Chapter 06: Fostering Innovation and Multi-disciplinary Research

Title

Chapter 06: Fostering Innovation and Multi-disciplinary Research

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Description

In this segment, Dr. Tomasovic talks about how interdisciplinary work –at MD Anderson and in general-- is crucial to treating cancer and fostering creativity in research.

Identifier

TomasovicSP_01_20110801_C06

Publication Date

8-1-2011

Publisher

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

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Multi-disciplinary Approaches; Growth and/or Change; The Business of MD Anderson; Portraits

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

Tacey A. Rosolowski, Ph.D:

Before we speak more specifically about some of those many roles that you've taken on, I wanted to pick up on the theme of the interdisciplinary work that was really obviously the core of that program. Because as I understand it, team interaction, interdisciplinary work was really part of the ethos of MD Anderson from its very founding. So I'm wondering if you could comment on that and how what you did was developing that, and also maybe even part of a national movement.

Stephen Tomasovic, PhD:

Yeah, that's correct. That was one of the unique things about MD Anderson from its beginning. And it was one of the very smart things that R. Lee Clark did. At the time when he was beginning his practice as a physician, physician practices were very discipline-segregated. That is if you had cancer and you visited the surgeon, you got surgical treatment for your cancer. If you happened to visit a radiation therapist you got radiation therapy. Medical oncology was just beginning to become -- it was really World War II where they began to discover some of the really cancer chemotherapeutic drugs. Because of some effects they saw from some of the gases that were being used. Or was that the end of World War I?

Tacey A. Rosolowski, Ph.D:

I think it was mustard gas, yeah.

Stephen Tomasovic, PhD:

Mustard gas. So that probably was World War I.

Tacey A. Rosolowski, Ph.D:

Yeah, I think it was World War I, yeah.

Stephen Tomasovic, PhD:

So it was after that point they began to develop medical oncology. But they had as I mentioned earlier a pretty toxic set of things to work with. But again those disciplines did not work together. And part of the reason was your income depended on the number of patients that you saw. And then they paid you. So Clark did one thing that was very very smart. Everybody that worked for the hospital was paid, got all their salary from the hospital. They didn't work part-time here and have a private practice. So they worked here. We paid all of their salary. So now something becomes very easy. You don't lose any money if you collaborate with somebody else. Doesn't make any difference whether you treat the patient or the radiation therapist treats the patient or the medical oncologist treats the patient. You still get the same salary. So that made interdisciplinary ease. That took out the financial piece of interdisciplinary. And I think many people of course were of goodwill and would certainly want the best to patients. But that took it off the table. And then radiation therapy had progressed to the point where it was a useful and manageable reproducible component of therapy. And medical oncology was getting there as well. So surgery was the original treatment for cancer. They predominated for many many years. Now we had a situation where those folks could work together in a hospital where Clark was driving that kind of a culture.

Tacey A. Rosolowski, Ph.D:

Can I ask? Because I know from other academic experiences there can be all kinds of goodwill for people of different disciplines to sit around a table. But there are differences in vocabulary and theory. Were there those sorts of challenges to overcome?

Stephen Tomasovic, PhD:

Oh sure. There's always personal clashes. And if you look through the history of MD Anderson at various points -- I think I recall that some of the stuff in Jim Olson's book refers to that. This book.

Tacey A. Rosolowski, Ph.D:

Making Cancer History.

Stephen Tomasovic, PhD:

Making Cancer History. Gilbert Fletcher was arguing, complaining that the surgeons weren't collaborating.

Tacey A. Rosolowski, Ph.D:

I guess I wasn't referring so much to personality conflicts. But just at a very practical level there's someone's trained in a particular area. They have a particular paradigm for thinking about a problem. So how were those kinds of issues overcome? Or how were they addressed?

Stephen Tomasovic, PhD:

Well, they were -- it was a struggle. There would be people who would -- surgeons who would think that the radiation therapy was no good. No use to their patients. And the same about medical oncology. So there was certainly lack of knowledge. There was certainly discipline-related egotism. Differences in knowledge, what works, what doesn't work. Still persists to this day. People have their theories. But over time -- but Clark set organizational structures where people were expected to work together, and they learned to do that. They learned more about each other's disciplines. They all really were desperately wanting to make progress against cancer. And when you began to learn more about radiation therapy or medical oncology and you realized your surgery couldn't do it, and your patient was going to die, what could -- you start looking around. And if people are there, they're working with you, or you're hearing about what they're doing, having this all together in an organizational structure that fostered that climate and that culture began to have its effect. And that has continued to this day. And the clinics are all integrated. People are seen by multiple -- and they try to figure out given this particular patient. That was almost the beginnings if you will of individualized patient care. That's where it began, because you no longer thought about them as a radiation therapy patient alone or surgical patient alone. Began to think about this patient. Where's the tumor located? What kind of a tumor is it? We know that's not going to respond to radiation very well. We better use surgery on it because we know this history. And so before they had molecular biology tools they had these histories of different types of cancers. And they had a primitive idea of how they had to individualize therapy to some degree for that type of patient with that type of tumor. It was very crude. But that in my view is how we began to think about personalized cancer therapy is when you got these teams of people together and they began to think about what therapy would work best for this patient. And yeah I can't get it all surgically, so I'm going to -- I know the margins on this type of cancer are very bad, or it's already metastasized when I see it. So I know I'm not going to be successful. I've got to hand them off to somebody else because it's not going to work in this patient. This other patient, I could see I got a clear margin. I can just treat this patient that way. But this patient I have to get somebody else involved, because this patient is a little different. So that's the kind of thinking. And research tended to follow because you were using multiple therapies and you were trying to bring up new therapies. And the research departments had lots of connections with the clinical faculty in this organization. So did I answer your question?

Tacey A. Rosolowski, Ph.D:

You did. And I'm just seeing how you were talking on one side, which is delivery of care. And I'm thinking about how in that period in the 1980s when you were setting up the interdisciplinary program you're basically getting faculty and students to sit in a room and think about interconnections between different perspectives on a particular subject area.

Stephen Tomasovic, PhD:

So we had multiple -- we were teaching cancer biology. You had to have multiple people. Dr. Josh Fidler [Oral History Interview] was a veterinary pathologist. So he came and talked about pathology of cancers. And people talked about -- basic researchers that were talking about what we knew about signaling pathways in cells, what we knew about the cell cycle. And of course the content from 1981 was very different -- '86. Excuse me. When we started that course. The world is different now.

Tacey A. Rosolowski, Ph.D:

What effects did you see from putting together that interdisciplinary experience for the students and for the faculty? What did you notice in the next year or two?

Stephen Tomasovic, PhD:

Well, it increased the number of students that we had in the department. It helped us recruit faculty. And we established some relationships with other departments whose faculty were participating in the program. Some collaborative studies. And Garth was a collaborator with a friend and colleague of Dr. Kripke who was in the Department of Immunology. Dr. Fidler who was in the Department of -- what did he call their department? We were tumor biology. I think he was called cancer biology from the beginning. I'm trying to remember that. I think he was called cancer biology from the beginning. And so it helped when you're working together as teachers and talking about research and talking about problems in the field, it tends to help establish personal relationships and collaborative relationships. And networks that are very fundamental to research in academia. It's all these people that you meet, talk about your science with, and they tell you about something they're working on. And you begin to discuss it and you begin to see ways that you might work together. Different approaches to it. It's very popular now to talk about this in a formalized way. Innovative thinking. The intellectual framework around innovative thinking calls for people to try to think outside of their frames. I think you may have mentioned that a few minutes ago. So the really innovative thinkers, the people who make leaps, generally are able to see things in a different way. They are able to break out of the frames of their cultural experience, their educational experience, the normal way that people think who have that kind of a context around them and their life experience. They're able to get out of that. And you foster that kind of frame breaking, critical thinking, innovative thinking when you bring people with different frames together, and they start talking. And it makes it easier for them to move beyond the frames of thinking that they're normally in.

Tacey A. Rosolowski, Ph.D:

Can you think of a specific example in which that happened? Sounds like it would be a really cool story.

Stephen Tomasovic, PhD:

Yeah, it would be a really cool story. There are probably dozens of them. I don't know that I can think of one at the moment.

Tacey A. Rosolowski, Ph.D:

Perhaps one will come to mind.

Stephen Tomasovic, PhD:

Well, one of the -- we've certainly had individuals here over the course of history of MD Anderson. If you look in the Making Cancer History book. People like [J Freireich] and [Emil Frei] who I believe we're going to organize another interview with J. They had a different way of looking and thinking about chemotherapy and developed a number of areas that essentially changed. They, because they could pull it all together and think in innovative ways, moved childhood leukemias from being a death sentence to near 100% cure. And they had to fight to do that and had to think very differently than lots of people. Some of the radiation therapists that are -- Gilbert Fletcher and others. R. Lee Clark himself in figuring out OK, I'm going to get beyond this individual discipline care for patients. I'm going to have multidisciplinary care and I'm going to have all our docs supported by salaries and we're going to turn cancer from being you send people off to the sanitarium to being where people come here for treatment and they go home. And they don't die in the hospital, they don't live in the hospital. We want outpatient care. They're going to come here, take their treatment, go home, live their lives, do their work. That was very different thinking than most people were able to do at the time. So I see I'm rattling my keys in my pocket. If I make any distracting noises like that remind me to stop it.

Tacey A. Rosolowski, Ph.D:

OK. I will.

Stephen Tomasovic, PhD:

I don't know if that's picked up by your microphone or not.

Tacey A. Rosolowski, Ph.D:

It does get picked up by the mike. And if there are ever times when you want to use the direct audio it can be -- somebody will be scratching their head. What is that little noise? That's all right. I'm glad you became aware of it.

Stephen Tomasovic, PhD:

So if you look at the history of cancer therapy there are real leaps that people made. Recognizing, someone observing the big increases in the effect of the mustard gas on blood cells and thinking wow. I could maybe use that to kill leukemia cells. That was an innovative leap. And so those are the things that people tend to be getting Nobel prizes for and things like that.

Tacey A. Rosolowski, Ph.D:

I'm also struck how those stories that you're telling about the decisions that were made about institutional structure from the very beginning were about throwing people together. Helping them do that. Maybe we can talk more about your own role in that kind of institution and culture building right now.

Stephen Tomasovic, PhD:

Well, I came pretty much late to that game. That culture was established when I came in 1980. And we were a much simpler organization in 1980 than we are now. And what we've become has had some pluses and minuses depending on how you view the different aspects of the organization. So I think I've had roles in relatively small ways in small pieces of that. And I think what I did to help establish cancer biology as an area of education in the institution and helping establish that cancer biology program was one of the things that was an important contribution on the way to us becoming more predominant in the graduate school as an institution. And many years later I was one of the key individuals I think along with Michael Ahearn in helping MD Anderson become an independent degree-granting institution. Certainly we were urged to do that. Dr. LeMaistre wanted us to gain more recognition for our institution as an educational institution. But it was largely left to Michael and I to work with others to pursue degree granting authority for MD Anderson in the graduate school. To pursue being able to award the baccalaureate degrees. And to get the institution accredited by the Southern Association of Colleges and Schools. So I think that was another step that we accomplished ultimately. We worked on it in the late 1990s. But we ultimately got that accomplished in '99, 2000, 2001.

Tacey A. Rosolowski, Ph.D:

Let me interrupt you just for a second. I'd like to pause the unit for just a moment.

Stephen Tomasovic, PhD:

Do you want to check sound again to make sure?

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Chapter 06: Fostering Innovation and Multi-disciplinary Research

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