancer Medicine. He didn’t care that it wasn’t his adult sarcoma physicians that came up with this idea. He was just going to help a young faculty member, because he knew all these important people in the field. So he brought them all down here. One of them couldn’t come, so they sent one of their pediatric oncologists, who just happened to be the head of the Bone Tumor Strategy Group in the opposing for the Children’s Cancer Study Group. And that’s how I got the Phase 3 trial done. If it weren’t for Irv Krakoff and if it weren’t for his enthusiasm and willingness to help a junior faculty member outside of his division, it never would have happened. And that gives you an idea of the atmosphere, the collegiality, the passion for the mission. It didn’t matter who. The idea was we need to help each other and get these things through. So now I think people are much more rigid, and, “Well, you know, but did you think about this and did you think about this?” And, “You know, that’s not the way we do things,” and, “What do you know?” I mean, truly, I was an assistant professor. What did I know compared to Norman Jaffe, who was the father of chemotherapy in osteosarcoma? I came here and said, “I have this idea.” He said, “Eugenie, we need all the help we can get. I’m there with you.” Assistant professor, full processor, internationally known, says to me, “I’m your partner,” where at the NCI it was always, “Well, you have to do this. You can’t do this. Yu know, this is the way we do it.” And I see that changing. I see that changing.
Tacey Ann Rosolowski, PhD:
Wow. Very interesting.
Eugenie Kleinerman, MD:
Because if you’re not in—I mean, everything is genomics right now. Genomics, genomics, genomics. And if you’re not on the genomics path, you’re not taken seriously and you’re not considered part of the team. And I think there has to be a place for people who don’t necessarily think the same way. That’s what makes us stronger.
Tacey Ann Rosolowski, PhD:
Thank you. Yeah, it’s a very interesting contrast, and I appreciate your stories that really demonstrate it. It’s good to be a storyteller. (laughs) I’d like to pause the recorder for just a moment, if I may.
Eugenie Kleinerman, MD:
Sure.
Tacey Ann Rosolowski, PhD:
All right. I’m pausing at twenty-six after two. [recorder is paused]
Recommended Citation
Kleinerman, Eugenie S. MD and Rosolowski, Tacey A. PhD, "Chapter 2: MD Anderson Culture and Faculty: In Transition with a New Administration" (2014). Interview Chapters. 1398.
https://openworks.mdanderson.org/mchv_interviewchapters/1398
Conditions Governing Access
Open
