Chapter 13: The Breast Cancer Research Group –Bringing Together Clinicians and Basic Scientists
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Description
Dr. Hortobagyi explains that frustrations with research motivated him to accept a 1990 invitation from Dr. James Cox [Oral History Interview] to pull together a comprehensive group to study breast cancer. The Breast Cancer Research Group linked radiologists, surgeons, and other specialists, as well as basic researchers interested in the disease. This request came at a time that the administration wanted to enhance the quality of research and to make it more collaborative and translational. Dr. Hortobagyi also notes the growing suspicion, at the time, that basic scientists would spend their time doing research for its own sake, without necessarily linking their research questions or discoveries to patient care. He explains that the process for awarding grants prevented scientists from taking bold steps or thinking outside the box. Dr. Hortobagyi describes the challenges of getting the specialties to work together. He describes setting up talks with luminary scientists and researchers –for only very low turnout. Laboratory scientists communicate differently than clinical specialists, he notes. Their days are also organized very differently, which made it difficult to find a time when everyone could gather. In addition, the institution offered no incentives for communication across specialty lines –and he says this is still true. He offers observations on Dr. Ronald DePinho’s support of basic scientists.
Identifier
HortobagyiGN_02_20130107_C13
Publication Date
1-7-2013
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, January 07, 2013
Topics Covered
The Interview Subject's Story - The AdministratorThe Researcher Beyond the Institution Institutional Mission and Values Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care Professional Practice The Professional at Work Collaborations Controversy MD Anderson Culture
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
Gabriel Hortobagyi, MD:
Then in part because of frustration with traditional new drug development, in part because we were learning so much about science and science was becoming so much more exciting, and in part because I was asked in the early 1990s to actually pull together a more cohesive group—everybody who was interested in breast cancer—then I organized what is now called the Breast Cancer Research Group. Then with the Breast Cancer Research Group, we faced the challenge of not only bringing together the surgeons and the radiotherapists and the medical oncologists and the radiologists and the pathologists but all of those plus all of the basic scientists who had any interest in anything resembling breast cancer. The Breast Cancer Research Group has about 200 members, maybe more, from about thirty-seven departments throughout the institution. And if you think there are cultural differences between surgeons and radiotherapists and medical oncologists, that’s nothing compared to the chasm between laboratory scientists and clinical investigators. It’s different planets. That kept me occupied for the next couple of decades.
Tacey Ann Rosolowski, PhD:
What year were you asked to put together this group?
Gabriel Hortobagyi, MD:
I believe 1990-1991.
Tacey Ann Rosolowski, PhD:
And who suggested this to you?
Gabriel Hortobagyi, MD:
I think it was Jim Cox [Oral History Interview], who was at that time the executive vice president and physician-in-chief for a short period of time. I think it was between the time about Hickey retired and Charlie Balch or David Hohn took over. I don’t remember exactly, but it was Jim Cox who was the head of Radiation Oncology for a long time.
Tacey Ann Rosolowski, PhD:
What was going on in 1990 that made it then that you were asked, do you think?
Gabriel Hortobagyi, MD:
I think there was an effort on the part of institutional leadership to enhance the quality of our science and to make our science more collaborative and more translational because there was an increasing perception—and I think it was real—that basic scientists, laboratory scientists could spend their entire lifespan doing research for the sake of research. And our entire research enterprise in this country is based on sort of a circular methodology. In order for you to do research, you have to get research funding. But in order to do research funding, you have to have completed your research because otherwise you are told it’s not possible to do what you're proposing to do. Laboratory researchers became quite comfortable with getting their first grant somehow and then sort of tweaking in a minor way their early application for the renewal so that by the time they went for the renewal, they had already completed what they were proposing to do, and then they perpetuated their funding by doing that. And while that was sort of good for the individual investigator—and in some ways good for the institution in a very cynical manner—because research funding kept coming, it was bad for the field because you didn’t make progress because you couldn’t take bold steps. You couldn’t take risks because the review system was so conservative that if you took risks and if you thought outside the box, you were almost certain to be rejected and disapproved.
And over the years, when I started to look at what people were doing in different parts of the institution, I realized that they were individuals who were pretty bright individuals who had worked in the same thing for twenty, thirty years. We had no idea what to do with their discoveries, and they were just planning to continue doing the same for the next twenty to thirty years. And of course we are a cancer center, so we are supposed to convert knowledge into something that is useful for people, and that wasn’t happening. The other part that became very evident is that laboratory scientists and physician scientists are trained differently. They speak different languages, and they don’t like to listen to each other because they don’t see the benefit—or at least that was the case twenty years ago. They didn’t see the benefit of getting involved with these people who worked with rats all their lives, and nothing ever came out of that. And by the same token, the basic scientists said, “Well, these guys don’t understand science. When I talk to them about the cell cycle and I talk to them about growth factors and when I talk to them about A, B, C, or D, they look at me with glazed-over eyes, and they don’t understand me. So why waste my time?” To some extent that is true even today. It is very hard. They are such different cultures. So, for instance, I started to organize conferences. I called one Translational Breast Cancer Research Conference. And to try to get everybody in the same conference room at the same time, it was like trying to get Martians and folks from Mercury on the moon.
The surgeons get up at five o’clock in the morning. They’re at work by 6:45 or 7:00. By three o’clock they are dead, and they go home. The basic scientists waltz in at 10:30 or 11:00 in the morning. They have a leisurely lunch, but they are still here at seven-, eight-, nine o’clock. Try to find an hour of the day or day of the week when those two shall meet. So, over the years, we’ve got a lot of very famous and exciting speakers from outside because nobody is a prophet in his own lab. To put one of us to speak, it would not be good enough. I got Nobel Prize winners and Lasker winners and people who were plenary speakers at the ACR or ASCO or whatnot and tried to alternate between basic scientists and physician scientists. And if I organized the meeting early in the morning—like seven- or eight o’clock in the morning—I lost all of my basic scientists, regardless of who the speaker was. They wouldn’t come. If I organized it at noon, nobody would come because everybody is in clinic or at lunch. If I organized it in the afternoon, then I lost the surgeons and many of the clinicians, and the basic scientists would come if I had free food for them. It was really, really a challenge to do this, and it continues to be a challenge. If you walk through the hallways and you ask random people with white coats whether they believe in translational research, they will all nod, and they will agree with the concept, even though each of them will define translational research differently. But when you ask them, okay, “How are you cooperating with people who are not in your narrow area of interest?” you will still get a lot of answers of, “I'm not.” And I think that’s part of what is holding us back. But I'm not trying to point fingers, because there are many other systemic issues within this institution and other institutions that perpetuate that.
Gabriel Hortobagyi, MD:
There is no incentive for the basic scientists to “waste their time” talking to dumb clinicians, and there is no incentive for the clinicians—who are increasingly being asked to see more and more patients and generate more income—to spend time trying to understand stuff that is not going to be of immediate application to what their major responsibilities are. It’s a difficult problem, but we need to get over that, and certainly President [Ronald A.] DePinho has been making the right noises, although not necessarily the right moves, to make this happen. I think he does believe that this is important, but since he has never been on the clinical side, he doesn’t quite understand what it takes to do that from this side. I think he understands it better from the laboratory research side.
Recommended Citation
Hortobagyi, Gabriel N. MD and Rosolowski, Tacey A. PhD, "Chapter 13: The Breast Cancer Research Group –Bringing Together Clinicians and Basic Scientists" (2013). Interview Chapters. 1118.
https://openworks.mdanderson.org/mchv_interviewchapters/1118
Conditions Governing Access
Open
