Chapter 10: A Pioneering Attitude at MD Anderson: The Nature of Translational Research and The Physician-Scientist --a ‘Dying Breed’
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Description
Dr. Kleinerman begins by explaining that she looked at problems differently because of her basic sciences background. She then explains her view that physician-scientists are a dying breed, and goes on to explain her definition of translational research and important a physician’s perspective is to it.
Picking up a thread of the discussion about MD Anderson culture in Session I, she explains that closing clinicians out of research is a “national tragedy” created by the decreases in money available for funding. She observes that before Dr. Ronald DePinho assumed the presidency of MD Anderson, the institution held the attitude that it was unique and did not want to rely on external systems to validate the research conducted within the institution.
Identifier
KleinermanES_02_20140529_C10
Publication Date
5-29-2014
City
Houston, Texas
Interview Session
Eugenie Kleinerman, MD, Oral History Interview, May 29, 2014
Topics Covered
The University of Texas MD Anderson Cancer Center - MD Anderson CultureThe Researcher Character, Values, Beliefs, Talents Understanding Cancer, the History of Science, Cancer Research Critical Perspectives on MD Anderson Growth and/or Change MD Anderson Culture 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:
Let me ask you why do you think you looked at problems so differently.
Eugenie Kleinerman, MD:
I think because I had a basic science training. I think that it is imperative that we preserve physician scientists who have a laboratory perspective. And, unfortunately, physician scientists are a dying breed because of the funding situation and the pressure on physicians to see patients. And if you want to go into laboratory, you have to get your salary on grants, and the NIH is drying up in terms of salary on grants. The NIH, I mean, there is a study section that looks at translational research and clinical trials, but it’s a very small number. You know, I was on that study section for four years, and I think we didn’t fund one single pediatric clinical trial, translational type of work. So I mean, if you’re doing basic research with pediatric cancer cells, that is not the same as doing translational research that’s going to end up in a clinical trial. It is not. And that’s where I have a lot of problem, because people say, “Oh, we are funding pediatric-focused research,” because they’re using leukemia cells, childhood leukemia cells. But that’s not going to get it to the patient.
Tacey Ann Rosolowski, PhD:
Is this a change in the conception of what translational is or part of the argument about what translational research is?
Eugenie Kleinerman, MD:
Yes, I think there’s much more discussion today on what is really translational research, but I still don’t think we’ve got it right.
Tacey Ann Rosolowski, PhD:
And your definition of and kind of your perspective on translational research, I mean, obviously it’s about clinical trials, but what else does it encompass?
Eugenie Kleinerman, MD:
Translational research, to me, is like what Dr. Fidler did. He used an animal model to describe how therapy was going to work so that we knew the scientific parameters so that we then could design a trial based on what we learned in the laboratory, and the design of the trial would be unique based on the laboratory findings. For example, one of my faculty members is doing research on NK cell therapy, and he’s trying to find out what’s the best NK cell; what’s the most active NK cell; how do we isolate it; how do we augment it; what drugs can we use to make it more potent. This is not science that’s going to get published in Cell and Nature and win a Nobel Prize, but, boy, it can really make a difference in terms of how we use these therapies for patient.
Tacey Ann Rosolowski, PhD:
Why wouldn’t this get published in Cell or Nature?
Eugenie Kleinerman, MD:
That’s the viewpoint.
Tacey Ann Rosolowski, PhD:
Because it’s—I mean, it sounds to me like this work—and it’s something that, you know, since I’m not a scientist, I might get this information coming in and I’m trying to process it and make sense of it, and it sounds to me that a lot of this work is about developing broad context, you know, what are the biological systems that are coming together to make an effect happen and how can we design research which actually starts to reveal systems we didn’t even know about before. To me, that’s what I’ve been hearing from people. Is that [unclear]?
Eugenie Kleinerman, MD:
Yes, yes, and that’s what would get published in Cell and Nature.
Tacey Ann Rosolowski, PhD:
Oh, okay.
Eugenie Kleinerman, MD:
But something like this is viewed as derivative.
Tacey Ann Rosolowski, PhD:
Interesting.
Eugenie Kleinerman, MD:
If somebody found the NK cell and all you’re doing is tweaking the system, I agree, it’s not Nobel Prize work. I agree. But if we’re going to make it—what’s your goal here? If your goal is to make an impact in patient treatment, then you’ve got to recognize that this is important research and you’ve got to have funding for it, and you need the physician perspective.
Tacey Ann Rosolowski, PhD:
So the goal being clinical impact.
Eugenie Kleinerman, MD:
Yes. Yes.
Tacey Ann Rosolowski, PhD:
And that’s where the physician’s perspective comes in.
Eugenie Kleinerman, MD:
Correct. You know, can we give this to—I’m so sick of reading articles—and I read it all the time in Cell and Cancer Cell—“Here we’ve defined this pathway and this can be a new target for cancer therapy.” Okay. How are you going to get it to the metastasis? You know, we can cure the primary tumor really nice. The surgeons can cure the primary tumor. How are we going to get it to the metastasis? How are we going to be able to evaluate whether this is doing in the body what it’s doing in the tissue culture dish? How do we know it’s going to get taken up? All the things that we did, is it going to get taken up? Is it going to produce the change in the cell that you want? And how do you give it? What do you look for? Not just, “Here I have identified this pathway and this is controlled by this gene that is abnormally regulated in cancer cells.” Wonderful. Okay. Great.
Tacey Ann Rosolowski, PhD:
What do we do about it?
Eugenie Kleinerman, MD:
What do we do about it? And you need the physician scientist there to say, “Okay, I understand how this is, but I also understand I’ve got a patient here. How am I going to design the clinical trial so I can assess whether this is effective?” Just like I did. How am I going to design a clinical trial that’s really going to be able to test whether activating the immune system has any impact on the tumor within the confines of doing a clinical trial? I can’t just go in and do multiple surgeries on a patient. I have ethics involved. I have informed consent. And I don’t think the basic scientists truly understand all of the intricacies of a clinical trial and what you have to do to make a clinical trial work. I think they’re very glib about, “This can be the next cure for cancer, the next treatment that will make a significant impact,” and they say these words with absolutely no understanding.
Tacey Ann Rosolowski, PhD:
So this is kind of going back to the conversation that we had last time with the—I mean, I assume about the shift in perspective of the institution to a more basic science focus. Is that the concern, that now the support is for research that really isn’t taking into account the physician scientist perspective, disconnecting discovery from delivery, basically?
Eugenie Kleinerman, MD:
Right. Right. Now, I think they say all the right things, and I may be wrong, but what I see from the landscape is that the physician scientist is still going to be required to bring in significant grant funding to cover the salary for the portion of the time they spend in the lab.
Tacey Ann Rosolowski, PhD:
Now, is that—I mean, it seems to me—am I assuming correctly from the conversation we’ve had so far, that the emergence of that attitude at MD Anderson reflects an attitude that is controlling what publications appear in very high-impact journals, for example, so that it’s not a new thing unique to MD Anderson, it’s kind of part of the politics of the field?
Eugenie Kleinerman, MD:
No, absolutely. It’s a national—it’s a national—I think it’s a national tragedy. Yes, I think so. I think so.
Tacey Ann Rosolowski, PhD:
And what do you think has caused that?
Eugenie Kleinerman, MD:
The decrease in the funding.
Tacey Ann Rosolowski, PhD:
Decrease in funding. Wow.
Eugenie Kleinerman, MD:
Yeah. I think the decrease in the NIH funding has caused it. I think that the change in healthcare reimbursement has changed that. I think I mentioned to you, when I first came here, we weren’t required to put any of our salary on grants. We had hard-money salary, and our job was to do research. And I understand why things have changed, sort of, but I think MD Anderson, that’s what made MD Anderson so great. They said, “You know, we don’t want to be like Harvard. We don’t want to be like Stanford and Scripps Institute. We don’t want to rely on external systems to validate the importance of the research that we do,” which is what you’re really saying when you say you’re a researcher, you have to get grant funding, outside peer-review funding, and particularly NIH funding. So what you’re saying is that you’re going to allow to be determined what research is done in this institution by the NIH and what they deem to be important. And while I did have, you know, twenty-something years of NIH funding, I also had the ability to have support, institutional support, to do the creative types of things that would never be funded by the NIH. And I think we’re losing that. I fear we’re losing that.
Tacey Ann Rosolowski, PhD:
Well, I’m glad we’ve had that discussion, because I think it’s an important follow-up to the conversation we had last time about the culture of MD Anderson, and kind of sets it in a broader perspective of what’s going on in the field in general. It’s very concerning.
Eugenie Kleinerman, MD:
It is concerning, and that’s why it upsets me, because I think that MD Anderson could take a lead and say, “You know what? We’re not going to do things like everybody else. We’re going to determine. We’re going to allow people to have the freedom to come up with the unique ideas that have made this institution great, that have put this institution in the forefront of clinical research.”
Recommended Citation
Kleinerman, Eugenie S. MD and Rosolowski, Tacey A. PhD, "Chapter 10: A Pioneering Attitude at MD Anderson: The Nature of Translational Research and The Physician-Scientist --a ‘Dying Breed’" (2014). Interview Chapters. 1406.
https://openworks.mdanderson.org/mchv_interviewchapters/1406
Conditions Governing Access
Open
