Chapter 11: Leaving the NIH for a Turbulent Research Environment at MD Anderson

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Chapter 11: Leaving the NIH for a Turbulent Research Environment at MD Anderson

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In this chapter, Dr. Freireich says that “We’re now in ’64, and things are going along famously. I had the biggest and best pediatric leukemia service in the world. We were internationally famous. Everybody was following our lead. People came to learn how to do platelets, how to do white cells, how to do antibiotics, and how to do combination chemotherapy. We were really rolling.” He then talks about why he left the National Institutes of Health and joined MD Anderson Cancer Center, his relationship with Dr. R. Lee Clark, and why his family’s transition to Houston was “painful.”

Identifier

FreireicEJ_02_20010730_C11

Publication Date

7-30-2001

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

Joining MD Anderson/Coming to Texas; Joining MD Anderson; Personal Background; Portraits; MD Anderson Culture; Working Environment; Growth and/or Change; Leadership; Obstacles, Challenges; Institutional Politics; Controversy; Critical Perspectives on MD Anderson; MD Anderson History; On Texas and Texans; Cultural/Social Influences

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

Emil J Freireich, MD

We're now in '64, and things are going along famously. I had the biggest and best pediatric leukemia service in the world. We were internationally famous. Everybody was following our lead. People came to learn how to do platelets, how to do white cells, how to do antibiotics, and how to do combination chemotherapy. We were really rolling. But we were too successful. There are 2 ways to get fired: hopelessly ineffective and too successful. You've got to be careful not to be too successful. We had taken over another ward. Our practice was booming. We had people calling us 10 times a day, "Please take my children." We had no room, and we had no resources. We were bursting at the seams.

Now came a tragedy. Dr. Zubrod and I had a third-party relationship. We're like cousins. Frei was like his son. He trained him, and he brought him from St. Louis. So the hierarchy was me, Frei, then Zubrod. Dr. Frei, my dear friend and someone I will always trust, a wonderful person, married a woman who was a very abnormal person. She was not under psychiatric care, but she was an extraordinary person. Everybody loved her, but she was unpredictable. This was his first wife.

When Deanie and I came here in '55, Liz and Tom Frei had us to their house the day we arrived. For 10 years we were social and personal friends. They had 5 children. Their children were poorly cared for. Their household was—what's the word?—casual. There was never food, everything was dirty, and they slept on the floor. My wife is the inverse. We're meticulous. Or she is meticulous, and I have to go along with it. She runs the house. I'm at work all the time. When we went to their house, it was very uncomfortable. We didn't go very often, and they didn't come to our house, but we were friends.

Liz Frei had a sister who was married to an alcoholic veteran in Boston, and she had 6 children. Her husband was cared for at the VA until he finally died of tuberculosis. He left her with no money and 6 children. Her only living relative was her sister, Liz. Dr. Frei, being a wonderful person, said, "No choice." They moved in with him. So now he's got a 3-bedroom, little matchbox house with 11 children and 3 adults. The sister is like his wife, worthless. She's a very passive, ineffective person. It was a houseful of children raising themselves.

Lesley Brunet, MA

Incredible stress.

Emil J Freireich, MD

It was incredible financial stress, because we worked for the federal government. I was making $5,600 a year. Dr. Frei was a big wheel, Chief of Medicine. He's making maybe $6,600 a year, but he couldn't possibly raise this family with that income. Enter the world's greatest entrepreneur, the builder of MD Anderson Cancer Center, R. Lee Clark

Lesley Brunet, MA

I was wondering when you first met him.

Emil J Freireich, MD

Now we're in '64, and MD Anderson has been here for 18 years. Dr. Clark had a big vision. He built a clinic based on the Mayo Clinic model of excellent patient service. He built a basic science organization because he felt that just practice wasn't enough. There had to be clinical epidemiology. He hired Eleanor MacDonald, and he hired Felix Haas. He actually applied to UT to get a graduate school. He convinced the legislature we needed a public health school and we needed a medical school. He wanted a complete medical center in Houston. Mind you, Galveston is the home base for the whole UT System. Here's an upstart in Houston that wants to build a medical center 50 miles away from Galveston.

He'd been watching things going on at the NIH. As I mentioned, the 10 years from '55 to '65 revolutionized clinical research in the United States. The people who trained at the NIH, all these young men who came there, went off to medical centers all over the country and built clinical research units. The federal government began making grants to these institutions. Eugene Braunwald, my personal friend, ended up chairman of the Department of Medicine at Harvard. The NIH alumni were chairmen of medicine all over the country. Dr. Clark is watching all this, and he says, "I've got to get some of this federal money." So Bill Russell wrote a grant, and he got a big grant to do laboratory medicine. He applied for a clinical research center, and he got funded. What he needed was some tiger from the NIH: Frei. "Guess what, Frei. I'm going to pay you a lot of money." I don't know what he actually offered him. I've never asked him. Dr. Frei looked at his social situation; he looked at NCI, which he adored; he looked at Zubrod, whom he adored; and he said, "Got to take it."

One day there was an announcement. "Dr. Frei is moving to Texas." We were shell-shocked. The entire NCI was shaken. Dr. Zubrod called in all his management people and all the bureaucrats. They had meetings after meetings. I was not in that circle. "What are we going to do if Dr. Frei leaves?" There was only one solution. Dr. Frei could not leave. So they made him a general, upped his salary, and he decided to stay. But that only lasted 3 months, and the reason it only lasted 3 months was purely social. I have asked Dr. Frei what changed his mind. He said it was strictly money. There were acute episodes at home. There was one day when he got called at work because one of his children was left in a supermarket, and he had to go get him. He just could not manage this household. Zubrod tried. They made Frei a general; that is the top. That's as much money as the federal government can pay anybody, but Dr. Clark more than doubled it. So he had to change his mind again. I'll never forget the day he changed his mind a second time. Remember, now they've done all this jostling. What's going to happen if Frei leaves? Of course, the heir apparent to the empire was Freireich.

So during the first resignation, there was all kinds of jostling. I'm the heir apparent. All the forces were descending on Zubrod, but he was going to appoint me, nonetheless, when Frei left. We even had meetings to that effect. Then Frei stayed. Everything calmed down again. All the forces of evil were gone.

Then within 6 months he changed his mind again. David P. Rall, who was head of Pharmacology, who had another very unusual wife, an artist, had a traditional New Year's party at his home. We all went there and got very high on martinis. At that party Dr. Frei said, "J, I've changed my mind. I'm going." That was the first of January '65. That was the only time in my life that I became so intoxicated on gin that I actually became unconscious, anesthetized.

Lesley Brunet, MA

Is this with joy or fear?

Emil J Freireich, MD

I was so depressed, because I knew there was going to be trouble. I don't know what happened after that, but my wife told me that several colleagues put me in the backseat of my car, and she drove me home. I threw up all over my car. I was in bed for 2 days in coma. I was really anesthetized. I woke up, and I said, "What day is it?" My wife said, "You've been out for 2 days."

But what followed after he resigned were, again, the forces of evil. Dr. Zubrod appointed Seymour Perry, my archenemy, to be head of the medicine branch. That was bad enough, but I was still in charge of leukemia. After about 3 months, Dr. Perry called me to his office and said, "Freireich, I've decided to replace you with your student, Ed Henderson," who was my first post doc. He's the author of that book, Leukemia. Ed Henderson came to my office, and he said, "J, this is really terrible. I mean, I don't see how I can head the thing." So I said, "Well, it's obvious they want me to leave, so I'm leaving." He said, "Okay," but he promised me that he would carry on the Freireich tradition. The study after VAMP was a study called POMP. Then Dr. Frei started with Dr. de Vita to treat solid tumors, and he started the MOPP in Hodgkin's disease. So this was all going on, and Ed Henderson promised me he would continue those programs without change to all my protocols. We'd at least complete those studies with follow-up; he'd be first author. I said, "Fine."

I decided to leave, but I had to find a job. My personal adviser was Sidney Farber. Sidney Farber was the godfather of the NIH. He worked with Mary Lasker to get the money and create the legislation. So I went to Boston, I spoke to Dr. Farber, and he offered me a job. Then I talked to Tom Hall, my very good friend who was there. I got advice from a lot of people.

Then I got a call from Danny Bergsagel, who used to be here. He had left in '64 to go to the University of Toronto as the chairman of Medicine. He and I were very good friends and colleagues. He offered me a position at the University of Toronto, so I went up there. That was a very attractive position, because I would be clinical director and run the clinical research center.

Then, of course, Tom Frei calls me up and says, "Freireich, Houston is great. Dr. Clark is a great leader. The one problem we had at the Cancer Institute is we'd reached capacity. Dr. Clark has unbridled vision for the future of MD Anderson. He already has in hand the money to build the Lutheran Hospital Pavilion and the research building, and he's got all the things arranged so that we're going to be a complete health science center." The coordinating board for education for the state had approved a medical school for Houston. It was to start in '65. "So this is going to be a great place. Dr. Clark knows the future. You and I have spent our time talking about what we really want to do, which is to revolutionize medical education. We want doctors to be trained by scientists, not physicians."

You see, medicine at the turn of the century was an apprenticeship. You just followed around and did what a doctor did. But at the turn of the century, the Flexner Report made medicine scientific as a basis. So medical schools are dominated by PhD's who teach you science for 2 years, and then when you start your clinical years, you go around and follow doctors around and do what they do, like an apprenticeship. Sometimes you never meet a guy who discovers things. My ambition was to have a medical education where all the teachers were scientists who were doing research.

Dr. Frei said, "We could do it in Houston. Dr. Clark wants to do it. It's never been done in the United States. They tried it at Yale; it didn't work. You've got to come to Houston. You've got a great opportunity."

Dr. Clark appointed Dr. Frei the associate director for Research. So Dr. Frei was in charge of all research, clinical and basic. At that time, there was only one other associate director, and I think that was Murray Copeland, who was in charge of educational things. So Dr. Frei wrote me a letter.

"Dear J, I am the associate director for Science at MD Anderson Cancer Center. We're going to give you a chance to do what we did at the Cancer Institute. You're going to build a clinical research center. You can have your own department, your own personnel, and your own grant money. We want you to build an institute within MD Anderson. Dr. Clark is totally behind it."

Wow, what an opportunity! At NCI, I was in charge of leukemia, and Dr. Frei was in charge of the solid tumors. We had a guy in charge of the medicine branch, and then we had Dr. Zubrod. Well, Frei was now Zubrod, and I could be Frei. I wanted to finish up the MOPP, to cure lymphoma, to get into the solid tumors. That was hard, to turn down that opportunity. I came down here. I gave a seminar for Dr. Grant Taylor.

Lesley Brunet, MA

What time of year did you come down?

Emil J Freireich, MD

It must have been in the winter. I would say February. You have to understand that I was working 20 hours a day, every day. There was just too much going on. I just couldn't contain myself. We were poor. We never went to a movie. We never went out to dinner. Whatever time I had, I spent with my kids. My wife worked to raise enough money to pay the rent. We lived in a little rental.

Lesley Brunet, MA

Your wife was working, too?

Emil J Freireich, MD

Oh, yes. We couldn't afford a babysitter, so we took turns. I used to run home, she'd work night shift, then she'd come home, and I'd go to work. She did that for about a year. We were working very hard. After I got the letter from Dr. Frei, I came home from work one day, and who was in my living room? Dr. Clark.

Lesley Brunet, MA

Had you met Dr. Clark before?

Emil J Freireich, MD

Never. He had an aura about him that really attracted people. He was charismatic. He appeared in my house unannounced. "I'm Dr. Clark. Dr. Frei tells me that you're very important to his program, and we want you to come to MD Anderson." He sat down in the living room in my little teeny rental house. My 4 kids all jumped on him. He had them on his lap. "Oh, cute kids." He talked to my wife. "How are you, dear?" You have to realize, we'd come from Chicago, trained in Boston, and went to Washington, where things were still black and white. It was the South, but Texas? Good grief.

Lesley Brunet, MA

LBJ was president.

Emil J Freireich, MD

My wife thought that there would be Indians. She was terrified about going to the South, with all those rednecks and southerners. In 5 minutes she was in the palm of his hand. He had dinner at our house. She cooked something, he ate, and we talked. When he left, my wife said, "We gotta go to Texas. He's a great man." That's typical Clark. He was impressive.

So I called Dr. Farber, and I said I had this opportunity. He said, "Well, I think you're doing the right thing." I called my friend, Danny Bergsagel, and I said, "You know Anderson better than I, but things have changed." He said, "Well, I still think you should come to Toronto, but I can understand." I resigned somewhere around April. I was to move in July, so I had to finish up a lot of stuff. I had resigned my commission in the Public Health Service. Then I got a really important letter from Dr. Frei. Dr. Frei got fired.

Lesley Brunet, MA

That was in '65?

Emil J Freireich, MD

Yes, before I got here. So I got a letter from Dr. Frei, and he said, "Guess what, J? Dr. Clark has reorganized it." Dr. Frei had started to do what he did at NCI. He used his authority to change Medicine, Pediatrics, and all the research. Dr. Clark, being always loyal to the people who are loyal to him, said "Frei, maybe it would be better if you just work on your own institute and leave the rest of the place alone." So he was fired as the associate director of research.

Lesley Brunet, MA

But he was still in charge of the chemotherapy?

Emil J Freireich, MD

His new title is head of the new department. This is my department. Dr. Frei and I had put together the name, "Developmental Therapeutics." No one had ever had a Department of Developmental Therapeutics before. We just invented it. I invented it because Dr. Farber had taught me that we don't experiment on people. The focus of this department was going to be therapeutic, not prevention. It's going to be treatment, but all treatment. We used the word developmental because we thought that it indicated that it was research, but we don't do research; we're actually developing treatment. Then I got another letter from Dr. Frei. "I'm head of the department, not you. You are going to be deputy head. You and I can work closely together." But I'm not the big power anymore.

Lesley Brunet, MA

How did you feel about that?

Emil J Freireich, MD

Well, after I got through crying, I went back to Dr. Farber.

Lesley Brunet, MA

So you were crushed because you're no longer head of DT?

Emil J Freireich, MD

Yes. Now we're in bad shape. Now there's no reason to leave, so I was going to stay at NCI. I talked to Dr. Zubrod, and he said, "Well, they can't undo the damage they've done." I talked to Dr. Farber. He said, "Well, you probably still have a good opportunity." I talked to Danny Bergsagel. He said, "I'm telling you, you should come to Toronto." So Deanie and I had a long conversation.

Lesley Brunet, MA

Do you remember what Danny Bergsagel said about things at Anderson, because he had been here?

Emil J Freireich, MD

He was positive. He left here for a good reason. He trained in Toronto. He had a good experience here. He had no reason to want to leave, but he had enormous opportunity in Toronto, and he's been very successful. He was the chairman of Medicine. He built a great department. He's retired now. He came to our festschrift, so he's still a very good friend of mine. But Tom Frei put the pressure on me. He said, "You know, even though we're not in charge of everything, we do have enormous opportunities." So I came.

Lesley Brunet, MA

Those first few years here must have been tough.

Emil J Freireich, MD

The toughness has just begun.

Lesley Brunet, MA

You haven't even gotten here yet. I thought you got here about July.

Emil J Freireich, MD

No, you see, I love Dr. Clark, but he was brutally cruel to us.

Lesley Brunet, MA

Oh, really? In terms of what he had promised and then what was delivered?

Emil J Freireich, MD

Correct.

Lesley Brunet, MA

You mentioned before it was because of his loyalties to other people.

Emil J Freireich, MD

Presumably. I'm giving him the benefit of the doubt. But as far as Dr. Frei is concerned, he had the money, but he was totally crushed. He'd given up a position of enormous authority and power to come here for a new opportunity, and it vanished before he even started. You'll see how he feels about Dr. Clark today. But at that time, in '65, it was a very bitter pill at best.

Lesley Brunet, MA

Was it deception on Clark's part?

Emil J Freireich, MD

No.

Lesley Brunet, MA

Or had he simply been naïve about how people would take this?

Emil J Freireich, MD

No. I just saw the Pirates of Penzance—honor and duty. Everybody does the best they can do. No one tries to deceive, but it turned out to be a deception. In other words, he'd made a commitment without anticipating the backlash from his own faculty. That was naïve, in a way. Clark was very optimistic, so he presumed that everybody would go along. When Dr. Frei was being recruited, Grant Taylor and Cliff Howe all gave him the red carpet. "Oh, we'll work together." But when he got here and started telling them what to do, then things changed. It was tough to change, but he did change. His loyalty to his commitment to Dr. Frei was second to his loyalty to the people who had worked here for 20 years. So one would say that in retrospect it's a good idea, but as far as Dr. Frei was concerned, it was bitter.

So Frei called me and told me he was bitterly disappointed, but we still had a chance, and he couldn't do anything if I didn't come. As I say, I went back over all my tracks, and it was just too late to change. We had to go to Houston. We continued our commitment, but another very important event occurred in 1965—the war in Vietnam.

Lesley Brunet, MA

Of course.

Emil J Freireich, MD

So between Frei getting fired and me committing to coming, the next blow was, because of the war, the federal matching funds for the Lutheran Pavilion and our Clinical Research Center were frozen. Secondly, our medical school was shifted from Houston to San Antonio by the legislature. By the time I arrived in July, my department was gone, my medical school was gone, and my hospital was gone.

Lesley Brunet, MA

It's pointless to ask you if you were a little nervous about your decision.

Emil J Freireich, MD

When you're in that circumstance, all you can do is the best you can do. It's like when you're drowning, you've only got so many choices. So I piled my family in my black Ford station wagon, we went to Chicago to see my relatives, and then we came down from Chicago to Houston. We arrived July 15.

Lesley Brunet, MA

Just when it's heating up.

Emil J Freireich, MD

We'd never been outside of the Northeast.

Lesley Brunet, MA

So you didn't even come down and look at things here?

Emil J Freireich, MD

Yes, I did.

Lesley Brunet, MA

You did, but did your wife?

Emil J Freireich, MD

No. They couldn't afford that. Family life was different in the '60s than in the '90s. My wife was a normal wife, and she would go where my job was. If I decided to go, she was going to make the best of it. We got in our station wagon, and we headed down. Once we got to Kansas and Oklahoma, we began to think that this decision wasn't a very good idea.

Lesley Brunet, MA

Was this before air conditioning in cars?

Emil J Freireich, MD

No, we had a unit in the car that was installed. It didn't really cool.

Lesley Brunet, MA

It blows?

Emil J Freireich, MD

It blows. We were in a black station wagon with 4 children. My baby son was 5, and my oldest was 11.

Lesley Brunet, MA

No dog?

Emil J Freireich, MD

No dog or cat, just the 4 kids, my wife, and myself in a Ford station wagon. When we got to Oklahoma, it began to be bleak. You know how Oklahoma is? There's nothing in sight but a couple of oil wells. Finally, when we got to Dallas, the car boiled over. So we had to spend a day in a garage getting the radiator fixed, with the 4 kids screaming and shouting, in this hot repair place with no place to go. We were too poor to get a place to stay, so we just sat in this car dealership and waited for him to fix the radiator. We got back in our car, and we drove to Houston. Dr. Frei had recruited 2 other people since I had agreed to come. One was Ti Li Loo. Dr. Loo had been the pharmacologist at the Cancer Institute. So after I agreed to come, and Loo knew I was going, he agreed to go. He's a dear personal friend. His daughter has cancer of the colon, unfortunately.

Lesley Brunet, MA

Is he in good health?

Emil J Freireich, MD

He's struggling. Also, Dah Hsi Ho, who's still working every day here. She came from Buffalo.Dr. Ho and Dr. Loo were both here. Dr. Frei was trying to make our transition easy, so he rented an apartment in a rental facility. I can't remember the name of it; it's since been condemned. It was on South MacGregor, on the bayou. They were called the Field Town Apartments. I love thinking about it. If my wife were here, you would get a horror story. Dr. Loo and Dr. Ho were there, and Dr. Frei was still there.

Lesley Brunet, MA

In these apartments?

Emil J Freireich, MD

Yes, in these apartments. He had just arrived in late '64, about 6 months before, and he was still living in this apartment. He thought it was wonderful. It was a slum apartment. This was the filthiest, dirtiest place I have ever seen. This place was strictly a slum apartment. Of course, Dr. Frei and his wife and kids loved it. They had a dirty swimming pool; it was all contaminated with algae. The playground, everything was broken. Nothing worked. We arrived in the afternoon. We got out of our car, we got the keys to our apartment, went to the apartment, and we met the most horrible animal in all Texas.

Lesley Brunet, MA

The cockroach. I don't know if other people understand that.

Emil J Freireich, MD

We opened the back door, and there were 5000 of them. This place was a garbage dump. There were roaches everywhere. We got back in the car. There were no Kmarts or Walmarts. We bought mattresses, toilet seats, cleaners, everything we could imagine, and we spent a day and a half, without sleeping, cleaning that apartment just so we could live in it overnight. My wife wouldn't let the children use the john. They had to go outside in the pool. The first thing that happened is my daughter broke her finger on the poolside, and we had to take her to the hospital. Oh, our first few days were so horrible.

I came to MD Anderson. I slipped on the stairs and got a big hematoma in my hip. I was in bed for a day and a half. My wife said, "J, if we don't buy a house today, I am going back to Washington." I told Dr. Frei, "You're not going to see me at work. I have to go buy a house." When we left Washington, our teacher had recommended the Memorial school district, so we looked on the map for the Memorial school district, we got in our black station wagon with our 4 kids, and we drove out to Memorial. We drove up and down the streets until we could find a house that we could move into, and we found a house.

Lesley Brunet, MA

That's at least a pretty neighborhood.

Emil J Freireich, MD

The same house we live in today, 35 years later. This house was a spec house. It was standing. The guy who built it was a builder named Smith or something, and he had bought a piece of land in Hedwig Village and had subdivided. It was one person's home with a racetrack and everything. He put, I think, 12 homes on this zoned half acre. It was about a 6-acre plot. Our house was standing there, and they had curbs and sewers. You had to be interviewed by the sales guy and by the builder in order to get into this community, because they wanted handpicked people. They liked this young doctor from MD Anderson with 4 kids. He actually gave me one of his poodles from his litter, and we bought this house. We paid $47,500 for it.

Lesley Brunet, MA

That's in 1965?

Emil J Freireich, MD

Yes, in '65. You have to understand that when I left the government, my salary was $5600 per annum. Dr. Clark paid me $25,000.

Lesley Brunet, MA

That's quite an increase.

Emil J Freireich, MD

We were rich. I have no idea what Dr. Frei was being paid, but it was more than me. Dr. Clark was very well connected, so I talked to him, and he sent me to a bank, where we got a 5½ percent, 30-year loan. I think our down payment was whatever we sold our house for, maybe $4,000. Only Dr. Clark could make that deal. We had our house. The day we moved in, the air conditioning broke down, so I fixed the air conditioning. Our transition to Houston was painful.

Chapter 11: Leaving the NIH for a Turbulent Research Environment at MD Anderson

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