Chapter 15: The Culture of the Division and Its Impact
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Description
Dr. Levin explains that during his tenure as Vice President and Head, the Division of Cancer Prevention was a loosely defined entity, but one characterized by a spirit of discovery and a commitment to application of knowledge. He then talks about what is left to be done.
Dr. Levin discusses the impact of the Division and what has contributed to its success.
Dr. Levin responds to the observation that many believe that physicians and institutions do not support prevention because it will put cancer institutions out of business, ending with the comment, “That’s my dream.”
Dr. Levin explains that “cancers survive because they are smarter than we are,” but the many tools included in prevention can help make the disease controllable and turn it into a chronic rather than a deadly disease.
Dr. Levin makes final comments on the notion that cancer can be ‘curable.’
Identifier
LevinB_01_20130207_C15
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 MD Anderson Culture Professional Practice The Professional at Work Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care Overview Definitions, Explanations, Translations
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:
Is there—how would you describe the culture of the Division of Cancer Prevention and Population Sciences?
Bernard Levin, MD:
I can only say how it was, obviously. I believe there was a real sense of belonging to a somewhat poorly defined entity that was different from much of the rest of MD Anderson in that it was not focused on treatment of cancer but on the prevention of cancer. And it had a real spirit about it of discovery and of application of knowledge that promised a great deal for both individuals who were at standard risk and people who were at high risk. The execution of the prevention model in the Clinical Prevention Center was a very good way to give expression to that.
Tacey Ann Rosolowski, PhD:
How do you think the division over time—how was it able to educate the MD Anderson community about practicalities and also about how this new approach could serve?
Bernard Levin, MD:
That, too, is a good question. Because I would be confronted, as I have mentioned, by individuals who were surprised by the size of the division. And they would raise questions about specific segments, for example, Behavioral Science. And my answer to them was always, “If you could see the amount of research funding that Dr. Gritz and her colleagues have been able to garner, you would gain some appreciation for the fact that this is highly regarded as first-class science. They are able to compete with the best of institutions and do tremendous work.” That was one example. Epidemiology—faculty (was able to collaborate and provide extraordinarily valuable research and put into SPOREs, program project grants, collaborative research across the institution. Dr. Spitz and her colleagues were phenomenal collaborators. Behavior Science was to a lesser extent. But to some extent, they were able to also. That was a little bit more difficult.
Tacey Ann Rosolowski, PhD:
Why was that?
Bernard Levin, MD:
I think Epidemiology feels like a natural part of understanding the distribution and determinants of disease. The behavioral aspects are less familiar to many people. Even though, obviously, behavior plays a huge role in lung cancer, tobacco control. There was less willingness on the part of some individuals to include that initially. Subsequently, that changed. And I think there were some hard battles fought by researchers in Prevention to establish their credentials as card-carrying, peer-reviewed earning members of society.
Tacey Ann Rosolowski, PhD:
What’s left to be done?
Bernard Levin, MD:
You can always do better at what you’re doing, expand the research aspects of clinical cancer prevention. I think, currently, that’s a focus. Better methods of screening. We’ve barely begun to touch that. Better methods of screening for all common malignancies—genome chip, the expansion of screening to other populations in other countries. Learn how to expand MD Anderson’s influence through the global academic program for cancer prevention.
Tacey Ann Rosolowski, PhD:
When you look at the reputation of the department when you left—I don’t know the extent to which you can speak about it now—are you satisfied with how far the reputation of the division—do you feel MD Anderson has been receptive, unusually resistant? What’s your assessment of that cultural space?
Bernard Levin, MD:
I feel very good that the division has made a major impact and continues to be respected. I know that Ernie Hawk is viewed as a senior leader within the institution. Not only as a head of Prevention, but he represents a bulwark of strength within the institution. I think there were significant odds against Prevention’s success at the beginning. But I think that by virtue of successful collaborations, influential peer-reviewed funding, philanthropy, contributions of faculty in many spheres and levels—for example, Ellen Gritz being very involved in the woman’s faculty organization and being involved in efforts to minimize faculty burnout, all sorts of areas like that—the contributions have been substantial outside of the division within the institution. The roles played on institutional committees. I think they all serve to justify the growth and development and enabled them to stand up proudly that they’re part of the larger MD Anderson.
Tacey Ann Rosolowski, PhD:
It just sounds like it’s been a very slow process of education, shifting the culture, shifting people’s assumptions to get them to embrace this.
Bernard Levin, MD:
I agree. I think that it was not a natural phenomenon. It took time.
Tacey Ann Rosolowski, PhD:
I want to ask—we’re actually a little bit after 4 o’clock. Is it okay if I ask you one more question?
Bernard Levin, MD:
Sure.
Tacey Ann Rosolowski, PhD:
I mean, this is sort of coming on an aside. But it’s a question grounded in some conversations I’ve had with other people who have said that perhaps the field and patients are a little bit suspicious. And they say that doctors and institutions don’t actually want to focus on prevention, because it means it will put cancer centers out of business. What’s your response to that?
Bernard Levin, MD:
Well, people used to say that to me. And I would say, “That’s my dream is to put you out of business.” I think that’s a forlorn hope for the foreseeable future. We have some inklings of how to prevent cancer, but obviously it’s not universally successful. And it’s a very gross example—people who don’t smoke get lung cancer. We don’t know how to prevent that. We don’t know how to prevent many of the most common cancers. We’ve learned a lot about early detection. We’ve learned a lot about the biology enabling us to begin to think of ways you can intervene to make a substantial impact. But we’re far from being successful at preventing most forms of cancer. So, unfortunately, the need for really good treatment options is going to be around for a long time.
Tacey Ann Rosolowski, PhD:
Now is your perspective—there are some people that just say flat out, “I believe we can cure cancer.” Other people say our hope is to make it into a controllable, chronic disease. How do you see medicine intervening in all of that?
Bernard Levin, MD:
I think greater emphasis has to be placed on prevention in the first place—vaccines, screening. Those are essential. We’ve seen vaccines come into play—hepatitis B virus, very powerful, human papilloma virus, very powerful. We have every hope that we will be able to control HIV/AIDS with medication—another pre-cancerous set of conditions. We know a great deal more than we did about screening. But there will always be people who will develop, I believe, will develop cancer, because people are living longer. And that’s the phenomenon that’s occurring throughout the world. I think it will occur in phases. For some conditions, as we are now, some forms of leukemia are chronic conditions. Some people with prostate cancer have a chronic condition you can watch waiting. They don’t need treatment. Or if they do need treatment, it can be administered very easily. There are conditions where already we have a chronic condition with very minimal impact. And there are obviously cancers where we already have cures. We know that for testicular cancer, choriocarcinoma in women, some forms of lymphoma—Hodgkin’s—that are cured already. So we have good examples of both those states that you mentioned. But for the commonest advanced cases—metastatic cancer—I think a cure is going to be very allusive, because those cancers survive because they’re smarter than we are. They have tricks—genetic tricks—that they have learned or acquired. So I don’t see that some forms of cancer will ever be cured, at least not in the immediate future. But they might be controllable, because we’ll learn what those tricks are, and we’ll be able to intervene and manipulate the environment for the cancers. But I have questions at what cost will that be done and in what ways will that be available to the public.
Tacey Ann Rosolowski, PhD:
When you say cost, do you mean financial cost?
Bernard Levin, MD:
Financial cost and to some extent physical cost. Elderly people who may not be absolutely able to tolerate some of the more drastic treatments that may be required. But I have real hope that cancer can be made a chronic condition and cured for some. I mean, we know we can cure some already. It’s not a mystical area that we’re going to break through and say, “A-ha, we now can cure cancer.” And cancer isn’t one disease. Obviously, it’s a hundred plus diseases or maybe more.
Tacey Ann Rosolowski, PhD:
And morphing all the time, as I have learned from speaking with John Mendelsohn about the personalized perspective.
Bernard Levin, MD:
That’s what he’s devoting his time to now. I’m a little dubious about the people who say our goal is the cure of cancer in the sense that I wouldn’t promise it. That is the goal. That’s what I believe, too. But to say that in our lifetime we’re going to do that, it sounds a little bit like the war on cancer. We’re going to wage war on cancer, and we’re going to defeat the enemy. I think that’s too simplistic.
Tacey Ann Rosolowski, PhD:
Multifaceted. Would you like to—
Bernard Levin, MD:
Sure. Does this seem like a reasonable time?
Tacey Ann Rosolowski, PhD:
It does. All right. So I’m turning off the recorder at 4:10. (End of Audio Two Session One)
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 15: The Culture of the Division and Its Impact" (2013). Interview Chapters. 1351.
https://openworks.mdanderson.org/mchv_interviewchapters/1351
Conditions Governing Access
Open
