
Chapter 16: Associate Head for Clinical Research in Leukemia; The Global Research Foundation
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Description
Dr. Keating begins this chapter by explaining that he left his role with Clinical Investigations because the Leukemia group needed more leadership and he disagreed with the new emphasis Dr. David Hone was placing on randomized trials. He wanted a more inventive way of doing things and accepted the role of Associate Head for Clinical Research in Leukemia (1995−1999). He sketches his leadership principles of allowing individuals free rein and lists the areas in which he had an impact of research, providing a “more free-flowing environment” for research innovation. Dr. Keating expresses his dissatisfaction with following rules: he tells a story about a patient running into difficulties with getting information about clinical trials and notes that it demonstrates how excessive adherence to rules “betrays the intelligence of the institution.”
Dr. Keating next discusses how he set up the CLL Group, hiring Susan Lerner as research coordinator. He explains how effective she was at creating a humane work environment. He then goes talks about a group he founded about a decade ago, The CLL Global Research Foundation, which awards about three million dollars yearly in research grants. He explains that the money comes from former patients and that he is a “schmoozer” who offers a good product. He describes the unusual environment of transparency at the bi-annual meetings when the researchers share their research and results.
Identifier
KeatingM_01_20140520_C16
Publication Date
5-20-2014
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Administrator; The Administrator; Character, Values, Beliefs, Talents; Professional Values, Ethics, Purpose; Building/Transforming the Institution; Critical Perspectives on MD Anderson; Beyond the Institution; On Research and Researchers
Transcript
Tacey Ann Rosolowski, PhD:
(laughs) Well, the next big appointment you had was right after that associate vice president role, associate head for clinical research in leukemia, if I’m getting that correct.
Michael Keating, MD:
Mm-hmm.
Tacey Ann Rosolowski, PhD:
And that was ’95 to ’99. So tell me about that. Why did you leave the VP for patient care and take on this new role?
Michael Keating, MD:
I think it was that I felt that I’d accomplished most of what I wanted to do, and I wanted to get back. I was getting more and more involved in the clinical research in CLL, and I thought that we needed more leadership in that environment, in the leukemias. So it was an opportunity to get more involved in that. And I think it was at a point where Dr. Cox was replaced by Dr. Hohn, and he had a very different philosophy, and the philosophy was that you had to do these randomized trials, and if you were trying to prove something, you would have patients not accessible to something else. And I just disagreed with his philosophy, so that it was time to go back to home base with a more inventive way to go about doing it. And we had a number of very bright people that were coming along that had the likelihood on making an impact on different tumors. Dr. Kantarjian was one of them and Dr. Eli Estey was another, and Dr. Cortes subsequently came along. So these were all people that needed to have an area to grow. And I’ve always believed that you don’t control people. You facilitate them, you assist them, you challenge them, etc., but you don’t tell them what to do. And they are all things I’d learned from Dr. Freireich. He gave people free rein, and as long as they didn’t do anything crazy and they were succeeding, they would be able to enrich their activities. So that it was an exciting time in a lot of the blood cancers, and I decided that I was a good fit for it.
Tacey Ann Rosolowski, PhD:
What do you feel that you accomplished during those four years?
Michael Keating, MD:
I think I brought a lot of the structures that had been developed from the databases to get expectations so that there was always this concept of an observed outcome versus an expected outcome from our historical data, so that you would get ideas after ten to twenty patients as to whether you were exceeding expectations or not, and so that if you weren’t exceeding them, you would then move on to something else. And it was also a sense that there was a way to define unmet medical needs, because by then we’d set up a database for all the different leukemias so that you could find out the characteristics that were associated with very bad outcomes that we didn’t have any effective treatment for. So they were the ones that we would do more inventive ways and trying to see if something different happened.
Tacey Ann Rosolowski, PhD:
Was this a matter of kind of working with the culture of the department?
Michael Keating, MD:
Yes.
Tacey Ann Rosolowski, PhD:
Okay. Tell me about that process, because it sounds like a pretty subtle paradigm shift, if you will.
Michael Keating, MD:
Yeah, it was, and I think it’s just that at that time we were getting more and more regulated by the Division of Cancer Medicine, so that there were more and more rules that were being put in place, and they were fairly restrictive. And I thought that, well, I prefer the more free-flowing environment and I think it’s a lot more stimulating than just following the rules. You know, we’re supposed to be the number-one Cancer Center in the world, so why are we following all the rules that apply to mediocre Cancer Centers? And mediocrity never sells, so you have to provide people a different option. I got really disappointed one time when there was a patient who came, who was a friend of the Bushes, and they arranged for him to go down to see a guy in gastrointestinal oncology. I asked the guy, “How did things go?” And he said, “Oh, well, they’re very nice, but then they came in and they said, ‘Well, we have this protocol, we have that protocol, we have that protocol.’” And he said, “Well, which one do you recommend?” And they said, “Oh, they’re all about the same. You can just pick whatever one you want.” So we still have these flaws in our system that don’t betray the intelligence of the institution, so that the more that we get into this structure of fitting in with everyone else, the less effective we’re going to be. So that’s the rebel part, which has sometimes served me well. (laughter) And sometimes not, so anyway.
Tacey Ann Rosolowski, PhD:
Yeah, everybody brings their piece to an institution. I mean, as you tell stories like that, I mean, I see connections with stories that you told last time. I mean, that’s who you are. That’s your perspective, you know, the person who would say, “We had to do an N-equals-1 study sometime. We had to just try it. We would not look at the rules.”
Michael Keating, MD:
Yeah, we’d have to make something up.
Tacey Ann Rosolowski, PhD:
Right. The person who said his ADHD helped because it meant that he might think outside the box. (laughter)
Michael Keating, MD:
I think that the experience of that has served me very well in setting up the CLL group.
Tacey Ann Rosolowski, PhD:
Hmm. How so?
Michael Keating, MD:
It’s very stressful being a research nurse and going along, and the degree of documentation, etc., and the workload. And if you get it wrong, there’s a culture of being punitive at the present time, that someone gets punished if they don’t follow the rules, because you’re frightened that someone will come and chastise you. So that the culture is being set up that they have to know that they were going to be supported and if something was going wrong, it wasn’t their fault; it was my fault. So that there are people that are quite happy to bully clerical people and research faculty and research nurses and data management coordinators, etc., but it’s ultimately the responsibility of the person leading the group. So that I think as long as they know that you have their back and as long as you don’t say that, “You have to come in and do overtime and I can’t pay you for it, but you have to do it because that’s part of your job,” you can’t expect that. There was a term that Dr. Freireich used at one point; you’ve got to have a bit of fat in the system. So that there’s a bit of laxity. The person who was my research coordinator or program director was Susan Lerner. I would go to the clinic every day at around about eight o’clock, and as soon as I left, she would go and do rounds of all the people and say, “How are things?” And if someone’s mother was sick, she would find out if they needed a little extra time off and send them off and do this, etc., etc., and it was much more of a humane experience than in a lot of places at the present time. The other feature that I’m probably the most proud of is the development of the CLL Global Research Foundation, which I was encouraged to set up by a couple of my patients that donated substantial amounts of money, 100,000 here and 100,000 there. And it’s been set up in a way that we’re able to fund research anywhere around the world.
Tacey Ann Rosolowski, PhD:
When was that founded? I couldn’t—
Michael Keating, MD:
It was about—oh, I never remember dates. Probably about ten or eleven years ago. So now we give away $3 million a year in research grants, and just over half of it is to investigators here and half of it is given to other people that fill in the missing links.
Tacey Ann Rosolowski, PhD:
Interesting. And the funds are generated how?
Michael Keating, MD:
Just by my patients donate.
Tacey Ann Rosolowski, PhD:
Wow. Wow. That’s amazing. That’s an amazing vote from the patients, isn’t it.
Michael Keating, MD:
Yeah, I’m a good schmoozer. (laughter)
Tacey Ann Rosolowski, PhD:
You’re a good schmoozer.
Michael Keating, MD:
To be a good schmoozer, they have to trust you, and a lot of patients that can give large amounts of money are used to evaluating whether the product is good. People don’t get rich by being dumb, and so that they look at that, and we have a very strict financial accounting and keep our noses clean and nothing ever gets wasted. We meet twice a year, once here at Anderson and once after the European meeting in wherever it happens to be for the European hematology meeting. It’s amazing that you have twenty-five or thirty people there, and they all share their most current data without filtering it, and they trust everyone to do it, and it really creates a very energetic process.
Tacey Ann Rosolowski, PhD:
And these are the researchers who’ve been funded who share this?
Michael Keating, MD:
Yeah, yeah.
Tacey Ann Rosolowski, PhD:
Wow. That’s amazing to have that trust and transparency in such a competitive research environment these days.
Michael Keating, MD:
Yeah. And they actually end up sitting down with each other and then developing collaborations and sharing their ideas and their wisdom, and they celebrate the success of the other people, which again is a very unusual circumstance.
Recommended Citation
Keating, Michael MD and Rosolowski, Tacey A. PhD, "Chapter 16: Associate Head for Clinical Research in Leukemia; The Global Research Foundation" (2014). Interview Chapters. 1184.
https://openworks.mdanderson.org/mchv_interviewchapters/1184
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