Chapter 13: The Emerging Need for an Ambulatory Care Clinic
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Description
In this chapter, Dr. Hill explains that the need for a new clinic grew in part with the increasing use of (the controversially) aggressive chemotherapy promoted by Dr. Emil J Freireich [Oral History Interview], Emil Frei and others in the new Department of Developmental Therapeutics. He talks about the tension created between MD Anderson’s “Old Guard” as this “New Guard” increased the institution’s reputation and patient volume.
Identifier
HillCS_03_20120220_C013
Publication Date
2-20-2012
City
Houston, Texas
Interview Session
C. Stratton Hill, MD, Oral History Interview, February 20, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; MD Anderson History; Overview; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Controversy; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches
Transcript
Tacey Ann Rosolowski, PhD:
I wanted to ask you about becoming the—well, basically establishing the Ambulatory Care Clinic, because that was one of the topics that we haven’t addressed yet.
C. Stratton Hill, MD:
That was about 1974.
Tacey Ann Rosolowski, PhD:
And you were in conversation with Dr. Clark about the need for that?
C. Stratton Hill, MD:
No, Dr. Clark had— I mean, it was obvious that we needed more space. Dr. Clark, along about that same time, went to the National Cancer Institute, and he recruited [Emil] J Freireich [Oral History Interview]. You probably are going to talk to him.
Tacey Ann Rosolowski, PhD:
I already have, actually.
C. Stratton Hill, MD:
He ought to tell you a lot, J Freireich and Emil Frei. I think Frei is still living, but I heard he also had Alzheimer’s.
Tacey Ann Rosolowski, PhD:
No, I think he’s passed away, actually.
C. Stratton Hill, MD:
Oh, did he? Okay. Anyway, they came together. They were the bright young stars of chemotherapy, and of course, they brought all the latest studies. I don’t know whether it’s come out about the tension, shall we say, that developed between the old guard and the new guard.
Tacey Ann Rosolowski, PhD:
What was it about?
C. Stratton Hill, MD:
It was just about basically the philosophy, and it was sort of a clash of values. For instance, Dr. Clark was very supportive of people who had been loyal to him, and he had Ed White and Cliff Howe. Ed White was the head of surgery, and Cliff Howe was head of medicine, and then they had several people there that they had recruited—Dr. Shullenberger, who was head of hematology—and this was really before chemotherapy was a prominent part of cancer. See, Memorial Sloan-Kettering was a big surgical hospital, and when Dr. Clark organized Anderson, he had in mind that there was going to be a multidisciplinary thing. He was going to have radiotherapists. You were going to have the best radiotherapists, and then you’re going to have the best surgeons in all the various surgical sections. Then as chemotherapy came along, that was the last major component of the treatment modalities—surgery, radiation, and chemotherapy. Now you’ve got a lot of different things, biological modifiers and all that kind of stuff. But chemotherapy was just kind of an afterthought at that point in time, and so you didn’t have anybody that was very aggressive, and that was what Frei and Freireich had made their reputation on was the combined therapy. When I was at Memorial, you did one drug at a time. Nobody ever actually combined therapies. Number one, they didn’t know enough about them so that you could plug in a complementary drug. One drug was complementary to another one, and they just didn’t know about it. They were finding out about it, but Freireich and that group at the NCI were really the ones that were pushing it for acute leukemia and things of that sort. I think I told you that when I was at Memorial, the median survival from diagnosis to death was three weeks for acute leukemia. Anyway, Clark brought that entire group into the old guard, shall we say, who were not into that. Internists were basically the ones who were— Since that was a drug, you would have to do the chemotherapy, and nobody did very much chemotherapy at that time. You had a few people who did breast work, but that was manipulating hormones and things of that sort for metastatic disease. The main thing was surgery. I’ll never forget seeing this one young woman. She got pregnant while she had breast cancer, and her father-in-law was a surgeon in Lufkin or someplace like that. Don’t put Lufkin down. I don’t know whether it was Lufkin or not. But he did the most god-awful surgery on her. He cut her to where you could— I mean, you’d have to graft her skin. There’s just no way you could do it, but that was kind of what it was. You may or may not have heard people, surgeons say, “Oh, we got it all.” I used to say, “You got all you could see. You couldn’t see that microscopic disease that was already there.” That was a big problem. But anyway, there was nobody there that really did much chemotherapy. You had nitrogen mustard and some of these crazy things that were just beginning to get—Karnofsky and that group up in Memorial. How they got into it was they were in the army poison section, whatever that was called. I think it was Fort Detrick, or something, Maryland. That was where all that came—and some of these—like mustard gas. That’s where nitrogen mustard came from. They would see some people that had the tumor or something, and they got nitrogen mustard, and the tumor would shrink up a little bit. So they started working, and then that’s how they got into it. Anyway, we didn’t have anybody, but then this group comes in, and Dr. Clark, he was torn between those people who had helped him start the whole thing and this other group that was very aggressive. That was just— Boy, they were going right ahead with things. As a matter of fact, Grant Taylor, the guy that was in pediatrics, he was in the Department of Medicine, Pediatric Department of Medicine at the time, and because of this aggressiveness and these new people that were coming in, he decided he’d like to be in— See, they called it Developmental Therapeutics, and he decided he’d like to be in that department. Boy, he didn’t know what he was getting into. They came in, and they started treating those kids with this high-powered stuff and making them sick and all that kind of stuff, and he really became depressed. He asked to get out of that group and get back like he was, which Dr. Clark let him do that.
Tacey Ann Rosolowski, PhD:
How long did that take him to become disillusioned with—?
C. Stratton Hill, MD:
Not long. No, a few months.
Tacey Ann Rosolowski, PhD:
Was that the source of the concern, that this aggressive treatment was making patients ostensibly worse?
C. Stratton Hill, MD:
Yeah, I think it was the fact that it was just new, and so they were applying aggressive chemotherapy. You see, you did get remissions from leukemia and the lymphomas that you didn’t get with solid tumors like stomach tumors and other tumors. But they were very, very methodical. You put a person that had to qualify for a study, and you had to stick with it, and you have to have the temperament of seeing the little kids vomit a lot and things like that. That was very dramatic, because chemotherapy, boom, that’s what they were doing. You radiate them, and it takes them a while before they start doing that, before they lose their hair and all that kind of stuff. And Dr. Clark would not—he didn’t step up and say, “Look, I’m sorry, guys, but this is the way it’s got to be.” You had these two camps that were at war with one another out there for a long time, and it just went on for years, but it became so— [REDACTED] And he became a very good friend of mine because his wife was from Tennessee. My wife went to interior design school in New York, and when we lived in upstate New York, we bought a lot of early American furniture. But then she got interested more in European style and so forth, so when we were moving to Houston, there was an antique dealer in Manhattan that she knew well. She said, “I reckon I’ll sell this early American furniture,” and she said, “Well, you’re going to Houston, look up Jane Mosbacher.” We thought she was an antique dealer, actually, but she was Bob Mosbacher’s wife, who was a millionaire oilman. I had had a friend from my hometown in Tennessee, who became the national sales manager for Squibb Pharmaceutical Company, and he was my parents’ vintage. He would invite us over. They had an apartment over on Central Park South, and they’d invite us over for dinner from time to time. He was telling me about his friend that he went to the University of Tennessee with that, during the Depression in the ‘30s, went to school at University of Edinburgh because it was cheaper and that he stayed on and just became a British citizen. But he became the Regius Professor of Neurosurgery at the University of Oxford, and he told me about how he was a good friend of that family and so forth. So when we got in, we met Jane Mosbacher. She and Charlotte really hit it off, and so Charlotte came home one day and said, “You know, Jane Mosbacher was telling me that her brother was the Regius Professor of Neurosurgery at the University of Oxford.” I said, “My gosh, that’s Joe Pennybacker’s sister,” and it turned out that she was. My wife jumped on the phone and said, “Jane, was your name Pennybacker before it was Mosbacher?” She said, “Yes.” I was going to that calcitonin meeting in London in 1969, so Jane Mosbacher said, “Oh, you’ve got to go see my brother in Oxford,” so we did. We went up. We caught a train and went up there. They invited us up for dinner, so we went up there, and we had dinner. [ ]
Tacey Ann Rosolowski, PhD:
Were those kinds of successes really instrumental in putting to rest this tension between the old guard and the new guard?
C. Stratton Hill, MD:
Well, it was just kind of overwhelming for the old guard. Like I said, they were getting all the money, and that’s when it became so obvious that we couldn’t handle everybody. The reputation then just exploded, and we just had people standing in—like I think I told you—like feed lots. They were just standing up because we didn’t have enough room for them to sit down.
Tacey Ann Rosolowski, PhD:
This was when the conversation began about the need for an ambulatory clinic.
C. Stratton Hill, MD:
Exactly, and at that time, a guy down in Beeville or someplace like that wanted to give some money to Hermann Hospital, but at that time they had—I think it was called Hill. There was a senator from Alabama named Hill, I think, and he set up where they would match funds if you had matching funds, so the— What’s that pavilion called? This was called the Lutheran Pavilion, but the family—Lutheran Pavilion at MD Anderson. There are portraits. Of course, now it’s kind of lost in the shuffle, but it was called Lutheran Pavilion at one time. I think it probably still is. Then this Alkek put about eleven stories on top of that, and I don’t know how they’ve divided it up out there now. But this couple had some property in Florida, and they wanted to give it to Hermann. Hermann says, “We’re not taking any government money.” They said, “Forget you; we’ll go take it over to Anderson.” Clark said, “We’ll take it.” They matched that, and they built the Lutheran Pavilion and— Let’s see. I think it was the Gimbel wing or maybe the— Anyway that’s when the clinic— Oh, yeah. It was the Lutheran Hospital and the new clinic building. See, we knew they didn’t have—shouldn’t be called the new clinic building because we didn’t have a clinic building. It was just in the building, and so it was a separate building. You can’t even see it now. I mean, it’s been modified and expanded so much that you can’t identify where that was.
Recommended Citation
Hill, C. Stratton Jr. MD and Rosolowski, Tacey A. PhD, "Chapter 13: The Emerging Need for an Ambulatory Care Clinic" (2012). Interview Chapters. 1052.
https://openworks.mdanderson.org/mchv_interviewchapters/1052
Conditions Governing Access
Redacted
