Chapter 10: The New Division of Cancer Prevention (and Questions about Whether It Should Exist)
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Description
Dr. Levin first lists the departments included in the new Division of Cancer Prevention and the key individuals first involved. During the first two to four years, there was a great deal of interest in the institution in chemoprevention. Dr. Levin notes that, in this context, he saw the Division’s role as a platform and resource, not as taking “ownership” over prevention at MD Anderson. Political issues continued to surface, as individuals continued to question whether the Division should even exist. Dr. Levin explains acknowledges his lack of specific training in prevention and his strategy of recruiting to supplement those gaps. He also evaluates his hiring and firing decisions, considering how well his recruitments set the Division on a strong path.
Identifier
LevinB_01_20130207_C10
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 - An Institutional UnitThe Administrator 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
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:
So tell me how—what did you see as your mandate? And then what did you see as your goals?
Bernard Levin, MD:
The institution, including Mickey, wanted a broad-based cancer prevention program. And the way we sketched that out, initially, would be to include epidemiology as the cornerstone, and then behavioral science, which I was not very familiar with and needed some education about. And I suppose I learned quickly what that was all about and how important that was. Then a clinical program with the screening center also became relevant. There had been something called Station 7, which was started and I believe headed by at the time Michele Follen, who was a gynecological oncologist and a very bright individual who was a pioneer in working in cervix cancer screening. And she developed sort of a screening center. So there was some belief that that should be incorporated as well into the program.
Tacey Ann Rosolowski, PhD:
And when—did this come through discussions between you and Dr. LeMaistre and Guy Newell and Margaret Spitz? I mean, how did all of this decision making take place?
Bernard Levin, MD:
It came more from discussions with Dr. LeMaistre and with others at the more senior level as well as with Guy and Margaret. I recall that the role of a screening center was very contentious. It was not clear how that should be. And in particular, the personalities of the individuals involved were at times troublesome. Enough said.
Tacey Ann Rosolowski, PhD:
The life in institutions.
Bernard Levin, MD:
Right. And it became clear that to achieve any level of success, we needed to have research labs, which weren’t widely or freely available at that point. And one of the people I had recruited to gastroenterology, who actually worked in prevention to some extent, was Michael Wargovich, who was interested in natural compounds, particularly garlic. And we had done some work together in gastroenterology on garlic as a chemopreventive agent. And he, and I on his coattails, had formed a relationship with the Wakunaga Company in Hiroshima, Japan. So Michael and I visited there, and that was the most amazing company. They had one half of their company making these very ultra-fine, biochemically pure products of reagent grade, and the other half was devoted to natural compounds and had sort of a museum full of plant specimens in preservatives. They had the highest—I recall—the highest technology auditorium I had seen up to that point in this place 100 miles from Hiroshima. But Mr. Wakunaga was very interested in pharmaceuticals derived from herbs and natural products. And Michael was also very much interested in that. And subsequently, we had considered moving him to Prevention, but for a variety of reasons that didn’t work out. Another person who was very involved in discussions about prevention at that time was Fred Becker, who was Vice President for Research in control of all the laboratories. So in my recruitment package, the word “laboratories” was mentioned, but Fred hastened to assure me that there wasn’t much space and that it would be an uphill struggle, which was, I suppose, one of the reasons some of the other candidates hadn’t taken the position. I think that, at the time, I had not a lot of need for laboratory space, because I didn’t have anyone on hand who was doing laboratory research. And I also believed that eventually that would come about. So there was also other interest in prevention at the time in the institution. Ki Hong had an interest in retinoids and was working in the Department of Medical Oncology. And back in Gastroenterology, I had recruited someone (Gideon Steinbacd,Ph.D.,M.D.) who became involved in studying cox-2 inhibitor, Celebrex, as a chemopreventive, and worked together with Patrick Lynch, who is still there, whose family is involved with the discovery and identification of Lynch syndrome. Actually, his father was Henry, who was primarily involved, but Patrick also played a role. So Patrick and Gideon became involved in cox-2 studies in familial adenomatous polyposis. So there were some other prevention issues going on in Gastroenterology and Medical Oncology. Ki Hong recruited Scott Lippman, who initially worked in Medical Oncology and was also interested in chemoprevention. He subsequently came over to Prevention. So there was some sort of internal ferment. Roger Winn, whose name I have mentioned, also was interested in studies of calcium. And we did studies of calcium in people to see what doses were tolerated, pushed the dose of oral calcium, and then subsequently studied the effect on polyp regression. Over a period of two to four years, there was quite a lot of interest in chemoprevention, and how this played out in terms of cancer prevention wasn’t always clear. In other words, I believed that we didn’t own the field, that others could be doing prevention work, that we should be a platform or a nucleus—a resource. But we didn’t have proprietary ownership of prevention. And for obvious reasons, that was probably the most politically sound approach. So that sort of gives you a little bit of background. Just in terms of the political issues again, there were individuals in the institution who firmly believed that neither I nor the prevention division should exist. And two very well-known faculty members made that known at public faculty meetings—singled me out and said really, “This is nonsense.”
Tacey Ann Rosolowski, PhD:
Can you say who those people are?
Bernard Levin, MD:
No.
Tacey Ann Rosolowski, PhD:
I only ask—not to dig up dirt—but simply to get a perspective. But if you don’t care to, that’s absolutely fine.
Bernard Levin, MD:
One subsequently left the institution, having retired. And the other is sort of in semi-retirement but is still around the institution.
Tacey Ann Rosolowski, PhD:
So what do you believe their objection was?
Bernard Levin, MD:
They just didn’t have a clue.
Tacey Ann Rosolowski, PhD:
So ignorance?
Bernard Levin, MD:
One of them was a well-known cancer biologist. And the other one was a head and neck surgeon, both of whom should have had some insights into the issues involved.
Tacey Ann Rosolowski, PhD:
Now do you think—was this a fallout from a particular kind of training that put blinders on, the culture of the institution? Where do you think that came from?
Bernard Levin, MD:
Those are good comments. Both of those, I think, apply to those individuals. I think that Mickey [LeMaistre] hadn’t necessarily communicated his views as forcefully as he subsequently came to do about the importance of prevention. And initially, he appointed me vice president, and I sat in the council of elders with the other vice presidents and individuals he surrounded himself with. I, undoubtedly, had a bit of a chip on my shoulder. But I would always have to remind him and others that, yes, it’s education, research, and clinical care—but there is also prevention. And I’m sure that I became a nuisance in that this always had to be brought up. It was not an immediate reaction, even though the mission stated it that way. It was often, if not always, an afterthought.
Tacey Ann Rosolowski, PhD:
Is this an MD Anderson burden? Or when you spoke to colleagues at other institutions working with prevention, did they have the same kind of complaint?
Bernard Levin, MD:
Few institutions had prevention programs. Memorial didn’t for a very long time. Roswell Park didn’t for a long time—Mayo Clinic, also. So the three major institutions which I—and the University of Chicago—which I knew something about didn’t have much in prevention.
Tacey Ann Rosolowski, PhD:
So MD Anderson was really a forerunner in this.
Bernard Levin, MD:
Yes. There’s little doubt about that. So there became this kind of political struggle. I was overly concerned about recognition of prevention as an entity and sought to make links with others to gain some strength. I didn’t have, I felt, the credentials for laboratory research that I needed. So I recruited Reuben Lotan—who subsequently has died, unfortunately, in the last three years—as Vice President of Research, or Associate Vice President for Research in Cancer Prevention, because he had a very strong laboratory background, and he was working with Ki Hong and with others. I got him to come over part time as Associate Vice President for Research and to lend some credence to the fact that we were a strong research group---we would become a strong research group.
Tacey Ann Rosolowski, PhD:
I’m sorry, could you tell me again the name of your Assoc. VP of research?
Bernard Levin, MD:
Reuben Lotan.
Tacey Ann Rosolowski, PhD:
Thank you.
Bernard Levin, MD:
I made one error in this time. I appointed—I recruited a very weak division administrator. I did not realize that at the time. That led to a lack of decision making aver delineation of space and resources that came to be a burden over time. I was forced to actually fire him. I was fortunate enough to recruit a very strong division administrator, someone who had been in the institution in the budget office and who had a reputation as a very clear and crisp thinker. Her name was Elizabeth Gammon. Liz was someone who had a real gift for numbers. She’s an accountant. And she saw things as black and white. There were few grays. And in some ways, that was beneficial. She really did help to bolster the administrative side of the division.
Tacey Ann Rosolowski, PhD:
What were some of the contributions she made with decisions that helped?
Bernard Levin, MD:
She put us on a sound financial basis. She instituted very good departmental management structure. She taught me a good deal about management of departments. And I felt that she made strong contributions. She was a controversial figure, because she was not scared to take on anybody. And she did not relish the role of having to administer the harsh judgments and try to make sure that I took on that responsibility. So there was always a little tussle as to who was going to break the bad news. But I learned a lot from her.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 10: The New Division of Cancer Prevention (and Questions about Whether It Should Exist)" (2013). Interview Chapters. 1346.
https://openworks.mdanderson.org/mchv_interviewchapters/1346
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Open
