Chapter 14: Expanding the Division of Cancer Prevention, Funding Sources, and Public Awareness
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Description
Dr. Levin explains how both state funds and philanthropy (via the Development Office) support faculty and initiatives in the Division, then talks about the important of raising public awareness for prevention. He explains some of the history of colorectal cancer screening, notes his own work in the area, and Katie Kouric’s role as a much-needed a public champion. Dr. Levin then talks about John Mendelsohn’s development activities, explaining that Prevention sent teams of people with Dr. Mendelsohn to speak to potential donors about key elements of prevention.
Dr. Levin notes that the Division has relied heavily on philanthropy to move projects ahead. For example, donated funds allowed the Division to purchase a computer to run population analyses.
Dr. Levin ends this Chapter with observations about why he was unable to start a Department of Health Services Research and comments on the search for his successor.
Identifier
LevinB_01_20130207_C14
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 Cultural/Social Influences Professional Practice The Professional at Work The Business of MD Anderson Philanthropy, Fundraising, Donations, Volunteers Activities Outside Institution
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:
I can imagine. Is the financial piece something you’d like to talk about now? I mean, the funding of prevention and the funding of healthcare in general just seems very key to all this. And as I was doing background research, it was a subject that came up over and over and as you were making statements.
Bernard Levin, MD:
The division—the funding of the division rested on probably a variety of sources, as must be the case throughout MD Anderson. We had, obviously, state support for faculty positions and for support personnel. In the days when we began this, the support was quite generous. Research faculty were expected to generate thirty percent of their salary within about three years of their arrival. But there was not an arduous barrier when money was relatively plentiful. So there was the state support. Then research faculty, of course, were expected to apply for and generate additional funding from grants—both from federal sources as well as foundation sources. But we, obviously, looked around for every possible means of support—state, local, local foundations. I spent a fair amount of time on the road, so to speak, trying to raise money and raising money with the support of the Development Office. And that was both direct and indirect. In other words, directly for the Cancer Prevention Program but more indirectly for MD Anderson as a whole. And Dr. Mendelsohn would make teams of faculty that would go and give talks in various places to well-heeled donors.
Tacey Ann Rosolowski, PhD:
And what was your message when you went on those?
Bernard Levin, MD:
My message was prevention.
Tacey Ann Rosolowski, PhD:
But, I mean, how did you take that message to the well-heeled donors who may have never seen some of the issues that were being addressed?
Bernard Levin, MD:
I focused, personally, on colon cancer and talked about screening and prevention. I was quite involved in chemoprevention research, which subsequently did some studies on celecoxib, Celebrex. And I was interested in screening using colonoscopy, occult blood, and the message was, of course, get screened. I had some personal visibility because I was part of Katie Couric’s panel, so I could always use that as kind of a background.
Tacey Ann Rosolowski, PhD:
I don’t have the date of that in my mind immediately.
Bernard Levin, MD:
It was probably in 2005.
Tacey Ann Rosolowski, PhD:
Did that come on the heels of your testimony?
Bernard Levin, MD:
A few years later—a couple years later. Denny Slamon, who was one of the discoverers of the HER2/neu oncogene and Herceptin, was putting together a panel. And he was friends with someone in the Goldwyn-Mayer organization, whose husband had died of lymphoma, who started a foundation which supported Denny. And Denny became interested in colon cancer. And with this woman’s support—we can look it up—he approached Katie Couric, who at that time was mourning the tragic loss of her husband, James Monahan, public. Katie and this individual got together, and Katie wanted an advisory panel. And Denny invited me to be part of that together with some other colleagues and friends. There were about five or six of us who were invited and joined. And we met several times with Katie over a couple-year period.
Tacey Ann Rosolowski, PhD:
That story of raising awareness about the need for screening for colorectal cancer—I became aware of that when I was doing background research for my interview with Dr. Stroehlein, obviously. And I kind of remembered that in the media at that time, but reading his materials and your materials, I recalled that it was really a taboo subject. I mean, people didn’t talk about it. There was a lot of discomfort in talking about the subject. And certainly, there was no media attention. So that story about the awareness of colorectal cancer, which I think I read somewhere in your background materials you said there were basically the tools in place to do screenings in the 1950s, and nobody used it. That’s kind of shocking. So what did you see? I mean, obviously that moment with Katie Couric—here is a public figure who is able to push this into the media eye. What was a little bit of what came before?
Bernard Levin, MD:
There came to be some visibility of the importance of colon cancer, because it was clear that this was a considerable source of morbidity and mortality in this country. The American Cancer Society—and I was involved in some of this—was quite vocal about the need to be screened. But it needed a public champion with a particular story to tell to bring it to full visibility. Now, Katie’s story, and her husband’s, is somewhat anomalous, because he was a younger man. He was forty-three. And we could never answer her question. Well, if you had started screening at fifty, which is the age that we recommend, you still wouldn’t have found him. The answer is correct. Perhaps there would have been greater heightened awareness of the fact that a young person presenting with symptoms of bleeding, et cetera, could have cancer as opposed to dismissal or trying to find a benign answer to that complaint. But nevertheless, she agreed that she could use her tremendous visibility and personality to bring people’s attention to colorectal cancer awareness and screening. And she and others—without going off on a tangent—a lot of the work done on the National Colorectal Round Table, which I was happy to be a co-founder, was also involved in trying to find other spokespersons—a black spokesperson, or people who appeal to another segment of the population other than a white woman. So the recognition amongst everyone that they were at risk.
Tacey Ann Rosolowski, PhD:
Were you successful at finding some other spokespeople?
Bernard Levin, MD:
Yes, there were sports personalities who definitely became spokespersons.
Tacey Ann Rosolowski, PhD:
Who were some of those individuals?
Bernard Levin, MD:
This will amuse you, but I sat next to one of them and didn’t know how important this was. I don’t know a lot about professional sports in this country. He was a very tall man, who I think was a basketball star, well known in this country, a black man. Now, that doesn’t mean anything, because many7of them are tall and black. But he was of a particular generation, probably well known in the 70s. And there were others, too, that we enlisted. So where were we?
Tacey Ann Rosolowski, PhD:
Talking about bringing it to public awareness.
Bernard Levin, MD:
So going around with John and giving talks—not only that, we would bring a team. So we would have someone on tobacco, like Alex Prokhorov or Ellen Gritz, people talk about breast cancer screening, or Victor Vogel, who particularly was good at that. We would try and represent key elements of prevention for a public audience. So it was fundraising. Otherwise, we were dependent on philanthropy. And that became an important part, because that enabled much greater flexibility in terms of ability to start programs, buy equipment, do something that was a pilot for which consequences need not be necessarily financial solvency. You could lose money on a small project. Buy equipment—we bought for Epidemiology—well, we bought—when Chris Amos, now at dartmouth—he’s a very excellent epidemiologist. When he came, Margaret Spitz came to me and said, “We need to buy a very fancy computer for him.” It cost $100,000. And that amount of computing fifteen years ago now could probably be done by your cell phone. But in those days, it cost a lot of money. And he was a population scientist with a lot of numbers to be crunched. When Xifeng Wu, who is now the Chair of Epidemiology, and Margaret came and said, “We need to do gene sequencing, we need an Illumina instrument,” which was state-of-the-art at the time, we formed a coalition of potential users in Epidemiology using donor money and a couple of other departments—Systems Biology and one other department—to assemble the hundreds of thousands of dollars that it took. If I had had to apply for that through usual channels—it’s a major equipment purchase—it might have taken two years, where I could go out and write a check for a third of that equipment since others were sharing into it.
Tacey Ann Rosolowski, PhD:
And looking back the investment of those monies was—
Bernard Levin, MD:
Extraordinarily well worth it, absolutely. I feel completely guiltless about investing those monies. I think we were well served by doing it. And I think the donors, if they were around today, would have been delighted with the outcome.
Tacey Ann Rosolowski, PhD:
As you look over—I mean, we looked at that list of the different divisions and programs within the Division of Cancer Prevention and Population Sciences. As you look at that array that was put in place what—do you kind of say, “Yeah, this is what was achieved?” And is there something that you believe needs to be added to that or what you wish you might have added?
Bernard Levin, MD:
Those are very good questions. I tried very hard to start another department, Health Services Research. And the reason was that there were investigators in Biostatistics who actually are health service researchers. And they were in Biostatistics just by default. There were three. At least two of them were unhappy enough to actually want to be in another home, much more a population sciences home. I couldn’t find a natural fit in the existing departments for a variety of reasons. And I launched a formal recruitment for a new chair of Health Services Research. We interviewed about three or four individuals. And we couldn’t find a fit. They were people who either didn’t seem to have the energy or the charisma to do something quite so innovative—
Tacey Ann Rosolowski, PhD:
What did you want that individual to achieve?
Bernard Levin, MD:
We were looking for someone who had already credentials in that area of sort of economics.
Tacey Ann Rosolowski, PhD:
And would this be to kind of analyze and evaluate the effectiveness of these programs?
Bernard Levin, MD:
Not only in Prevention but throughout the institution. It would be a program that was heavily grounded in economics and knowledge of how to define cost effectiveness and that sort of thing.
Tacey Ann Rosolowski, PhD:
And this was about—when were you looking for this?
Bernard Levin, MD:
This was probably about 2005 or ’06. And it was formally sanctioned by the institution to be a small department. But we never could find a leader. I recall with humor there was one individual who, for whatever reason, had a particularly poor way of expressing himself and of behavior. I think he had a psychological flaw. He was extraordinarily smart. He had the credentials, but he would do things like sit in a very informal way during a formal interview—sprawled out. And he would let his tongue use whatever swear words came to his mind. So an interview with him would be a nightmare. And I could just see that this would not work. And I coached him for his second visit. I said, “This is the way you behave at MD Anderson. You sit properly. You don’t use words that belong in the playground. You behave properly. You’re really a strong candidate.” Well, he could not control himself.
Tacey Ann Rosolowski, PhD:
A cultural mismatch there.
Bernard Levin, MD:
A total mismatch. And besides that, he would have been very good. So I eventually folded that idea. So that was one that fell. Subsequently, my successor, Ernie Hawk, has found someone to lead that small department. I’m not sure exactly what format it takes. But it is there. I had tried to recruit, unsuccessfully, a successor for the Department of Clinical Cancer Prevention after Scott Lippman left and went back to Medical Oncology as Head of Thoracic and Head and Neck Medical Oncology. There was a vacuum, and I filled it. As the division head I was the chair of the department. But it’s not something I relished, being a chair of a department. I tried very hard to recruit someone, and for a variety of reasons it didn’t work out. My choice candidate subsequently has been recruited to that role and is doing very well. It was always my sense of failure that I couldn’t do it. It wasn’t my problem, but we didn’t have adequate lab space. And that was the major impediment. And I suppose, in the best of all possible worlds, the Center for Research and Minority Health would have folded neatly and happily into the Department of Health Disparities. I wish that could have been the case, but personalities played a big role in that not happening.
Tacey Ann Rosolowski, PhD:
What would have been the advantage?
Bernard Levin, MD:
Just there would have been a harmony and a force of coming together of faculty that I think could have achieved more than each has alone been successful in doing.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 14: Expanding the Division of Cancer Prevention, Funding Sources, and Public Awareness" (2013). Interview Chapters. 1350.
https://openworks.mdanderson.org/mchv_interviewchapters/1350
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