Chapter 04: Building a Modern Department of Pathology

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Chapter 04: Building a Modern Department of Pathology

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In this chapter, Dr. Becker talks about taking over as Chair of Pathology where "there was almost no research going on." He characterizes his leadership style and offers a telling anecdote about supporting a young and creative faculty member. He talks about challenges he faced as he went about modernizing research, some of which came from the institutional structure, and offers his view that all researchers evolve through experience. He goes into detail about the challenges he faced and he talks about his own requirements for upgrading his MD Anderson laboratory (detailed in a letter that came to be called "the Bill of Particulars"). There were no cold rooms, for example, some of the facilities assigned to him had inadequate electricity, and a previous faculty member had left behind radioactive materials. Dr. Becker describes how he intervened in an unusual dimension of the culture that held back researchers' careers at MD Anderson: though researchers had access to very unusual tumors, but were hesitant to publish on them. Dr. Becker encouraged them to go ahead and publish. He talks about the perception of other faculty that he was at MD Anderson to convert pathology to laboratory research rather than a complementary clinical activity.

Identifier

BeckerF_01_20121213_C04

Publication Date

12-13-2011

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Building/Transforming the Institution; MD Anderson History; MD Anderson Snapshot; The Leader; The Mentor; On the Nature of Institutions; On Research and Researchers; Devices, Drugs, Procedures; Multi-disciplinary Approaches

Transcript

Frederick F. Becker, MD:

Pathology had in it, five or six of the leading figures in specialty pathology in the world. Blood, breast, skin, [and GI] pathology. And it had almost no research going on. Now remember, in my department, the legacy of Lew Thomas at NYU, we not only had some of the great pathologists, Bellevue Hospital and so forth, and I was taught by some of the greatest pathologists. My head of anatomic pathology was named Marvin [Kuschner], I’d been in this business for years and years, I’ve never met anyone who was a better all around pathologist. The head of the medical examiner’s office was named Milton [Helpern], he was the premiere medical examiner in the world. So I was so well trained in pathology, and I had the eye, that I was a little shocking to the people here, because they thought they were getting a pure researcher, and they were very nervous about this. And they said to me, what would you do in pathology? And I said, the first thing is, I’d sit in as a [surgical] pathologist, which kind of shocked them, because they heard I wasn’t a pathologist, I was just researcher. By my major job here would be to bring in research into the department of pathology, to modernize it, to bring it up in that quality. And as Lee told me privately, and also, he expected me, over the next couple of years, to look at other research going on, and give him my opinion on where it was going. It was close to the end of the first 30 years, [ ] when I got here. They had just put up two new buildings, one of which was a clinic building, which was filled to the brim with patients in three months. The facilities in research were old, having been built at the beginning. The cold rooms were frequently former butcher cold rooms. Wooden, beautiful, and they did work, but the pipes had lead linings. And what was characteristic of the place was that many of the chairmen of research, of science, had started here as graduate students. Now, some of them were terrific, but there was a lot of -- in those days, the term would be dead wood. I chose the word “hangers on,” people who weren't getting grants, people who were dependent on the dole from administration, people who had been doing the same thing with the same graduate students, and evolving not at all.

Tacey Ann Rosolowski, PhD:

Was this sort of part of the old problem that you were talking about a little earlier about inbreeding? Or was that...

Frederick F. Becker, MD:

Yes.

Tacey Ann Rosolowski, PhD:

Because there’s a different spin on it...

Frederick F. Becker, MD:

No, I want to tell you what my theory is. There’s a limit to energy. God knows, we know that now. And the choice of the administration, wisely, in those first 30 years, buildings [ ]was to focus on the clinical excellence of the place, to husband their energy, which means money, support, and so on, and focus upon a few areas. So for example, Gilbert Fletcher had been brought in, and in a very short time, had built a fabulous department of radiation oncology that was beginning to be worldwide in its reputation. Lee had brought in, from the National Cancer Institute, J Freireich [oral history interview], and Tom Frei [Emil Frei, III], two of the most brilliant and fertile minds in oncology, medical oncology. The treatment of human tumors. And within a very short time, they started to recruit bright young people, a lot of them from the NCI, and were already beginning to achieve a reputation that went, you know, exponential. A lot of the chairmen, however, were people who were the first chairmen. The man I succeeded in pathology was the man who had been the first chairman of pathology. Pretty humorous, [since] I was the 17th after William Welch at Bellevue. The chairman of this and that were people -- I’m not in any way demeaning their excellence, but in terms of dynamics, in terms of energetics, in terms of moving modernly, were people who were of a previous era.

Tacey Ann Rosolowski, PhD:

I mean, this is a time when there were major transformations occurring in the thinking about cancer. And...

Frederick F. Becker, MD:

And Lee was involved in all of them, as you know. But that’s his life story. He was one of the instigators of international oncology, of the National Cancer Act, of all of these things.

Tacey Ann Rosolowski, PhD:

I mean, do you think it takes a certain kind of research mind to want to keep up with those shifts, because...

Frederick F. Becker, MD:

Experience.

Tacey Ann Rosolowski, PhD:

Experience?

Frederick F. Becker, MD:

[ ]

Tacey Ann Rosolowski, PhD:

[ ]

Frederick F. Becker, MD:

[ ]

Tacey Ann Rosolowski, PhD:

[ ]

Frederick F. Becker, MD:

Yes. You take someone from a major place who’s been doing a major job in that place. You couldn’t expect more than what they accomplished here, it was amazing, it was miraculous. In 30 years, I mean, good grief. And to put it up there, where it would be [ ]counted as one of the three [leading institutions] with Roswell Park, and Sloan-Kettering Memorial, was an accomplishment of miraculous level. You can't do it all. And not only that, it’s very hard to pick the person who should do your lawn, unless you get the recommendation from someone with a lawn.

Tacey Ann Rosolowski, PhD:

[ ]

Frederick F. Becker, MD:

[ ]

Tacey Ann Rosolowski, PhD:

[ ]

Frederick F. Becker, MD:

[ ]

Tacey Ann Rosolowski, PhD:

[ ]

Frederick F. Becker, MD:

And so, one of the best ways to do it, is get someone in house, from somewhere like that, who can then be the instigator of change. Because if you do it with just outsiders, they have their own agenda, hmm? And we did get a lot from outsiders, which I’ll tell you about if I get to my board of advisors, if my memory still survives, which is -- it used to be eidetic.

Tacey Ann Rosolowski, PhD:

You’ve been real [inaudible].

Frederick F. Becker, MD:

Yeah, but now it’s just incredible. (laughter) John Mendelsohn [Oral History Interview] said to Tom Frei when Tom Frei [ ] had gone up to be the head of the Dana Farber, and was visiting us for an honor, Mendelsohn said to him, don’t you hate it when you find that Fred remembers your life better than you do? (laughter) []

Tacey Ann Rosolowski, PhD:

That eidetic memory must’ve helped you a lot in pathology, obviously.

Frederick F. Becker, MD:

In everything.

Tacey Ann Rosolowski, PhD:

Yeah.

Frederick F. Becker, MD:

Yeah. But some people were a little taken aback occasionally, when you mention something they were saying, you know, ten years ago. [But] I’ve lost that, I tell everybody, so they can feel more comfortable. OK.

Tacey Ann Rosolowski, PhD:

So what...

Frederick F. Becker, MD:

Lee and I then discussed what I’d want, and he said send me something. So I send him a four page...

Tacey Ann Rosolowski, PhD:

I’m not sure if this is it.

Frederick F. Becker, MD:

Um...

Tacey Ann Rosolowski, PhD:

Or is this -- this is only a two page...

Frederick F. Becker, MD:

Yeah, yeah.

Tacey Ann Rosolowski, PhD:

[ ]

Frederick F. Becker, MD:

[ ]

Tacey Ann Rosolowski, PhD:

That’s it?

Frederick F. Becker, MD:

This was it. [Correspondence, “Bill of Particulars,” 19 December 1975. See document, next page.] I think there was an addendum to it. That’s wonderful. Good grief. Send me a copy of that, will you?  

Frederick F. Becker, MD:

: “Bill of Particulars” []

Tacey Ann Rosolowski, PhD:

I will, absolutely.

Frederick F. Becker, MD:

OK. I will only tell you that it turned out that when I came here, the first person I wanted to talk to was Mr. [Elmer] Gilley, the guy with the desk.

Tacey Ann Rosolowski, PhD:

Uh huh? (laughter)

Frederick F. Becker, MD:

And Mr. Gilley, who had a very austere facial expression, and I, became extremely good friends. And he said well, Dr. Becker, I certainly was interested in your bill of particulars. This place, you have to understand, had never received a bill of particulars before, because it had recruited only a few people. And by the way, things that I’ve helped here, which many people don’t know about, was no one paid for moving expenses. They had another way of doing it, I asked for moving expenses. They never paid for equipment to be brought here, most of the people didn’t have equipment, or technicians, and so on.

Tacey Ann Rosolowski, PhD:

Yeah, I think in one of the letters that you wrote, you talk about what it would take, in terms of that kind of support, to recruit good faculty, and it’s like (inaudible)...

Frederick F. Becker, MD:

Yeah, absolutely. And he looked really sour about this. And I said, Well, my father brought me up to be businesslike. And he looked at me and said, “thank god. Most of the time, I never knew what Lee promised.”

Tacey Ann Rosolowski, PhD:

Ah.

Frederick F. Becker, MD:

And [Elmer said,] people would come into me five years later and say, and by the way, Lee promised... I said, you mean, you're pleased? He said absolutely pleased. And he said we’re going to be able to do business together.

Tacey Ann Rosolowski, PhD:

What did your father do?

Frederick F. Becker, MD:

He was an architect, builder! [ ]

Tacey Ann Rosolowski, PhD:

OK. So he knew all about drawing up lists, and...

Frederick F. Becker, MD:

Oh, oh. My father didn’t allow erasers.

Tacey Ann Rosolowski, PhD:

Oh, really?

Frederick F. Becker, MD:

Yeah, if you didn’t do it right, you started over.

Tacey Ann Rosolowski, PhD:

Oh, wow.

Frederick F. Becker, MD:

Marvelous man. I was one of those people, you hear all of the terrible stories, I was blessed with parents, blessed. Let’s see. OK.

Tacey Ann Rosolowski, PhD:

So your bill of particulars.

Frederick F. Becker, MD:

Yeah, and they agreed to everything plus, you know, things I might want.

Tacey Ann Rosolowski, PhD:

And just for the record, because, you know, we’re looking at a document here, and I want to make sure there are some of the details on the -- for the recorder, because you’re talking about structural changes that you want to some of the spaces that you’re going to be occupying.

Frederick F. Becker, MD:

Right.

Tacey Ann Rosolowski, PhD:

Removing intervening walls, and basically making a suitable lab space. Sufficient electricity, I like that.

Frederick F. Becker, MD:

It wasn’t here.

Tacey Ann Rosolowski, PhD:

Yeah, no, I believe it. I believe it. It sounds like, from here, you were kind of designing it from scratch.

Frederick F. Becker, MD:

Yes, I wanted some of the butcher rooms replaced by actual cold rooms.

Tacey Ann Rosolowski, PhD:

(laughter)

Frederick F. Becker, MD:

I found in a refrigerator, that the previous chairman had filled with radioactive materials for an experiment he had planned five years before. And no one knew that this atomic bomb [existed], no, (laughter) it wasn’t that bad.

Tacey Ann Rosolowski, PhD:

Well, sure, but there’s radiation there.

Frederick F. Becker, MD:

But the way that had to be removed is a company came in, taped it shut, dumped it in concrete, and moved it out to some place in the far west.

Tacey Ann Rosolowski, PhD:

Did he ever do the experiment?

Frederick F. Becker, MD:

No!

Tacey Ann Rosolowski, PhD:

Oh my gosh.

Frederick F. Becker, MD:

But here’s -- you know what, it’s rather indicative. He wanted to show everybody, he was doing “modern research.”

Tacey Ann Rosolowski, PhD:

Some of the other things, yeah, you had the cold rooms, and then you have a heavy equipment room, and you’re requesting three Beckman ultra centrifuges, and making specifications for the electrical lines that would feed those, as well as water and drainage requirements, and air conditioning.

Frederick F. Becker, MD:

Yeah, well that seemed a good idea, drainage.

Tacey Ann Rosolowski, PhD:

Yeah, I know. Well, no, I’m just -- you know, but these are the particulars, you really thought []out everything, and specified it.

Frederick F. Becker, MD:

Oh, well, I was from an area where we had all of that.

Tacey Ann Rosolowski, PhD:

Mmhmm, mmhmm.

Frederick F. Becker, MD:

Interestingly enough, my laboratories were in a building called the Gimbel Building. We’ve changed names so often here in the recent years, I don’t know, it was one of the old -- original buildings. It’s a fascinating building because it was built by a donation from the Jewish community of Houston. Now, you must understand, New York has Jewish communities. But you rarely ever hear anything designated like that. And let me say that this is the -- this is an interesting side, because now I’m here, OK? I have positions, I have this, I have a vision. I met with the -- every member of the department of pathology, and let me say that at least overtly, since I’m a very knowledgable about human -- overtly, eventually, I became good friends with every member, even those who were terrified of me and what I represented. Because, as a matter of fact, I think I enhanced their careers. They would come to me and say, well, I have 26 examples of such and such a tumor. Now, I was the head of pathology at Bellevue Hospital and the co-head at University Hospital, I had never seen that tumor. I didn’t tell them that, and I said well, when are you going to publish it? No, I want 30. See, this place is like a giant funnel, into which huge numbers of tumors of every type come. And the reason these people stayed, even though they grumped about it, was they knew, the minute they stepped outside those doors, they would never have this type of material to study right up, report, never.

Tacey Ann Rosolowski, PhD:

] Now, when they -- when that researcher, for example, said, I have 26...

Frederick F. Becker, MD:

Now, this is a pathology researcher, this is the...

Tacey Ann Rosolowski, PhD:

Is that a legitimate reason to not publish?

Frederick F. Becker, MD:

No.

Tacey Ann Rosolowski, PhD:

OK, I’m just -- now, is that...

Frederick F. Becker, MD:

Now, it’s a tumor that most people have never even seen.

Tacey Ann Rosolowski, PhD:

So, were they -- was that part of the kind of, maybe, a provincialism, or not having experienced a wider research context? What’s your diagnosis of that?

Frederick F. Becker, MD:

Let me call it, one, a desire to be very thorough. Two, to be certain that the paper would impress, and three, they could expect five more.

Tacey Ann Rosolowski, PhD:

(laughter) OK, yeah.

Frederick F. Becker, MD:

At Bellevue, the person would die before the fourth or fifth one came in. Those three components, that’s well said, by the way. And I said, publish! And they did, and their reputations were further enhanced, and they got lots of requests to talk about those. And they realized I was supporting that, and I told them, my first job, as good as you all are, is to make certain that anatomic pathology here is the best there is. Because that’s our primary responsibility, that when a surgeon cuts out a tissue, we know what it is. We tell them efficiently. When we get a slide from outside, we tell them what it is, and correct and misapprehensions. They didn’t expect that. But I meant it, I was a pathologist, I had my boards. And that’s the responsibility of pathology that can never be forgotten. And besides, it’s a valuable thing that’s been going on for 150 years, I’m proud of it, OK?

Tacey Ann Rosolowski, PhD:

Let me just ask you, because you mentioned that these people that you were talking to were afraid of you because of what you represented. What was that?

Frederick F. Becker, MD:

They thought I represented.

Tacey Ann Rosolowski, PhD:

What wouldn’t be...

Frederick F. Becker, MD:

They thought I was here to convert pathology into laboratory research.

Tacey Ann Rosolowski, PhD:

Oh, OK.

Frederick F. Becker, MD:

Rather than to build it as a complementary activity, from which they could profit. Because new technologies, new application, things that would put them up front in the field. That’s what I was brought up with, you know? Excellence, but in terms of being rec -- you know, the recognition of tumor, tumor pathology, it was the best there was in many of these fields. And in the fields where we didn’t have that expectation, I wanted to bring it in. And I didn’t care if we didn’t have neuropathology, I wanted the best people who knew what it looked like, because at that time, that was important. But I wanted people who were already doing histochemistry, and maybe some immunochemistry, which was a new science in those days.

Tacey Ann Rosolowski, PhD:

So I’m getting a picture of this moment when you come in, as an institution which has done amazing things, but it’s almost as if there are certain parts of the institutional culture that are not letting the institution, kind of, explode with its resources the way it has the potential to do it. And you’re kind of coming in to give people that message here, you have a really unusual situation here, with all of these tumors, here’s how to make your -- here’s how to get your public presences even higher up.

Frederick F. Becker, MD:

Here’s how to exploit them even better.

Tacey Ann Rosolowski, PhD:

Yes, yes.

Frederick F. Becker, MD:

Period.

Tacey Ann Rosolowski, PhD:

Yeah.

Frederick F. Becker, MD:

Now, that was in pathology, you’re very wise in saying that. It was not my institutional mission yet. And although Lee had made it clear he wanted me looking around and answering him, that was not why I was hired, I was hired in pathology.

Tacey Ann Rosolowski, PhD:

OK.

Frederick F. Becker, MD:

It was also an unusual situation, because of my background, I served both on the clinical and the basic activity boards, because at that time, they were not unified. So I was serving a clinical purpose. And by the way, I was trained in internal medicine also, and so forth. So I enjoyed it, I thought it was a terrific opportunity. OK. I’m now going to just shift a little bit, for a little bit of time, and then stop.

Tacey Ann Rosolowski, PhD:

OK.

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Chapter 04: Building a Modern Department of Pathology

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