Chapter 18:  Departments Undergoing Change under Charles LeMaistre

Title

Chapter 18: Departments Undergoing Change under Charles LeMaistre

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In this chapter, Dr. Freireich talks about the many changes that occurred at MD Anderson under the leadership of Dr. Charles LeMaistre.

Identifier

FreireicEJ_03_20010806_C18

Publication Date

8-6-2001

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

Building the Institution; Leadership; Portraits; The Professional at Work; C: Education at MD Anderson; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Understanding the Institution; The Researcher; Overview; Definitions, Explanations, Translations; Discovery and Success; Critical Perspectives on MD Anderson; MD Anderson History; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Lesley Brunet, MA

So what was your position then?

Emil J Freireich, MD

I became chairman of a Department of Hematology, because my specialty is hematology.

Lesley Brunet, MA

This was after Shullenberger?

Emil J Freireich, MD

Shullenberger had retired. The head of Hematology at that time was Raymond Alexanian. Jessie Gamble had died. Fredrick Hagemeister and Peter McLaughlin were there, and Alexanian. They mostly saw some myeloma patients. That was about it. So in 1983, I went to Dr. LeMaistre, and I said, "Dr. LeMaistre, this is a very bad thing. You have eliminated the most creative, most successful, most financially successful department in your institution. It's not a good thing." He said, "It's very bad, J, but it was Krakoff's decision, and it was up to him."

Lesley Brunet, MA

What did you say when he said that?

Emil J Freireich, MD

There was nothing more to say. That was Dr. LeMaistre. That's the way he operates. Nothing is his decision. This was Krakoff's decision, and Krakoff was an absolute goon. You couldn't talk to him in more than one sentence at a time. He's a very unintelligent guy.

Lesley Brunet, MA

Is he still here?

Emil J Freireich, MD

Yes. He stayed for 10 years and then resigned. He created nothing but chaos, nothing positive. He brought nothing to the institution that I can think of. But I had a very negative view of him as a person, because he was the inverse of LeMaistre. LeMaistre was a movie star. Krakoff, he rolled up his sleeves and buttons were popping. He didn't comb his hair. He was crude and spoke in ugly, declarative sentences. Mickey, his prose is like music. When he speaks, you just listen to the words. No content, but beautiful stuff. It's like listening to Mozart. You don't have to walk away with anything. It's just pleasant. So I'm head of Hematology. Mickey did a few other things before Krakoff that gave me a clue as to what he was going to do. Dr. Jose Trujillo, may he rest in peace, who was a good friend of mine, had gone to LeMaistre. He was upset about the fact that we ran the transfusion service for the hospital. We ran the platelets, we ran the white cells, we ran the Pheresis Center, and all they did was issue blood for the surgeons. He didn't think that was right. He thought that they should have their own platelet program, because Pediatrics used to get platelets from him, and surgeons used to ask him for platelets. I used to just provide DT. So LeMaistre called me to his office, and Trujillo was in the room. He said, "You know, Freireich, you're not a pathologist. The blood banks are certified by the American College of Pathology, and you're not certified. We think that this center should come under the Department of Laboratory Medicine." "Are you kidding? Laboratory Medicine, they haven't discovered anything. They haven't brought any money in. Why would you put it in Laboratory Medicine? It's ridiculous. This is a research operation. We create peripheral blood stem cells and granulocytes and platelets for support, and we're doing research." Well, Dr. LeMaistre, see? We both left the room feeling we had won, but I realized there was something amiss here. It was one of those things. They eventually turned the pheresis unit over to Transplant. We had several of these kinds of confrontations that were nurses and stuff, and every time it came up the same way; that is, he never made a decision. The people who were combating had to work it out amongst themselves. Trujillo and I eventually worked out a deal where it worked okay. I'm head of Hematology, and Krakoff calls me to his office one day. "Dr. Alexanian wants to be in charge of lymphoma." I said, "Dr. Krakoff, if you want me to be head of the Department of Hematology, I'll decide who's in charge of lymphoma. Dr. Fernando Cabanillas is infinitely more qualified than Dr. Alexanian. He's more creative, he's more of a leader, and I have appointed Dr. Cabanillas, period." Confrontation with Krakoff was a bad thing. I won that battle, and Cabanillas is still head of lymphoma. He's the world's greatest. He's one of the DT fellows who came here. Leukemia, of course, is all dominated by DT fellows. Hagop Kantarjian, Susan O'Brien, Elihu Estey, and Michael Keating [oral history interview] were all trained by me. They all came here to work with me. I had another confrontation with Krakoff. He used to meet with the department chairmen. I've forgotten how often. It was maybe once a month. We had one meeting, and he announced that Dr. Blumenschein was leaving. Blumenschein, you remember, was in Medicine, but he was very close to DT. When we were Balkanized, he became head of medical breast in the Division of Medicine under Krakoff. He built the most magnificent medical breast program in the country. We started the Adriamycin stuff. We did the first adjuvant therapy for breast cancer. We did the first Adriamycin-Cytoxan. It's still the standard of therapy around the world. The breast cancer clinic was the successful clinic in the place, except for hematology, of course.

Why would Blumenschein be leaving? He fired Blumenschein because Blumenschein was one of these physicians that patients simply identified with, and his practice grew and grew and grew. He had his clinics in the afternoon, and he hired more and more personnel, but his patients came to see him. If he had 25 patients, they gladly would wait until 9:00 at night if they wanted to see Blumenschein. They came from Seattle; they were going to sit there until they saw him at 9:00. So his clinic used to run until 9:00 or 10:00 every night. The nurses complained to Krakoff, so Krakoff called Blumenschein into his office and said, "Blumenschein, you have to quit your clinic at 6:00." Blumenschein said, "Dr. Krakoff, I can't do anything about it. These women want to see me. I can only see so many patients an hour. If they want to wait, I have to see them. You have to provide nurses." He gave him an order, and he didn't follow the order. His clinic still ran till 10:00, so he fired him. Krakoff fired Blumenschein. Blumenschein's in practice in Arlington. He took two-thirds of his patients with him. They all loved him. He's very successful in private practice, and our breast clinic has never recovered. It was typical Krakoff. Krakoff did all kinds of bad things. He brought in this guy, Robert Newman. He's worthless. He fired Dr. Loo as head of Pharmacology. He almost destroyed Pharmacology.

Lesley Brunet, MA

I was going to ask you about Dr. Loo, because there are a lot of hints of something going on, but I couldn't tell.

Emil J Freireich, MD

I can tell you about the Loo caper. That's a very long story. That's why he was fired, and it was the reason Krakoff was brought in. I don't have evidence to support it, but my theory is that Dr. DeVita, as NCI director, suggested to LeMaistre that he hire Krakoff, because LeMaistre would have no idea where Krakoff came from. He wouldn't know him from Adam. He didn't know anybody in oncology. The main reason that DeVita wanted Krakoff here was because we confronted DeVita repeatedly. We were the center of chemotherapy research in the United States, and DeVita wanted to control everything from Washington. He was an NCI director who was an absolute despot. He wanted to run everything. When I confronted him when Clark was here, Clark supported us. He was on the National Cancer Advisory Board. So DeVita couldn't do anything about MD Anderson. I had a confrontation with DeVita over a drug once, and Clark called him up while I was in the office. "Vince, what is this problem?" "Oh, yeah, Vince, you're right." So the main purpose that Krakoff had in coming here was to make sure that the DT program was responsive to the NCI. That's my personal theory, although there may be many other factors, undoubtedly. Shortly after he came, he hired Newman, and Loo was asked to move out of his office and give up his lab, so he just retired. I can tell you about the Loo caper, but let me finish the Krakoff story, because it gets more interesting.

So after about 2 years of continually conflicting with Dr. Krakoff, I decided that in that 2-year period, what happened to DT happened to Hematology. I'm just a natural born leader, and we recruited dynamite people, the ones I've mentioned. Our practice in leukemia boomed. Our practice in lymphoma took off. It used to only be in Medicine, but we developed new combinations and new intensification. We were curing lymphoma. We hired Karel Dicke. We initiated a transplant program. Karel Dicke is still working in Arlington Cancer Center. Hematology was booming. It was the same problem. What are we going to do about Hematology? Well, I made a very serious mistake of being arrogant and very self-confident and not yet having proven Mickey completely incompetent. I wrote a memo to Dr. LeMaistre. I said that Hematology had reached the point where it should be elevated to division status, because the hematology practice, the grant support, the number of research patients that we were developing, our beds and our support were such that we needed to be independent of Krakoff. I wanted to get around Krakoff. This is not known to me for sure, but when the memo arrived to LeMaistre, the first thing he did was call Krakoff and say, "What is this all about?" Krakoff took one look at the memo and called me to his office. He was going to Japan for a meeting or something. He called me to his office and said, "Freireich, you've been fired as head of Hematology, and you're replaced by Bart Barlogie," who was one of my faculty. That was in 1985. The same thing that happened to DT in '83 happened to Hematology in '85. So now I was fired as head of Hematology, and Krakoff left town. So this got really exciting.

Lesley Brunet, MA

What happens if they fire you from head of Hematology, but you had so many grants? You're wrapped around the grants.

Emil J Freireich, MD

It just so happened that the year that I was fired, I had been awarded the first Outstanding Investigator Award in the United States. There were only 20 awarded in the United States, and I was 1 of 20 outstanding investigators. The important thing that happened when I got fired is I now understood Dr. LeMaistre. I was very upset about this because I'd been fired 2 years ago as DT head. Now I was really angry. The first thing I did was I went around and talked to all the chairmen of all the division heads, to tell them what I thought was going on. I wanted them to understand. Everybody supported me except one, Jan van Eys. He was really a cartoon character. Jan van Eys said, "Freireich, isn't it obvious to you that they want you to leave?" I said, "Yeah, it's pretty obvious. But shouldn't it be obvious to you that I'm not going to leave?" When Krakoff fired me, I said, "Irv, I'm going to be here long after you're gone."

Lesley Brunet, MA

Is that why you stayed?

Emil J Freireich, MD

No.

Lesley Brunet, MA

I'm sure you've had many offers.

Emil J Freireich, MD

I love MD Anderson. This is the best place in the world for anyone to work. There's no question in my mind about it. That's why I've recruited outstanding people. That's why I trained outstanding people. That's why everybody loves it. It's just a great place. LeMaistre can't ruin it and Krakoff can't ruin it. It's too good. Clark created a gem. It's a unique place in the entire world.

Lesley Brunet, MA

Yes, I have that feeling.

Emil J Freireich, MD

This place has everything. I have no intention of leaving because of some jerk like Krakoff that doesn't care about anything. I want to cure cancer. So I was very upset about being fired as chief of Hematology.

Lesley Brunet, MA

You're still on staff.

Emil J Freireich, MD

I counsel with everybody, including Conrad. Oh, maybe Conrad was dead already.

Lesley Brunet, MA

Hadn't Conrad been killed?

Emil J Freireich, MD

Had he been shot already? I can't tell you what year it is.

Lesley Brunet, MA

I think he had. I think it was '82.

Emil J Freireich, MD

I went to Fred Becker, and Fred Becker really helped me, because I was so angry, so upset, and I had no idea what the next step would be. Dr. Becker said, "Freireich, I've learned one thing in dealing with Dr. LeMaistre. If you want to accomplish anything, you use 3 words: 'Board of Regents.' That gets his attention."

I said, "Now, that's a very good idea." So I made an appointment with Dr. LeMaistre, and I said, "Dr. LeMaistre, I've been fired as head of Hematology. I think it's bad for the institution, and I wish to bring this to the attention of the Board of Regents." Whoa! Remember, everybody always gets what he wants from Mickey. That's why they call him Mickey, as in Mickey Mouse.

Lesley Brunet, MA

That's not really why they call him Mickey.

Emil J Freireich, MD

It's his name. He calls himself Mickey. I call him Mickey Mouse. He's about that level of skill and intelligence. Mickey Mouse was a great entertainer. You'd want to go see him anytime, but you don't want to put your life in his hands. "Board of Regents," he said. "Well, J, in order to get to the Board of Regents, there's a protocol you have to follow." I said, "Yes. That's why I came to you. What is the protocol?" "Well, first you have to go to the vice chancellor for Health Affairs. Then you have to go to the chancellor, and the chancellor goes to the regents." "Okay. I want to talk to the vice chancellor for Health Affairs, Dr. Charles Mullins." "I'll arrange an appointment." "Thank you." I went back to doing my thing. One day I get a page from Dr. LeMaistre's office to come to his office. The secretary says, "Dr. Mullins wants to speak to you." "Hello, Dr. Mullins." "Hi." "I want to talk to the Board of Regents." "What's the problem?" "I think that Dr. LeMaistre and Dr. Krakoff are harming MD Anderson. I love MD Anderson, and I don't think it's right. I think the regents should try to straighten it out." He listened very carefully, and he said, "You know, the way the University of Texas is organized, the president, once appointed, has absolute authority. The administration in Austin has no effect on the institution. So whatever Dr. LeMaistre wants to do, that's his privilege." I said, "Well, thank you, Dr. Mullins. I think that's a very good system, but in this instance, I don't think it will work, and I would like to go to the regents." "Well, you can't do that." That was the end of that conversation. I forgot all about it. [LS2]

Incidentally, Dr. Mullins said, "Put it in writing." So I wrote him a memo. "Dear Dr. Mullins: Here's what's wrong." A couple of weeks later, I get another phone call from Dr. LeMaistre's office. "You have an appointment with Dr. Hans Mark in Austin, the chancellor." So I get in my car and drive to Austin.

So I walked into the chancellor's office in Austin; it was a very impressive place. Sitting in his office was Dr. Mullins, Dr. LeMaistre, and Dr. Mark. "Dr. Freireich, what's your problem?"Well, I told them the problem.

It's interesting, because LeMaistre was in the room, but by that time I understood him. I didn't hesitate to say that I thought he was incompetent, in his presence. I would say it to him anytime. I said that I think that the decision to hire Dr. Krakoff was harmful to the institution, the decision to eliminate the Department of Developmental Therapeutics was harmful to the institution, and the decision to eliminate me as head of the Department of Hematology was harmful for the institution. I thought it was time for the Board of Regents to review the situation of the administration of MD Anderson Cancer Center. Dr. Mark said, "Dr. LeMaistre, what do you think?" "Well, Freireich's got a good point." Okay. That's the end of the meeting. It was very emotional for me. I'm just a young whippersnapper, and I'm talking to the kings. I got in my car, drove back to Houston, and went back to work. I've never stopped working. I'm still taking care of leukemia patients. I do what I do every day. About 3 weeks later, Dr. Mark appears in my office. "Freireich, I want to know what you do." I told him what I do. I took him on a little tour of the protective environment, the Pheresis Center, the clinic, and gave him some figures. "Thank you." Dr. Mark was too good for chancellor of the University of Texas. It's a position that was perfect for Mickey. You don't have any idea the dimension of the University of Texas. I do, because I was on UT Faculty Advisory Council. But Dr. Mark was a wonderful chancellor. One of the good things he did was he created the Faculty Advisory Council and the Student Advisory Council. It was true what Dr. Mullins said. The way the university ran was the way it ran in 1860. You appoint a president, and he ran the Health Science Center. The administration had nothing to do with it. But when it gets big, there has to be someone who is worried about it.Of course, when Mark became chancellor, he realized that the presidents were not all perfect. In fact, the president of Dallas was fired, and the president of San Antonio was fired. They had to fire Mickey. He was a hopeless case. But Mark realized that the administration of the University of Texas required someone with academics, intelligence, and leadership, who could make the university run. It's too big to be totally Balkanized. Someone has to be thinking about it. The legislature can't run it. The coordinating board can't run it. You need administration in Austin which is strong, and Mark realized that to communicate with these presidents, he had to have some information other than what the president feeds him, because that's all PR. The president just tells him how great he is. He wants to know what's going on there. So each campus has a faculty. They elect a chairman. The chairman of the Faculty Senate is a faculty member that goes to Austin and tells them what's going on. All the campuses talk to each other. They have committees, and they have structures, so we have common language and common grounds and common degree-granting authority. It's a wonderful thing, all established by Mark.Mark is a wonderful guy. He really cared about it, so he came to MD Anderson to see how it worked. Before, when I had left his office, I said, "Dr. Mark, I would like to go to the regents with this." Mark was offended. He said, "My responsibility is the regents, not yours, Freireich. So if you have any problem, come to me, and I run to the regents." Then, to represent the regents, he came to my office. He really cared about MD Anderson. He found out how it worked. So I was very flattered that he would take the time. I mean, he's got lots of stuff to worry about.

Two weeks later, the most interesting meeting that ever happened occurred. I was called to the Governor Allan Shivers Conference Room. Dr. LeMaistre was at the head of the table. Also at the head of the table was the chairman of the Board of Regents, and around the table are sitting Krakoff, Becker, and all the division heads. This is the guns of MD Anderson Hospital. They had obviously been in session for many minutes before I arrived. It was like a courtroom proceeding. The secretary takes me in the side door. Whoa! What am I doing here? "Dr. Freireich, please take a seat." Dr. LeMaistre said, "Well, you're concerned about these decisions. Tell us what you're concerned about."

Lesley Brunet, MA

Haven't you already told him enough times?

Emil J Freireich, MD

Not the chairman of the Board of Regents. This is my hearing with the regents. Dr. Mark is not here, but Dr. Mullins is here. Dr. LeMaistre and the chairman of the Board of Regents are there. They want me to tell Mr. So-and-so what my problem is. Everybody in the room knows what my problem is. I said, "I just want you all to understand one thing. Emil J Freireich is completely happy. There is nothing that you can do for me. Nor is there anything that I want you to do for me. What I want you to understand is that decisions are being taken here which are harmful to the goals of this institution: research, education, and patient care. That's what I'm talking about." Everybody listened very quietly. They had already had a meeting and decided everything. So then Dr. LeMaistre makes a speech. "J, here's what we decided to do. You're now director of the Adult Leukemia Research Program." "What is that?" "Since your primary interest is in leukemia, and you want to cure it, with Adult Leukemia Research Program, your office will remain intact. You'll have administrative people. You'll have secretaries and clerks. You'll be able to do your work. There will be no interference with progress in leukemia research, and you will have all this authority." "Thank you." End of meeting.

Lesley Brunet, MA

Did they just want to make you happier so you would shut up?

Emil J Freireich, MD

They wanted to shut me up. After that I repeated, "This will do nothing to the problem, and I don't need anything for me, but I will continue to do the best I can as director of Adult Leukemia Research Program."

Lesley Brunet, MA

Is this just an organizational change, or were they actually giving you something?

Emil J Freireich, MD

It was organizational change. Don Pinkel had been recruited by Jan van Eys to work in the Department of Pediatrics, and he was having the same problem with van Eys that everybody did. He was hopeless. Van Eys was hopeless. Pinkel had already made a stink, and I had made a stink. Mickey is very good at administrative things, so he got the idea that I would be director of the Adult Leukemia Research Program and Don Pinkel would be director of the Pediatric Leukemia Program. We would work together, and leukemia would be a prime activity at MD Anderson. Everybody would be happy, and we could leave Krakoff and van Eys alone. Pinkel and I were administratively to report to none other than Fred Becker.

Lesley Brunet, MA

Was that a little unusual?

Emil J Freireich, MD

Becker was to assure that this clinical research activity continued. In other words, he was going to have an influence on clinical research.

Lesley Brunet, MA

Who's in charge of patient care now?

Emil J Freireich, MD

When Conrad got shot, it was Stratton Hill [oral history interview]. Howe and I had a confrontation at one point about admissions to leukemia. We were developing our own practice, and Howe wanted to control our practice, and he declared that we could not admit patients without his office approval. We had a meeting with Dr. Clark, and Dr. Clark said, "Cliff, you can't do this kind of thing. It's not useful." So he fired him, and Stratton Hill became Director of Clinics.

So Howe was replaced by Stratton Hill as head of clinics. Then when Conrad was shot, as I recall, Stratton Hill became director of the hospital, because he was already in charge of the clinics. Stratton Hill was a very colorful guy, and he was a positive guy. He was here before I came, and he liked DT. We got along very well. Our clinic was thriving, everything was going fine, and then he got fired and replaced by Joe Ainsworth. Joe Ainsworth was the perfect solution to running anything, because he was exactly like Dr. LeMaistre. He didn't care about cancer. He didn't care about anything. He was a retired family doctor. He was the sweetest guy. He still is a lovely guy and very well intentioned, but no academic nothing. Unlike Conrad, he wasn't a cruel, vicious, arbitrary person. He was a very nice, sweet, and kind person. After Joe Ainsworth, I guess Charles Balch came next, and Balch is still alive. Anyhow, we were supposed to report to Becker, and we had a budget and all that, but Becker didn't care about it. Nothing ever came of it. So that was the end of the Freireich caper.

Lesley Brunet, MA

That was the end of your caper?

Emil J Freireich, MD

That was the end of the caper.

Chapter 18:  Departments Undergoing Change under Charles LeMaistre

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