Chapter 16: Leading a New Division and Lessons Learned
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Description
In this Chapter, Dr. Levin talks about some Division of Cancer Prevention initiatives and makes observations on leading a new and evolving division. He first describes the contributions that Dr. Alvin Tarlov, who specializes in the social determinants of health and helped the Division of Cancer Prevention think through the rationale for a Department of Health Disparities Research. He then talks about examples of Division research translating into interventions for patient care and health. Dr. Levin assesses what was achieved between ’92 and 2007, a period of great growth into virtually a new area and how role of a comprehensive cancer center evolved.
Dr. Levin discusses what he learned about leadership during his years as head of the Division of Cancer Prevention, then comments on the vast resources available throughout the Texas Medical Center and other institutions that have furthered work on cancer prevention.
Dr. Levin next characterizes himself as an ambitious leader, noting that he needed to come up top speed on the subject of cancer prevention and relied heavily on peer experts. He also praises the support that the Legislature and the institution’s administration gave the Division of Cancer Prevention. Dr. Levin then talks about the specific challenge of simultaneously mastering a field and developing a new institutional division from scratch, a situation he describes as “novel, if not unique.”
Identifier
LevinB_02_20130208_C16
Publication Date
2-8-2013
City
Houston, Texas
Interview Session
Bernard Levin, MD, Oral History Interview, February 08, 2013
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional UnitThe Administrator Understanding the Institution Professional Practice The Professional at Work Leadership On Leadership The Administrator MD Anderson and Other Institutions The Healthcare Industry Professional Path Evolution of Career On Leadership Beyond the Institution Collaborations The Healthcare Industry
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:
Okay. I just wanted to say—this is Tacey Ann Rosolowski, and we’re in our first session with Dr. Bernard Levin. The time is 9:30, and the date is February 8, 2013. So you were saying you had—
Bernard Levin, MD:
I’m saying that at MD Anderson, unfortunately, often we would be the bearer of bad news.
Tacey Ann Rosolowski, PhD:
Hmm.
Bernard Levin, MD:
So a box of tissues in the room was always a good thing. It reminds me—maybe some of the people you’ve interviewed have become emotional and need to weep.
Tacey Ann Rosolowski, PhD:
Actually, it has happened—becoming emotional. The tissues right now are for me because I’m worried about a cold coming on. I’ll keep my distance.
Bernard Levin, MD:
No, it’s okay. I’m sure I’ve had my share this season. I was going to say in the prelude to discussing health services research, there was a very important figure, whose name I don’t want to omit, and that is Alvin Tarlov—T-A-R-L-O-V. Alvin had been a very young Chair of Medicine at the University of Chicago when I was a very young faculty member and subsequently became President of the Kaiser Family Foundation and then had other parts of his career develop in Boston and at Harvard. But then he came to Houston as Director of the Texas Health Institute at the James Baker Center at Rice University. There, after a lapse of many years, our paths crossed again because I had known him for a long time prior to that. He was very much an expert on social determinants of health. Although his program at the Baker Institute didn’t quite succeed for a variety of reasons, nevertheless, he was quite influential in helping me and helping us at MD Anderson think through the rationale and the practical implications of a department of health disparities research. So for that I will always be grateful to him. He has subsequently retired, first to Chicago where he helped at the University of Chicago again in applying for some grants and taking courses at the Art Institute as a cartoonist. Then he subsequently remarried and moved to—first New York and then to Arizona, where he now resides.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Bernard Levin, MD:
A very fond and meaningful memory.
Tacey Ann Rosolowski, PhD:
Do you have a recollection of the kinds of insights that he was able to provide to you?
Bernard Levin, MD:
Well, he had had a lot of background in the specific issue of the social determinants of health as applied to studies of health disparities in the U.S. He had been influential at the Robert Wood Johnson Foundation and sat on an advisory board there or a research grant selection committee. So he was quite invested with the knowledge of how this could be translated into an academic department.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Bernard Levin, MD:
And helped us conceptualize not only why this was important but also why it was relevant to a department of cancer prevention and population sciences in Houston, Texas with its marked and interesting racial or ethnic diversity and immigrant populations and, hence, disparities.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative). Which have only increased over—
Bernard Levin, MD:
Which have only increased as magnified by the very poor coverage for children in particular but also for minorities and undocumented individuals.
Tacey Ann Rosolowski, PhD:
I guess that leads to a second question. When we spoke yesterday, you underscored that the Department of Health Disparities was really research focused. But were there instances in which that research—you found ways to carry that research over into action?
Bernard Levin, MD:
There were instances in other elements of the Cancer Prevention Center—
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Bernard Levin, MD:
The Cancer Prevention Center and, also, in outreach programs. But I think the best example is that related to tobacco for which interventions were designed by David Wetter and his colleagues in their department. But also in collaboration with others in Behavioral Science who—as I had mentioned yesterday—there was a fairly significant amount of tobacco control research, both within the institution for patients but also much more generally within Texas aimed at minorities in particular and also those with HIV/AIDS. Although one tends to be compartmentalized, if you go the thousand-foot view, one can certainly see how there are synergies and significant collaborations.
Tacey Ann Rosolowski, PhD:
I guess—I wanted to ask you to take that thousand-foot view. It seems like we’re kind of coming to the end of your discussion of your role as VP of that division. How would you assess what was achieved between those years of 1992 and then 2007 when you retired?
Bernard Levin, MD:
Well, I look back upon them as important years for MD Anderson as a period of great growth into what was virtually a new area and a realization that the role of a cancer—a comprehensive cancer center was exemplified by having a comprehensive approach to individuals and groups both at risk for the development of cancer and yhose who already had cancer. I also, of course, view the whole period with great personal satisfaction but recognize that this really was a team effort which many people contributed. I learned a lot from the—not only on the political level, the managerial level, administrative level but also on the scientific level and came to appreciate the tremendous contributions of many of my colleagues and the people they recruited.
Tacey Ann Rosolowski, PhD:
What were some of the lessons you learned?
Bernard Levin, MD:
I believe that one of the most important from an institutional point of view is that the commitments have to come from the top initially—that new programs can’t just bubble up from the lower faculty levels. There has to be major commitment provided by the president—in the case of MD Anderson—and that the signals have to be extraordinarily clear as to the importance and to some extent as to direction and the amount of support. Of course, I was privileged to have that, primarily from Mickey LeMaistre, but subsequently also from John Mendelsohn. I also underestimated initially the amount of institutional resistance to new ideas—novel programs—the competition for resources as perceived by some. Also, the recognition in my mind that it is best not to become monopolistic about concepts and ideas and programs, that willingness from a position of strength, but nevertheless, willingness to share carries one further than trying to go it alone. I also came to value the potential but not completely realized strengths of others in the Texas Medical Center who could contribute. For example, the School of Public Health. Although we didn’t have the best of working relationships for a variety of reasons, nevertheless, we saw that as an additional resource. There were already beginning collaborations with other institutions, such as Children’s Hospital—Children’s—that was a very important framework for a couple of the faculty members and particularly in Epidemiology.
Tacey Ann Rosolowski, PhD:
I think there was also—wasn’t there also some connection with Rice University—The Center for Computational Research—to handle genetic data for bioinformatics?
Bernard Levin, MD:
Yes. I omitted to include Rice University—very important. I mentioned the Texas Health Institute and Baker Institute—the Baker Center—but also that computational strength and also subsequently collaborations had developed with the Department of Biomedical Engineering—not necessarily through Cancer Prevention but with individuals in Gastroenterology, which contributed to the overall institutional collaborations with Rice University as a major center.
Tacey Ann Rosolowski, PhD:
How would you characterize the value of creating those connections across institutions?
Bernard Levin, MD:
Pragmatically, both sides have to benefit for success to be achieved, but there is little question in my mind that when properly designed and instructed such collaborations bring enormous value, particularly when they’re unique disciplines or strengths that aren’t present in one institution but are in another. Those examples, for example, related to the strength of Rice as a center of engineering research—computational research—are particularly good examples. I also think that future collaboration with Baylor College of Medicine is likely to be very important, a new center for global health or tropical health I see is—I hope will become an ally in the whole area of cancer prevention and population sciences applied to other countries.
Tacey Ann Rosolowski, PhD:
This kind of synergetic alignment of interesting resources—I’m thinking too about how just as everything is becoming more expensive to run programs, too, that kind of collaboration can help people do a little more with less.
Bernard Levin, MD:
I agree entirely.
Tacey Ann Rosolowski, PhD:
Yeah. In terms of your own—you mentioned some of the lessons learned. But I’m also wondering if you could reflect a bit on just how would you characterize yourself as a person who led this initiative or helped organize this initiative, and what was your learning curve like, and how would you characterize yourself as a leader and administrator?
Bernard Levin, MD:
Well, certainly I was an ambitious leader but probably made many mistakes along the way, so my learning curve was very steep. I had to learn a considerable amount about the science and practice of cancer prevention. I had some rudimentary knowledge. I, nevertheless, specifically needed to gain much more information about the science of epidemiology. I hardly scratched the surface, I’m afraid, and behavioral science, too. Those were relatively new areas to me, and I found them extraordinarily interesting to learn about. I am sure that my own skills at political leadership were enhanced by this process of having to develop something from relatively unformed ideas and an unformed matrix. But, as in all areas of leadership, one learns from one’s peers and one’s colleagues, sometimes pleasantly and sometimes unpleasantly. I’m sure I was a better person for both those kinds of learning experiences. I also found that exposure to figures at a national level who were facing somewhat similar problems, particularly through the American Society of Preventive Oncology, of which a number of my colleagues became president, such as Ellen Gritz and Margaret Spitz and others, who were program chairs and other officers of the organization. Sharing those ideas at a national level once a year was helpful because one could see that there was a commonality of issues. In fact, it helped me understand how fortunate we were at MD Anderson to have a very robust, well-supported program with hard money—so to speak—in terms of state support with presidential seal of approval and with the ability to raise philanthropic dollars virtually in an unlimited way. So the sense of appreciation of the good of what we had was also extraordinarily important to me in the growth of my own understanding of the field. I would occasionally bump into individuals who had at one time considered becoming the vice president of MD Anderson, and one in particular would always reflect on how fortunate we were compared to the average state institution, particularly in a matrix cancer center, where there is intense competition between the medical school and the adjacent hospital, and within the medical school, the fact that oncology isn’t the only important child.
Tacey Ann Rosolowski, PhD:
Right.
Bernard Levin, MD:
So these were all—I think—molding influences. But overall, of course, I feel a tremendous sense of pride and gratitude at having had this experience.
Tacey Ann Rosolowski, PhD:
I’m wondering, too, since you underscored a couple of times that you had to come up to speed on the subject matter and the content, I’m sure it was also a moving target because the research and cancer prevention was continually evolving. What’s your view, as you look back, on coming into a leadership role at the same time as having to master a subject matter? How did that affect you? I’m thinking of individuals who might be listening to this and thinking, “Huh, should I take on a role of this kind if I’m not a master in the field—if I’m not a specialist?” What’s your reflection on that process?
Bernard Levin, MD:
It was challenging, and undoubtedly I did not have the credentials of some of the individuals who I was recruiting. In a very specific element or discipline they had been working or were masters of the field and were highly respected. I think I got a lot of credit and perhaps some lack of challenge as to my role because it was perceived to be novel, if not unique. The fact that I was willing to try and achieve this in a novel way probably gave me more credit than I deserved. I tried my best to learn—not only in a formal didactic way but also by encounters with numerous faculty, with the chairs in particular but with other faculty members about what was important and what was involving in this discipline—in the disciplines. Also, the institution more broadly with its evolving interest in genomic medicine also provided an impetus to driving the development of molecular epidemiology as very much part of the present department as developed by Margaret Spitz and her colleagues. The evolving interest in behavioral science—not only as a psychological—in a psychological format but also neurophysiological began to play a role in understanding neuropharmacology in terms of tobacco control. All of these were influences that consciously or subconsciously pervaded discussions of which I was a small part.
Tacey Ann Rosolowski, PhD:
So how did you see your role amid all of this?
Bernard Levin, MD:
I saw it in two ways. I was the champion advocate for cancer prevention in the institution at a managerial level—administrative level—and to my peers in the Departments of Medicine and Surgery and others. But I was also the cheerleader and coordinator and facilitator within the division, trying to provide with some degree an equitable division of resources to various departments—trying to keep peace between various factions that inevitably developed and trying to enhance growth. I felt we could with a certain degree of confidence look to continued growth for a period of time. The growth curve was quite steep, not only in terms of faculty size, administrative support, but also in terms of grants received. There was a substantial amount of peer-reviewed funding.
Tacey Ann Rosolowski, PhD:
Can you give me an overview of how that growth occurred? What did you start with in terms of faculty numbers and support, and where did you end up by 2007? I mean, in rough terms. I realize it’s been a while.
Bernard Levin, MD:
We probably began with twelve to fifteen faculty and ended up close to seventy to seventy-five over a period of perhaps a decade. Of course, this would not have been possible without very strong institutional support—support by, initially, Mickey LeMaistre, Andy von Eschenbach, Fred Becker, David Bachrach. Then, subsequently, support from other individuals who came into the roles of providing resources, particularly Margaret Kripke.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 16: Leading a New Division and Lessons Learned" (2013). Interview Chapters. 1352.
https://openworks.mdanderson.org/mchv_interviewchapters/1352
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