Chapter 10: Threats to MD Anderson's Status: Losing Focus on Innovative Research and Problems with Regulatory Procedures

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Chapter 10: Threats to MD Anderson's Status: Losing Focus on Innovative Research and Problems with Regulatory Procedures

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In this section, Dr. Alexanian comments on the uneven focus on innovative research among the faculty during his years at MD Anderson. He explains innovative clinical researchers in many sections were not promoted or recognized for their work and often left the institution. He cites several areas that are making innovative contributions and acknowledges that factors outside the institution create fluctuations in national standing and research contributions. Dr. Alexanian next sets some context for the research activities at MD Anderson, beginning with Dr. R. Lee Clark's desire to build a research mission into every department at the institution. He lists factors that accelerated research progress in the 60s, though he notes that many faculty were hired to be clinical experts in their field and had no desire or capacity to do research, leading to conflicts between clinical and research faculty. He uses the treatment of Hodgkin's disease as an example of a conflict.

Identifier

Alexanian_R_02_20140605_S10

Publication Date

6-5-2014

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

B: The University of Texas MD Anderson Cancer Center - B: Critical Evaluation; A: The Researcher; A: The Clinician; A: Professional Values, Ethics, Purpose; A: Critical Perspectives; B: MD Anderson History; B: Institutional Processes; B: Obstacles, Challenges; B: Beyond the Institution; B: MD Anderson and Government; B: Critical Perspectives on MD Anderson; C: Professional Practice; C: The Professional at Work

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

And before we turned on the recorder, you mentioned an issue that you wanted to address, an observation you’d made, and I wondered if you would kind of continue making that point for the record.

Raymond Alexanian, MD

Yes. You invited comments on any areas that might be of interest and might be different from those normally explored, and one issue has been over the years that there are many sections that have a cadre of scientists and clinical leaders who are exploring new research opportunities either in basic research or in clinical trials or in new therapies such as transplant or immunotherapy, and are making progress in their areas, but are often not recognized for their work and either not promoted in a timely manner or attracted elsewhere as other centers recognize the competence of these individuals, and therefore we lose on our own standing. And this is not across the board. Many of our department, since we’re dealing with more than a hundred different types of cancer, there are many areas of focus.

So some areas are holding their own in terms of national standing and competition for new knowledge, where others steadily fall behind because of perhaps resources or patients or personnel or, in some cases, the inclination of the department heads not to embark on certain research programs that might deflect from the clinical missions, and therefore staff is required to spend more time on patient care, and often the patient care is no better than what’s in the community, whereas others embark on newer things that have a chance of improving welfare at the same time as maintaining the best possible care and opportunities for patients and programs.

Tacey Ann Rosolowski, PhD

Are you able to share basically some divisions that you feel are making enormous headway in new knowledge versus others that have been more entrenched?

Raymond Alexanian, MD

Well, in my particular area, I have felt that in myeloma we have made progress, and leukemia is one of our star departments in terms of transplant department, has melded their technique and technology and resources with those of other departments so that there are strong cooperative links with the other departments that use transplant opportunities. Certain clinical departments such as medical [unclear] are leaders in the field or recognized, and the departments that are recognized are pretty well known to the staff because there is national recognition and awards and so on. So my comments suggest primarily those in hematology, and these comments change, so that’s from decade to decade, obviously. So some—

Tacey Ann Rosolowski, PhD

Right. I was going to ask you that, yeah.

Raymond Alexanian, MD

—become leaders and some fall behind, and a lot depends on the personnel, the resources in terms of grants and patients and other things, so that this is not a consistent opinion, so there’s variability.

Tacey Ann Rosolowski, PhD

I mean, I was curious because you came to the institution in 1964 and obviously were very involved in developing a research focus at that time and were working very actively with people who were busy pushing the envelope with treatment. So as you’re thinking decade to decade, I mean, what was this problem like in the mid-sixties, you know, and did you see changes in that balance? Did the institution, in your view, have a better record, you know, a greater percentage over time of faculty who were involved in that kind of pioneering research or has it remained the same? I mean, what’s your diagnosis over time?

Raymond Alexanian, MD

My view of it is maybe different from that of others, but in the 1960s when I was recruited, Dr. Clark recognized that there was a potential for important breakthroughs in cancer that were stimulated by the National Cancer Institute and their funding outlets that became more generous, so that he attempted to instill in departments the research mission, even though he himself was not that directly involved, although he may have been in his earlier years. But he felt that since the funding resources became more generous and expansion of the hospital in terms of physical stability and patient referrals were rising, that here was an opportunity to build up the research cadre, and there were also new technologies like CAT scans and MRI scans, transplant, new drugs, new combinations of new and old drugs, and so on, so that he was able to craft this thrust into these new areas. So I think that’s what I recognize, although I was very junior here, and I had the sense that this was the reason that I was hired here, you might say.

Tacey Ann Rosolowski, PhD

But it sounds like it was also a little bit of a cultural shift, that maybe the people who were already hired here, there were a good number of them who hadn’t anticipated that their careers would be required to take this kind of a turn.

Raymond Alexanian, MD

Well, those who were here, already here, were those staffed initially by Dr. Clark as clinical staff, and they were expert clinicians in their field. Many of them did not have an interest in research or the capacity for it, had no training in that area, and so there was, depending on department, by department, some resistance to that notion. “Why should my patients go into this program when he’s doing okay this way?” and so on.

So in order to create something new, you have to clash in some ways, educate, you might call it, and so there were often a series of mini confrontations in this sense, and usually these were resolved very amicably because of the family nature of the hospital that was kind of in a—that the team sense tended to balance the righteous new research push sense, you might say. There was a melding of interests so that as time went on, it was clear that the new ways were successful, and therefore they were pursued with different intensities or vigors.

And, of course, we’re talking about not just one disease or area. We’re talking about differences in different areas so that as with progress in many places, the advances came in, little steps in each different area at different times, so that sometimes there would be steps forward in one disease and then another disease and so on and so on.

Like one of the first controversies I remember was the treatment for Hodgkin’s disease. Hodgkin’s disease was a disease that was usually untreatable and incurable, and with the development of combined therapy such as chemotherapy, radiation therapy, staging, so that one could determine who would be potentially curable with radiation alone, who required combination therapy, and so on, this type of approach where medical and radiation therapy and possibly transplant-supported therapies were integrated could be done more easily at a center like MD Anderson, where all of these resources were available and where there was equivalent motivation by individuals in these different areas.

But it wasn’t easy. There was a period of steps and years of education, although it became accomplished here so that we were one of the first centers to apply such combined therapies, so that we now look on Hodgkin’s disease as cured in a large fraction of patients. And similar approaches were applied to lymphoma and leukemias and so on that were combined therapies and new therapies such as treatment of or prevention of meningeal leukemia, such as in children, so that children’s leukemia, which was once incurable, is now cured. I’m not saying that we were the pioneers in that particular area, but we certainly—our group followed up on advances elsewhere. So each area had its own pace of progress.

Tacey Ann Rosolowski, PhD

Now, obviously a key player in bringing—or key group of players in bringing this research focus to the fore at MD Anderson were all of the personalities involved with Developmental Therapeutics. And I guess, you know, one of the reasons I’m so glad you brought this up is that I have assumed that once developmental therapeutics came in and there was a period of adjustment to this new perception and there were certain administrative changes, that basically the commonly held mission of the institution to do pioneering work filtered out through the entire faculty. And I guess what you’re telling me is that is not necessarily the case.

Raymond Alexanian, MD

No, I think Developmental Therapeutics were the leaders in the program I just mentioned.

Tacey Ann Rosolowski, PhD

Right.

Raymond Alexanian, MD

With Dr. Frei and Dr. Freireich, the combined therapy was carried by them from the NIH, where they had originally done this work, and therefore applied here. Hodgkin’s disease is one of the examples I mentioned, and leukemia the second. These were developed through Developmental Therapeutics, so they were the leaders in the field, but the other aspects such as radiation therapy—and here is where you might want to interview Dr. Fuller, Lillian Fuller, because she was one of the leaders in combined therapy.

The other parts of hematology, like myself, learned from developmental therapeutics and tried to apply those principles in myeloma and other diseases related to myeloma, and I think the same principles were then also applied to breast cancer and other solid tumors where chemotherapy is often given first in order to reduce the bulk of cancer, so that resection may be more complete and then followed with radiation therapy. So the combined modality approach was pioneered by the Developmental Therapeutics here, but the application was done through each department separately so that while they were the leaders, I think it’s a mistake to say that they were the only group who were pursuing this.

Tacey Ann Rosolowski, PhD

Right. I didn’t mean to imply that, if that’s what you thought I said. I guess what I was thinking, more of a shifting, shifting the focus of the institution, that there became more and more individuals at MD Anderson who were doing that kind of work—

Raymond Alexanian, MD

Yes, that’s right.

Tacey Ann Rosolowski, PhD

—rather than focusing strictly on clinical care, as you said the original staff did.

Raymond Alexanian, MD

Yes. And also, as travel became easier, we were also influenced by other centers’ work and so that we were more aware of what might be useful elsewhere, although we considered ourselves the leaders. Of course, that may be an ego expression. So there was more interchange and we became more aware of other people’s work as we not only heard their presentations but also reviewed their papers before they were published. So we learned rapidly what was happening.

But we also—it’s not just learning, but you have to then say, well, we have to then apply it ourselves and push it through our own system.

Chapter 10: Threats to MD Anderson's Status: Losing Focus on Innovative Research and Problems with Regulatory Procedures

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