Chapter 25: Multi-Disciplinary Clinics in a Politicized Environment and a Review of Key MD Anderson People [Restricted]

Chapter 25: Multi-Disciplinary Clinics in a Politicized Environment and a Review of Key MD Anderson People [Restricted]

Description

This interview chapter is restricted. Please contact archivist for details.

In this chapter, Dr. Freireich talks about the operation of multi-disciplinary clinics in a highly politicized environment and discusses his thoughts about key personnel and leaders at MD Anderson.

Identifier

FreireicEJ_04_20010813_C25

Publication Date

8-13-2001

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

Building the Institution; Leadership; Portraits; Professional Practice; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Understanding the Institution; Critical Perspectives on MD Anderson; MD Anderson History; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care

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

I told you the reason DT was eliminated. We were Balkanized. I was head of Hematology. Hematology boomed for 2½ years. We were the best in the place. During that time, between ’83 and ’85, Mickey got a brilliant idea. There was another physician here,CliffMountain.

CliffMountainis somewhere inCalifornia with a gold chain and a young wife. He’s gone into that phase of his life. CliffMountainwas a thoracic surgeon who had a national reputation because he worked with the cooperative groups and developed staging systems for lung cancer. He had a big reputation. He got a big grant. He went to LeMaistre, and he said, “The problem with our thoracic program here is it’s not integrated.” Dr. LeMaistre agreed. So Dr. Mountain created the first multidisciplinary clinic at MD Anderson.

It was thoracic oncology, and the internist came from DT. It was Dr. Manuel Valdivieso, who’s now at Southwestern as head of Oncology. The surgeon wasCliffMountain. The radiologist was probably Sid Wallace [oral history interview] or someone like that. The radiotherapist, I can’t recall who it was. But they created a multidisciplinary clinic for lung cancer. Oh, they had an epidemiologist. They had a statistician. They got a big grant.

I really liked that. So onJune 10, 1985, I wrote a letter to Dr. LeMaistre. Now, you can tell right away that I’m stupid, because here you are in 1985. He’s been here 7 years. I know what’s between the ears now. It’s not like I’m dealing with a rookie. Here’s stupid Freireich, writing a 2-page memo to Dr. LeMaistre. Now, that was the dumbest thing I ever did.

What the memo says is, “I like multidisciplinary clinics, and I think that since you’ve created one in thoracic, the second one should be in leukemia. I’m head of the Hematology Department, and we have multidisciplinary programs. We have surgeons involved in the pathology staging. We have the lymphoma people involved in the pathology review. We had a lady in Surgery, who is working on immunotherapy. We had radiotherapists involved in lymphoma treatment. We should have a multidisciplinary program in hematology, because that is the biggest program at MD Anderson, dollar-wise, if you put it all together.”

Lesley Brunet, MA

What did he say?

Emil J Freireich, MD

Well, you know what he said.

Lesley Brunet, MA

I assume he said no. I don’t remember seeing this.

Emil J Freireich, MD

Well, what’s the date?

Lesley Brunet, MA

This isJune 7, 1985.

Emil J Freireich, MD

On June 14, Dr. Krakoff called me, I came to his office, and he said, “You’re fired.”

Lesley Brunet, MA

You’re fired from your program, or you’re fired from the whole place?

Emil J Freireich, MD

Head of the Department of Hematology and replaced by one of my students. It took me about a year to figure out that what happened was—and I’m certain of it—Mickey looked at this. It’s 2 pages and has a lot of words. He can read, but only a limited amount of reading, and he can understand things, but only limited, so he had no idea what this memo was about. So he told his girl, Judy Johnson, “Show this to Krakoff and ask him what he thinks.” Krakoff took one look at this, and he said, “Insubordinate.” He called me to his office and fired me.

Lesley Brunet, MA

Because you wrote to LeMaistre directly?

Emil J Freireich, MD

Correct. I went around him. This was not a Medicine proposal. This was multidisciplinary. It had no business being in Krakoff’s hands. But it made him angry, and that’s why he fired me.

Lesley Brunet, MA

I’d like to read the whole thing.

Emil J Freireich, MD

It’s a good memo, but not for LeMaistre. He never spoke about it. After I was fired, and I went through the entire thing with the dean, he never mentioned this, ever. He had no perception of it. I don’t think he ever read it. I swear he never read it.

.

Now, there’s another thing I think you need to understand. I told you about this prescription business. The prescription business is quite important. Do you have the date that Fred Conrad was shot?

Lesley Brunet, MA

0:

28:52.6

I think was December.

Emil J Freireich, MD

It wasDecember 17, 1982, and in ’83 I got fired, DT was eliminated, Krakoff came in, and all that stuff. The prescription thing is very important, because when it occurred, LeMaistre acted in his usual way. I told you I had my heart attack. The heart attack was clearly over the prescription thing. I was just insanely angry. Believe it or not, when I was in the hospital, almost dead, he called a meeting of Dr. Kenneth McCredie and Dr. Michael Keating.

Lesley Brunet, MA

March 10, 1987?

Emil J Freireich, MD

Yes. My heart attack occurred March 1. I had a heart attack with 80 percent mortality in the absence of tissue plasminogen activator, which I got a shot of, fortunately, because I was in the trial at Baylor. I recovered, and I had a bypass, so I’m postop. I had my surgery on the third, so it’s one week after an open-heart surgery. Dr. LeMaistre resolves the issue that he and I had confronted for months, and the memo says, “All taken care of.” It shows you the character of the person. He had no concern about me. He was just hoping I would die. I’m sure of it. But anyhow, even if I didn’t die, he wanted to get the issue settled while I was gone. So he settled it with a 3-page memo: “All settled.” When I recovered, after about a week, I came back. I immediately responded with a memo that said, “Fine. You decided it’s settled, but I’m not going to agree to it because physicians’ privileges were suspended. Again, you knuckled under to the Cancer Institute, which is unacceptable. There was no crime committed, and this has to be abolished from our records,” which he did. It was put into the personnel files that their suspensions were as physicians. That was eliminated. Dr. Ainsworth sent me a memo, and he said, “We’ve taken it out of their personnel files. No privileges were suspended. Nothing of the sort.” But he never had the guts to write to NCI to say the mistake was not in DT, the mistake was in Krakoff’s office. He never had the guts to do that. The thing ended with my memo saying that, “The issue is not closed until you close the loop and tell the NCI we’re innocent.” Here are the 7 patients who got the AMSA. These were the controls. They certainly weren’t harmed. These 7 people caused this whole whoop-de-do.

I have a good friend named Robert Mosbacher. [Redacted] I called him up, and I said, “You know, I’m really upset about this. I think Mickey is hurting MD Anderson. What should I do?” He said, “Well, I have a good friend named Jack Trotter.” He was either on the Board of Regents, or he knew everybody on the regents. “Why don’t you go over it with him?”

I developed a psychiatric dialogue with Jack Trotter. Jack Trotter owned some oil companies. He had a fancy office on top of a building downtown. I think I would have died of my heart attack if I had continued the tension I was under. But I went to Jack Trotter, and he’s a lovely guy. For no reason, just friendship, he set aside a half hour to an hour. He’d talk to me, and I’d tell him what I thought, and he wouldn’t do anything. Then a week would go by, and I’d call him again and say, “There’s something new,” and he’d say, “Fine. Come by.” I’d tell him what was going on. But during one of our Mickey conversations, he became insanely angry, because he said I was contacting politicians, which was true.

Lesley Brunet, MA

Trotter became angry?

Emil J Freireich, MD

No.

Lesley Brunet, MA

LeMaistre became angry?

Emil J Freireich, MD

Yes, LeMaistre. I told you what Fred Becker said. Dr. LeMaistre is like a government employee. All he cared about was his position. He loved power. He loved money. He loved prestige. Everybody does. Everyone loves power, prestige, and money. Have you seen the Wizard of Oz?

Lesley Brunet, MA

Sure.

Emil J Freireich, MD

The rock musical Wizard of Oz?

Lesley Brunet, MA

Oh, no.

Emil J Freireich, MD

Well, the rock musical Wizard of Oz, when the Wiz comes out and he’s revealed as a fake, they say, “Why would you do this horrible thing?” He says, “I’m like everybody else.” Power, fame, and money—Mickey loves those things, so he had to protect them. I don’t blame him. If I loved those things, that’s what I would protect, too. The things that made him insanely angry were any politicians, because his base was political. I was talking to Jack Trotter, and Jack Trotter, obviously, talked to regents, and regents asked questions. LeMaistre had to answer them, and he always had the appropriate answers. Of course, I lost, but I just wanted you to know that that happened.

The people who built DT were Dr. Emil “Tom” Frei III, who’s alive; he’s got Parkinson’s, but his brain’s okay. He was here ’65 to ’72. He knew Dr. Clark probably better than I did, because he was closer to Clark than I. I was his deputy. After ’72, I dealt with Clark largely through Hickey, and I became close to Clark after he got fired in ’79 or ’80. Dr. Frei and I, when we came here in ’65, we hired Dr. Loo, so he was here in ’65. He retired in’94? So he was here 29 years. That’s the person who really did a lot for this place.

Lesley Brunet, MA

Oh, yes, he did.

Emil J Freireich, MD

Dr. David Farquhar, who’s still here, was his postdoc. Dah Hsi Ho was recruited from Roswell Park, and she’s still here. She retired, but she still comes to work every day, without cost, and she’s right down the hall here. Grady Saunders is also retired. He was recruited in 1966. He’s still very compos. He still has a grant, and he works, not every day, but pretty close to every day. He came in ’66 or ’67. His wife, Priscilla Saunders, was a member of our department. She’s still alive and well. She was fired by Krakoff when he hired Bob Newman. I personally recruited Bill Plunkett [oral history interview] as a post doc, and he’s still here. I took him to a hockey game, as I recall. That’s Pharmacology.

The first person we recruited was Gerald Bodey, Sr [oral history interview]. Dr. Bodey is very alive and very compos. He retired maybe 4 or 5 years ago and lives in The Woodlands. He’s now coming back part-time to help us out. Dr. Bodey is an enormously intelligent, distinguished, accomplished person. He’s world famous for his work on infectious diseases. He was the first director of the Office of Protocol Research. When we had the festouche over the Loo caper, he was given the responsibility of running the review protocols. He was head of our Chemotherapy. He’s a very good man.

Evan Hersh was here from ’66 until, again, the Krakoff business. Before Krakoff came, I had gone to LeMaistre. He wanted the departments to come together and all that bull, and I convinced him that Hersh had built up a program that was so large and so effective that it deserved departmental status. We had an external review of the pharmacology program, and I was convinced we needed a pharmacology department, separate from DT. I convinced him that we needed a chemotherapy department separate from DT.

So when DT was Balkanized, Hersh became the department chairman. In fact, in 1981 Hersh was made a head of a department. Dr. Hersh is, again, enormously intelligent, accomplished, intellectual, just a fine, fine person. Hersh is now head of Oncology at the University of Arizona in Tucson. He comes back regularly, about once a year, for a Gottlieb program. His heart’s at MD Anderson. He came here as a rookie and built up a tremendous program. He recruited Jordan Gutterman [oral history interview],[LS1] did all the interferon work. He recruited Giora Mavligit, who is still here, working in the GI department. He recruited Yehuda Patt, who is still here, working on liver cancer. He trained a lot of very famous tumor immunology people, including Jules Harris, who’s at Rush Medical College. So when DT was at its peak, my executive committee was Hersh, Bodey, Loo, and I. We met and made all of the personnel decisions. I kept rosters like this so people were treated fairly.

Ken McCredie came here in 1969, and he died in 1991. McCredie was very, very important in our program. McCredie had a professorship at the University of Sydney. He’s from New Zealand and trained in Australia. I went to Australia to talk about curing leukemia, and he liked it. He’s a person who goes for what he believes he should be doing. It’s not power, fame, and glory. He likes to get things done. He’s a person of action. He called me up, and he said, “You know, I want to work with you because I like the way you think.” I said, “Fine.” I had a rule that no one became a professor in DT unless they did training, because they had to learn how I did things. I said, “You have to become a fellow.” He said, “Fine.” For $12,000 a year, he came over from Australia with his 3 daughters and his wife. He came as a fellow for 1 year, and then in ’70 was appointed assistant professor at $18,000. He did really well. In ’83 he had $100,000. He was an enormously accomplished person. He died, of course, tragically. It was reported to be suicide. [Redacted]

Emil J Freireich, MD

Yes. He was here working. He was on our faculty. He was fantastically effective. But McCredie was very big. One of the reasons he was big is because he recruited Michael Keating.

Michael Keating was an Australian. He was born in Australia and trained in Melbourne. Ken McCredie had returned to Australia several times to give talks. Keating came here as a fellow in 1974. It’s now ’01, so he’s been here 27 years. He came primarily to work with McCredie. He had a faculty appointment at Melbourne, and we went through the same thing.

I said, “You can’t become staff unless you’re a fellow,” so he came as a fellow for $15,000 in 1974. Michael Keating picked up his 2 sons, 2 daughters, and wife, and came to the United States. It takes tough people to do that kind of thing. He rapidly rose to professor. In ’77, after he’d been here 3 years, they offered him a staff job in Australia, so he went back to Australia. He stayed there for exactly 1 year, and he came back because he said he couldn’t do what he did with DT.

Michael Keating is the world’s greatest physician-scientist. He is infinitely smarter than I am. He’s a terrific person. He’s developed the treatment for chronic lymphocytic leukemia. He is an absolute superstar. There is no one better than Michael Keating. So from ’74 on, Michael Keating is someone that should be on your list. He directed the Office of Protocol Research for a while. When James Cox [oral history interview] came in as vice president for Patient Affairs, Michael Keating was assistant. Incidentally, Cox is someone you definitely ought to have on your list, because LeMaistre hired Cox to be physician-in-chief and then fired him. Cox will have a lot to tell you about Mickey. Keating has played a big role in this institution. Again, he came primarily as a DT guy.

Lesley Brunet, MA

Where is he now?

Emil J Freireich, MD

He’s in Leukemia.

Lesley Brunet, MA

He’s still there?

Emil J Freireich, MD

He’s still in the Department of Leukemia, where he’s been for his whole career. He’s still working very actively, and he’s a dynamo and an absolutely wonderful person.

I mentioned Jordan Gutterman. He came in ’71. He’s still here. I mentioned Dr. Mavligit. He came in ’71. I mentioned Dr. Valdivieso, who came in ’72. He was the first thoracic oncology multidisciplinary guy. Karel Dicke is still alive. I don’t know if you want to talk to him. Raymond Alexanian you know about. Bob Benjamin came here in 1974, so he’s been here 27 years, also. Bob came here after training at the Cancer Institute in Washington. He came to work primarily with Jeff Gottlieb, who died of cancer. Dr. Benjamin was a clinical pharmacologist, and he’s been a very important factor in the growth of MD Anderson. He’s now chairman of the sarcoma department, and he’s going to give grand rounds on Friday. He’s a very, very good man. A peculiar person, but someone who’s interesting, is Dr. Michael Burgess. Dr. Burgess came here in 1970, also from Australia. He knew McCredie and Keating.

Lesley Brunet, MA

Why do you say he’s peculiar?

Emil J Freireich, MD

Well, because he took a sabbatical. He sailed around the world for 3 or 4 years. He became a sail bum. Then he came back, and he works in Sarcoma with Benjamin. But he was very important in DT. He ran the outpatient clinic, and the fellows just adored him. He was a wonderful professor. He’s still here, working at MD Anderson.

Jeane Hester came in 1971. I mentioned her before. She’s still alive and in the community. She’s a tremendous person. She came to us from University of Oklahoma, just having finished her residency. She did her fellowship here. She’s the one who developed the blood cell separator, almost single-handedly, to where it is today. She also got fired.

There’s an episode we haven’t covered, which is the hiring of Albert Deisseroth. When I got fired as head of Hematology, they had this search committee, and they hired Albert Deisseroth. Deisseroth came in ’86, and he made a mess of the Department of Hematology. We can get into that. That’s more modern history. But Deisseroth is still alive. He just took a job in San Diego as the director of the Sidney Kimmel Cancer Center. He left here to go to Yale to work with DeVita, and then he went to San Diego. He was very bad for DT, for the leukemia program, but that’s what his job was. He was hired to replace me.

Bill Murphy is still alive. He came in ’72. He worked in thoracic oncology for many years. He retired. He was one of the first DT people to retire. I went to the retirement party, and I said to my wife, “It’s a bad thing when your students retire.” He came here from San Antonio Medical School and did his entire training here. He’s a very good guy.

Michael Keating I mentioned. Bart Barlogie I mentioned. He came here in ’74. He came out of just house-staff training in Germany. He’s a very colorful figure. He built the first flow machine in the United States. He’s a fantastically energetic investigator. He was the one that Krakoff convinced to replace me in ’85. He and Deisseroth, of course, had nothing in common, so he left to go to Arkansas, where he’s established the country’s best program in myeloma. He’s alive and very compos. He was born in ’44, so he’s only 57 years old, I guess.

Fernando Cabanillas came in 1974 from Puerto Rico as a fellow. After his training, he advanced to where he is now. He’s chairman of the Lymphoma Department. As I told you, when I had my first confrontation with Krakoff over the Hematology Department in 1983, I insisted Cabanillas be head of Lymphoma instead of Alexanian. He’s internationally famous in the lymphoma field. He’s very competent, very intelligent, and well worth talking to.

Yehuda Patt came in 1975. He still runs the liver program in GI. Axel Zander came in ’77. He’s in Switzerland. Sewa Legha came in ’76. He’s in practice at Saint Luke’s. He got fired by the Board of Regents over a trivial issue. He’s still very important in the world of melanoma. He authored some very innovative stuff. He’s someone you can talk to. He’s very intelligent. He’s across the street.

Dr. Miloslav Beran came to us in 1983. He’s still here in the Department of Leukemia. He is a staff member. Lynn Feun is in Florida. We’re getting down to the more modern ones that probably are less interesting. Gabriel Lopez-Bernstein is a big power around here. He came to DT in ’79. He’s one of our fellows. John Kavanagh was in Medicine. Dr. Adan Rios, who’s going to get the Alumnus of the Year Award, came in ’81. Ron Walters, who runs our thing, was a DT fellow in ’79. He runs the outreach program for MD Anderson. Hagop Kantarjian, of course, is a superstar. He’s chairman of the Leukemia Department. He’s internationally famous. He came as a DT fellow in 1981. I mentioned Ho and Potu Rao, Farquhar, Priscilla Saunders, Bill Plunkett. Michael Rosenblum, who’s still here, came in ’79. Jim Reuben came in ’79.

Lesley Brunet, MA

That’s quite a list of physician-scientists that were here.

Emil J Freireich, MD

The reason I went over this list is because these people are still compos, they are still working, and they are accomplished people. They’re people who, after I die, you can find out more from.

Conditions Governing Access

Redacted

Chapter 25: Multi-Disciplinary Clinics in a Politicized Environment and a Review of Key MD Anderson People [Restricted]

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