Chapter 25: The Section of Melanoma/Sarcoma: A History of Reorganization at MD Anderson

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Chapter 25: The Section of Melanoma/Sarcoma: A History of Reorganization at MD Anderson

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In this chapter, Dr. Benjamin explains the administrative structure in which the Section of Melanoma/Sarcoma was situated. He talks about political issues at work in the merging of Developmental Therapeutics and Internal Medicine in the early eighties. He explains why he was a good choice to head the section of Melanoma/Sarcoma. He says that as section chief he tried to build an adequate group of people to do clinical research and care for patients. He observes that the section was always behind in staffing, as sarcoma is not considered a high priority at the institution, despite the fact that the section/department is the most productive in the country. He explains the section initially conducted many clinical trials and succeeded very well, also providing leadership to national organizations. Dr. Benjamin notes that he is one of the founding members of the Connective Tissue Oncology Society. Looking back at his administrative roles, Dr. Benjamin acknowledges that this area of service was not his top priority and he was ultimately a better clinician than administrator. Dates of Administrative Service: Section Chief, Melanoma-Sarcoma, Departments of Internal Medicine and Developmental Therapeutics 9/1981-8/1983 Section Chief, Melanoma-Sarcoma, Department of Internal Medicine 9/1983-8/1985 Section Chief, Melanoma-Sarcoma, Department of Medical Oncology 9/1985-8/1991 Section Chief, Sarcoma, Department of Medical Oncology 1/1991-1/1992

Identifier

BenjaminR_03_20150306_C25

Publication Date

3-6-2015

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - An Institutional Unit; Character, Values, Beliefs, Talents; The Clinician; The Administrator; Professional Values, Ethics, Purpose; Critical Perspectives; MD Anderson History; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Portraits

Transcript

We are recording, and today is March 6th, 2015, and this afternoon I am in the office of Dr. Robert S. Benjamin, in Sarcoma Medical Oncology. This is our third session together, and, let’s see, the time is about fourteen minutes after two. And I wanted to thank you, Dr. Benjamin, for making the time for me today.

Robert Benjamin, MD:

You’re more than welcome.

Tacey Ann Rosolowski, PhD:

It’s been a while since we’ve chatted.

Robert Benjamin, MD:

I’m happy to chat with you.

Tacey Ann Rosolowski, PhD:

Yes. So we, as I mentioned before we started, we’re really at the point to start talking about your administrative work and contributions within the institution, and I know that you had first served as Chief of Section of Sarcoma. This was in ’81 to ’91. So I wanted to ask you if that was significant to talk about during that period, and I don’t mean to say that in a, you know, dismissive way, but I don’t know if that was an important period to discuss.

Robert Benjamin, MD:

So that’s, I guess, the time that I switched over from clinical pharmacology to disease-oriented medical oncology. I mean, I was always a medical oncologist, but my administrative role previously had been in pharmacology rather than in medical oncology. And it was the time when the Departments of Developmental Therapeutics and Internal Medicine were merged into a single department, which I think was called Medical Oncology at that time.

Tacey Ann Rosolowski, PhD:

Oh, wow. I haven’t heard that history. (laughs) Now, was that controversial?

Robert Benjamin, MD:

Yeah, if you were in DT it was controversial.

Tacey Ann Rosolowski, PhD:

I can imagine.

Robert Benjamin, MD:

I think that’s about the right time. I came in ’74. It may have been earlier than that that some of this happened. I don’t remember the timing. I remember what happened, but I can’t tell you exactly when.

Tacey Ann Rosolowski, PhD:

So why was that decision made to merge those two groups?

Robert Benjamin, MD:

It was part of a power play to downgrade the role of Dr. Freireich in the institution while still realizing that a number of the people that had been in his department were still considered important members of the institution.

Tacey Ann Rosolowski, PhD:

What was the perception of Dr. Freireich that there was a political move to kind of push him to the side?

Robert Benjamin, MD:

Oh, Dr. Freireich was a bit of a firebrand. He was a genius. He was clearly, and still is, one of the absolute giants in the history of medical oncology, but he could be personally offensive, and he sort of lived on the edge and so managed to offend a lot of important people at various—not just within the institution, but within the oncologic community in general, I think.

Tacey Ann Rosolowski, PhD:

So the reservations about him were focused more on personal issues than on his research?

Robert Benjamin, MD:

Oh, yeah, absolutely. Well, yeah, almost completely. There were some issues about the way in which some of the research was done, but it was largely, I think, personal. At least that’s my interpretation. The person who could give you a different perspective on it would be Mickey LeMaistre [oral history interview], because he was the president at the time.

Tacey Ann Rosolowski, PhD:

So you mentioned that as background to you becoming Chief of Section of Sarcoma. So how are those things connected, the organization—

Robert Benjamin, MD:

So the thing which is of interest is Sarcoma was a group that had membership both from Department of Medicine and from Developmental Therapeutics, and they chose to allow me from Developmental Therapeutics to become the section head in that area.

Tacey Ann Rosolowski, PhD:

Why do you think that was?

Robert Benjamin, MD:

I don’t know. Maybe because I was the right one for the job. But—

Tacey Ann Rosolowski, PhD:

But do you have a sense of why that might have been at that time? I mean, different people bring different things to the plate, who can be useful at different times in an institution.

Robert Benjamin, MD:

I’m a good spokesman.

Tacey Ann Rosolowski, PhD:

Oh, okay.

Robert Benjamin, MD:

And I was sort of the heir apparent, as it were, to Jeff Gottlieb in terms of the research of developing new treatment strategies for sarcoma, and I guess that was considered important, because there were certainly others at that time who probably knew as much as I did about the disease itself, but who may not have been as effective as leaders or as national spokesmen for what we do. I think that’s probably the reason for it.

Tacey Ann Rosolowski, PhD:

Let me ask you kind of a related question. Did you have concerns yourself, coming from Developmental Therapeutics? Did you have some concerns about how your activities would be able to evolve in this new combined department? What was the context like?

Robert Benjamin, MD:

I was a fervent and outwardly vocal supporter of Dr. Freireich to be the leader of the combined department, and that was clearly not the path that the institution wanted to take.

Tacey Ann Rosolowski, PhD:

Who was chair?

Robert Benjamin, MD:

So Dr. Krakoff ultimately was recruited to become the first Chair of the Division of Cancer Medicine, or I guess it was called Division of Medicine at that time. And I guess before Dr. Krakoff was recruited to that position, there may have been others who served as an interim role. It may have been Dr. Raber, but I’m not sure of exactly when, when all of what happened.

Tacey Ann Rosolowski, PhD:

So tell me about your activities as section chief.

Robert Benjamin, MD:

So I tried, first of all, to build up an adequate group of people to be able to take care of the patients and then to do some clinical research in the area. We were always behind in terms of staffing of number of people required to do adequate patient care and have a lot of time for research, and that was true from the beginning when I was section chief to the time when I retired as department chair.

Tacey Ann Rosolowski, PhD:

Really. Why is that?

Robert Benjamin, MD:

I think you’ll have to ask somebody else. (laughs)

Tacey Ann Rosolowski, PhD:

I was just wondering if you had any suspicions.

Robert Benjamin, MD:

I think Sarcoma was never considered to be a high-priority institutional area, although it clearly—we had a program that for a long time, I think, was probably the largest and at least initially probably the most productive department or section or whatever it was at the time, depending on where it was in the history of the various transitions, of any in the country. But sarcomas are rare tumors, and there are always other tumors that either by their frequency or for some other reasons attract higher levels of funding than sarcomas do. But we were never able to really fully develop, or even not even fully—significantly to any extent develop a laboratory-based research program in sarcomas because there were never open slots to do that—

Tacey Ann Rosolowski, PhD:

Wow.

Robert Benjamin, MD:

—and finding, and there wasn’t a person who was a high-priority target recruit who said, “This is what I want to do,” where the institution might have wanted to find the resources to be able to get that done. But initially, we were able to do a large number of clinical trials, and I think the program on the whole developed pretty well.

Tacey Ann Rosolowski, PhD:

What were some of the measures that said, yeah, we’re succeeding at developing the program?

Robert Benjamin, MD:

Probably the most important would be the people who were chosen as and developed leadership positions within the Connective Tissue Oncology Society, which is a global organization that I was one of the founding members of, that has sort of served as the scientific clinical research organization where everybody interested in sarcomas belongs, and we interact and have discussions. We have very prominent positions, even through today. Dr. Patel just finished his stay as president of CTOS. I was one of the former presidents of CTOS. So we’ve had people who’ve been on the CTOS board from the very beginning and frequently we’re among those who have platform presentations at CTOS. So I think, and similarly, within the sarcoma subsection of ASCO, which is a much bigger organization and a much smaller subsection, but still we’ve had fairly prominent positions there. But I think if you ask me how I view my administrative accomplishments as head of Sarcoma, I would say it was never my top priority to be an administrator, and so I’m a much better physician and clinical researcher than I am an administrator, in terms of developing or running a department.

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Chapter 25: The Section of Melanoma/Sarcoma: A History of Reorganization at MD Anderson

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