
Chapter 06: Developmental Therapeutics in 1974
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Dr. Hortobagyi talks about his fellowship in Developmental Therapeutics (DT, ’74 – ’75), beginning with a discussion of the “serious political split” between the Division of Medicine, which focused on patient care to the near-complete exclusion of research, and Developmental Therapeutics, which focused closely on research. Though Dr. Hortobagyi was interested in breast cancer, Developmental Therapeutics had no access to breast cancer patients, handled via the Division of Medicine, and the head of the Fellowship Program, Ken McCready, assigned him to the leukemia service. Dr. Hortobagyi describes his busy days on this service, then recounts how he was assigned to Developmental Therapeutics’ Outpatient Service. Dr. Hortobagyi describes the influence of Anthony Burgess (head of the Outpatient Clinic) and Jeffrey Gottlieb (Chief of Solid Tumors in Developmental Therapeutics).
Dr. Hortobagyi describes his interest in singing. He sang with the Cleveland Symphony while living in Ohio and he auditioned for the Houston Symphony Chorale and sang with them until 1979. He then explains that he was married in 1976 to Agnes, whom he met on a date arranged by his sister.
Dr. Hortobagyi describes some of the research he conducted while in the Department of Developmental Therapeutics. Dr. Jordan Gutterman recruited him to work on immunotherapy research using BCG (Bacillus Calmette-Guérin). He describes DT as a “tornado of intellectual activity” that nonetheless left him little time for innovation and creative thinking.
Dr. Hortobagyi states that his Fellowship in Developmental Therapeutics prepared him with the basic concepts of clinical research. He describes specific lessons he learned and compares his experience with the more structured training programs offered today.
Identifier
HortobagyiGN_01_20121130_C06
Publication Date
11-30-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Gabriel Hortobagyi, MD, Oral History Interview, November 30, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional UnitMD Anderson History Institutional Politics Building/Transforming the Institution Multi-disciplinary Approaches Understanding the Institution Personal background Character, Values, Beliefs, Talents Personal Background The Researcher Understanding the Institution MD Anderson Culture Evolution of Career This is MD Anderson Education at MD Anderson On Research and Researchers On Education
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:
So how did that work? Because I am little confused from the details that are on your CV because it said from ’74 to ’75 you were in Developmental Therapeutics.
Gabriel Hortobagyi, MD:
That’s right.
Tacey Ann Rosolowski, PhD:
And then from ’75 to ’76 you were in medical oncology. So that was when you crossed over to—
Gabriel Hortobagyi, MD:
So that—so when I arrived in 1974, this institution had a serious political split. The Department of Medicine was a traditional department of medicine that was started when MD Anderson was founded in maybe the 1940s. And they did excellent patient care, but there was relatively little research being done. So, Dr. [R. Lee] Clark—in the mid-1960s—called the NCI and said, “I need a couple of go-getters to start the—jump start the real research department of oncology.” So, they sent down J Freireich, [Emil] Tom Frei—who then later went to the Dana-Farber—Ti Li Loo, and I think [Gerald] Gerry Bodey—and the four of them were not welcomed by the Department of Medicine. So, they established for them a different department that was called Developmental Therapeutics. So, when I arrived here there were two separate and intensely competitive programs—competitive with each other. I didn’t know that the other program existed in the Department of Medicine, so for me it was irrelevant. So I was in Developmental Therapeutics, which was headed by J Freireich, and all of the really well-known investigators were in that department. But soon after I arrived I realized that not only was this political split—but that like the Pope did in the 1400s where he gave the east to the Portuguese and the west to the Spaniards—somehow the way it ended up is that developmental therapeutics had access to only some types of cancer like melanoma and leukemia and sarcoma and whatnot, and all of the others were in the Department of Medicine, including breast cancer. So, because I wanted to do breast cancer, I couldn’t stay in Developmental Therapeutics because there was no—I mean there was an occasional patient with breast cancer who just happened to be referred to a member of DT, but the bulk went to medicine.
Tacey Ann Rosolowski, PhD:
Can you tell me because—I mean that puts you in a very odd position, obviously.
Gabriel Hortobagyi, MD:
Oh, yes. Oh, yes.
Tacey Ann Rosolowski, PhD:
I’m kind of getting that. So—well, I’m very interested to know, first of all, like how Developmental Therapeutics was when you got there and what you got from that. But then, of course, how you dealt with the whole political problem once you crossed over. So how do you want to tell that story? (laughing) I am leaving that one to you.
Gabriel Hortobagyi, MD:
Now you are talking about sensitivities. So, when I arrived, I had no clue about any of this, so I reported to Dr. Freireich’s office, and Dr. Freireich passed me on to—I think it was Ken McCredie. He was an Australian who was the head of leukemia, and he was also in charge of the fellowship program. He was a big burly man like most Australians—pretty loud and not terribly discrete or polite. But he was a wonderful guy and a great physician and a wonderful oncologist. So, he immediately assigned me to the leukemia service, and I knew close to minus two—as opposed to zero—about leukemia. So, I was assigned to leukemia with Michael Keating. I don’t know if he is on your list, but he should be. So, Michael was another Aussie, and he was, I think, a year older than me, and he had had a little bit more experience in oncology and leukemia before coming over. So, he and I were on the leukemia service, and they worked us to the bone. I was still single at that time, and Mike was married. So, we would start rounds around six in the morning. We would work throughout the day. We would have thirty, forty inpatients, and those patients are as sick as dogs. And then in between we had to do conferences, and at that time we had to run the patients down to x-ray ourselves and draw blood, and we did a lot more stuff than our trainees do today. And then we had to catch up on paperwork. And then we had to do some of the research projects of some of the attendings. And then we had special assignments at midnight, so we would crawl home between one and two in the morning only to get back at six. (laughs) So this went on for a couple of months, and it really tries your mettle. But it was fun, and I learned an incredible amount about—from these folks.
Tacey Ann Rosolowski, PhD:
Well, I suppose that also just—it’s almost like being at war, you know. You’re in the trenches with people.
Gabriel Hortobagyi, MD:
Absolutely.
Tacey Ann Rosolowski, PhD:
You create these bonds.
Gabriel Hortobagyi, MD:
It’s boot camp. It’s boot camp but with real bullets. So, then I was assigned to the outpatient clinic of DT, and that was under the control of another Aussie—actually [M. Andrew] Andy Burgess. And Andy was sort of the quiet—imagine the Clint Eastwood type—sort of quiet but extremely smart and a very, very nice fellow. And so, he took me under his wings, and he taught me a lot about oncology and about common sense. He had a lot of common sense, and he was not as outspoken and as aggressive as McCredie, but he was a wonderful person.
Tacey Ann Rosolowski, PhD:
Could you explain that common sense piece to me? What is that about?
Gabriel Hortobagyi, MD:
Common sense is a misnomer because there’s the least common sense in a human being. There are a lot of very smart people in this world, either by book or because they are just quick at grasping concepts and whatnot. But despite that, it is surprising how many people make absolutely wrong decisions because they don’t have the ability to place certain decisions in the context of real life. And I think common sense is just that ability—which is mostly innate—to figure out among the various options one has at every step what would make sense really—what would really make sense not because you read it in a book, not because someone necessarily told you but because it is just the only logical thing to do that fits into your context. It fits in your surroundings. It fits in your—what you are doing at that time. And the number of individuals—very bright individuals including many of my colleagues—don’t have that—don’t have that. And yet they have to make decisions every day.
Tacey Ann Rosolowski, PhD:
What were some instances in which you learned that from Dr. Burgess?
Gabriel Hortobagyi, MD:
Well, you know, there are many small things. So suppose that we are talking about treating someone with testicular cancer with the best treatment, which at that time had just become a platinum-based regimen, and then he listens to you and says, “Yeah, that is a wonderful idea, but you do realize that this person has renal failure, and platinum is just going to kill that kidney.” So platinum is out of the picture, and it doesn’t take great science. It’s just—it makes no sense to do otherwise. It’s a small thing. Or you are talking about someone who is very obese and who needs to lose weight, and you go into this thing of well, we need to put him on a diet and an intensive exercise program, and then Mike turns around and says, “That is fine, but you realize that this guy is in a wheelchair and has not walked in two years.” That’s common sense. It doesn’t take a genius, but a lot of people don’t figure it out. And then it goes all the way up to much more important and perhaps more weighty decisions. So, Mike was very famous for that. He talked to me about taking care of patients in the ambulatory setting, and we also became very good friends. During that time there was also another fellow here whose name was Jeffrey Gottlieb. I don’t know if you’ve heard of him.
Tacey Ann Rosolowski, PhD:
I don’t think so.
Gabriel Hortobagyi, MD:
So Jeff Gottlieb was a young man. He was—he might have been thirty-three or thirty-four at that time, and J Freireich had appointed him as the chief or the head of solid tumors within Developmental Therapeutics. That was a big title with a very small property, and Jeff—Jeff was very, very bright, and very outspoken and very [redacted]. But from the first day we met, and we talked, he says, “You know, you seem to have a good voice, do you sing?” And I said, “Yeah, sure I sing. In fact, I used to sing with the Cleveland Symphony.” He says, “Well, what are you doing tonight?” I said, “Working, I assume.” He said, “No, no. You are coming with me.” So, we went downtown to Jones Hall. That was the major center, and I auditioned, and he was already a member of the Houston Symphony Chorale, and I became a member of the Houston Symphony Chorale. [redacted]
Tacey Ann Rosolowski, PhD:
What part do you sing?
Gabriel Hortobagyi, MD:
Bass baritone, too.
Tacey Ann Rosolowski, PhD:
Did you sing with the Chorale after that as well?
Gabriel Hortobagyi, MD:
I did. I continued to sing until late—oh, maybe early 1979. And at that time our oldest daughter was born, and then it became apparent that the chorale work was—took me away from home for too much.
Tacey Ann Rosolowski, PhD:
When did you get married amid all of this amazing workload?
Gabriel Hortobagyi, MD:
I got married in November of 1976.
Tacey Ann Rosolowski, PhD:
And what is your wife’s name? And how did you meet her?
Gabriel Hortobagyi, MD:
My wife’s name is Agnes, and I met her in Toronto in May of 1976. The ASCO (American Society of Clinical Oncology) meeting was held in Toronto in May of 1976. But I arrived to Toronto, I called my sister, and I asked whether she knew—she had any nice friends that I could take out for dinner perhaps. So, she gave me my wife’s phone number, and I called her, and eventually we connected and went out for dinner, and we got married on our third date.
Tacey Ann Rosolowski, PhD:
I get the sense that people in DT make quick decisions.
Gabriel Hortobagyi, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
So I guess good ones since it has lasted forty years.
Gabriel Hortobagyi, MD:
That’s right.
Tacey Ann Rosolowski, PhD:
Yeah?
Gabriel Hortobagyi, MD:
That’s right. It was a wonderful, wonderful thing. Her parents were absolutely frantic, because how can you marry someone you don’t know?
Tacey Ann Rosolowski, PhD:
Well, congratulations.
Gabriel Hortobagyi, MD:
Well, thank you. Thank you. She is a wonderful human being and a great partner. So, at that time I stopped singing, and anyway I was too busy preparing for my boards—for my board exam in 1976. And so that was it. So, I—
Tacey Ann Rosolowski, PhD:
Excuse me, but what were you working on in Developmental Therapeutics? You didn’t tell me what your focus was.
Gabriel Hortobagyi, MD:
Okay. In Developmental Therapeutics I was quickly recruited by one of the faculty members, who was Jordan Gutterman, and he gave me a project of immunotherapy with BCG (Bacillus Calmette–Guérin) in breast cancer.
Tacey Ann Rosolowski, PhD:
Oh, okay.
Gabriel Hortobagyi, MD:
And my role was to run a clinical trial and to recruit patients and make sure that they got all their treatment and that I interacted with the immunotherapy nurses and the research nurses and eventually to write papers about this and whatnot. And then from that came several other projects with other types of immunotherapies, and I worked on that for the first probably four or five years of my career.
Tacey Ann Rosolowski, PhD:
And as you were getting into immunotherapy did you find that that was satisfying this need that you had to be looking at the broader picture? And how is that working with your need for the intellectual stimulation piece of oncology?
Gabriel Hortobagyi, MD:
So at that time it was very, very satisfying because I felt in the middle of this tornado of intellectual activity. In retrospect I was so busy with so many tasks and so many things that there was relatively little time for innovative and creative thinking. And that came actually a little bit later—certainly way, way beyond my fellowship years, but my fellowship years prepared me for the basic concepts of doing clinical research and understanding what was known and what was thought to be known and to continuously question and to continuously search and to become systematic in what you do. And it is a process. Nobody is born with that. And as opposed to now when we have a much more structured training program for our fellows, in those years it was a little bit of sink or swim. You were thrown in the water and said, “Take this project and run with it.” But there was not really an attempt to educate you. These are the processes of research, and this is what you need to do, and this is how you go about it and whatnot.
Tacey Ann Rosolowski, PhD:
Do you—
Gabriel Hortobagyi, MD:
Not because there was no willingness but because these were the early days of (both speaking at once).
Tacey Ann Rosolowski, PhD:
Yeah—people were learning on the job.
Gabriel Hortobagyi, MD:
Absolutely.
Tacey Ann Rosolowski, PhD:
I mean making it up. Now did you—if you think about if you had entered a training program now, would you have flourished as quickly or do you—with your learning style did you—was that tornado situation more nourishing to you do you think?
Gabriel Hortobagyi, MD:
So I’ve always been fiercely independent, and I have been to a large extent a loner. So, I think that environment was perfect for me. With what I know today, I probably could have trained in a number of other areas. I probably could have or should have spent some time in the lab to acquire additional skills, but I don’t know how I would have done there. I did some lab research back in Cleveland, but there too I was pretty much left to my own devices. After giving me some very basic instructions I was essentially told, “Run with it.”
Tacey Ann Rosolowski, PhD:
And hope you figure it out.
Gabriel Hortobagyi, MD:
Yeah. And I work well in those circumstances. I do less well when there are—when I am one of five people who are in charge of the same thing. I am uncomfortable there because I am not fully in charge.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative). I kind of get the sense actually when I—because I have spoken to a few people who worked in Developmental Therapeutics, and it is almost as if that particular program is selected for people who all worked well.
Gabriel Hortobagyi, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
I mean they are all kind of loners; all take charge.
Gabriel Hortobagyi, MD:
Right. Right, right, right.
Tacey Ann Rosolowski, PhD:
All very independent people.
Gabriel Hortobagyi, MD:
Right.
Tacey Ann Rosolowski, PhD:
So it doesn’t surprise me that you say that.
Gabriel Hortobagyi, MD:
And that was sort of the Wild West spirit because there was so much to discover, and there was so much room for exploration. But there were no real rivalries in the sense that there was plenty for everyone to do.
Tacey Ann Rosolowski, PhD:
So it really was a good—I mean a good place for big egos at the time.
Gabriel Hortobagyi, MD:
Right. Absolutely. And there were plenty of them. Oh, believe you me. At the same time in the reverse of that is that if you got into this program—and for instance, several people on the other side in the Department of Medicine who got into that training program who did not have this incredible personal drive and this ambition to get ahead on their own—they got lost because there was not a real effort to say, “Now let me pick you up little birdy, and I will spoon feed you through the next two or three years.” All right. And that may be a deficiency, but that was the—those were the times, and I don’t think things were very different in any of the other major cancer centers at that time of which there were few.
Recommended Citation
Hortobagyi, Gabriel N. MD and Rosolowski, Tacey A. PhD, "Chapter 06: Developmental Therapeutics in 1974" (2012). Interview Chapters. 1111.
https://openworks.mdanderson.org/mchv_interviewchapters/1111
Conditions Governing Access
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