Chapter 09: Supporting Physician-Scientists

Chapter 09: Supporting Physician-Scientists

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Dr. Goepfert begins this chapter by noting any physician-scientist must have passion in order to succeed. The idea that time can be protected for research in the current work environment is a myth, and research simply has to be added to the long list of activities demanded of the academic medical professional. A main question for administrators planning support systems for surgical physician-scientists is When does one begin the training? Absence from clinical practice can compromise a surgeon’s skills. In the Head and Neck Department, physician-scientists spend 1-2 years in a lab before their advanced training, and it’s key that a department have a team of faculty who believe in the principles of translational research. He mentions Jeffrey Myers and J Freireich as true physician-scientists. He explains that the program for physician-scientists in Head and Neck began in the mid eighties, when the chief of surgery, Charles Balch, arranged for a outside review of the Department and received feedback that they needed a basic scientist on the faculty to encourage translational research. Dr. Goepfert sketches how this idea developed and the involvement of Garth Nicholson and Joshua Fidler. He notes that it has been difficult to fund head and neck research because the cancers are diseases of the working class. He mentions that he approached the president of the institution, John Mendelsohn, to establish the Helmuth Goepfert Society to train physician-scientists. He notes that Dr. Mendelsohn did not offer practical support, and the Society eventually was only able to support a lectureship.

Identifier

GeopfertH_01_20120827_C09

Publication Date

8-27-2012

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; On Research and Researchers; The Life and Dedication of Clinicians and Researchers; Patients; Cancer and Disease; Building/Transforming the Institution; Multi-disciplinary Approaches

Transcript

Tacey Ann Rosolowski, PhD:

When I spoke with Margaret Kripke [Oral History Interview]she was saying that the one thing she regretted after she left service as Executive Vice President of Academic Affairs was that she had not been able to make more headway in solving problems and supporting the career path of a physician-scientist, because there’s probably no individual who is under more pressure, with the clinical demands plus the research demands.

Helmuth Goepfert, MD:

And MD Anderson had the funds to do that. MD Anderson has enough endowment to do that.

Tacey Ann Rosolowski, PhD:

What would it take? Aside from the question of why it hadn’t been done, what would be needed?

Helmuth Goepfert, MD:

The difficulty is that you have to see— For one, it is necessary to have a certain passion for it. That’s fundamental. People have to have a passion for pursuing that. Protected time is a myth. You just work on top of the time that you do something else, and most of the physician-scientists have done it that way. The training is crucial, and when do you begin it? If you start too early in the career, like, for example, going through an MD/PhD in medical school. By the time you have finished your residency or want to start research of the residency, you have to retool because it’s at least 8 years.

Tacey Ann Rosolowski, PhD:

Things change so fast.

Helmuth Goepfert, MD:

They change so fast. Technology changes so fast. So, when do you start this? Now at MD Anderson, we in Head and Neck Surgery have played around with this idea and established basically that a fellow that wanted to do advanced training should spend a year or two in the lab before they did their advanced training so that it doesn’t become too late and so that they don’t lose what they have learned clinically to apply. So that was the principle we established. Yes, it is easier, though not totally easy, to do this in an organization where we don’t keep control of our monies but where there is money to support the time that these people need to be in the lab or need to work on their masters or work on their PhD or whatever they want to pursue in doing so, and you have to have a team of scientists—basic scientists—that believe in this principle. There is where Garth Nicolson came, and certainly the one that has done the most for this has been Josh Fidler [Isaiah Joshua Filder, DVM, PhD [Oral History Interview]] over and over again. So these are issues that MD Anderson, to some extent, has funded and supported. They even have a vice president for that. I forget his name. He used to be the chief of medicine. He is the one that is in charge of translational research. How efficient is it, and have these people been able to get grants? Some of them did. Some of them really did very well. Clayman did very well until he decided to step down from there and devote himself exclusively now to head and neck surgery. He is their national expert in advanced thyroid cancer. The one that still does it very efficiently is Jeffrey Myers. So, these are people that really had the passion for it, had the dedication, and went to do it. There are others in other departments. The one that in this institution is to be credited with being the leader in this is J Freireich [Oral History Interview]. J Freireich really was the one that recognized this as a fundamental way to improve the care of leukemia and lymphoma. He really is the one that has put physician-scientists on the map in oncology. Others in history have been important outside of the institution, but within the institution is certainly was J Freireich.

Tacey Ann Rosolowski, PhD:

Well, while we’re on the subject, could you tell me about the system that you set up in Head and Neck to support the physician-scientist? Talk about that in more detail. When did that initiative begin?

Helmuth Goepfert, MD:

It was somewhere in the mid ‘80s, and it actually came about around the time that the head of surgery, Dr. Charlie Balch, wanted to do an outside review of the department. Now it needs to be said that he basically wanted to do this to oust me. That didn’t work, but in doing so the committee that came recommended that the department in this hospital would deserve to have a basic scientist on its faculty in order to create translational research. Now, I had been playing around with that idea already with Garth Nicolson, but this gave it the impetus. Now, the funny thing is that I basically went out and got the most visible candidate out there, brought him in, asked him what could be done, said, “What would you require to do this? Give me your list.” I agreed with the list. When I moved forward in the institution they said, “No, we’re not going to do that.” So that was the beginning.

Tacey Ann Rosolowski, PhD:

Who was the candidate you approached?

Helmuth Goepfert, MD:

Thomas Carey.

Tacey Ann Rosolowski, PhD:

And what was on his list that you agreed with?

Helmuth Goepfert, MD:

Oh, all that was necessary for the lab that he would run. Basically, a basic science lab was a necessary space and so forth.

Tacey Ann Rosolowski, PhD:

What was—?

Helmuth Goepfert, MD:

The details escape me, but he was already a well-known entity in Michigan.

Tacey Ann Rosolowski, PhD:

And what was his area of research at the time?

Helmuth Goepfert, MD:

1:38:16:.8 You know, I forgot what it was. Later, when we reinitiated this, the natural killer cells were there. Dr. Jack Roth’s wife in basic science—her name was [Dr.] Elizabeth [Grimm] something—she was the one that ran that, and it developed in that direction. But he basically—I don’t know—because what we started with Garth Nicolson was metastasis—was dealing with the study of metastasis. It became much more focused and much more diverse in its approach under Dr. Josh Fidler. He and his seed and soil theories and his macrophages and all of that played a role in that. So it was along those lines that it was done then. Yes, we dealt for a while with perineural invasion, which is one way of head and neck cancer to progress, and we had a program there. We even had a researcher that was with us for quite a while here and worked on it, but it was not that formalized, and it was always a difficulty.

Tacey Ann Rosolowski, PhD:

So did the institution ever get behind Head and Neck establishing this?

Helmuth Goepfert, MD:

Yes, but on chips here and there. I’ve never been very good at asking for money from potential donors out there. I’ve never been very good at that. Besides, head and neck patients—by and large, it’s not the upper class. Prostate and breast cancer are much more upper-class people that have money left, but head and neck is becoming more now where the human papilloma virus is bringing some of the young executives in with cancer of the tonsil. Yeah. The HPV has changed the demographics of head and neck cancer.

Tacey Ann Rosolowski, PhD:

I had no idea that there was a class differentiation with head and neck cancers.

Helmuth Goepfert, MD:

Head and neck cancers were usually the drunks and the smokers—the majority of them. Yes, when thyroid came about it was shifted more in that direction, but the history of modern head and neck cancer in the sense of cancer of the upper digestive tract is right now basically focused on the advent of the HPV virus infection and HPV virus cause of certain cancers of the head and neck. That has changed in the last 10 years. But, yes, I repeatedly went to John Mendelsohn and said couldn’t we establish—I mean—we wrote up a proposal for—and the other thing to be mentioned is that when I retired—and that was my first retirement in nineteen—what was it?

Tacey Ann Rosolowski, PhD:

In 2003?

Helmuth Goepfert, MD:

In 2002, my first retirement, because I said I’m going to retire, and they did the party and they created the Helmuth Goepfert Society. The proceeds of that society were for the purpose of training physician-scientists. It was started, but then history changed. They had not elected a chair member when 2002 came around, and they asked me to stay on for a year. This year produced—at the end Dr. Weber was elected chairman, and all the efforts that had been put into gathering the funds for the Helmuth Goepfert Society of Head and Neck went by the wayside. Now the funds that exist there basically support a lectureship a year, which is considerably less than what I intended to do, and I must admit that Dr. Mendelsohn was never up front with me on this issue, because I went to him several times including a couple years later. I said, “Listen, you can change the name, but I think that the Head and Neck Department deserves to have an independent major endowment for the training of physician-scientists.” He said, “Yes, I will do it if you agree to talk to Dr. Hong and to Dr.—then it was Lester Peters? No. It was after Lester Peters. It was Kian Ang. Everybody agreed, yes, let’s do it. So, I sent them the result of my recommendation and all of them said yes, but he said, “Okay, we’ll do it,” and never did it. So as a result of what—that’s one of the things done that I feel sorry that it never happened. But I’ve still been able to get, here and there, some support from the institution in order to get somebody through on the career for physician-scientist.

Tacey Ann Rosolowski, PhD:

It seems like a very thorny problem.

Helmuth Goepfert, MD:

Oh yeah. It is a thorny problem, but it’s life. Now, the other thing that—and we have tomorrow still to discuss the issue of the electronic publishing in the institution because that’s something else that I want to address is the publications and the electronic publishing.

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Chapter 09: Supporting Physician-Scientists

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