Chapter 06: Recruited to MD Anderson; A History of Translational Research at MD Anderson

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Chapter 06: Recruited to MD Anderson; A History of Translational Research at MD Anderson

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Dr. Mills first tells how he was recruited to MD Anderson by Robert Bast, MD, VP of Translational Research, to set up "the best ovarian research center." He explains why he left Toronto Hospital and cites the fact that "no other institution has more potential to make a difference." Next, Dr. Mills sketches the history of translational research at MD Anderson. He begins with the 1970s, noting that the patient driven clinical research at that time was "not real team science." He talks about the context for research under Charles LeMaistre and the VP of Research, Frederick Becker [oral history interview] and the vestiges of their approach still lingering. He explains that the institution has now embraced the concept that research is a driver in patient outcomes. Dr. Mills explains that leaders need to function as change agents and set in place processes that allow the success of research. He then compares the approach of John Mendelsohn, who allowed institutional change to be driven from the bottom up, with Ronald DePinho, who has taken the opposite approach as he framed the question, Is research progress an engineering and implementation question or do we lack the basic research to make progress at this time.

Identifier

Mills,GB_01_20160505_C06

Publication Date

5-23-2016

Publisher

The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Personal Background; Joining MD Anderson; Critical Perspectives; MD Anderson History; MD Anderson Culture; Healing, Hope, and the Promise of Research; Leadership; On Leadership; On the Nature of Institutions; Patients; Patients, Treatment, Survivors; Growth and/or Change

Transcript

Gordon B. Mills, MD, PhD :

Well, I got a call. Bob Bast and I had been to multiple different meetings together. He had attempted to recruit me to Duke twice and it just did not work out. Then I got a call one day saying I'm going to MD Anderson, we want you to come and set up the best ovarian cancer research program in the world, we have the resources to do so, and I said well, you know, "Don't I need to come down and interview?" He said, "No, the job is yours." How do you say no?

Tacey Ann Rosolowski, PhD:

Yeah, no kidding.

Gordon B. Mills, MD, PhD :

And so, that resulted in me moving and to a degree, even more of a switch from my immune aspects of what I was doing, through really focusing on tumor biology, tumor molecular genetics.

Tacey Ann Rosolowski, PhD:

You said, How can you say no but well, you could have. What did the job offer you? Why were you ready to leave where you were, you know what was the decision about?

Gordon B. Mills, MD, PhD :

There were two pushes and one pull, and I think that always happens in any recruitment. My wife is American, she was born in California.

Tacey Ann Rosolowski, PhD:

Her name?

Gordon B. Mills, MD, PhD :

Kris, K-R-I-S-T-I-N, and absolutely interested, at that time, in coming back to the U.S. There were aspects of living in Canada and I think that being interested in moving to the U.S. was part of it. The second piece was that many of the things I wanted to do in terms of taking the laboratory and translational research we were doing, to clinical trials and patients, was difficult at that time in Toronto. And I think the statement I made when I came, and I continue to make; there is no place in the world with a greater potential to make a difference for patient outcome than the MD Anderson Cancer Center. Now, I want to emphasize the term potential. That potential, I think really has not been achieved at the level many of us would like. We've done incredible things, but we are still talking about potential.

Tacey Ann Rosolowski, PhD:

Why is that?

Gordon B. Mills, MD, PhD :

I think there are many reasons for why is that, but they are ones that are evolving and changing, and it is difficult to change and improve patient outcomes, and so that process I think that many of us thought was going to be much more rapid than it is, is really just a demonstration that this is a very, very tough process.

Tacey Ann Rosolowski, PhD:

So it has more to do with the actual difficulty or complexity of the subject matter? I mean, are there certain structural or systemic things going on?

Gordon B. Mills, MD, PhD :

There are many structural or systemic things going on at the MD Anderson Cancer Center and I think that there have been many changes. One of the challenges that was here when I came was the reputation, and I think appropriately so, that MD Anderson was led in the translational area, by a bunch of cowboys who were going to do what they did.

Tacey Ann Rosolowski, PhD:

And you're talking about the '70s.

Gordon B. Mills, MD, PhD :

Mm-hmm. That the MD Anderson way was different and not necessarily integrated into this concept of sharing and team science that I've been talking about, and I think that that clearly was true. I think that potentially, because of where MD Anderson is, it had been very difficult to recruit and retain an incredible cadre of basic scientists that could drive that process, and that to a degree, I don't think the institution really had decided what it was. Was it a research university, was it a cancer center? Was it really dedicated solely to making improved outcomes for patients, and what were its strengths, weaknesses and advantages. Indeed, shortly after I came, we I think put together one of many visions for the future, that we have gone through, and I think that it was a time of evolution. There was an evolution in science in general, but MD Anderson really was a unique institution that really didn't integrate well with the rest of the community at that time.

Tacey Ann Rosolowski, PhD:

You mean the surrounding community.

Gordon B. Mills, MD, PhD :

Well, no, national and international.

Tacey Ann Rosolowski, PhD:

International as well, yeah.

Gordon B. Mills, MD, PhD :

We were cowboys, gunslingers.

Tacey Ann Rosolowski, PhD:

And had that had reputation, absolutely, absolutely. No, that's very interesting, and I'm also just kind of clicking in a little late in the day, because you came to the institution in '94.

Gordon B. Mills, MD, PhD :

With "Mickey" LeMaistre.

Tacey Ann Rosolowski, PhD:

With Mickey LeMaistre, or Charles LeMaistre, right, for the record, yeah, exactly. So this was before John Mendelsohn came, and John Mendelsohn being much more known as someone who had gone bench to bedside, right?

Gordon B. Mills, MD, PhD :

Dr. LeMaistre was a cardiologist and really had done a very good job of managing MD Anderson, and of moving it forward at an important time. For reasons that I cannot really completely understand, we became very good friends and colleagues. If I give a talk anywhere near where he is, he and his wife will attend, if they have questions, they pick up the phone and call me. I was in his office for some very difficult discussions and concepts and listening to him struggling with the transition of leading the institution, to passing it on to a new leader and whether he should have rebuilt many of the systems to make it easier for the new leader, or as the regents asked, just leave it alone, let the new leader build it in the way he wanted to do. So it was a very interesting interaction for me.

Tacey Ann Rosolowski, PhD:

Yeah. Did you kind of glean any lessons from that, I mean, kind of observing someone think about organization at such a high level.

Gordon B. Mills, MD, PhD :

[01:16:[00] I think there is a real question of what the outgoing president should do in terms of setting up systems for the incoming president. There were significant structural problems at MD Anderson at that time and actually, some of them still remain.

Tacey Ann Rosolowski, PhD:

Can you kind of itemize?

Gordon B. Mills, MD, PhD :

Yeah, I'll give you a couple that are polite. For example, our divisions and departments are backwards and that makes great difficulty outside, and to a degree internally, for people to understand what their roles are. So, is a department chair really a department chair, or are they a division head in any other institution? So the structures that were put in place at MD Anderson, to a degree were, I think unnecessarily complex and not really following an easily understood process. Some of the others, we had had a vice president for research who had very much separated the clinical and basic sciences and translational sciences, and left behind a very difficult legacy to deal with and to harmonize across the institution. That really was one of the challenges that John Mendelsohn [oral history interview] inherited, with Fred Becker [oral history interview] having been in place. I think that when Fred came to MD Anderson, that probably was a necessary process in that the basic sciences really needed to be built almost from scratch, but by the time I came, I think this had become a major problem. There were concepts of a research institute separate from the clinical aspects that really, I think was a challenge that needed to be resolved and changed. I think the vestiges of this are still there. There are still people who do not see MD Anderson as a translational engine, that being our renewable, competitive advantage that we should build on, versus those that still believe we should have a pure curiosity research program within MD Anderson, because that could lead to things that are exciting, and how to cross those boundaries and make them the most efficient and profitable. And again, with my basis around translational science and helping patients, I think that we have very much more so embraced the concept that we really are a driver of change in patient management, and that is our renewable competitive advantage. The number of patients we see, the unbelievably dedicated doctors and staff in a freestanding cancer center --and that is an interesting process and there aren't many of them-- but basically that's what we are and what we do. We are not a university that has a cancer center sort of as an adjunct or an important aspect of it. That is our whole basis to exist and it has a big advantage.

Tacey Ann Rosolowski, PhD:

You were talking about some of those -- your conversation with Charles LeMaistre and some of the kind of lessons you learned from watching someone kind of process.

Gordon B. Mills, MD, PhD :

I think that one of the things that leaders need to do is to be change agents and to a major degree, put in place the processes that will allow success. That means that they have to be the drivers of harmonizing the system, decreasing the bureaucracy, orienting every person in the institution for success, rather than protecting their job and their butt, and if I ever hear another person say, Well, the regents or system won't let me do this, when it's really an excuse not to do something, that really has to come from president down. Even though you would love to see it being an organic growth up, that's the one thing that the people down can't influence, and it really needs to be sort of a senior leadership saying that we will put everything in place to let the people that are going to make a difference, make a difference.

Tacey Ann Rosolowski, PhD:

You were talking about being recruited here.

Gordon B. Mills, MD, PhD :

I was recruited here and I think the comment to make is that Mickey LeMaistre [oral history interview] had one management style. John Mendelsohn let the institution grow organically. His job, in his mind, was to bring in the resources, to put the buildings in place, to bring in new faculty, to give them an opportunity to flourish. In his mind, every single individual we recruited would be successful if we gave them the appropriate support, mentoring, and resources. I'm not sure that I necessarily agree with that. You do make mistakes and you need to deal with those, but his belief really was in an organic growth and very much bottom up. He put the resources in place, the others were to make it happen, and there really wasn't a lot of planning that led to setting of priorities. It really was planning of, Here are interesting opportunities to move forward and we can make everything move concurrently. We have a new president who, I think has almost exactly the opposite point of view, but again, both of those can work in the right environment. There are ends of spectrums of management and it's not one is right or one is wrong, but rather, what Dr. DePinho [oral history interview] came in with, is the concept of saying it is time to ask the question of whether making major progress in translational research is an engineering and implementation question, or is this still a case where we lack the basic knowledge to do so? And so he brought in a much more focused, driven program, to say can we make a difference in a short period of time? Both are right, both work, both have strengths and weaknesses, and one of the challenges that we are seeing now is still five years out, the transition from one model to another model, that in each case can make a difference.

Chapter 06: Recruited to MD Anderson; A History of Translational Research at MD Anderson

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