Chapter 20: Leading the Section of Gastrointestinal Oncology
Files
Description
[Because of a recorder malfunction, some material is lost.] Dr. Levin speaks about his role in establishing the Section of Gastrointestinal Oncology. He speaks about the his dream of creating a multi-disciplinary service by recruiting younger gastroenterologists interested in medical oncology, then explains some of the practical limitations that impeded movement to that goal at the time. He felt that sharing and communicating about patient care across disciplines would move the field forward. He mentions the linkages he built between MD Anderson and the UT Health Sciences Center to expose fellows to the full array of oncologic problems.
Summary of lost material:
Dr. Levin looks at the period when the Section transitioned to a new status as a Department, evaluating what he might have done differently in his role as outgoing head. He describes MD Anderson was reorganized, with departments splitting into a variety of medical specialties; with gastroenterology becoming part of the Division of Medicine, as that split from Medical Oncology. Dr. Levin saw this as a natural evolution that “emboldened” individuals to develop valuable skills and interests. He evaluates his own contributions to this shifting structure: he “straddled the fence,” in his words, developing skills in oncology and patient treatment as well as the laboratory and he understood the language and motivations of many different communities in the institution. He explains that his “one unfulfilled dream” was that he was not able to establish a Houston-wide fellowship training program that would enable fellows to work at many different institutions in the city.
[Note, recorder malfunction at end of Chapter: At explanation of what this training program would provide.]
Identifier
LevinB_02_20130208_C20
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 MD Anderson History Building/Transforming the Institution Multi-disciplinary Approaches Growth and/or Change Obstacles, Challenges Controversy Education Beyond the 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:
Okay. Let me get us back on gear here. Okay. Turning the recorder back on at 10:39. Do you want to start by just finishing up with the administrative thing? I wanted to ask you about the—we only spoke briefly about the role that you served in establishing the gastrointestinal oncology section.
Bernard Levin, MD:
The idea of a multidisciplinary department was one which Irv Krakoff embraced and, hence, my recruitment. I came there when morale was extremely low in the then section of Gastroenterology. There were tense relationships with—amongst the faculty and with faculty of University of Texas Health Science Center in Houston with whom the gastroenterology training program was shared. There was a perception that the faculty at MD Anderson were over-worked, and there was very little reward because mostly there was no real support mechanism for a non-oncologic discipline at MD Anderson. There were already several oncologists within a loose framework of medical oncology, but they had no distinct relationship to gastroenterology, although they treated patients with GI malignancies and several had already achieved considerable success.
Tacey Ann Rosolowski, PhD:
Was it unusual that a distinct section did not exist at this particular time in 1984?
Bernard Levin, MD:
Well, there was a section of Gastroenterology and there was a—there were medical oncologists treating, but they were not in a combined setting and certainly not physically co-located.
Tacey Ann Rosolowski, PhD:
But that wasn’t unusual across the country?
Bernard Levin, MD:
That was not the case anywhere else either.
Tacey Ann Rosolowski, PhD:
Okay.
Bernard Levin, MD:
So my dream was to bring these two disparate elements together, because I felt that by sharing and communicating overall research and patient care would be enhanced. I also was able to recruit several younger gastroenterologists who were interested in the kind of clinical problems posed at MD Anderson to develop further with, initially, Roger Lester and then with Joseph Sellin and Larry Scott—the combined GI Training Program between UT Health Science Center and MD Anderson. It was essential in my mind that fellows would be able to be exposed to a broad array of gastrological and liver problems by attendance at the university as opposed to their only very relatively more narrow oncological issues related to gastroenterology that they would see at MD Anderson. The faculty did not rotate, however, and in some senses that led to some—an occasional disappointment because the practice was more limited than it was at a university center where the whole panoply of diseases would be seen as opposed to those primarily at MD Anderson where a lot of issues related to management and presentation of late cancer. It was only subsequently that the role of screening became more apparent and more evident, and the gastroenterologist assumed a greater role in that. From the medical oncology point of view, the advantages of working in a combined or a multidisciplinary section were less evident than I thought they would be because the medical oncologist tended to be mostly interested in management of patients with advanced malignancy, as well as adjuvant therapy, and benefitted relatively little from the physical co-location of colleagues in gastroenterology. There was some advantage in discussing mutual areas of interest but probably not as tangible as I thought they would be. The other component of the department was research, and over time I was able to recruit primarily three researchers, one interested in high-risk individuals with inherited predisposition to colon cancer, and that was Bruce Boman, who subsequently developed a cell line from a patient with familial polyposis and the Gardner syndrome where there was development of adenomas throughout the GI tract. The DiFi line subsequently became important in research done by Dr. Mendelsohn because it highly expressed a receptor on cells that was important in his work of targeted monoclonal antibodies. That was an interesting coincidence. Also, Michael Wargovich I recruited who—as I mentioned earlier—was interested in natural products and particularly garlic and derivatives and also nutrition—in its broader sense—applied to cancer, particularly colon cancer. Then Marsha Frazier, who was interested in molecular mechanisms of cancer development, first colon cancer and then subsequently pancreatic cancer. To this day, she is still an active member now in the Department of Epidemiology. In retrospect, the transition years, when I was sole chair of what had become a department, although that transition from section to department was really a paper transformation and it had very little legislative or biological significance. It was more an act of a decision about how—what to term these large sections. In retrospect, when I was chair of that department and also ad interim vice president I feel that I—in retrospect—I let my leadership of the department slip unnecessarily and did not pay enough attention to a successful transition to another leader. If I had the opportunity to do that again I would have paid more attention. After I appointed with the support of Dr. Krakoff and subsequently Dr. Bass who became Chair of Medicine—after I appointed a new chair—there was a period where relationships between the gastroenterologists and the medical oncologists didn’t work out well. Subsequently, and with my tacit support, the agreement was made to separate the two such that there became a Department of Gastroenterology. That’s evolved into Gastroenterology, Hepatology and Nutrition and a Department of Gastrointestinal Oncology, which has also grown substantially. The Department of Gastroenterology, Hepatology and Nutrition became one of the departments in a newly constituted Department of Medical Specialties or Department of Medicine as it’s now—or Division of Medicine as it’s now called. It was a break from what had been the pattern, which was that the Chair of Medical Oncology would have within his domain a Department of Medical Specialties, but that become clear that one individual couldn’t possibly be responsible and responsive to the needs of a growing Department of Medical Specialties. So a new division was created for which I was a strong protagonist in leadership circles which would encompass the areas such as dermatology, cardiology, general medicine, gastroenterology, rheumatology, nephrology—mostly full-time but also some part-time people from the University of Texas Health Science Center. Under that jurisdiction, those departments have grown, both in depth and breadth.
Tacey Ann Rosolowski, PhD:
Do you think that the practice has a different character because of this institutional organization? If it had been possible to bring together that multidisciplinary team that you first envisioned would the institution—would the practice of patient care and of research be different—look different today?
Bernard Levin, MD:
I don’t really think so, because I think it was the natural evolution that gastroenterology be a part of a Division of Medicine. When I came, that wasn’t there. There was some resistance to splitting medicine from medical oncology for reasons that aren’t really relevant today, but I believe it was much for the better and emboldened individuals who were not oncologists to develop research and clinical interests that are extremely valuable and relevant.
Tacey Ann Rosolowski, PhD:
Now as you look back—I mean you focused on—you’ve taken me through this kind of split that took place. During your guidance of this section and the section which became a department, what do you feel that your perspective added to the conversation that strengthened this?
Bernard Levin, MD:
Well, I had a significant interest in oncology. Almost by default—as I mentioned much earlier—I had grown to learn how to treat people with cancer, and although I had not completed a formal certification in medical oncology I had acquired—by osmosis I suppose—some of the skills and knowledge, and in collaboration with colleagues in GI medical oncology or GI oncology as it was then, participated in a number of therapeutic trials. Also, I was in a sense a card-carrying gastroenterologist, so I believe I straddled the fence between these two different disciplines—sometimes successfully and sometimes not. But I understood their language and their motivations. I also had some interest in the laboratory aspect of the work, although I did not personally have any direct involvement in laboratory. I met with the laboratory researchers frequently and was extremely supportive of their work. Our laboratory program was limited by space and by available talent, but nevertheless, made some good contributions.
Tacey Ann Rosolowski, PhD:
So did you feel as though your—was this another facilitative role, basically, that you were taking between these different subspecialties?
Bernard Levin, MD:
Yes, to some extent it was. Perhaps when I had partly successfully or even unsuccessfully decided that this exercise had gone as far as I could, I think my own natural restlessness became more apparent, and I probably began to think about other possibilities within the institution, and hence, a receptiveness to this new role in cancer prevention.
Tacey Ann Rosolowski, PhD:
Right. Right. I understand. Is there anything else that you would like to add about that period of the section and department of—
Bernard Levin, MD:
Well, I had one unfulfilled dream, which didn’t work out as well as I would have wanted as that was to have a joint fellowship training program in gastroenterology that was Houston-wide and involved collaborations with Baylor and its very strong programs at the Houston VA, Ben Taub, and at private hospitals—The University of Texas Health Science Center at Hermann Hospital and MD Anderson because I thought that would provide— (End of Audio One)
Bernard Levin, MD:
So would you—do you think that there was some—
Tacey Ann Rosolowski, PhD:
Put it on record which I just did—the light is stable and—okay. Well, let me just—and the counter is moving—all right. After a brief break, I am turning the recorder back on at 12:16. Let’s see.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 20: Leading the Section of Gastrointestinal Oncology" (2013). Interview Chapters. 1356.
https://openworks.mdanderson.org/mchv_interviewchapters/1356
Conditions Governing Access
Open
