Chapter 05: Recruitments for the New Department of Neurosurgery
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Description
In this Chapter, Dr. Sawaya begins to sketch the process he went through to turn his vision for a neuro-service into a reality. He first talks about recruitments. He first hired Dr. Justi Rao, a basic scientist whose work on brain invasiveness supported his own interest in the subject. He notes that the Department’s research portfolio has diversified significantly since that time.
Dr. Sawaya next hired neurosurgeon Ian McCutcheon, who worked on mapping the brain. Dr. Sawaya explains the problems brain surgeons face when trying to locate tumors, focusing in particular on the challenges that base-of-skull tumors present. He notes that he hired Dr. Frank Delmonte to address tumors in this region.
Dr. Sawaya next hired neurosurgeon Sam Hassenbusch, who became the director of the pain program and the stereotactic surgery program. Dr. Sawaya explains the equipment that makes stereotactic surgery possible.
Dr. Sawaya next hired Dr. Zia Gokaslan to develop the program in spinal oncology. He then goes on to talk about the “rough patch” with managed care in the mid-nineties, and the way he managed to hire Dr. Fred Lang in 1996 as Director of Clinical Research, despite budget limitations. Dr. Sawaya notes that by 1996, he had established the nucleus of the Department.
Identifier
SawayaR_01_20130604_C05
Publication Date
6-4-2013
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionThe Administrator; The Leader; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Portraits; Evolution of Career; Professional Practice; The Professional at Work; Leadership; On Leadership; Professional Values, Ethics, Purpose; Overview; Definitions, Explanations, Translations
Transcript
Tacey Ann Rosolowski, PhD:
How long did it take you after you arrived in 1990 to kind of get the department on the path? Because as we’ve been talking, I think you’ve been giving me a snapshot of a well-established department. But what about when you arrived? What was the situation on the ground then?
Raymond Sawaya, MD:
I was forty-one. So I do want to emphasize I was young. And when you’re that young, you really don’t have enough experience. So if I’m trying to tell you that I knew it all along from day one, I knew everything I needed to do and how to do it, then obviously I’m not being truthful with you.
Tacey Ann Rosolowski, PhD:
Somehow, just even talking to you a few minutes, I sort of would know that—that you wouldn’t try and convince me of that.
Raymond Sawaya, MD:
Accepting that we don’t know everything is crucial, but not letting that get in the way or stop you. And it requires an enormous amount of energy and really desire to build something big. And that’s why I do believe the vision is what leads you, because I had the vision, there is no question about it. Now I look back— When I was at Cincinnati I knew what the vision was. I asked for that vision. I asked for the resources to make that vision happen. So that part I had. But how to—with resources—how to make it happen, that’s not a given. And so that’s where working hard and working long and accepting that I make mistakes or I have made mistakes and therefore correcting the course of action is part of it all. And I’m sure I did that. But the strongest element that makes you move forward is to see small pockets of success along that path—along the mistakes or the uncertainty or not being really sure, “Am I that good?” Once you see bits and pieces of success and you get feedback that it’s going great, then that emboldens you—that infuses you with more energy and more desire to keep building. And I think it started on very early with recruitment and with specific programmatic accomplishments that we did and the growth. Once you see growth—
Tacey Ann Rosolowski, PhD:
So tell me about those first steps. Kind of—this is really up to you to kind of figure out what are the high points. What was that process of setting the pieces in place like? What did you do first?
Raymond Sawaya, MD:
So my first recruitment was a basic scientist, because—as I said earlier—I suffered in Cincinnati not to be able to hire a PhD. I was a busy clinician. I did have a lab, I did have some basic research going on, but I was only one person. I felt that if I would bring professionals—a professional PhD who would focus his or her entire research on the field that we’re trying to study, then we can accomplish so much more. Then we can collaborate together. I can bring the clinical and the tissue material—the real humans—and then they can do the testing in the lab with animals or whatever. Then the synergy can be very successful.
Tacey Ann Rosolowski, PhD:
Was there a little discomfort with that? I mean, as I’ve heard stories about the kind of big divide between the Division of Medicine and Developmental Therapeutics and the way one had kind of control over the laboratory and the other had control over the clinic. That was a big cultural change.
Raymond Sawaya, MD:
Yeah, but having all that in the same department, you avoid that kind of thing, because we’re the same department with one leader. No, again, I’m not saying that I’m the creator of that model. I’m not. It existed before in the program in San Francisco, as I mentioned to you, was successful in great part because that one chairman created all aspects of brain tumor care and research in one center, in one department. So that model existed. And so I wanted to emulate that.
Tacey Ann Rosolowski, PhD:
Who was that first recruitment?
Raymond Sawaya, MD:
Jasti Rao, R-A-O. He was with me until 2001. So from 1991 to 2001. He was highly successful, did a lot of great work.
Tacey Ann Rosolowski, PhD:
Why did you select this person?
Raymond Sawaya, MD:
Because I was in touch with him before I came here to MD Anderson. My interest in the lab was in studying tumor invasiveness. Why do brain tumors like to invade the brain and penetrate deep into the brain, which makes them out of reach and, therefore, not curable? Because we cannot get to them. And I had done a lot of research on the enzymes that make cells have this ability to invade. They are called proteases. And Jasti was one of very, very few people in the country that I knew of that had a background in this field. So he was very eager to come and join me right away, actually. It took no time to recruit him. And he was very successful in that field. In 2001, he was offered a chairmanship of Cancer Biology at the University of Illinois at Peoria. And so he left here for that tremendous—since then I’ve hired five or six PhD’s that developed a much broader and much more diverse portfolio of laboratory research, which is essential because I frequently say, “You can’t put all your eggs in one basket.” The basket falls, then you are empty handed. And you never know which approach is going to be perhaps the most important—the one that’s going to lead to the greatest breakthroughs. And by having these different approaches, they all have merit, they all have scientific basis, but some will succeed more than others. Some will succeed sooner than others. So that’s another principle that I believe in. And so we have established that here at MD Anderson. In 2001, it also happened that I was made officially the director of the Brain Tumor Program. And that by itself is a long story that we may talk about in our second interview, because there was a lot around that as well. So throughout my early years, I hired Jasti Rao, then I hired Ian McCutcheon from the Montreal Neurological Institute. And my interest in hiring Ian was that early on I wanted to have the capability of mapping the brain. And this is now a very hot area. Obama just proposed $100 million to map the brain. Well, for a neurosurgeon that operates on the brain, mapping the brain is crucial. It is not a luxury, it’s a necessity. And they were not doing that at MD Anderson at the time. So I wanted to bring that expertise, and so Ian McCutcheon, having trained in an institution where Wilder Penfield, the father of brain mapping and neurosurgery was—of course, he’s long passed away. And so Ian trained in an institution where they had a lot of expertise in brain mapping.
Tacey Ann Rosolowski, PhD:
Now was he a PhD or an MD?
Raymond Sawaya, MD:
MD.
Tacey Ann Rosolowski, PhD:
MD. Okay.
Raymond Sawaya, MD:
He’s a neurosurgeon. He’s still with me twenty-two years later and very successful and has a very thriving program. Then after hiring him, I needed to hire a skull-based neurosurgeon. I did not have the skills, not the time, to really handle the problems that patients who have tumors in their base of skull. That’s a very complicated part of the head.
Tacey Ann Rosolowski, PhD:
I was reading that. And I was—could you talk a little bit about why that is such a tricky area?
Raymond Sawaya, MD:
It’s a difficult anatomy that neither we, as neurosurgeons, know nor the head and neck ENT surgeons, who look at things from outside the skull, know. It’s no man’s land. It’s in between the brain and the soft tissues of the neck and the head and the throat. So it’s this entire complicated layer of bone—which is the base of the skull, that solid bone—that a lot of problems occur that involve that part. So here’s the base. Here’s the skull.
Tacey Ann Rosolowski, PhD:
Right, just around where the spinal column would enter the skull.
Raymond Sawaya, MD:
And all these holes you see there, they have nerves or blood vessels that go through. So it’s very complicated. And you can get tumors here, or here, or here, or here, all over the place, and even here on the inside.
Tacey Ann Rosolowski, PhD:
So this is basically completely inaccessible.
Raymond Sawaya, MD:
It is inaccessible unless you have the right training and the right skills and the right passion to deal with this problem. And I was extremely lucky to have hired Franco DeMonte [MD], who since 1992—so that’s 21 years he’s been with me—has developed the largest malignant skull-based program in the country.
Tacey Ann Rosolowski, PhD:
So how long did it take you to recruit these three individuals?
Raymond Sawaya, MD:
One per year.
Tacey Ann Rosolowski, PhD:
So in three years you were pretty much starting on your comprehensive vision.
Raymond Sawaya, MD:
Yeah. That was the plan.
Tacey Ann Rosolowski, PhD:
I never doubted you for a moment.
Raymond Sawaya, MD:
That was the vision. If you don’t have—as they say, if you don’t know where you’re going, you don’t know when you get there. You know that. So clearly that was the very outline. Now what was not clear is for me to find the right people, to find the people who will work out well. Those are the things where a little bit of luck helps. Perhaps knowing how to interview helps. And getting input from others and so on and so forth . So that was the skull-based program. Then the year after that in 1993 was a former trainee of mine from Johns Hopkins, Sam Hassenbusch [Redacted] You will find a lot of material on Sam. He was an absolutely special person. Sam had a PhD from Johns Hopkins. He was a neurosurgeon. He went to the Cleveland Clinic to practice. And I had met him at Johns Hopkins when I was a chief resident. He was my intern. There’s a huge bond that occurs between the intern and the chief resident. Because chief resident relies heavily on the interns. And the interns look at the chief resident as almost like God—you know. They depend on them so much for their life, their work, their learning and everything. So we bonded very much. And then I left as I finished my training. We stayed in touch. He was not happy at the Cleveland Clinic. They were pushing him there to just generate money for the institution, something that I hope we will learn to avoid here. But that’s today’s culture—it seems to go in that direction here at MD Anderson. So you asked me before about potential thoughts about where we are today— (End of Audio 1 Session 1)
Raymond Sawaya, MD:
—at MD Anderson. That is a serious concern of mine. So anyhow, I was able to create a position and to recruit him to be the director of the pain program. And I mentioned to you earlier, how important a pain program is or was—and to do the stereotactic program. Stereotactic is a special technique where we use a frame that will guide a needle with high-precision into a specific point in the brain.
Tacey Ann Rosolowski, PhD:
So this is the frame—the skull is actually immobilized in that frame.
Raymond Sawaya, MD:
Exactly. So that technique is called stereotactic, meaning technique in space. Stereo is three dimensions of space.
Tacey Ann Rosolowski, PhD:
Right. I had a whole list of technological details I wanted to ask you about at some point. [Redacted]
Tacey Ann Rosolowski, PhD:
So what was the outcome of that? Have there been more studies of that? Is that going to go into clinical trials?
Raymond Sawaya, MD:
Oh yes. It doubled the median survival. It has gone into Phase 3 trials. It doubled the median survival. However, the vaccine is not for every glioblastoma patient. They have to express on themselves a specific molecule called the EGFR V3 variant—epidermal growth factor receptor, which is mutated and has a V3—the variant-3, the different mutation that occurs. Tacey Rosolowski, PhD It’s highly specific?
Raymond Sawaya, MD:
Very, very specific. You can find it with immunohistochemistry, and if you find that expression on the tumor cells, then they qualify for the vaccine. [Redacted] During that time I had a resident from Baylor who spent a year with me here as a resident. He loved it—phenomenal guy. I approached him as he was doing his chief residency. I said, “Listen, we do not have a spinal oncology specialist here, and we need one. Are you interested?” He said, “Absolutely.” So he applied for a fellowship. He was accepted at NYU, a very strong fellowship in spine surgery, did a year and when he finished in June of 1994, we signed him up. So he came to build the spine program, which he did until 2002. And in 2002, Johns Hopkins hired him to be the vice chairman and the director of their spine program there. So we lost Dr. Ziya Gokaslan—a Turkish name—the most talented spine surgeon in the country. He’s an unbelievable guy. We really bonded very well. I eventually made him the vice chair here and everything, but I guess he got lured by the Johns Hopkins name or whatever. And he’s continued there now. He’s quite successful. So that was 1994. In 1995, MD Anderson went through a rough patch of financial difficulties, and they said managed care was coming from California. We would not be able to afford the number of beds we have. And they laid off hundreds of employees if not more. And that’s the year I was training one of the top leaders of brain tumor neurosurgery in the country today. His name is Fred Lang. Fred was a fellow with me here. He came from NYU, and I wanted to keep him as the director of Clinical Research. He got involved in gene therapy in the lab during his fellowship, and I felt this was a major area that we needed to have. The institution would not let me hire him. So I used a ploy by diverting my M&O funds—that’s a state fund that they give each chair to run the department—it’s called Maintenance and Operations fund—M&O. And so I had enough money in that fund to pay half of his salary, which usually comes from state funds, and the other half comes from the practice plan. And the institution’s concern was with the state’s fund, so I said, “Well, I’ll use mine,” and it worked. I was able to hire Fred in 1996 when he finished his fellowship. And he is with me still today—highly successful national leader. He is the only person in the country that has presided or chaired over the two dominant brain tumor programs—brain tumor societies that exist in the country. There are only two of them, and he was the president of both overlapping. Each of them is a two-year presidency, and the second year of the first one was the first year of the second one. So he was president of two societies—the only two brain tumor societies—so clearly highly successful. And a very nice person. We can talk a lot about Fred, because he’s leading now a major virotherapy—oncolytic virotherapy, called Delta-24, which you may have material written on it by MD Anderson usually. You have stuff to read about that. So Fred is carrying his tremendous work in clinical research. He has a laboratory NIH funded. And so a very successful—so by the recruitment of Fred in 1996, so within six years—or you would say within five years, because really in 1991 is when I started hiring—I had the absolute nucleus that was a requirement to build on this program. And along those lines, I established a database. We had worked on creating a tissue bank with spectrology, and we upgraded the technology available to us in the operating room. We influenced the institution to hire high-level radiology program, and bring several MRI scans, because that’s very important for our work. So a lot of stuff went on around, not only in neurosurgery but outside of neurosurgery, to kind of support all this work that was going on.
Recommended Citation
Sawaya, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 05: Recruitments for the New Department of Neurosurgery" (2013). Interview Chapters. 1541.
https://openworks.mdanderson.org/mchv_interviewchapters/1541
Conditions Governing Access
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