Chapter 07: Building the

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Chapter 07: Building the "Best Graduate Medical Education Program in the Country"

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Dr. Freiriech next traces the growth of education at MD Anderson when Dr. Charles A. [Mickey] LeMaistre took over as president from Dr. R. Lee Clark. He describes his close collaboration with Dr. Emil Frei, III. He explains how the Department of Developmental Therapeutics evolved because of initial connections with Japanese and Mexican Fellowship students. He explains his role in taking medical oncology to Japan and to Mexico. Dr. Freireich also sheds light on the development of the administrative structure governing clinical and basic research and explains how he established the Institutional Grand Rounds, a contributor to what he calls "the best graduate medical education program in the country."

Publication Date

10-6-2011

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Personal Background; Professional Path; The Educator; Education; MD Anderson History; Building/Transforming the Institution

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Disciplines

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

Transcript

Tacey Ann Rosolowski, PhD:

Would you tell me about what happened to—?

Emil J Freireich, MD:

I’m getting to education now. Go ahead. I can get back to it.

Tacey Ann Rosolowski, PhD:

I was interested in how that educational leg of the stool got put back.

Emil J Freireich, MD:

Well, that’s the thing. So the medical school started with this ad interim dean, and then they hired the guy from the space program. I can’t remember his name. He was hopelessly incompetent, and he had to start a medical school. A private hospital, a couple of rooms, and the only faculty they had was MD Anderson, so all of us became professors at the medical school. I was head of my oncology. Joel Moake was head of hematology. They recruited him. We were very close friends. We worked together.

So the medical school began with MD Anderson faculty, but the money rears its ugly head. They fired Clark. Dr. LeMaistre—others may have told you this, and it’s my—I want you to be careful how you quote all this because it’s going to hurt me. Dr. LeMaistre—I already mentioned this, but he was a very good friend of mine.

Tacey Ann Rosolowski, PhD:

Could I interrupt you just a second? All of this is being recorded, so if you prefer it to be off the record, I can turn off the machine right now.

Emil J Freireich, MD:

No, I just want you to treat it gracefully.

Tacey Ann Rosolowski, PhD:

Okay.

Emil J Freireich, MD:

Dr. LeMaistre was chancellor of the University of Texas. I know the story of how he got to that position. It was not because of achievement. He was not competent. He was not a competent chancellor. The reason he got the job is that the guy that was chairman of the board of regents, Frank Erwin, was using the university as his political base to become governor of the state ofTexas, and he ran the university. Mickey was, and always has been, a front man. He’s handsome, he’s thin, he gets his hair coiffed every morning. He has a deep base voice and speaks very beautifully. He’s God’s send to mankind. He’s Mr. Perfect, provided someone else runs the university, which was Frank Erwin. Frank Erwin, as you know, got arrested on a DWI and his political career disappeared, so he resigned as chairman of the regents. They appointed a regular guy. The regular guy didn’t want to run the university, so they had Mickey run the university.

Mickey insisted you call him Mickey, by the way. It’s demeaning to me, but that’s the way he liked to be addressed. I used to call him Dr. LeMaistre. He said, “Call me Mickey.” So Mickey couldn’t run the university, and it didn’t take the regents five minutes to figure that out. So they had to get him a job without scandal. They don’t fire people. So they made him chair of the research committee to replace Dr. Clark. At the same time, the no-good president of the health science center resigned. They told him, look, you can have your choice of jobs. Well, if he had a choice of that struggling institution and this enormously successful powerhouse created by Dr. Clark, with a great retirement program and everything in place, he took MD Anderson.

I was a candidate for that job. It’s a tragedy that at that point in history they replaced Clark with Dr. LeMaistre. And as I mentioned before, LeMaistre immediately turned all the responsibility over to everybody else, and he became an administrative, not a—he wasn’t a general; he was a secretary of state.

I was running the medical school and teaching at the medical school. The students rotated—the undergraduate students—rotated through our hospital, because we had much better teaching than Hermann Hospital, who had a non-academic faculty. There was no one there who—they were all practitioners. They recruited a few guys like Joel Moake and the guy who ended up running the heart institute, so they had a few academics, but, to a large extent, the students were learning the way they did before Flexner. They learned apprenticed medicine. You follow some doctor around and do what he does. When the guy has swelling, you give him mercury. Why do you give him mercury? Well, we always give him mercury. Okay. So that’s how they learned. Then there were us guys who were all scientists. We said, wait a minute—leukemia, hematology, science, blood. Well, the students hated the rotation order, because the kind of students they attracted were not academic types, they were practicing types. The mandate was produce family doctors. Family doctors don’t think about science. So when they went to their class and they say, “Why are you giving him mercury?” They say, “Well, that’s just the way you do it. Shut up and pass the test and go practice in Wichita.”

So that situation didn’t work at all. The students hated it. They didn’t come. Some of the house staff liked it. That is, the graduate medical education was reasonable. But again, the people who wanted to be internists didn’t want to learn the science of oncology; they wanted to learn everything—cardiology, et cetera. So again, the graduate medical program didn’t work very well. There was only one thing that worked—graduate medical education. We trained the oncology specialists of the future. If a guy was a surgeon and wanted to treat cancer, come to MD Anderson.

So my situation with the medical school revolved around money. I was head of oncology. Oncology was the biggest service at Hermann Hospital. We were making tons of money. But what about the professional fees? I’m a full-time employee under contract. All the professional fees came to MD Anderson. The medical school guys realized that, “Dr. LeMaistre, we need the professional fees.” “Yeah, but they’re my faculty.” “Well, we’ll get our own faculty.” LeMaistre compromised so that they kept the fees and we did the work. I staffed oncology with my trainees here—good oncology guys. We didn’t have any money, so we applied for a training grant from the federal government. We got a good training grant. We began to—well, I’ll tell you how the training program began. But anyway, the long and the short of it is that Dr. LeMaistre, in his perfect style, negotiated a settlement where they kept the fees and they had their own head and that was over. The relationship to the medical school disappeared in one day, because no one can have administrative responsibility when all the money goes toHermannHospital.

So that was the end of our connection to the medical school. I still have a joint appointment, but I go over there and give a lecture every two years. It’s trivial. But graduate medical education was what we did here. It was just like NIH. What we did was make oncologists—surgical oncologists, medical oncologists.

My specialty was leukemia. As you know, I started the department of Developmental Therapeutics. Dr. Frei was the first head, but I was deputy head. Frei and Freireich were like two arms of a body. I mean, I loved the man. I respected him, and he respected me. We had totally different personalities, but we were completely complementary. So Frei and Freireich didn’t equal two; we equaled four. We were really—our brains were intermingled. We started this fellowship program in developmental therapeutics. It started with—I think I mentioned the other day—with the Japanese exchange students. We had a very good friend in Dallas, Dr. Hill, who ran the blood bank. He tried to recruit me, initially, so we were good friends. He had a number of these Japanese fellows come over to learn blood banking. He would send them up to rotate, and they would stay.

My first fellow was a Mexican. His name was Adolfo Isassi. He ended up being dean of a medical school inMexico. He is a very smart, academic guy. Then we started to get these Japanese fellows. The important point is that our training program, which began with these foreign nationals, has populated the world. The first fellow we had from Japan, Nazemi Hurano, became president of a new medical school in Nagoya. He’s one of the most famous academics inJapan. The second one we had who got the award as a distinguished alumni, Dr. Ohno, became the chair of the first Japanese cooperative chemotherapy group and he became dean of a medical school. He’s still working, very famous.

When I go to Japan, and I go often, the famous academics in Japan have a party for me—a geisha party—and we sit and they all talk about old times at MD Anderson. We developed—I don’t want to say singlehandedly, but almost singlehandedly—created academic oncology in Japan. FromJapan, we began—as I said, we hadMexico. We had a young physician, Carlos Vallejos, who from—notChile, notArgentina—what’s the other one on the west coast? Anyhow, he was director of the cancer center there and very famous. We populated academic oncology around the world with our training program. We attracted them.

Then we began to attract some Americans when Americans realized that oncology, in universities, was a discipline. We began to attract and we trained some of the most famous medical oncologists in the United States—Larry Einhorn, who won the Lasker Prize for his work on testicular cancer; Bob Livingston, who became head of oncology at Washington University. We trained all the giants here—Hagop Kantarjian, who is head of leukemia; Bob Benjamin, who is head of sarcoma; Gabe Hortobagyi [Gabriel Hortobagyi, MD [Oral History Interview]], who is head of the breast cancer service. We populated the institution with academically trained people who came to DT to learn oncology as a science—research-driven patient care. So we created that element at MD Anderson, and we were very successful, which leads to vulcanizing our department.

When Dr. LeMaistre eliminated DT, the training responsibilities devolved to the various departments. Then, as I say, he gave me hematology, and hematology got too big. They hired this guy, [Al] Deisseroth. They vulcanized hematology. It was too big. So now we have leukemia transplant. See, we brought immunology, infectious disease, pharmacology, hematology, molecular biology—all the disciplines came through DT, so when they finally vulcanized leukemia, I was head of the leukemia service. Dr. LeMaistre realized that he had Conrad running the hospital. He had Fred Becker recruited to run the basic sciences in laboratory medicine. He needed someone to run the clinical science, so he invited me to be vice president for clinical research. There was nothing I would rather do than that. So we had a meeting, a typical LeMaistre meeting.

All the LeMaistre meetings were the same. You do the talking, he listens, and then he says, well, this and that. No decision is ever made. He had a sign on his desk, you never make a decision, because if you make a decision, it’s going to come back and bite you. So he never made a decision. It was part of his public presence. So he said, okay, it’s a great idea. It was Dr. Hickey’s idea, actually. Dr. Hickey was an academic surgeon. He was the director. Dr. LeMaistre appointed him so he wouldn’t have to worry about directing the hospital, and he had Conrad running the medical oncology. He said, “It’s a great idea, but before we do it, we don’t want to upset anybody, so you have to get approval from Dr. Becker, who is vice president of research, and Dr. Conrad, who is the vice president for patient care, and you’ll be vice president for clinical research.”

At the time we had a clinic center grant, which I was the PI on, and we had a whole ward on Three West, which was our clinical research center, so I was already running the clinical research program here. So I went to Fred Becker [Frederick Becker, MD [Oral History Interview]], and Becker said, “Wow.” Do you know Fred Becker?

Tacey Ann Rosolowski, PhD:

Uh-hunh (affirmative).

Emil J Freireich, MD:

Is he on the thing?

Tacey Ann Rosolowski, PhD:

No.

Emil J Freireich, MD:

Fred Becker is another giant. He said, “Great idea. Just what we need. Freireich, you and I, we can work together.” Then I went to see Conrad. Conrad said, “Clinical research? If it’s patient care, it’s mine. There’s no clinical research.” So I went back to LeMaistre and I said, “Dr. Conrad—Becker is totally on, but Conrad”— He said, “Wait a minute, I have a note here from Fred Becker. Fred Becker says, ‘There’s no such thing as clinical research. If it’s research, I’m in charge.’” Becker—swine. What he told me was the inverse of what he wrote. So LeMaistre said, “Okay, you can’t get approval from two vice presidents. You’re out.” So I got fired again. I’ve been fired eight times by LeMaistre. He couldn’t tolerate me. Well, we’re actually good friends. He comes up and puts his arm around me. So I’m missing a big part of the story. Can I take notes?

Tacey Ann Rosolowski, PhD:

Sure.

Emil J Freireich, MD:

He realized that he had Conrad who did no research. He had Becker who did lab research. He needed this vice president for clinical research. He had a brilliant idea. He needed a chief academic officer, what DuBois is now. That was a brilliant idea. He looked around at who he could get, and he selected Andrew von Eschenbach. He’s probably on your list to interview. I hope you interview him. He was the head of GU surgery. He’s a surgeon, a very accomplished academic surgeon. He and I were very good friends. We worked together on many projects. He became chief academic officer. Wow.

He did many good things. He was chief academic officer for about a year. The first thing he did was they built this building for all the administrators. He said, no, let’s put the faculty over there. We need more room over here. He was a very strong advocate in the faculty. It didn’t take long for Dr. LeMaistre to realize he created a monster, because now he had someone who was actually doing something, which was bad for him because there was going to be conflict between him and Conrad and Becker, which was just what he can’t stand because he’d have to make a decision. He never made a decision. So [Andrew] von Eschenbach was fired after a year, and he went to the FDA. But von Eschenbach, during his time, realized that although we were the most powerful graduate medical education organization in the country, we didn’t have a graduate medical education program. So he called me to his office and said, “Freireich, you’ve done a lot. Why don’t you take over education?” And it was actually his idea to create a core curriculum and have a place where the graduate medical trainees can go for guidance in their careers, other than their subspecialty.

At the time, grand rounds were being run by Dr. [Aman U.] Buzdar, who is another one of my very good friends, a Neanderthal from India or somewhere. Dr. Buzdar was running grand rounds. I was interested in teaching, and I used to go. We had maybe ten to twenty people coming to the Hickey Auditorium every week. It was a dying enterprise. Von Eschenbach called me up and said, “Why don’t you take over grand rounds?” And I did. So of course I made grand rounds a major teaching thing because we focus on research. We don’t have a one-hour seminar; we have multi-disciplinary presentations. It’s now the number one teaching program in the institution.

Tacey Ann Rosolowski, PhD:

So that was in 1997?

Emil J Freireich, MD:

I think so.

Tacey Ann Rosolowski, PhD:

Yeah, 1997, Institutional Grand Rounds is what the name of the program—

Emil J Freireich, MD:

The core curriculum became part of the GME program, and then we got an organized GME program. We recruited people to be head of GME, and Dr. [Stephen P.] Tomasovic was made vice president for academic affairs. Then, when von Eschenbach was fired, they hired Margaret Kripke [Oral History Interview], and Kripke, first class lady, scientist, quality person. She looked at what we were doing, and she said, “Freireich, why don’t you take over graduate medical education?” Fine. So she told Tomasovic [Stephen Tomasovic, Ph.D. [Oral History Interview]] to take me.

Tomasovic controls all the education activities in the institution, but he hasn’t got a single doctor on his faculty. All the directors are librarians and stuff. So Tomasovic said, “Good idea.” So they made me director of medical education. But they didn’t want me to be director of anything because, be careful, first thing you know I’d take over the whole thing, so they called me Director of Special Medical Education, meaning that I only control things that Tomasovic lets me control. And that’s a position I still have, which I’m delighted to have. It is seventy percent of my activity that I spend on graduate medical education, and I love it, and the fellows love it. We have the best Graduate Medical Education Program in the country, believe me.

Chapter 07: Building the

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