Chapter 23: Projects Remaining Before Retirement

Chapter 23: Projects Remaining Before Retirement

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Description

Dr. Elting first talks about the writing and research she will focus on in her remaining time at MD Anderson. She notes that she is very proud of her work on the Institutional Review Boards (she was the first woman chair of an IRB) and her early work on treatment outcomes. (Health Issue raised, no HIPPA authorization needed.) She says she never realized how much her work on controlling infection effectiveness mattered until her mother was treated for cancer.

Dr. Elting recalls that when she came to MD Anderson nearly everyone died from infection. She notes that it could be a depressing place, but the researchers and support people who stayed helped each other through that time and achieved great things.

Dr. Elting also observes that she was one of the first people at MD Anderson to look at health issues from a population perspective. She is pleased at how far the institution has come in supporting that research.

Identifier

EltingL_04_20150423_C23

Publication Date

4-23-2015

City

Houston, Texas

Topics Covered

The Interview Subject's Story - View on Career and Accomplishments; Career and Accomplishments; Contributions; MD Anderson History; MD Anderson Impact; MD Anderson Culture; Patients, Treatment, Survivors; Personal Reflections, Memories of MD Anderson; MD Anderson Past; Discovery and Success; Patients; Offering Care, Compassion, Help; This is MD Anderson

Transcript

Tacey A. Rosolowski, PhD:

Well, I wanted to just ask some final questions. What are you planning on doing in your remaining time here is the first.

Linda S. Elting, DrPh:

I'm planning on spending most of my time writing and doing research. I'm trying to spend less and less and less time doing administrative anything. So I'm trying to pull back from being principal investigator on big projects. I'd rather be a collaborator so I can do my writing and not have to do annual progress reports and budgets and all that other stuff. I'm not doing much traveling. It takes away from the time I have to write and focus. I'm really focused on trying to fill gaps for cancer patients in Texas. It's been a desire of mine to focus on Texas and to look at where Texas is unique, where there are gaps in what we provide, and where we can be a model for other places. So that's what I'm trying to do. Texas is different in many respects from other states demographically, in size, in the distribution of health care facilities, in the politics and the policies that are in place or lack of same. And so it's an interesting contrast to other states in the country. So I think it's scientifically interesting but it's a hometown commitment sort of idea that really interests me. So that's where I'm focusing currently.

Tacey A. Rosolowski, PhD:

How do you anticipate that this work will be a model outside of the state?

Linda S. Elting, DrPh:

Well, there are things thatyou'll be surprised to hear this because most people say Texas does everything wrong with health care. But there are things we do right. (laughter) There are things that we do right. There are things that we try that other people don't have the guts to try.

Tacey A. Rosolowski, PhD:

Such as?

Linda S. Elting, DrPh:

So there was this program that was highly touted to really improve things. And it was a model that was being suggested for use in Medicaid and delivering Medicaid services. And it was a primary care physician case manager notion. And the feeling was that if you had a primary care provider who was paid money to manage the care of a person, you would have better and more efficient use of resources, you'd have shorter time periods in getting from one kind of provider to another, and it would work well. And so you could imagine theoretically that that kind of a model would work well for a state that had lots of rural areas where HMOs might not be interested in serving those but where a primary care provider in a small town could be paid to manage patients in that area who had complex illnesses and required a lot of referral to different specialists, and where that kind of an approach would work. And it was highly touted, still is. Lots of states around the country are thinking about doing that for their Medicaid programs. Well, Texas tried it, and tried it first. And it doesn't make any difference. It just costs more money. So there are things that Texas tries because we're different or because demographically we're different, or because we don't want to spend money on what everybody else says is the best way. And sometimes they work and sometimes they don't. But any time you get a positive or a negative answer, it's a benefit to other people who might want to try or need not to try. So there are programs like that that I have an interest in working on. I'm very interested in trying to examine carefully how Texas's approach to Medicaid either is better or worse than the approach to Medicaid in the Affordable Care Act. And so in order to do that we need to develop data sources about Texas that can be examined and compared to others. And we need to put together teams that can look at it objectively instead of politically and provide the kind of information that can inform good decision making. And so that's where I would like to focus my efforts.

Tacey A. Rosolowski, PhD:

As you take account of what you've done at the institution, what are some of the things you're most gratified to have completed?

Linda S. Elting, DrPh:

That's a hard question. I'm very proud of the work I did on the IRB. That probably comes through in what I say and the way I say it. I was the first woman chair (laughter) of an IRB at MD Anderson. I'm very proud of that. That was something thatit's a system that works, and I had a lot to do with creating it. I'm very proud of that. A lot of the work that I did early in my career, even some of the work that I did when I was not the principal investigator, just seemed, OK, we're going to develop this, and it's going to be better for patients and all that. And I guess I never highly valued it until I realized that those drugs that I studied back then were making such a difference in my mother's life and in her experience of cancer. She takes some supportive care drugs every day that I helped bring to market. Some new first-in-class drugs that we tested here first and produced the information, a lot of the cost information that we did, as well as the clinical information that has meant that those drugs are available to people. And it's really hit home for me personally since I have seen what a difference it's made in my mother's experience of cancer. So I guess at this point in my life I feel very gratified to have been part of that. I guess the thing that is most gratifying, and it's hard to express because it's not real specific, is that when I came to MD Anderson almost everybody died. All the patients died. Mostly from infections. And that doesn't happen anymore. Certainly I'm not the only one. Lots of people contributed more than I did. But a lot of the work that we did decades ago made it possible to do the kinds of studies in treatment that we have done. And some of those have been very successful. So just being part of the organization that made those early steps. Those were really hard days. None of our patients survived. And most of them died here with us. We met them, we got to know them, we knew their families, and then they died before our eyes. That was a very difficult place to work. Lots of people couldn't do it. Those of us who stayed, we helped each other through those days (laughter) when most people died. But I'm very proud of the work we all did together and how far it has enabled everybody to come since those early days when so many people died. I think at MD Anderson I was one of the first people who looked at this problem from a population perspective. It was a patient care and a clinical trial factory. And expanding into the population and beginning to look at those sorts of questions, I wouldn't say it's well integrated yet. But it is becoming a more and more important part of what we do. And I think it will be increasingly important as MD Anderson gets more and more affiliated practices and we develop the ability to measure the outcomes of those institutions and to begin to pool data. But the whole notion of a population perspective is not one that was quick to come to MD Anderson. And I'm gratified by how far it's come. There was a time when I thought we would never do any of it, or I would be the only person (laughter) or one of five people who would take that look at things. And so I'm glad we're moving in that direction, largely because there's an awful lot good that happens here that is never translated to the community. I don't think we know why. I'm not sure we even know what the things are that cause it to be better here. But what we do know is that it's not just developing a new drug. Because we've done that and it doesn't get translated to the community, to everybody. So there's something about what we do or the way we do it here, and I'm sure it's true of other large cancer centers as well, that we need to learn how to transfer into the community. And we can only do that if we study both MD Anderson and the community. And so I think taking a more population perspective is a way to start to do that.

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Chapter 23: Projects Remaining Before Retirement

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