Chapter 13: Cancer Prevention: Expanding into New Departments and Programs
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Description
Dr. Levin begins this Chapter by explaining how he built the case to include population sciences, health disparities research, and minority health in cancer prevention, despite controversy. He notes that Dr. Andrew von Eschenbach was a great supporter. He then discussed the Cancer Prevention Education Fellowship, noting the administrators involved, funding sources, and the numbers of fellows in the early years. He also talks about the Tobacco Treatment Program and the program in Professional Education for Early Detection, noting the missions of these initiatives and the individuals involved.
Identifier
LevinB_01_20130207_C13
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 Building/Transforming the Institution Multi-disciplinary Approaches The History of Health Care, Patient Care Growth and/or Change Obstacles, Challenges Controversy Global Issues –Cancer, Health, Medicine
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
Yeah, we can go through, and then there is another question I want to ask. Here are the various divisions and elements that I have listed that’s included in the Division of Cancer Prevention and Population Sciences—by the way, I know that the Population Sciences was an add-on. When did that happen?
Bernard Levin, MD:
I was thinking of that. When I began to build a case for health disparities research it seemed appropriate—and I think it was also the time that Margaret Kripke became the vice president for—or Executive Vice President for Academic Affairs and took over from Dr. [Andrew] von Eschenbach, that his became a logical transition point. Andy von Eschenbach had been a supporter of cancer prevention in many ways. But he came—I remember one day he said to me, “You know, you’ve built this program—”you being collective you, not me personally—“You’ve built this program under the radar. It’s not been very obvious what’s been going on. And suddenly we discover that it’s actually a major program, so it’s time to be more visible.”
Tacey Ann Rosolowski, PhD:
Political savvy.
Bernard Levin, MD:
Yes. That in part answers what you asked me earlier. Initially, I thought it was wise to make a big fuss. Then I subsequently realized that I’d do much better just keeping quiet and just keeping on building the program. That was the subsequent tactic.
Tacey Ann Rosolowski, PhD:
And apparently it worked.
Bernard Levin, MD:
I suppose. I didn’t do a controlled experiment. So when Margaret came and we discussed this health disparities research—and there was a lot of work needed to gain the support for a new department that brought up, again, issues of size, growth, who we were, what we were doing.
Tacey Ann Rosolowski, PhD:
I can imagine, too, that Margaret Kripke would just be a huge supporter given her focus on photoimmunology.
Bernard Levin, MD:
Yeah, she was definitely on our side. Not even people in then the Division of Cancer Prevention were necessarily in favor of this. There was certainly controversy from both, probably from people who thought it would be taking away some of their goodies to share the good things in the division. But there were others who intellectually thought there may not be a place for it, and then there were probably others who had some jealousy as to the fact that one of the current faculty became a department head and others didn’t, obviously. There were probably a lot of mixed emotions about the establishment of that department.
Tacey Ann Rosolowski, PhD:
What was the philosophical basis and practical basis for establishing it?
Bernard Levin, MD:
Well, there was a significant problem, and it wouldn’t go away, and we should learn about it. And there had been examples of very good studies done at Harvard School of Public Health on health disparities that informed some of this. So there were other—departments in other universities. When I say ours was the first in a cancer center, there were other departments studying this issue—University of Michigan, Harvard, Duke, UNC, I believe—strong, intellectually well-based programs that were trying to understand what this was all about, describe it, and try and mitigate it. Obviously, it has roots in the history of America and in the whole funding of healthcare and lack thereof.
Tacey Ann Rosolowski, PhD:
So when was that decision made to add Population Sciences as part of the division?
Bernard Levin, MD:
Probably within the year prior to the establishment of health disparities research.
Tacey Ann Rosolowski, PhD:
Okay, so 2005 or so. So here’s also what I have on my list—the Center for Research on Minority Health which I assume was part of—
Bernard Levin, MD:
That was Lovell Jones. We tried to put that into the Department of Health Disparities Research under David. It had a huge expansive space at a facility that was east on Holcombe. I don’t remember the—it used to be the Nabisco factory. And when Nabisco was there, there had been this wonderful release of aromas at about 4 o’clock in the afternoon. It would waft over the medical center. This facility was replaced then by offices, and the Center for Research and Minority Health had quite substantial space there, probably more than they really needed. They were subsequently moved after I left into the Faculty Academic building together with the rest of Health Disparities rRsearch.
Tacey Ann Rosolowski, PhD:
What are some of the projects that you recalled them working on that were really significant?
Bernard Levin, MD:
The health disparities research?
Tacey Ann Rosolowski, PhD:
Either one.
Bernard Levin, MD:
I think the basic issues of access to the control of tobacco in various racial groups. That was a very important one, and the social determinants of health as viewed through minority eyes of Latinos, Latinas, and African Americans in Texas and Houston. Those are some of the broad components, but a lot of it had to do with tobacco.
Tacey Ann Rosolowski, PhD:
And the Center for Research on Minority Health also focused on tobacco?
Bernard Levin, MD:
Focused on nutrition, and to a lesser extent, on tobacco—physical activity.
Tacey Ann Rosolowski, PhD:
And that was some of the things you mentioned—access to parks and being afraid to go in elevators, that kind of thing.
Bernard Levin, MD:
And they also studied environmental exposures—insecticides, pesticides, in parts of Texas. That was the Center of Research in Minority Health. They had a major interest in that.
Tacey Ann Rosolowski, PhD:
I also have the Cancer Prevention Education Fellowship Program.
Bernard Levin, MD:
That was a very fundamental part of our efforts. It had been housed primarily in Epidemiology under the leadership of Dr. Spitz. Eventually, we recruited someone from the National Cancer Institute who had been a fellow of Dr. Spitz, went to the NCI and to the Cancer Prevention Program and then came back. Her name is Shine Chang. And she was a natural for heading this Cancer Prevention Program which had been—for years—successfully developed and led by Bob Chamberlain, who had been a faculty member who was an epidemiologist—a social epidemiologist—initially with Dr. Newell and then with Margaret. He was Deputy Chair. He, too, was a natural at education. He established a world-class education program that took into account all of cancer prevention, not just epidemiology. So then Shine Chang took over when Bob retired. And Shine brought a lot of vigor and interest to this program, and it became one of the largest in the country.
Tacey Ann Rosolowski, PhD:
What was the aim?
Bernard Levin, MD:
Provide opportunities for education of pre-doctoral and post-doctoral individuals in the science and practice of prevention in its broadest elements. All departments were involved. Even some that were not in the Division of Cancer Prevention you could be enrolled in.
Tacey Ann Rosolowski, PhD:
What did you discover when you—excuse me just for a moment. (The recorder is paused.)
Bernard Levin, MD:
That can be filtered out, I’m sure.
Tacey Ann Rosolowski, PhD:
I was wondering, what did you discover when people came to the fellowship program and the preparation of researchers and clinicians in general to study this? Were you finding that—who was being attracted, and what were they getting from it?
Bernard Levin, MD:
A variety of individuals were interested. There were occasionally some physicians who wanted to gain extra training in epidemiology, for example. There were people who had already had some undergraduate and even post-graduate exposure to one or another of the disciplines but wanted an opportunity to do research in a big program. Because there were—in Epidemiology and in Behavioral Science, there was exposure to lots of projects because of the faculty size, which was substantial—projects which needed access to human materials or human subjects, human interventions. So it was a broad array of possibilities that weren’t available in some other places.
Tacey Ann Rosolowski, PhD:
So how many fellows was this program handling at one time?
Bernard Levin, MD:
At its height, when I was there—and it has grown substantially since then—there may have been as many as thirty or forty fellows.
Tacey Ann Rosolowski, PhD:
How was that funded?
Bernard Levin, MD:
Funded primarily by training grants through the NIH, NCI, and then also with some additional private monies, which I, obviously, fought to obtain.
Tacey Ann Rosolowski, PhD:
And I also have the Tobacco Treatment Program. Is this the program you mentioned earlier?
Bernard Levin, MD:
I viewed it as part of that center. I’m not sure if I was didactically correct, but the Tobacco Treatment Program was the natural expression of behavioral research and treatment.
Tacey Ann Rosolowski, PhD:
So that was part of the Behavioral Research and Treatment Center?
Bernard Levin, MD:
Yes.
Tacey Ann Rosolowski, PhD:
And this was the program whereby MD Anderson patients who were addicted would get some sort of support?
Bernard Levin, MD:
Correct. But there was a much broader—within behavioral science—I’m not sure if the name was used as Behavioral Research and Treatment Center, but there was a very broad program led by Alex Prokhorov on the modification of behavior, as far as tobacco was concerned, amongst minority youth using very innovative approaches such as what are called photo novellas—the almost video games aimed at delivering the message but in a culturally sensitive way that’s appealing to young people, because much of the tobacco addiction occurs at a very young age. It may even occur pre-teen, and certainly in the early teens.
Tacey Ann Rosolowski, PhD:
So this was—the Tobacco Treatment Program—I’m sorry, I’m getting something glitched in my mind. So Dr. Prokhorov was working within the Tobacco Treatment Program? So this wasn’t just for MD Anderson patients, it also kind of spread beyond?
Bernard Levin, MD:
Way beyond.
Tacey Ann Rosolowski, PhD:
Okay. What were some of the other outreach initiatives that that program had?
Bernard Levin, MD:
There was a significant emphasis on delivering a cancer prevention—or stop smoking message to minorities throughout Texas. In Epidemiology, Melissa Bondy and Margaret Spitz and others had developed a cohort, a so-called Hispanic cohort, and there was beginning to be an understanding of all the various factors that led to tobacco use, obesity, diabetes. So that naturally provided opportunities for interventions amongst particularly Latinos and Latinas.
Tacey Ann Rosolowski, PhD:
And the final one I have on my list is the Professional Education Program for Early Detection. What was that about?
Bernard Levin, MD:
That was a program that I inherited, and it continued. It was primarily aimed at the education of nurses. And MD Anderson sent out a team of instructors to various places around the state and around the country providing very well-designed modules of training, particularly related to gynecological and breast cancer detection. That also—that model became financially difficult to sustain. So we changed it to be an in-house program where individuals came to be lectured to and given practical instruction on the premises as opposed to sending out a team of instructors. For a while I think there was a hybrid of both and then subsequently just the latter.
Tacey Ann Rosolowski, PhD:
Because I think I read an article about how it actually—there was a global part of that with MD Anderson people going to Japan, I think some other nations, to instruct people. And then also give certifications in some—I wasn’t clear about that.
Bernard Levin, MD:
There were elements of that. It becomes a bit vague in my mind, but I do remember trouble, perhaps how hard it became to sustain this financially.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 13: Cancer Prevention: Expanding into New Departments and Programs" (2013). Interview Chapters. 1349.
https://openworks.mdanderson.org/mchv_interviewchapters/1349
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