Chapter 04: A Reputation For Experimentation and the Impact of Shifting to a Division System in the Eighties

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Chapter 04: A Reputation For Experimentation and the Impact of Shifting to a Division System in the Eighties

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Dr. Yung connects MD Anderson's reputation for radical research in the 1980s to the move to reorganize the institution by Divisions in order to foster collaboration. He sets context by noting that MD Anderson struggled with a reputation for experimenting on people as well as with limits imposed on its growth. Dr. Yung explains how in 1982 the second president, Dr. Charles LeMaistre, reorganized the institution according to a division system to foster collaboration between departments and services and created a more systematic environment for promoting clinical research. The division system also fostered a more systematic approach to patient care and more structure in services by focusing on disease type. Dr. Yung next explains that, with that administrative reorganization, many new faculty were hired to provide a platform to enhance the quality of research and research driven patient care.

Identifier

Chapter 04: A Reputation For Experimentation and the Impact of Shifting to a Division System in the Eighties

Publication Date

3-20-2014

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Institutional Change; MD Anderson History; Understanding the Institution; Research, Care, and Education in Transition; Institutional Mission and Values; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Controversy; MD Anderson Culture; The MD Anderson Brand, Reputation

Transcript

Tacey Ann Rosolowski, PhD:

Well, what would you like to talk about next? Would you like to talk about your --- the way your research was evolving or do you want to talk about the clinical side first? What makes sense to tell your story?

Wai-Kwan Alfred Yung, MD:

Well. Actually, you know, the growth of Neuro-Oncology at Anderson, you know, have a much bigger component in the clinical side. You know, first.

Tacey Ann Rosolowski, PhD:

Why was that?

Wai-Kwan Alfred Yung, MD:

O --- that’s where, you know, I --- the --- the --- as Anderson grow the --- as the patient population grow --- there are, you know --- the --- the --- the --- the need for neu --- Neuro-Oncology consultation also increase. Because i --- it, you know, th --- the more patients have --- have brain metastases, has meningo metastasis,

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

and also as e --- as the treatment become, you know, more sophisticated in terms of radiation therapy and chemotherapy, you know, then more toxicity to the brain.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

So --- So we actually --- so the need on the Neurology side expands in parallel to the --- the to --- the other service --- to --- to the growth of --- of Anderson as an institution for patients.

Tacey Ann Rosolowski, PhD:

Uh-huh. And this was also a period too of intense experimentation, obviously in chemo and radiation.

Wai-Kwan Alfred Yung, MD:

Well --- I mean --- I think, you know, --- you --- you probably get, you know --- I think in the early 80s because of Dr. Freireich [Emil J Freireich, MD [Oral History Interview]

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

You know, presence here in --- with a --- a strong interest in development of experimental therapeutics so, you know, the intensity of chemotherapy, you know, advanced very rapidly.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

You know, in --- in the early ‘80s. And, in fact, is --- MD Anderson was kind of known as the, you know, experimentation place. I mean, we carry a name kind of not that very good fr --- in the community and say, you know, if you have cancer if you want to be a guinea pig

Tacey Ann Rosolowski, PhD:

A guinea pig. Right

Wai-Kwan Alfred Yung, MD:

You come to MD Anderson

Tacey Ann Rosolowski, PhD:

Right. I’ve heard that before. Yeah.

Wai-Kwan Alfred Yung, MD:

Right?

Tacey Ann Rosolowski, PhD:

Yep.

Wai-Kwan Alfred Yung, MD:

That, you know, --- at that time, you know, it’s a intense competition between Methodist and Baylor and Anderson.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

And --- And --- And that’s also the time that --- when Anderson was established the chart --- de --- de --- demanded from the State creating MD Anderson --- MD Anderson is created as a tertiary facility, the patient cannot self-refer to

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

MD Anderson. Has to be referred by --- by a doctor.

Tacey Ann Rosolowski, PhD:

Right.

Wai-Kwan Alfred Yung, MD:

And --- And that really is --- is --- is the way that it was started but it is also the way that --- that impede the --- the growth of An

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

--- Anderson, you know. We --- We get the --- Anderson get the, you know, end-stage disease people. Also getting the name --- get the name of, you know, you go there fo --- to be a

Tacey Ann Rosolowski, PhD:

To die.

Wai-Kwan Alfred Yung, MD:

guinea pig, to die.

Tacey Ann Rosolowski, PhD:

Yep. Yep.

Wai-Kwan Alfred Yung, MD:

For experiment. And Dr. Freireich is doing, you know, experiment to poison you guys.

Tacey Ann Rosolowski, PhD:

Yeah.

Wai-Kwan Alfred Yung, MD:

They say that.

Tacey Ann Rosolowski, PhD:

Yeah.

Wai-Kwan Alfred Yung, MD:

Right.

Tacey Ann Rosolowski, PhD:

Yeah.

Wai-Kwan Alfred Yung, MD:

And the --- so the --- that we were struggling that kind of reputation.

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

That --- that’s the period. But I --- I --- I think with, you know --- then Dr. LaMaistre reorganized, you know, --- the --- the --- the --- the --- the --- the institution in terms of creating, you know --- creating the --- the Division system. In --- In 1982 and bringing --- bringing a --- a --- a, you know --- a new group of faculty.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

I --- that’s --- Again, I think that’s a --- a --- a important milestone for Anderson between 1982 to ’86. You know, with the reorganization of these --- of --- of the --- the --- the institution go from Department system to Division creating --- creating the Division, you know.

Tacey Ann Rosolowski, PhD:

What did that --- What did that do for the institution that addressed these problems you were talking about earlier with reputation?

Wai-Kwan Alfred Yung, MD:

I --- You know --- With --- With the reorganization and bring in, you know, Dr. [Irwin] Krakoff to --- to head up Division of Medicine and I think to create a --- a better collaborative environment among the departments --between Medicine and Surgery and Radiation. And also, you know, with a, you know --- with some more systematic approach to promote clinical research. That, you know, I think created a --- a --- a new --- kind of new environment.

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

You know, of more col --- you know, integration among the --- the --- the different specialities. More cross talk be --- you know, among the facilities.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

And th --- At that time we’re small enough that almost everybody know everybody.

Tacey Ann Rosolowski, PhD:

1: Right. This is the second pen that’s run out of ink during this interview.

Wai-Kwan Alfred Yung, MD:

Yeah.

Tacey Ann Rosolowski, PhD:

So let me just dig for another one. I’m sorry to interrupt us.

Wai-Kwan Alfred Yung, MD:

So

Tacey Ann Rosolowski, PhD:

I --- I need to pause the recorder Dr. Yung.

Wai-Kwan Alfred Yung, MD:

Yeah. Pause it.

Tacey Ann Rosolowski, PhD:

Do you have a pen??

Wai-Kwan Alfred Yung, MD:

My pen doesn’t work. I’ll give you another one.

Tacey Ann Rosolowski, PhD:

I --- I apologize for th ---

Tacey Ann Rosolowski, PhD:

Wai-Kwan Alfred Yung, MD:

So I --- I think the reorganization from department to division … is a big milestone in the development of Anderson. It’s kind of --- it --- it’s --- I would say it was a first attempt to create, you know, more collegial environment, less competition. Because now, say, when we have a Department of Development Therapeutics, a Department of Medicine, now headed by Dr. Freireich and the other Department of Medicine is Dr. Conrad and Fred --- and --- and Fred Conrad and Tom Haney… there is sort of a artificial wall created between the two. The --- a Developmental Therapeutics is the research arm, ... you know. Intense chemotherapy arm. And, you know, the --- the Medicine side is sort of second class citizen when --- when we don’t want it.

Tacey Ann Rosolowski, PhD:

Yeah.

Wai-Kwan Alfred Yung, MD:

The patient that we don’t want to go to you.

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

It was not very --- I --- I think that --- that --- that, you know, the reorganize --- the reorganization take away the competition.

Tacey Ann Rosolowski, PhD:

Mhmm.

Wai-Kwan Alfred Yung, MD:

Or take away the --- that --- that kind of internal …

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

… competition and also with a bold systematic app --- approach of patient care and with --- with some more structure in --- in the different serv --- different group of patients go to different, you know, clinic …

Tacey Ann Rosolowski, PhD:

Mhmm.

Wai-Kwan Alfred Yung, MD:

… is allow, you know, a more --- a integrated development ...

Tacey Ann Rosolowski, PhD:

Mhmm.

Wai-Kwan Alfred Yung, MD:

… of patient care and research among the --- the team. Now we really focus more on disease type…

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

… as opposed to experimental therapeutic and not so experimental therapeutic, you know.

Tacey Ann Rosolowski, PhD:

Right.

Wai-Kwan Alfred Yung, MD:

The research group and the not --- the --- the --- the non-research group.

Tacey Ann Rosolowski, PhD:

Right. Yes, I see that

Wai-Kwan Alfred Yung, MD:

But now the research and patient care are more integrated under the --- under the --- the --- the --- the different disease …

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

… type. And integrated medicine and surgery and radiation, in a multidisciplinary approach.

Tacey Ann Rosolowski, PhD:

Hmm. Now you also mention – I just want to make sure I understood – because you also mentioned that a factor in this was the new faculty that were brought in at the time. Now, were there people who had kind of a different philosophy or --- I just want to make sure I understand what that piece was in this. How did the new faculty contribute to this new environment?

Wai-Kwan Alfred Yung, MD:

Would --- the --- the --- the --- the new faculty that come in would --- together with a new organization in the old … have --- the ___ 0 have the --- provide a platform …

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

… for us to re-enhance the quality of the research that we’re doing at the --- at the same time that, you know, starting the --- the --- the notion of, you know, research ___ and patient care. And so that we have a more concerted effort of elevated level of both and more, you know, more integrated. And --- and also allow us to increase our communication and collaboration with the outside …

Tacey Ann Rosolowski, PhD:

Mhmm.

Wai-Kwan Alfred Yung, MD:

… people like Memorial and other cancer centers, you know. Because that --- that --- would create more collaborative …

Tacey Ann Rosolowski, PhD:

Mhmm.

Wai-Kwan Alfred Yung, MD:

… environment internally as well as externally.

Tacey Ann Rosolowski, PhD:

Hmm. So it’s really a milestone period.

Wai-Kwan Alfred Yung, MD:

It --- it’s a milestone period because …

Tacey Ann Rosolowski, PhD:

Yeah.

Wai-Kwan Alfred Yung, MD:

…and --- and the new faculty also attract a lot more of grant funding. We were that is in the period with that --- the laboratory research group got expanded.

Tacey Ann Rosolowski, PhD:

Mhmm.

Wai-Kwan Alfred Yung, MD:

Fred Becker was including people like those at the time that --- that --- Josh Fidler and Cain ()...

Tacey Ann Rosolowski, PhD:

Mhmm.

Wai-Kwan Alfred Yung, MD:

… expanded on the research side.

Tacey Ann Rosolowski, PhD:

Right. Basic scientists

Wai-Kwan Alfred Yung, MD:

The basic scientists.

Tacey Ann Rosolowski, PhD:

Right.

Wai-Kwan Alfred Yung, MD:

_____ (). As well as the --- as the clinical research become more systematized with better regulation.

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

More comfort, you know, bringing more statistical approach. And that --- that’s the first time that --- that we sort of have better link --- better linkage ….

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

____ () without, you know.

Tacey Ann Rosolowski, PhD:

Interesting. We’re almost out of time for the day. Would --- do you mind if leave it at this?

Wai-Kwan Alfred Yung, MD:

Yeah, I think --- I think, we leave for another day, we can pick it up next.

Tacey Ann Rosolowski, PhD:

Sounds good.

Wai-Kwan Alfred Yung, MD:

Sounds good?

Tacey Ann Rosolowski, PhD:

Yes. Thank you very much for this because I think you’re the first person who’s ever kind of told the story about that particular period in this way, and it’s a really great summary, a snapshot.

Wai-Kwan Alfred Yung, MD:

____().

Tacey Ann Rosolowski, PhD:

Yeah, yeah.

Wai-Kwan Alfred Yung, MD:

.. with the --- the --- that’s --- that --- that --- I --- I think between ’83 now to the early ‘90 …

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

… when we encounter the first financial attack.

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

That was a really strong building period.

Tacey Ann Rosolowski, PhD:

Hmm. Well, I look forward to hearing more about the story next time.

Wai-Kwan Alfred Yung, MD:

Okay. Good.

Tacey Ann Rosolowski, PhD:

Okay. Thank you very much, Alfred WK Yung. And I’m turning off the recorder at 2 --- about

Wai-Kwan Alfred Yung, MD:

Yeah. Somewhere around there.

Chapter 04: A Reputation For Experimentation and the Impact of Shifting to a Division System in the Eighties

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