Chapter 09: Challenges to the Division of Cancer Prevention
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Description
Dr. Levin begins this Chapter with a brief history of Dr. Charles LeMaistre’s [Oral History Interview] interest in cancer prevention. He notes that MD Anderson’s external review committee produced a white paper stating that prevention is important and should be part of a cancer center. Immediately, Dr. Levin and others began to anticipate political opposition among clinicians to any such initiative. He describes investigating what was involved and also the process by which he was identified as an interim head of the new division as three external candidates were considered for the role. Each of them turned down the position, leaving the role open for Dr. Levin. He then describes how his perspective began to shift and he saw prevention as a very significant undertaking.
Identifier
LevinB_01_20130207_C09
Publication Date
2-7-2013
City
Houston, Texas
Interview Session
Bernard Levin, MD, Oral History Interview, February 07, 2013
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionThe Administrator MD Anderson History Institutional Mission and Values MD Anderson Culture Building/Transforming the Institution Multi-disciplinary Approaches Growth and/or Change Obstacles, Challenges Controversy Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care Evolution of Career Professional Values, Ethics, Purpose
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:
When we left off this morning, you were starting to talk about establishing the cancer prevention program at MD Anderson. So I wanted to ask you, did you want to continue with that cliff hanger? Because there are also the many dimensions of your own research that we haven’t covered. So what’s your choice?
Bernard Levin, MD:
Let’s do that. The cancer prevention, yes. So what happened was that, as I recall, Dr. LeMaistre long had an interest in cancer prevention stemming from his extensive work on tobacco. At some point, he organized an external review committee chaired by Dr. Maureen Henderson on which I believe Dr. Paul Engstrom, who was then at Fox Chase, also served. Then there was an epidemiologist from Indiana and a couple other people. They came out with a white paper addressed to LeMaistre that said that prevention is important. It should be part of a comprehensive cancer center, but it’s still not a well-defined field and likely to encounter political opposition, and if you want to do this right, you’ve got to imbue the person who runs this with considerable authority and make it equivalent to treatment in responsibility and reporting relationships at the institution.
Tacey Ann Rosolowski, PhD:
Can I ask you, when you used the word political opposition, what are you referring to there? Or what were they referring to?
Bernard Levin, MD:
What they were referring to was the fact that people in cancer saw the treatment of cancer as their theater of war. That’s where they played. They treated cancer, you detect it, you diagnose it, and you treat it with surgery, radiation therapy, and chemotherapy. And what came before or what came afterwards wasn’t terribly relevant, and certainly, given the lack of precise knowledge, had very little place to play. Dr. LeMaistre had this report, and I’m not entirely sure, but I think about that time he either appointed an internal search committee or one de facto came into being. And Roger Winn, whose name I mentioned earlier, was involved in that in a way that I can’t recall. When the search committee identified me as having some interest, I began to investigate what was really involved in this process. And I came across Guy Newell, who was then at MD Anderson, who had been recruited from the National Cancer Institute.
Tacey Ann Rosolowski, PhD:
And he came to MD Anderson in 1979. And that was when prevention was actually added formally and became the fourth of the mission areas of MD Anderson.
Bernard Levin, MD:
Correct.
Tacey Ann Rosolowski, PhD:
With research, education, patient care, and then prevention.
Bernard Levin, MD:
So Guy Newell was there. But he wasn’t given much of a role and was sort of shunted around. No one really wanted him in their department, and his office was elsewhere.
Tacey Ann Rosolowski, PhD:
And was that fallout from this political—what’s this person--?
Bernard Levin, MD:
I think just ignorance. So the search committee came into being, and I was identified as someone who might be willing to take on an ad interim role without any certainty that I would actually become that person. In fact, I was more or less told that I wasn’t going to be chosen by various people. The external search committee identified at least three external candidates. David Alberts, who was then at Arizona, and subsequently retired from the University of Arizona. He was a very, very well-known figure in cancer prevention. John Potter, a New Zealander, who was then either at the University of Minnesota or had already moved to the Fred Hutchinson Cancer Center, I’m not sure. I think he still was at the University of Minnesota—also a notable figure. And Paul Engstrom, at Fox Chase, who I believe was already involved in population sciences in some way but was also a medical oncologist, as was David Alberts. John Potter was trained more as a generalist epidemiologist and also had some psychiatric training, I think. So each of these people was offered the position and for a variety of reasons decided against it. David Alberts and John Potter because they needed more lab space and more positions than were available, and I think Paul Engstrom for reasons unknown to me. At some point, Jim Bowen, who was then Vice President for Academic Affairs, who was in charge of the whole search process, and I had many talks and many discussions. And I remember Jim Bowen driving up the ramp at one of the parking lots and actually being quite discouraging to me, saying, “Maybe you shouldn’t take this position,” since I was the last candidate. And I was never entirely sure why, because Jim was a good friend. But I disregarded his advice and made a formal plea or application . And it was a very difficult period because I was doing both gastrointestinal oncology and digestive disease and this. I would end the day in one and move over at about 4 o’clock, over the road to the Houston Main building and go to the office of whatever the Vice President of Prevention was and field some of the blows there.
Tacey Ann Rosolowski, PhD:
What was it that made you step up and decide to take on this huge additional role?
Bernard Levin, MD:
I just thought that it was an exciting future. I saw prevention as a much—for me—much more important than what I’d been doing.
Tacey Ann Rosolowski, PhD:
Why?
Bernard Levin, MD:
Because it seemed limitless—the importance, the significance, the potential seemed boundless. And I suppose I was also getting—I’d been in the position for which I was recruited about eight years, and I was getting a little tired. I thought that I had done as much as I was likely to be able to achieve. I had a number of recruitments, some successful, some not so successful. I had ‘exported ‘a few individuals who weren’t that productive. So it was a fairly tense time in terms of picking and choosing. And I think I felt that it was time to either embark on a major expansion or choose another direction. But I had several talks with Dr. LeMaistre, who was very indecisive in some ways. I was getting quite upset, because I could not get an answer from the institution as to whether I was or was not to be. And I went to a scientific conference, and the day arrived by which he had said he would make up his mind. And I’ll never forget, I was standing at a public telephone in the middle of Yosemite looking at Old Faithful. And I called him up and I said, “Well, it’s time. Yes or no?” And he said, “Yes.”
Tacey Ann Rosolowski, PhD:
Looking at Old Faithful.
Bernard Levin, MD:
It was a strange time. I’ll never forget it. It was such a strange event in the middle of winter. It was a winter cancer research conference. I was standing there in the cold at a public telephone.
Tacey Ann Rosolowski, PhD:
Do you have idea of why he was going back and forth about it?
Bernard Levin, MD:
I suspect I was not an obvious candidate in some ways.
Tacey Ann Rosolowski, PhD:
And yet you had been asked early?
Bernard Levin, MD:
I had been asked early, but I was the caretaker and didn’t come with the credentials that these other people had. There’s no doubt in my mind that that was the case. I had this colon cancer screening background and that major foray into population screening and that sort of thing, but not that much else. So it was a bit of a risk. Then once I got going, obviously I had a lot to learn. Guy Newell was very helpful. I asked him to stay on in an advisory role. Margaret Spitz, who was working with Guy Newell, and she’s a brilliant epidemiologist, also to some extent self-taught, although she had completed an MPH at University of Texas.
Tacey Ann Rosolowski, PhD:
Did you recruit Margaret Spitz?
Bernard Levin, MD:
No, well, yes and no. Margaret had been recruited by Guy Newell—or with Guy. I don’t know if it was by Guy Newell or she was there and she started working with Guy Newell. But she also worked with a number of other people. She worked with [John] Batsakis, who was a head and neck pathologist, because of her interest in tobacco. She started working early on with [Waun] Ki Hong, but that was subsequent to her appointment as an epidemiologist. So she was an epidemiologist, and in my mind she was the natural chair of Epidemiology. It took some persuasion on my part and others for her to see that as something she really wanted to do, because she already, as far as I recall, had quite a successful career. She didn’t need additional administrative load. And space was at a premium. I probably did not give her as much space as she needed. To my regret, in some ways, that caused friction, much of which was later repaired. But initially, I think we didn’t hit it off as smoothly as we should, because I should have been more cognizant of her needs as a new chair. But she was, and still is, extraordinarily successful in everything she has chosen to do in epidemiology.
Tacey Ann Rosolowski, PhD:
So you were saying that Guy Newell and Margaret Spitz were very supportive as you began—
Bernard Levin, MD:
—to develop the role.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 09: Challenges to the Division of Cancer Prevention" (2013). Interview Chapters. 1345.
https://openworks.mdanderson.org/mchv_interviewchapters/1345
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