Chapter 02: Creating a Comprehensive Neuro Service –and the Best Service
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Description
Dr. Sawaya states that his goal was to create a comprehensive neuro-service that was the best in all activities, a vision he (literally) illustrates by reference to an image entitled, “Neurosurgical Oncology.” (See image next page. Dr. Sawaya explains that he sketched the image and Dr. Ian Suk, a medical illustrationist, created the final design.)
Dr. Sawaya explains the elements of a comprehensive neuro-service: high-level surgery supported by technologies, infrastructure (such as a tissue bank); a database; and education and training. (Dr. Sawaya notes that he created the first neurosurgical oncology fellowship program in 1990, accepting its first fellows in 1991.) He goes on to explain other features of a comprehensive neuro-service. Next, he notes that pain is an essential element of neuro-oncology and describes how a patient’s suffering and reliance on opiates can be surgically alleviated in some cases. The surgeon creates a tiny brain lesion that destroys the patient’s ability to sense the cancer pain. Dr. Sawaya sketches the Department’s growth (300 procedures/year in 1972 to 1,700 during 2012), and notes that the faculty works well together.
Identifier
SawayaR_01_20130604_C02
Publication Date
6-4-2013
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionOverview; The Researcher; The Clinician; The Administrator; The Educator; The Leader; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Institutional Mission and Values; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; MD Anderson Culture; MD Anderson History
Transcript
Tacey Ann Rosolowski, PhD:
Interesting. It just occurred to me to ask you for another definition as we're beginning here. I don't know if I—I didn't mention before we started the interview proper that this archive is going to be available not only for people who are specialists in the medical field but also for laypersons, and so I wanted to make sure that there are some definitions of terms. As I was reading your background material, a term that comes up over and over again, and you used it here today, is the "model." I'm wondering if you could define what that means, like the sheep model or the mouse model. When you use that phrase, what does that signify? William C. Satterfield, DVM The model, in sort of generic terms, is that any kind of substitute for a human has to be in such a way that it can model that condition in the human, because that's our ultimate goal. Whatever we're doing, whatever research we're looking at—be it prostate cancer—we have to develop a mouse model that has the same kind of characteristics so we can—as the scientists that working with them can develop approaches to either diagnosing, preventing, or treating that particular condition in the "model."
Tacey Ann Rosolowski, PhD:
How do you know—? William C. Satterfield, DVM Which is separate from humans, so you're not doing this basic type of research in a human, because there are ethical reasons for not doing that. But we can do it in a sheep or we can do it—look at the pathogenesis of a viral condition or look at the—and put implants in the spinal cord of a sheep and test the analgesic's qualities of various types of analgesics to treat neuropathic pain. Neuropathic pain is pain that can't really be alleviated, and it can occur in a lot of cancer that affects the central nervous system with spinal pain. It can be quite clinically difficult.
Tacey Ann Rosolowski, PhD:
How do you know when you have an animal model that approximates what a human being would experience or what a human being's tissue is like? How do you determine that? William C. Satterfield, DVM The whole thing about using animals is that all of us, including the whole phyla or the whole—if you look at it from a comparative point of view, all the animals with backbones, including us, have an evolutionary history that is similar. So the way our cells work and the way a mouse cell works are basically the same. Now, there are other things that affect those, obviously, so we have to take all of that in consideration. And this is what the people who are not in favor of animal research say. "You can't compare what happens in a mouse to what kind of thing happens in a human." But if you take it in just the context of what you're looking at, a lot of that can be certainly instructive, and you can get a pretty good idea how it's going to work in humans. And that is one of the reasons in the safeguards of developing drugs. You usually have to use several models to make sure, or several different animals to make sure, that it still is a consistent result.
Tacey Ann Rosolowski, PhD:
I see. So, you're ramping up basically to say, "Okay, we know enough—" William C. Satterfield, DVM And which is where—
Tacey Ann Rosolowski, PhD:
“—that we can do it in humans.” William C. Satterfield, DVM Exactly, and that's where primates come in, because primates are, in the case of chimpanzees, almost identical to a human genetically as well as physiologically, immunologically, everything else. Rhesus monkey, ninety percent; a mouse, seventy-five percent. Genetically, we can get a lot of similarities in the way—they got their same heart, liver. They may process their food a little differently in their intestines, but all animals do that, and the same with the way nerves work in terms of the sheep, using spinal treatments. Their nerves operate the same as ours. There is no difference in the way they work.
Tacey Ann Rosolowski, PhD:
Okay. We're kind of getting to the second general question I was going to ask, which is why animal research is so important for advancing the understanding of cancer and advancing cancer therapies. William C. Satterfield, DVM Cancer is a very complex—it's not a single syndrome. Cancer is as varied as genetics of a human being. There are some commonalities with the way cells mature, and they grow, and they die, and they multiply and so forth. But there are a lot of different types of cancer, and there is no one magic bullet for any one of these. So in looking at colon cancer, for example, we have a model of colon cancer in our rhesus monkeys. They develop colon cancer spontaneously just like people can. And we have a cohort, a little group of animals that are related that there is some genetic—apparently genetic—relationship that is causing this. And we are going to participate with a "Moon Shot" that Dr. DePinho is talking about with this particular model because there may be some questions that we can answer with our rhesus monkeys that develop this. And we also have basic scientists here who can grow some of these in tissue culture. We use tissue culture. That's a very important thing. We do as much "computering" as we can do, but you cannot replicate a complete, living organism with a computer. It just doesn't happen. Nobody has developed that program yet. And when they do, then maybe animals will become obsolete for this, but that's a long ways away. Personally, I have questions as to how far out that's going to be, because with all the millions of genes that we have within our single cell, each one of these could have a defect in it that you can't predict. You can't program a computer to predict those, so we do need animals. And you can't—some of the stuff that we do, some of the research or some of the projects or the studies we do in chimpanzees, are done specifically with that chimpanzee because there is no other animal except for human beings that those particular studies can be done in. There are specific antibodies that are directed against Crohn's disease, rheumatoid arthritis, and other things that we share with chimpanzees. Those antibody receptors are shared only with us and chimpanzees. If those studies are done in another animal, then the results would be fallacious, and they could be fatal for humans, in fact. There have been instances where that has occurred. So it's just—not every study is done in every animal, but there are— And that's one of the ways that we specialize here at the Keeling Center, is that we are able to help investigators use the right model to get the most reliable answers to help humans.
Tacey Ann Rosolowski, PhD:
The last kind of general question I wanted to ask you before we move on to probably the more chronological part was— First of all, on the outside, I wanted to note that you've been, for many years, responsible for the care of, in particular, the chimpanzees here. And I also read that you're one of the founding members of the National Chimpanzee Research consortium, so that's been a real commitment of yours. And I wanted to note that for some people, the use of research animals, and in particular, primates, is controversial and may be even considered immoral. So I wanted to know what your response is to that and what your personal mission and philosophy is regarding the use of all animals, but particularly the higher primates. William C. Satterfield, DVM It's a very controversial area, as you mentioned, and I appreciate the controversy. I understand it, and I have to say and be very blunt about this, unfortunately for society in general, there is a great deal of ignorance regarding science. People are scientifically illiterate for the most part. I love our animals. Every time we lose an animal here from natural causes, it is traumatic. I mean, we take that personally. I take it personally. All of my care staff takes it personally. It's a personal loss to us if we lose—for any reason, natural or otherwise. We have problems with—we treat our chimps for cardiac disease. They have naturally occurring cardiac disease. And we had one die of a sudden cardiac death. It's like a family member, losing a family member or personal pet. It's traumatic. But on the other hand, it's okay if we inconvenience a few animals for the benefit of mankind. For example, there are over 170 million people worldwide that are infected with hepatitis C. Several million of those reside in this country. Those are people walking around with the virus. There is no treatment for that virus. There are treatments that are emerging now because of the studies that we're able to do with chimpanzees, but chimpanzee is the only other animal that naturally can grow that virus in their system other than man. So we can use that model. They're like us. They walk around with it. In fact, chimps are less affected by it than humans are. Not to say that they are not affected by it, but they are less affected. They don't show any symptoms of it as we would as a human. But the point I was going to make is that of these 170 million or 200 million people—and it's more of an emerging disease outside of this country worldwide than it is in the US because we've done a better job in controlling our blood supplies—however, think of the cost to the families. A person has that for years and years and years. Think of the emotional and the physical and the financial cost to the families, not just the individual, but everybody associated with him and his family or her and her family. And the only treatment for it currently is liver transplant. There are some other treatments, but they are not—you feel as bad on those treatments as you do with the disease. But we're coming up with some actual, possible cures. We've actually been able to cure a chimpanzee with hepatitis C recently. That, to me, was just a huge, huge breakthrough.
Tacey Ann Rosolowski, PhD:
When did that happen? William C. Satterfield, DVM That happened about a year and a half ago. And the literature now is starting to be very optimistic about—hepatitis C is now going to be considered a treatable disease as opposed to a non-treatable disease, one that you just endure. So the cost of inconveniencing a few animals versus taking care of—not just the 170 million that are affected, but the millions otherwise that are also affected through the fallout—is just incalculable.
Tacey Ann Rosolowski, PhD:
How does that perspective influence just your day-to-day care of the animals? What do you do here to—? William C. Satterfield, DVM Day to day? We've got a—
Tacey Ann Rosolowski, PhD:
Now I'm thinking about how you—day to day you work with— William C. Satterfield, DVM We've got a—we treat each one of them like they're a family member. They've got a medical file. They're scheduled either as animals that are in really good condition. They get a physical once a year. They get ultrasound. They get their hearts checked. They do complete blood work.
Tacey Ann Rosolowski, PhD:
So you really treat them like human patients almost. William C. Satterfield, DVM And then if they have any other thing going on, they get looked at twice a year. Everybody over a certain age of twenty or so, and even all of our animals are getting echocardiograms. We have a cardiologist look at them. Sometimes they'll get two cardiac exams a year in addition to three physicals a year, dependent on their category. And we also classify our animals according to the American Heart Association's classification. We have a cardiac group. We're actually doing geriatric medicine on a lot of our animals because we have an aging colony. NIH has had a moratorium on breeding. All of our chimpanzees belong to the government, so we've had a moratorium on breeding basically since 1995, so the colony is throughout getting older.
Tacey Ann Rosolowski, PhD:
Why has there been a moratorium? William C. Satterfield, DVM Frankly, the controversy over using chimps was not the initial thing. It was more of a concern about what the cost—because they're not inexpensive to keep. It's an expensive model to keep. The NIH maintained these animals as a research resource. And that's what this colony is—a research resource. It's not—they don't get euthanized at the end of a study. All of the other species—smaller primates, rodents and so forth—at the end of the study will likely, in many cases, they'll be sacrificed and all of their organs examined. That doesn't ever happen with chimpanzee. Not ever, unless there's some unplanned accident that has happened, but only once in my career has that happened here. And that particular case prevented that particular product from going into humans and killing a bunch of people. So it would've killed a bunch of people had we not had a—we hated to have it happen here but—
Tacey Ann Rosolowski, PhD:
Can you tell me what that product was? William C. Satterfield, DVM It was a monoclonal antibody, and it was one that a drug company was developing. And they stopped the development of it because it couldn't go into humans, and that was their ultimate goal was to treat diseases that are caused by individual autoimmune diseases.
Recommended Citation
Sawaya, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 02: Creating a Comprehensive Neuro Service –and the Best Service" (2013). Interview Chapters. 1538.
https://openworks.mdanderson.org/mchv_interviewchapters/1538
Conditions Governing Access
Open
