Chapter 09: The Chiefs of Pediatrics at MD Anderson
Files
Description
At the beginning of this chapter, Dr. Jaffe explains that when he began as Chief of the Solid Tumors section, he had responsibility for musculoskeletal tumors, Wilm’s tumors and a number of others, including neuroblastoma, which he eventually ceded to a colleague. As a leader, he notes, he believes that “if you are doing a good job, continue,” and he is very proud that the Solid Tumor section “ran like a well-oiled machine.”
Dr. Jaffe then describes the sequence of Chiefs of Pediatrics, beginning with the first chief, Grant Taylor, who developed a comprehensive pediatric department, focusing on clinical initiatives and benchwork. He continued to check in on the progress of the Department after he retired and Dr. Jordan (Dan) Wilbur took over. Dr. Jordan is known for the VAC (vincristine, actinomycin, cyclophosphamide) chemotherapy protocol for soft tumors in children that has not changed in the past forty years. Dr. Jan Van Eys took over from Dr. Wilbur and brought a different outlook. This was when Dr. Jaffe was recruited: Dr. Van Eys enhanced the solid tumor section. He also focused on the psychosocial and religious aspects of patient care. He believed religion was a major mechanism of support for patients. Dr. Pat Sullivan was Chief for one year, then Dr. Ka Wa Chan served as interim director for 5 years, until Dr. Archie Bleyer took over and attempted to change the department in ways that Dr. Jaffe feels were not well received. Dr. Eugenie S. Kleinerman then assumed the position of Chief of Pediatrics and enhanced investigation of sarcoma. Dr. Jaffe notes Dr. Kleinerman’s laissez-faire approach toward department members who are performing well. He then talks about the areas in which the Department of Pediatrics has made particular contributions to pediatric oncology, going into particular detail about value of conventional therapeutic therapies and the rapid, intra-arterial deliver of chemotherapy developed by the Department.
Identifier
JaffeN_02_20120817_C09
Publication Date
8-17-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional Unit, Program; MD Anderson Past; The Administrator; Institutional Politics; MD Anderson and Government; Critical Perspectives on MD Anderson
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:
Would you like to continue with that story, or would you like to continue with the department?
Norman Jaffe, MD :
I think we can return now to the department. I was recruited in 1978, as I say, by Dr. van Eys, but at the instigation of Dr. Sutow. And once I had come over here, then I concentrated on two particular aspects—solid tumors in children and the long-term survivor clinic. With respect to the solid tumors, I was entirely in charge of the musculoskeletal tumors, that is, all the bone tumors and all the muscular tumors, also rhabdomyosarcoma, synovial sarcoma and the like. In addition, I had done a fair amount of work in Wilms’ tumor, tumor of the kidneys, so that was given to me as well. I did a little bit of work on neuroblastoma, but Dr. Ayten Cangir, who was responsible for neuroblastoma, was doing a particularly good job, and as head of the solid tumors, I thought it was important for her to maintain her interest and possibly also promote its further development. She was also interested in brain tumors together with Dr. van Eys. I had one policy at that particular time. If you’re doing a good job, continue. I think the common expression is “If it ain’t broke, don’t fix it,” so I didn’t fix it. I encouraged them. I supported them. I did whatever I could to ensure that there would be further development and expansion, and I think it really came through. The solid tumor section actually was running like a well-oiled machine. I was quite proud of it, and that, incidentally, remained so until Dr. Archie Bleyer came over here, and we can discuss the development and appointments of the new chiefs in the course of time. But Dr. Bleyer felt that he would like to make new changes in the Department of Pediatrics, and he released me from my self-imposed obligations, really, in the musculoskeletal tumors and told me to concentrate particularly and only, for that matter, on the bone tumors and not on the muscular tumors. He did permit me to continue working on Wilms’ tumor.
Tacey Ann Rosolowski, PhD:
And about what year was this that you shifted focus?
Norman Jaffe, MD :
I think Dr. Bleyer came here in 1996. I’m not sure of the exact time, but let me give you the sequence of events now of the chiefs who came here in Pediatrics and that will show you how the Department of Pediatrics developed. In fact, we can trace the development of the Department of Pediatrics to the first person who was appointed as the chief of Pediatrics, and that was Grant Taylor. That was many years ago. I was not here, but I was told that he was the first chief, and I met Grant Taylor on a number of occasions. I think I may have said this before, but Grant Taylor retired [and] Dr. Dan Wilbur was appointed the chief. Well, he was appointed the chief when Dr. Grant Taylor retired, and subsequently, Dr. Grant Taylor still came to the MD Anderson Cancer Center to see about its progress, its development. In fact, it was his little baby. He was always dressed in a suit, and he was very conscious of environmental factors. I may have mentioned this to you, but he eventually came to the decision that all the Coca-Cola cans and cans of this nature were in fact going to waste, so he used to go around every night and collect the Coca-Cola cans in a plastic bag and hang it over his shoulder, and once when my wife came to visit me to take me home she said, “You have a wonderful institution. Even the janitor wears a suit.” I thought that was very good and very clever. But he was the first chief.
Tacey Ann Rosolowski, PhD:
What was his vision for pediatrics, as you understand it?
Norman Jaffe, MD :
To develop a complete and comprehensive pediatric department which would encompass not only clinical work but also bench work, research work, and the like. He never quite achieved the bench work, but he did develop a pediatric clinical setup, and that was due entirely to two people, and those two people were Dr. Wataru Sutow, whom he recruited, and Dr. Margaret Patricia Sullivan, who we used to call Pat. It was Wataru Sutow and Pat Sullivan who were responsible for the further development of the pediatric department once it had been developed by Dr. Grant Taylor. When Grant Taylor retired, I don’t know what the circumstances were, but Dan Wilbur --Jordan Wilbur-- was recruited as the head of Pediatrics. His name was Jordan, but we called him Dan, and he did some remarkable work. He developed what was known as the VAC chemotherapy for soft tissue sarcomas in children. VAC compromises three agents: vincristine, actinomycin D and cyclophosphamide. VAC is an acronym for vincristine, actinomycin D, and cyclophosphamide, and that has had a major impact on the treatment of the soft tissue sarcomas in children, and it [also] has not changed over the past forty years. It has been added and modified, but it still remains the cornerstone of treatment. I don’t know how long Dan Wilbur was the chief, but when he retired and moved to San Francisco, Dr. Jan van Eys was then appointed Chief of Pediatrics. Jan van Eys had a different outlook for it. While he maintained what had been developed in the past and he wished to enhance certain aspects of pediatrics, namely the solid tumor sections in which he appointed me the chief of solid tumors, he concentrated a lot on the psychosocial aspects of patients and also on the religious aspects of patients. He was quite a religious man and used to get our department involved quite frequently in discussing religious matters and so on and so forth, and I think he used religion as a major mechanism of support for patients who were afflicted with cancer. I think it had a very, very profound influence on the patients and supported them. He was the chief of pediatrics for quite some time, and I worked under him for as long as he was here. I think it must have been about fifteen years.
Tacey Ann Rosolowski, PhD:
May I ask you how to you spell his last name?
Norman Jaffe, MD :
It’s actually Dutch, so it’s V-A-N, and then it’s E-Y-S. The van is a small v, V-A-N and E-Y-S. He spoke Dutch. I spoke Afrikaans. We would often converse in that particular language. It’s not the same, but there is a very close relationship and kinship, so much so I would say to you that when the prime minister of South Africa, a great man, Jan Smuts, who was responsible for an important document in the League of Nations in World War I, creating the concept of equality for all nations—when Jan Smuts, the prime minister, visited Holland and spoke to Queen Juliana, he spoke in Afrikaans, and she spoke in Dutch, and they could both understand each other very well. I don’t say that I was Jan Smuts and van Eys was Queen Juliana, but we used to speak Afrikaans and Dutch.
Tacey Ann Rosolowski, PhD:
It probably offered you a little bit of a home there for the moment.
Norman Jaffe, MD :
It did to some extent. We got on extremely well. There was no problem there. But eventually Dr. van Eys, I think, wanted to become head of a department of pediatrics, not just head of a cancer department, so he took over the head of the Department of Pediatrics at the Hermann Hospital in the University of Texas system at Hermann, and when he moved over Pat Sullivan was appointed Chief of Pediatrics. She held that position for approximately a year, and then she resigned or retired. I think she retired, and we were waiting for a new chief to be appointed, and during that interim period Dr. Chan, his name was Ka Wah Chan—C-H-A-N, K-A and W-A-H, two separate words, Ka Wah Chan—was appointed interim chief, pending the appointment of a permanent chief. He held that position for about five years and was quite competent in it, but at the end of it, as he explained to me, he was tired, and he felt that he wanted to resign, which he did.
Tacey Ann Rosolowski, PhD:
Was it unusual to have an interim chief for so long? Norman Jaffe, MD Yes, it was, because they couldn’t find anyone. Eventually they appointed Dr. Archie Bleyer as head of pediatrics. I think that could have been in 1995, and he probably accepted that position for eight to ten years, and then eventually he resigned, and Dr. Eugenie Kleinerman was appointed chief, and she’s held that position to this day.
Tacey Ann Rosolowski, PhD:
What did Dr. Bleyer bring to the department, his perspective and goal?
Norman Jaffe, MD :
He tried to change certain aspects. I must tell you that it was not entirely well received. He had major problems here, and people didn’t quite accept him as he had hoped that he would be accepted because of his attempt to change things.
Tacey Ann Rosolowski, PhD:
What did he try?
Norman Jaffe, MD :
For instance, let me give you my own example. He indicated to me that he felt as the chief of the solid tumors I had accepted too much, and therefore I should relinquish my responsibilities in the soft tissue sarcomas entirely to Dr. Beverly Raney. He brought Dr. Beverly Raney into the department as his assistant head of the department. That lasted one year, and Dr. Raney was demoted. And he enticed Dr. David Tubergen to come to the department. He accepted the position, and he became the head of leukemia in this department. That lasted—I don’t know—three or four years until Dr. Tubergen retired from that position. He also changed our relationship with the entire pediatric setup in the United States. There were two major cooperative groups in the United States. There was the Children’s Cancer Group and the Pediatric Oncology Group, and we were initially a part of the Pediatric [Oncology] Group. Dr. Bleyer was head of the Children’s Cancer Group, so he severed our relationship with our group and joined the MD Anderson Cancer Department with his group.
Tacey Ann Rosolowski, PhD:
With the Pediatric Cancer Group.
Norman Jaffe, MD :
And both groups eventually merged, and it is now known as the Pediatric Oncology Group. There was a little bit of resentment of that because we were loyal to the original group. Anyway, a lot of problems, and I think resentment did eventually occur to the extent that Dr. Bleyer felt he would be better off if he retired, which is what he did, and then Dr. Kleinerman took over.
Tacey Ann Rosolowski, PhD:
Did he leave a mark in any other way? You’ve talked about some upheavals that kind of got created. Were there some positive stamps he put on the department?
Norman Jaffe, MD :
I don’t think so.
Tacey Ann Rosolowski, PhD:
That’s an unfortunate period of time in the department’s history. And so when Dr. Kleinerman took over, what did she bring to the department?
Norman Jaffe, MD :
She enhanced the investigative aspects of osteosarcoma. While she’s a clinician and an investigator, her efforts now concentrated more on the investigative and bench work in pediatric oncology. She was a good clinician and worked with me. In fact, her interest in osteosarcoma developed as a result of our collaboration. She used to come at least once a week to my rounds and so on and so forth, and I invited her to give talks to our fellows during that particular period once a week as well, and those talks were well received. She did very well from that point of view, and she acquired several patients whom she addressed and tended to and things of that nature. I think that she acquitted herself well in that particular aspect, and I think she was better received than Dr. Bleyer, and so much so that she’s remained in that position even today.
Tacey Ann Rosolowski, PhD:
It sounds like she probably had a different leadership style.
Norman Jaffe, MD :
A different focus. That’s correct.
Tacey Ann Rosolowski, PhD:
How would you characterize her style vis-à-vis Dr. Bleyer?
Norman Jaffe, MD :
While I was there—I don’t know what’s happened since I’ve been retired for the past six years—but while I was there she let people continue in the manner in which they were doing because it was similar to mine, really. If you’re doing a good job, carry on. I’m happy to provide some interests and suggestions and guidance and so on if you feel it is required, and I’d like you to talk to me about these things, and meanwhile, if you’re doing a good job, carry on. That was the setup over there, and I don’t know what has happened since my retirement, but as far as I can see, the department has developed quite nicely, and that’s the situation today [Redacted]
Tacey Ann Rosolowski, PhD:
Wow, that’s a lot to go through.
Norman Jaffe, MD :
As far as I know, everything is in order. That’s the setup with Dr. Kleinerman, and those are the number of chiefs we’ve had in the department. I numbered them out the other day, and there were a total of seven to date.
Tacey Ann Rosolowski, PhD:
When you look at the entire scene of the department’s development, what are the big points of evolution that you see—the big themes?
Norman Jaffe, MD :
We’ve advanced in major respects in the solid tumors because we have published important articles on the treatment of osteosarcoma, both from the biochemical point of view with Dr. Kleinerman’s MTP-PE and also with the conventional forms of chemotherapy. We’ve also developed the concept of solid tumors because of our ability to destroy the primary tumor with intra-arterial platinum and also now with combination chemotherapy.
Tacey Ann Rosolowski, PhD:
How does that develop the concept of the solid tumor? I mean, I was listening to your phrasing. You said you’ve developed the concept of the solid tumor. Did I understand you correctly?
Norman Jaffe, MD :
It’s the concept of continuing and implementing limb salvage procedures. Limb salvage is not new. It has been done before, but it could not be maintained because of local recurrences developing at the site. With the administration of effective chemotherapy, the incidence of local recurrence was tremendously diminished. It’s not entirely eliminated, but it has diminished to the extent that now at least 80 percent of patients, instead of undergoing amputation, undergo limb salvage. We save their limbs.
Tacey Ann Rosolowski, PhD:
Now, let me understand how that works. When you discover the— There’s an initial tumor, and then it’s treated.
Norman Jaffe, MD :
Then we treat it with chemotherapy. Originally we used to use intra-arterial platinum. Unfortunately, intra-arterial platinum, while extremely good, is labor intensive. It requires a lot of work. It requires an anesthesiologist for doing conscious sedation. It requires the radiology suite to be dedicated to that particular individual for the morning and things of that nature. It’s not often and not commonly used [now], but it is used in certain circumstances when you need a rapid, definitive attack on the tumor, when you need a rapid answer for certain things and things of that nature. Now we’ve switched back to what is known as the conventional combination chemotherapy, which gives you more or less the same result as intra-arterial platinum, but the time taken to get that result is more prolonged. It may take you approximately three to four weeks, whereas with intra-arterial platinum you’ll get your answer within a few days.
Tacey Ann Rosolowski, PhD:
When do these recurrences emerge?
Norman Jaffe, MD :
In the course of treatment.
Tacey Ann Rosolowski, PhD:
So it’s very rapid.
Norman Jaffe, MD :
In about six to nine months you’ll see a recurrence. It is a different tactic that one employs with intra-arterial as opposed to intravenous, but because it’s so labor intensive, it’s more involved, and because it is also economically difficult to maintain, people have resorted now to the conventional form of treatment, whereas intra-arterial—although we used intra-arterial quite extensively during my tenure at this time.
Tacey Ann Rosolowski, PhD:
What is the difference for the patients? Because your patients are very tiny people. Is one of those easier for the patient to bear?
Norman Jaffe, MD :
Yes, I think that the intra-arterial is more difficult.
Tacey Ann Rosolowski, PhD:
Really? Why?
Norman Jaffe, MD :
You have to pierce the artery. You have to do the administration under conscious sedation. You have to keep the patient quiet for twenty-four hours and things of that nature, whereas with the intravenous form it’s done in the hospital ward. The patient has regular chemotherapy like every other patient and things of that nature. There is a tremendous difference, but the major difference between intra-arterial and conventional chemotherapy is that the intra-arterial is very rapid in terms of achieving a response.
Recommended Citation
Jaffe, Norman and Rosolowski, Tacey A. PhD, "Chapter 09: The Chiefs of Pediatrics at MD Anderson" (2012). Interview Chapters. 1147.
https://openworks.mdanderson.org/mchv_interviewchapters/1147
Conditions Governing Access
Redacted
