Chapter 10: Big Visions for the Tumor Program and Frustrations
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Description
Dr. Sawaya notes that MD Anderson attracted him because resources at the University of Cincinnati were limited, and he was unable to build an adequate neuroscience team. He notes that when he arrived at MD Anderson to head the Department of Neurosurgery, he turned his research over to Dr.Justi Rao to run his RO1 grants. He was pleased with the balance of his responsibilities: 60% program building, 20% clinical, 20% educational.
Dr. Sawaya explains that in 1997 he offered Dr. John Mendelsohn a plan for a “truly multi-disciplinary” brain tumor program. The plan was rejected, and Dr. Sawaya speculates on why that happened. He next explains that he now has plans for a whole new building to house the neurological program. He speculates on the reaction of new president, Dr. Ronald DePinho, to this proposal. (Dr. Sawaya thinks out loud during this Chapter, planning his strategy of presenting his proposal.) He also explains why physical proximity enhances the effectiveness of multi-disciplinary teams and helps prevents problems with accountability and coordination of activities. Dr. Sawaya also notes the difficulty of promoting multi-disciplinary research and other initiatives, when there is no formal system of accountability in place to hold individuals to the plan.
Dr. Sawaya next says that Dr. Mendelsohn named him Director of the Tumor Institute in 2001, speculating that Dr. Mendelsohn felt “he owed” him the favor. Dr. Sawaya admits that he was so frustrated at the time that he almost left MD Anderson. He explains why he stayed and lists some of the concessions he received: the Directorship; the executive committee that was allowed to raise dedicated funds; permission to recruit a Director for Research (Dr. Oliver Bogler) for all labs in brain tumor programs (and that resulted in a SPORE grant). He reports that a review of the program by five outside reviewers listed MD Anderson’s tumor program as one of the top if not the top program in North America.
Dr. Sawaya believes that more could be done for the neuro patient in a “brick and mortar” institution wher all activities related to all tumors of the nervous system were located under one roof. He describes what would be possible. He then notes that an article about him in the Texas Medical Center News states that he “dreams big.”
Identifier
SawayaR_02_20130625_C10
Publication Date
6-25-2013
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; Obstacles, Challenges; Controversy; MD Anderson History; Understanding the Institution; Institutional Processes; Portraits
Transcript
Raymond Sawaya, MD:
This was over eight years. And then when I came here, fortunately, I was able to hire a full-time PhD scientist. I recall telling you last time we met that this is one of the reasons I left Cincinnati. It’s not like I was searching or looking to become a chairman. That was not the attraction. The attraction was to be able to build a program. And building a program requires a team. And I was kind of held back in that former position. I just was limited in my ability to build that team. And when MD Anderson knocks at your door and says, “Hey, we want you to come and build that team here, and by the way here are the resources it takes to help you.” That’s a dream. That’s a dream come true. And yeah, I was the luckiest man you could find anywhere.
Tacey Ann Rosolowski, PhD:
So how did your research evolve once you came here?
Raymond Sawaya, MD:
Yeah, I mean, obviously I became very, very busy administratively building a major department. I gradually turned things over. I still had weekly lab meetings for several years and had some input and insights and discussions. But I really did turn it over to the PhD to lead his lab. And he was extremely successful. He had, at one point, four RO1 grants, NIH grants. There are very, very competitive grants, and he had four of them at one time. It’s extremely unusual.
Tacey Ann Rosolowski, PhD:
What was that person’s name?
Raymond Sawaya, MD:
Justi Rao.
Tacey Ann Rosolowski, PhD:
You mentioned him last time.
Raymond Sawaya, MD:
Yeah, R-A-O, Justi. And then ten years after that, he was offered chairmanship of a cancer biology program at the University of Illinois, and he left. And that’s fine. I mean, people evolve. And since then, I really have not had a direct lab effort. I just—I’ve hired faculty who have that and who have the time for that, and my focus has become, I would say, sixty percent program building. Sixty percent of my effort is program building, twenty percent is clinical, and twenty percent is education. But really program building, a lot goes in that—some research both clinical and laboratory, helping the brain tumor program develop and grow and evolve here at MD Anderson, helping my faculty grow their own programs, administration. My role at Baylor College of Medicine also is program building. So that’s—I feel I’m good at it, and they tell me I’m good at it, so it’s good to use my effort and energies to accomplish more than what I could accomplish alone doing my own work. So by extension, what gets done is much greater than what I could do by myself.
Tacey Ann Rosolowski, PhD:
I can also see how the variety of experiences that you had really helped you to understand exactly what MD Anderson wanted to achieve in terms of the mission of multi-disciplinary care and supporting basic research in addition to clinical research.
Raymond Sawaya, MD:
Absolutely. In fact, in 1997, we had a new president here, by the name of John Mendelsohn [MD [Oral History Interview] ]. He came in 1996. I offered him a vision of a truly multidisciplinary brain tumor program. I guess at the time it was viewed as too revolutionary, and so it wasn’t accepted.
Tacey Ann Rosolowski, PhD:
What were the features of it?
Raymond Sawaya, MD:
Bringing all the neuro components at MD Anderson under one umbrella.
Tacey Ann Rosolowski, PhD:
I guess I’m not seeing why that didn’t make sense.
Raymond Sawaya, MD:
There are political considerations. There may be cultural consideration, and when you are a new president who is still trying to establish his foothold and dealing with his own insecurities as a new president— And then, unfortunately, the time was such that he was hit by two potential scandals called Enron and Imclone. You’ve heard of these?
Tacey Ann Rosolowski, PhD:
Yes.
Raymond Sawaya, MD:
That shook his foundation, and to agree to a small earthquake was not something he could fifteen plus years later. And this is not a totally strange—not strange, but the concept is not a stranger to what we’re going through right now. Because if back then it was a major change, what I have in mind today is probably ten times bigger than what I had in mind in ’97.
Tacey Ann Rosolowski, PhD:
So what do you have in mind now?
Raymond Sawaya, MD:
A whole institute, a whole building. A whole building that will house the entire neurological program at MD Anderson. But we are in a situation where another president is finding himself under duress and controversy and where he is preoccupied by all of that. You probably read the news and—
Tacey Ann Rosolowski, PhD:
Sure.
Raymond Sawaya, MD:
Okay. So I don’t need to elaborate on that. So I think we as a group have matured tremendously over the last, I would say, fifteen years.
Tacey Ann Rosolowski, PhD:
Now, that vision that you presented to John Mendelsohn in 1997— Was that vision eventually achieved down the line?
Raymond Sawaya, MD:
Partially. And the reason it’s partial is because he didn’t give me what I asked for to accomplish the full vision.
Tacey Ann Rosolowski, PhD:
What was left out of it?
Raymond Sawaya, MD:
All the organization, all the—the level of authority that would allow a program to have accountability in it. And so if I cannot tell a key player in the program what to do or what not to do, then there is no accountability—neither on my part or that person’s part. Because there’s no contract. We’re in it together just because we want to be in it together. That’s all. And that’s how we’ve been able to accomplish everything we’ve accomplished in the last fifteen years is because we decided to work together. In that framework, there are many deficiencies that some we may be able to influence and address and many we can’t, just because we are not tied by any contractual agreement.
Tacey Ann Rosolowski, PhD:
I think that’s the first time anybody has ever mentioned this issue. It seems multidisciplinarity was sort of understood as part of the culture of doing science here.
Raymond Sawaya, MD:
Correct.
Tacey Ann Rosolowski, PhD:
But that’s not formalized.
Raymond Sawaya, MD:
It’s all voluntary. At some level, it may be a little more strict. In other words, if you have patients with breast cancer being seen in a breast center, then yeah, you’re going to have the surgeon, the oncologist, the radiation, the pathologist. They have to work together, because there’s a patient in the middle. But patient care is the final output of thousands of activities that must take place before it reaches that point. And we just talked about the need for science, the need for research, the need for resources, the need for having direction and a plan and a vision. Well, who’s going to be in charge of that? And if there is a person in charge of that, or an executive committee in charge of that—what authority, what power does this group or that person have over all the components, each one of which is important and essential, in fact, to the advancement of the field?
Tacey Ann Rosolowski, PhD:
And who does that executive report to as well?
Raymond Sawaya, MD:
Yeah, so they could report to a board, they could report to the president, whatever. But you’re right. And when I saw that there was very little accountability and therefore little coordination of effort, that’s when I came up with the plan and I presented it to Mendelsohn.
Tacey Ann Rosolowski, PhD:
Interesting. Well, it will be interesting to see what happens with your new vision. Is this something that you have presented to Dr. [Ronald] DePinho? So this is the Neurosciences Institute document that Dr. Sawaya just handed me, which is your plan.
Raymond Sawaya, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
Submitted in 1998, and this was to John Mendelsohn. This was the one presented to John Mendelsohn. Very interesting. Is this in the archives?
Raymond Sawaya, MD:
No. It’s in nowhere. Nowhere. And for now, it needs to remain non-public, just because it never really materialized. But you could see in here the seeds of what came. First of all, what I was able to accomplish over the past—I became the official—so as a result of this effort and Mendelsohn not really giving me this opportunity—he did through Dr. [Margaret] Kripke [Oral History Interview] at the time, the chief academic officer—he did officially name me as the director of the Brain Tumor Center. This was in 2001. I went through a couple years of turmoil, and I looked at leaving MD Anderson during those couple years, because I just wasn’t satisfied with the progress. I wasn’t satisfied that we could accomplish what we needed to accomplish, that I’ve outlined in here, without some reorganization.
Tacey Ann Rosolowski, PhD:
What convinced you to stay?
Raymond Sawaya, MD:
What convinced me to stay was that I went to Penn, and I went to University of Utah, two places where they needed a brain tumor leader. But I realized what I had here in neurosurgery, I couldn’t duplicate anywhere. And I said, even if I stick to neurosurgery, we have still a lot to accomplish, a lot of techniques and advances in research and recruitment that I could do. And I will just forego the vision of the grander vision of a comprehensive neuroscience program. Well, then what happened was that I was given some of what I was asking for. And that allowed me to continue to build on the strength of our brain tumor program. And I believe we are significantly stronger today than we were in 1997-’98. But we have not reached the level that we need to reach.
Tacey Ann Rosolowski, PhD:
What were you given in 1998?
Raymond Sawaya, MD:
I was given the directorship of the center, but keep in mind that’s a virtual center. It’s not a—it is a virtual center.
Tacey Ann Rosolowski, PhD:
There’s no real estate associated with it.
Raymond Sawaya, MD:
And the authority is very limited. But I did create an executive committee that was sanctioned by the administration, and so there was some influence there. I was allowed to raise funds from philanthropy specifically for brain tumors. And that’s significant, because that provided me with resources as well. And with money, you can influence people to do things they didn’t want to do. And when you tell them, “We need you to do it, and here’s money to do it,” you got their attention. So clearly progress. But is it the full, the real thing? No, it’s not. And so—you know—we went—so in 2005, four years afterwards, I was able to recruit a director for the research for the labs—all the labs of the brain tumor program. That’s something we never had before, and I was able to do that. And that person’s name is Oliver Bogler [PhD]. I think you know that name. And Oliver did exactly what was needed. He organized a new group and got us one of the toughest major grants in the country, a SPORE in brain tumor. He made it possible. We had not succeeded in getting it before he came, and he came and he made it possible. That was a five-year grant that we got in ’08. And this is the last year of the grant, and now we have a new PI, since he moved on, who is about to get a new one. We just, yesterday, got very positive news about it. So we really have established a lot of strengths. We had a review of our program a couple years ago, and five outside reviewers came and the looked at everything—every aspect of the clinical research, laboratory research, and so on a so forth. And their conclusion, that was a report that they gave Dr. Debois at the time, the chief academic officer, was that this is one of the top, if not the top, brain tumor program in North America. Those were five leaders in the brain tumor field, coming from five very strong universities. They made that statement. So clearly, we have done a lot of good work. But I go back to this same issue that I had in 1997 and 1998, that we can be so much more. But that needs continued refocusing, reorganization, reallocation of resources. And I think the best way now to do it is through our own building that will house all aspects of—you know—in institute fashion. Not a virtual, but a real institute where all activities pertaining to the nervous system tumors, wherever they are, be under this one giant roof. It’s very feasible. We have more resources here in people, in man power, in equipment than any other institution in the world focused on this. But we are spread out. We are distracted by organizational barriers, even silos. And I think the idea of breaking those silos is what—to me is the most attractive.
Tacey Ann Rosolowski, PhD:
What do you envision being possible if all of the specialties, all of the activities related to the nervous system were under one roof?
Raymond Sawaya, MD:
We will have a more cohesive vision. We would have a more productive output of activities. We would have a better use of our resources, because now they are being focused and spent on the top priorities. The way things are now, if in neurosurgery we have resources, we are going to spend them on neurosurgery obviously, because I got the money, and I spend it here. Somebody in neuro-oncology may get a $2 million gift, and they will spend it there. Is that where it’s the best place to spend it? Maybe yes, maybe no. What about neuro-pathology? There are needs in molecular neuro-pathology that are very relevant now. Do we have the right people there or enough people involved in the molecular fingerprinting of brain tumors? Maybe yes, maybe no. If I say no, I can’t do anything about it, assuming I’m right. I can’t do anything about it. If we’re all under one roof, accountable to one authority, and if this group maybe through external advisors, they come and they say, “You have clear gaps in your abilities.” In fact, we were told that in that report that I just told you about. They weren’t talking about pathology, they were talking about radiology. They said, “You have gaps in neuro-radiology of brain tumors.” We knew that. It wasn’t a discovery. We knew that. We can’t do anything about it. Yes, it came to the chief academic officer, who talked to the chief of Radiology saying, “You need to fix that.” But guess what? It just doesn’t happen, because we’re too big of an institution. That chief academic officer has probably 1,200 issues that he or she are dealing with. What do I do? I keep bouncing on his door and sending him e-mails every other day to the point of irritating him? That doesn’t work. So that’s where you bring all that—then it becomes too specific. It becomes too neuro. I mean, everything is neuro. Everything is interlinked there, and everybody in here cares about this because it’s their field. I talked to my neuro-radiologists and said, “How much rapport do you have with the other radiologists?” They tell me very little. (End of Audio 1 Session 2)
Raymond Sawaya, MD:
They are all radiologists, but they have very little rapport. Because they work in the brain or the spine. The others work in the liver, or abdomen, or lungs, or bone, or whatever. They’re in different fields. And yet, with us, we’re very, very close, very tight.
Tacey Ann Rosolowski, PhD:
You all speak the same language.
Raymond Sawaya, MD:
We speak the same language. The same thing in pathology. A neuro-pathologist has very little to do with a lymphoma pathologist or other pathologists. Radiation, same thing. There is a whole group of brain radiation therapists who deal much more with the brain than they deal with lungs or other illnesses. So that’s why this is so powerful. But again, this doesn’t seem to be the agenda of the current president, and with all his distractions, I’m not going to repeat the mistake I made here. Although I guess I have thicker skin now. Back then I got pretty upset. Now I can go to him—but I don’t want to miss this opportunity that maybe I can make it happen a year from now, but if I go to him now it’s not going to happen. So that’s the missed opportunity. And if he says no now, a year from now he may not be open-minded about it. But if I don’t say anything now, I wait until the dust settles and things are better, then maybe he will be more receptive a year from now. So that’s a dilemma. I’m struggling with this.
Tacey Ann Rosolowski, PhD:
A strategic thinking dilemma.
Raymond Sawaya, MD:
It is, very much so. But it’s interesting that I’ve been through this before. So it has opened my eyes.
Tacey Ann Rosolowski, PhD:
It sounds like you’re engaged not only in the building of the possibility for knowledge but also building a new kind of culture in which all of the—
Raymond Sawaya, MD:
Absolutely.
Tacey Ann Rosolowski, PhD:
And that takes time and it can be—seem like dramatic change and can be rather frightening to some people. But it’s a big job. It’s a very big job. It doesn’t happen overnight, it seems.
Raymond Sawaya, MD:
Actually, I’m ready to give up all my other responsibilities, including my chairmanship here to focus on that, if it were to be accepted by the institution.
Tacey Ann Rosolowski, PhD:
I don’t mean this to sound like a simplistic question, but why are you so committed to this kind of big vision issue? Why that?
Raymond Sawaya, MD:
Is there any other way? Is there any other way?
Tacey Ann Rosolowski, PhD:
Well, some people are very attracted to very tiny problems.
Raymond Sawaya, MD:
They wrote a piece about me in the Texas Medical Center News. Did you see that?
Tacey Ann Rosolowski, PhD:
No.
Raymond Sawaya, MD:
It really was amazing. You should read it.
Tacey Ann Rosolowski, PhD:
When did it come out?
Raymond Sawaya, MD:
It came out when I was hired at Baylor College of Medicine in 2005.
Tacey Ann Rosolowski, PhD:
I’ll have to look at the record.
Raymond Sawaya, MD:
I know I have it, so the question is, where will I be able to find it? It’s a one page. It’s not like a huge—and it would be—why am I mentioning it? It’s precisely because of your question. Why? Well, I think in it the writer described me as somebody that dreams big.
Tacey Ann Rosolowski, PhD:
There we go.
Raymond Sawaya, MD:
I’m sure I’ll find it somewhere.
Tacey Ann Rosolowski, PhD:
That’s fine. I made a note of it, so I can have a look for it.
Raymond Sawaya, MD:
I mean, I have copies of it. And I will find it for you someday. Maybe for the next time you come here. We’ll do that. Okay. All right.
Tacey Ann Rosolowski, PhD:
Well, it does sound like a big and exciting dream. I’m going to keep an eye out on this one. I think it does sound really exciting. Would you like to talk about technology now or would you like to talk about some of the other administrative things?
Recommended Citation
Sawaya, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 10: Big Visions for the Tumor Program and Frustrations" (2013). Interview Chapters. 1546.
https://openworks.mdanderson.org/mchv_interviewchapters/1546
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