Chapter 06: Shifting Research Focus from the Host to the Tumor
Files
Loading...
Description
In this Chapter Dr. Pollock gives an overview of the types of studies he has conducted. In response to a question from the interviewer, he begins with his first paper, published with his psychiatrist father in 1974, on the connection between the Cretan myth of the Minotaur and modern bullfighting. He then explains that after working on surgical stress and natural killer cells, he received a FIRST Award (First Independent Research Support & Transition Award) to shift his focus to the molecular biology of sarcoma. He notes that Dr. Josh Fidler and Dr. Garth Nicholson were both instrumental in shaping his thinking in this new research area. He also observes that renewed interest is growing in natural killer cells, and his early papers are being cited again. He insists, however, that the main contribution he has made has been in following a career path that can serve as “a template” for other young surgeons who wish to become surgeon-scientists; he has also provided leadership in his administrative roles to support new scientists. Dr. Pollock explains his belief that researchers also have a responsibility to address problems of technique that arise in the operating room. For ten years he has been involved in refining how sarcomas are staged (how their features are described and how scientists think about them). He notes that in collaboration with three investigators from other institutions, he has received a SPORE grant for sarcoma, the largest award ever granted. At the end of this Chapter, Dr. Pollock underscores how important collaboration is to surgical oncology and talks about how he interviews fellows to determine their willingness to collaborate.
Identifier
PollokRE_01_20121008-C06
Publication Date
10-8-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Raphael Pollock, MD, Oral History Interview, October 08, 2012
Topics Covered
The Interview Subject's Story - The ResearcherThe Researcher Personal Background Professional Path Professional Practice The Professional at Work Overview Definitions, Explanations, Translations The Leader Leadership Professional Values, Ethics, Purpose Understanding Cancer, the History of Science, Cancer Research Discovery and Success
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:
We’re okay. I was hoping to ask you to go into a bit more detail about the various areas that you’ve done research in, because there have been a number of them. And I also just had to mention that first paper on bullfighting and psychology. I was wondering what that— That was a 1974 paper, I think.
Raphael Pollock, MD:
It was 1974, but it was actually something that I did with my father.
Tacey Ann Rosolowski, PhD:
Oh, was it really?
Raphael Pollock, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
And tell me about that.
Raphael Pollock, MD:
My father was a Freudian psychoanalyst. Through him, I learned some things about psychoanalysis, at least to the extent a high school kid could absorb it. And it seemed to me that the old Cretan myth of the Minotaur—there were some elements in that that were very similar to the types of father/son struggles that take place if you let the bull be the symbol of the father and it was Zeus’ creature and so— And so the thought was is there some type of a—if not historical, then maybe historical and psychological—connection between modern-day bullfighting and the Minotaur games, which actually were games? They were called bull jumpers, who would grab the horns and be flipped over the bulls. It wasn’t just winding your way back through the maze. This was actually part of a process. The tribute was these young Athenians who would be sent to Crete every year, and if they survived that game, then they would be able to live. If they didn’t, then they would die. So how does this all tie together? So that paper was about that. And I wrote it with my father. It never got published while I was in high school, but it got published while I was in college.
Tacey Ann Rosolowski, PhD:
That must have been exciting.
Raphael Pollock, MD:
It was. It was the first time I’d ever seen my name in print, which was kind of fun—getting reprint requests. It was kind of neat, yeah. But it was not something that I pursued further. The two major thrusts of my research have been the whole surgical stress NK cell story, and then more recently—and when I say more recently, the past twenty years—I switched from the host immune side of the equation to the tumor side of the equation. Like everything, there’s a story behind that as well. I finished my PhD with Eva. I became promoted to associate professor. The closest, at that point, that I had ever come to leaving Anderson, I was offered the position to serve as the first chief of surgical oncology at Mass General. I was not certain that that would have been the right career move, although I was very, very intrigued. I made three visits. It was a very generous offer. I got mixed and confusing messages when I spoke to extra institutional mentors of mine, prominent people in American surgery, some of whom said, “Absolutely. Go for it.” Others said, “If you’re interested in sarcoma and research with sarcoma, stay where you are.” Ultimately I chose to. Part of that was facilitate by a very, very modest relative to the package that MGH was offering—a very modest retention package which enabled me to shift gears. The grant beyond the K Award at that time was an NIH grant that was called a FIRST Award. I don’t remember what the acronym stands for, but it was the equivalent of a FIRST R01 grant. I used that five-year grant to transition from studying NK cells to studying sarcoma molecular biology. So part of my retention when I turned down the MGH offer was the opportunity to spend six months in any research lab at MD Anderson.
Tacey Ann Rosolowski, PhD:
So that’s the sabbatical in 1992?
Raphael Pollock, MD:
That’s the sabbatical. Yeah. I had to see my own patients. I didn’t see new patients. I just had to see my return patients in the clinic, and the other six months was available for me to go into someone’s lab. A person that I really like very, very much was Mien-Chie Hung. What he was interested in overlapped what I was interested in, and he was very gracious about letting me come into his laboratory and start these sets of experiments.
Tacey Ann Rosolowski, PhD:
Let me ask you why is it that your focus shifted as it did from, as you said, the host side to the tumor side?
Raphael Pollock, MD:
One of the things that happened—this was—I’d already finished my PhD. I had defended it. I was now several years out from that in the early 1990s. Around the time that Mass General was trying to recruit me, I had the opportunity to present my NK cell work at a research seminar in [Isaiah] Josh Fidler’s [Oral History Interview] department. I presented the work, and Josh was extremely critical of it, which was probably the healthiest thing because he really challenged me on some issues, some of which I couldn’t answer with the constructs that I was working with. The NK cells were simply so rare within the circulating blood stream that patients who had sarcomas who, by and large, received chemotherapy prior to surgery, it was very hard to get enough NK cells out of those patients through blood draws to be able to actually study them. One of the people who had been on my candidacy committee, which is the group that gives you the oral exam before you start your dissertation, had been Garth Nicholson. Garth had been very, very critical of what I was doing. He said, “You’re processing these cells. They go through all of these different sorting processes and centrifugations. How do you even know that these cells are going to kill the way they normally do?” Which is a perfectly legitimate question. So another bold move—after I passed my candidacy exams and I had to assemble my dissertation committee, I went to Garth and I said, “I really appreciate all your help, but I’m not including you in my dissertation committee.” He said, “You mean you’re firing me from your program?” I said, “Well, you can call it that, I suppose.” And he said, “All right. That’s fine.” And then two years later, when I gave the seminar at the Smith Building and he was there also, and I drove back with him, and he said, “So, what did you think?” I said, “I’m really confused because I’m at an impasse and I’m looking at this job elsewhere.” He said, “Why don’t you come and talk to me.” So I came and talked to him, and in spite of all the problems that he had later on, I can tell you that at the time he was very intact and an excellent mentor. He was the one who said, “Look, you’ve been working on the immune effector cell side of the equation all this time. Why don’t you switch over and look at the tumor side? You’ve got this sabbatical. Why don’t you come into one of my labs here?” So he was the one who arranged for me to go work with Mien-Chie, and that sent me off on a totally different pattern. It was a productive period of time in Mien-Chie’s lab. A year later, or two years later, I became chair of the department, and one of the people that we recruited was Dihua Yu, with whom I enjoyed a very good working relationship for more than a decade. An R01 that was competitively renewed came out of that, and we were able to launch a program.
Tacey Ann Rosolowski, PhD:
It’s just such a special time, where immunology and virology and all these new fields that were evolving and presenting new territories for people to investigate.
Raphael Pollock, MD:
And it was so exciting.
Tacey Ann Rosolowski, PhD:
Were you aware of that from very beginning?
Raphael Pollock, MD:
Oh, yeah. No, that was part of my proposal to—because I had to justify why I was going into someone’s lab, and I’d written a twenty-page proposal about the fact that molecular biology of sarcoma was totally unknown. And that was one of the other problems. I was studying NK cells, and I was emerging as someone who wanted to focus on sarcoma. I asked the question, do NK cells kill autologous same-patient sarcoma? And the answer is they just sort of pass like ships in the night. So that was part of the additional piece of this dilemma. The work wasn’t going where I wanted it to, I was being recruited elsewhere, I wasn’t certain of the scientific direction, and Garth really helped me in a series of conversations. And he wasn’t judgmental. He didn’t put me down or anything. He said, “This is what people who think critically go through. You’ll have at least one or two more of these in your career.” He was right.
Tacey Ann Rosolowski, PhD:
So that’s just part of the whole scientific process—to begin something and then kind of work it through to its conclusion.
Raphael Pollock, MD:
Or as far as you can take it at the time.
Tacey Ann Rosolowski, PhD:
And then flail around a little bit while you’re figuring the next direction.
Raphael Pollock, MD:
Yeah. And ironically, NK cells have now come back in a very big way. I’m now having the chance to look at some of the literature, just because I’ve continued to follow it, and see my papers from the late 1980s being cited by people who are two and three generations downstream. It’s kind of fun.
Tacey Ann Rosolowski, PhD:
How are your findings being integrated? What’s the new science that they’re being integrated into?
Raphael Pollock, MD:
Well, people are still concerned about this whole issue of surgical stress impairment of perioperative immunity, and people are interested in looking at NK cells. They can now be cultured in ways that they couldn’t before. They can be propagated so you can get the cells that I couldn’t get, and, of course, the molecular biology and immune-triggering mechanisms—that was all speculative and has now been very well established, so there’s very good stuff. I’m not, in all likelihood, going to go back and do more research in that area, but it’s very gratifying to see something come full circle that I once was active in. To get a small measure of attribution out of it feels nice too.
Tacey Ann Rosolowski, PhD:
What do you feel were your contributing conclusions from that period of your work?
Raphael Pollock, MD:
Well, I think that one of the things—less the conclusions. We found we were able to establish mechanisms in murine models, but it was less that and more the conception that you could be a very good clinical surgeon if you would focus on a single disease, and if you were interested in the laboratory, you could cull those two things. So my career, in some ways, became a template that enabled a number of other younger surgeons to follow the same pathway, which is what has happened. And in the end of ’93, when I became chair of the Department of Surgical Oncology, everyone understood that we were going to try very hard to create an environment that a variety of different types of academic surgeons could thrive in including surgeons who had laboratory research interests. There have been easily a dozen people who have subsequently gone on just within that department alone to compete for NIH funding. If you look at the Division of Surgery as a whole, which I became division head in ’97, we’re now the fourth best funded surgery department in the entire United States in terms of total NIH dollars and the only one in the top fifty that’s not a medical school. I don’t take credit for that. It’s a wonderful group of people that surround me and are a part of that process, but, on the other hand, we worked very hard to establish the ability to have that type of a career trajectory here. I will take credit for having provided a measure—not the measure but a measure—of leadership around that issue.
Tacey Ann Rosolowski, PhD:
Yeah, we’ll come back to that. It’s interesting how that challenge of providing the right kind of environment for the physician-scientist is so challenging, particularly given the time pressures, the stresses, demands on time right now.
Raphael Pollock, MD:
So it was less the specifics of what I learned and more the pattern of what I learned and how that could be a template to benefit others that I would say would be—in an ultimate sense—what I got out of that.
Tacey Ann Rosolowski, PhD:
There is also— I made a list of some of the areas that, as I was scanning through the papers that you’ve published—and I just wondered if you could comment on the degree to which you—how important that line of research was. You did some work on surgical techniques too, didn’t you? There was free tissue transfer salvage. I have no idea what free tissue transfer salvage is.
Raphael Pollock, MD:
Well, those were—we’ve had a series of clinical papers through the years that are more focusing on problems or questions that we encountered in the operating room. I’ve always maintained that if you’re going to be in an academic, particularly surgical oncology, environment, use the patient as your textbook to point you to questions that need answering. Then all you have to do is figure out what’s the best way to answer it. Some of these need to be answered in the research laboratory, some of them need to be answered by clinical research approaches. We’ve always had an interest in trying to be as ecumenical as possible in thinking about questions and thinking about how they might best be answered. So, as you look through my CV, you’ll see interspersed every so often a paper on something that doesn’t look like it relates to anything else and it really doesn’t.
Tacey Ann Rosolowski, PhD:
Oh, well, I wasn’t actually thinking of it that way. I just thought there looked like a kind of—maybe not a 50/50 balance but a kind of rounding out, if you will, between questions about mechanisms and then questions about techniques. So you sort of addressed that in your philosophy of how someone ought to address questions.
Raphael Pollock, MD:
Yeah, I think so. And some of the papers I just haven’t had time to ask and answer the question myself, but if the question had validity, I tried to give the project to someone else to run with who may find that they can push it to the point where I couldn’t myself. I’m delighted about that.
Tacey Ann Rosolowski, PhD:
So what are some of the questions that you’ve taken up in the more technical clinical area?
Raphael Pollock, MD:
Well, the whole question of soft-tissue sarcoma staging has been something. I chair the AJCC Sarcoma Staging Committee.
Tacey Ann Rosolowski, PhD:
And what does that mean exactly?
Raphael Pollock, MD:
The American Joint Committee for Cancer Control. Staging means how we describe tumors on the basis of biological and clinical and pathological properties. And so we’ve had an opportunity working—gosh, it’s almost ten years now—to help refine how we think about sarcomas as tumors, and this has provided a platform for us to develop a number of clinical research proposals and papers, working with younger faculty members and fellows to try to think about how best to describe sarcomas so that we can compare results across institutions or within a similar institution across time.
Tacey Ann Rosolowski, PhD:
What are some of the challenges? You said you’ve been working for ten years, so you’ve got a problem to crack there that’s been taking some time.
Raphael Pollock, MD:
Getting good data, because it’s so rare. Getting sufficiently powered data is always an issue. So for example, we have a paper right now that is looking at developing a new staging process for a type of sarcoma called retroperitoneal sarcoma. This is tumors in the retroperitoneum, which is a specific anatomic compartment. There are about 600 a year in the entire United States, so it’s very, very rare. This manuscript, which is currently in review, makes use of the pooled data from MD Anderson, Sloan-Kettering, UCLA, and the National Cancer Institute of Italy in Milano, all four of which have extensive experience with this disease. So providing leadership to bring the senior people from those four institutions together around this issue is part of that. In terms of the laboratory focus, we recently were awarded a sarcoma SPORE grant that, in its aggregate, is the largest amount of funding ever offered by the National Cancer Institute to support sarcoma research. That’s a research collaboration involving MD Anderson, University of Michigan, the Harvard cancer centers, Stanford, and Columbia, where I serve as the principle investigator. So it’s a coalition of about fourteen investigators from those institutions. So I guess part of what I would say is a theme also is trying to make it clear to younger surgeons how important collaboration is in laboratory research. You can’t do it yourself, the science is way too sophisticated, and if you try to do it yourself you’re not going to get very far. Benjamin Franklin says, “A man wrapped up in himself makes for a very small package,” and there’s a lot to be said for that. So that’s been one of the themes as well. And, in some ways, to give younger people permission to work with others. These kids, it’s been very insular for so long. “Gotta get an A in Organic Chemistry.” You look at the other people as your competition, but there comes a point where the lines decussate. They are no longer your competition. These are not only your peers—and no matter how smart you are, some of them are going to be smarter than you—but the people you’ve got to work with in order to make any progress. If you want the satisfaction of making progress, you’ve got to work with them. It all fits together that way. Those are important lessons.
Tacey Ann Rosolowski, PhD:
Do you find that when students come—fellows come—that you kind of have to undo some of the culture that they’ve experienced? Do they bring a mindset that—?
Raphael Pollock, MD:
Occasionally, but we’ve tried to select—at least at the level of the fellowship—we’ve tried to select people who are very ego secure and already understand that value. There’s ways that you can tease that out in an interview process.
Tacey Ann Rosolowski, PhD:
How would you do that in an interview process?
Raphael Pollock, MD:
Oh, I’d just ask someone, “Tell me about a project that you’ve recently completed,” and see if it’s solo or involved other people. And if it’s solo, ask them, “Do you think you might have been more effective or something positive might have come had such-and-such—had you recruited this type of person to work with you?” The ones that say, “Didn’t need them,” we say, “Bye-bye.” (laughs) Because you want people who are flexible.
Tacey Ann Rosolowski, PhD:
Well, I noticed as I was reading some of the background materials you have a small paper that you wrote on training programs for people in surgical oncology. I noticed that you had mentioned teaching communication skills and teaching team skills. And that’s something that you don’t automatically think of as being on the roster of subjects for surgeons, so it’s interesting to see. It is a totally different kind of skill set.
Raphael Pollock, MD:
Right. But part of it is not only giving people permission who may not have thought about these things—permission to participate in that—but to help them understand it’s not only necessary, but you’re going to actually enjoy this. This is much more fun. You’re trying to find people who understand the value of team sports rather than people who revel in the loneliness of the long-distance runner. There’s room for long-distance runners as well, but we’re looking for team players, because it’s going to take all of us working together to beat this.
Tacey Ann Rosolowski, PhD:
We’re almost at noon. Would you like to finish up for today and we’ll resume on Wednesday?
Raphael Pollock, MD:
That’d be great.
Tacey Ann Rosolowski, PhD:
So I’m turning off the recorder at about 11:57. (End of Audio Session 1)
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter 06: Shifting Research Focus from the Host to the Tumor" (2012). Interview Chapters. 1318.
https://openworks.mdanderson.org/mchv_interviewchapters/1318
Conditions Governing Access
Open
