Chapter 03: An Education Leading to Clinical Study

Chapter 03: An Education Leading to Clinical Study

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Description

Here Dr. Cox explains the path that led him to clinical work in radiology. Dr. Cox became interested in cancer during his second year in medical school, while taking pathology, and he describes his first autopsy of an individual who had died from stomach cancer. He was fascinated by the cellular destruction and compares it to being “fascinated with a fire.”

Dr. Cox next talks about the curriculum he followed at the University of Rochester School of Medicine and Dentistry (Rochester, NY) and his year at the Penrose Cancer Hospital in Colorado Springs, where he saw how helpful radiation therapy could be in combination with surgery. This convinced him to return to U of R to train with Dr. Juan del Regato in radiation oncology. He talks about his shift to the residency program at Penrose, where he became involved in a B-04 trial on breast cancer run by Dr. Bernie Fisher.

Identifier

CoxJ_01_20130103_C03

Publication Date

1-3-2013

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Educational Path; The Researcher; Personal Background; Professional Path; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Evolution of Career; The Researcher; Formative Experiences

Transcript

Tacey Ann Rosolowski, PhD:

Where do you think you cultivated your abilities to set up these groups and discover how to answer those fundamental questions or needs that you identified earlier?

James D. Cox, MD:

I think it happened pretty early in medical school. When I was in college I did laboratory studies with amphibians, and I found it very fascinating. One of the things that I liked about it is I did these studies mostly with one colleague who was interested in the same kind of things. And it is probably worth noting that he went on to a career in the laboratory and I went to medical school, but we both had great fascination for what we were doing—working in the laboratory of a guy—or we were working with a senior investigator who had sort of given us the opportunity to work with some of the systems that he had worked with. And we were learning pretty fundamental things. I mean we were trying to make antibodies at a time when it was really hard to do. But then when I went to medical school, I became interested in cancer when I was a second-year medical student taking a course in pathology. What I saw happening clinically fascinated me more than what was going on, let’s say, in the laboratory in biochemistry—things like that.

Tacey Ann Rosolowski, PhD:

Tell me about what it was that interested you so much.

James D. Cox, MD:

The first autopsy in which I participated—and at that time they did autopsies far more frequently than they do now—the first autopsy I attended—or in which I participated—was a man who died of cancer of the stomach. You were able to observe quite directly how the tumor had spread within the abdomen, how it involved the liver in ways that were very obvious, and we had been reading about various fundamental pathologic processes—inflammation, degenerative processes, and so on. This was something that I found fascinating—maybe a little bit fascinating like you would find watching a fire fascinating because it was somebody who had died from a disease that was not able to be stopped.

Tacey Ann Rosolowski, PhD:

Like cellular conflagration.

James D. Cox, MD:

Yeah. Really. And so that is when I became interested in oncology. It was long before I was interested at all in radiation oncology. I mean—I was interested in cancer. And that gradually developed throughout my medical school experience as a third-year student. I saw patients with various types of cancer and leukemia. What I did not see ever were patients with cancer that had been successfully treated because they weren’t in the hospital. So partly—well—let me step back—there was a lot of encouragement for students at the University of Rochester—where I went—to take a year out of medical school and to work—to take a year out of medical school. The pathologist—and they were the ones who were driving this push towards taking a year out of medical school—wanted the students to work in the autopsy rotation where there were never quite enough people to keep up with all the work to be done or in the laboratories of the pathologists who were interested in various aspects of pathophysiology. And so they wanted them to take the year out between the second and third year of medical school. I did not want to do it at that time, but I wanted to take a year out after my third year of medical school, and I wanted to work in a cancer hospital. I applied to several cancer hospitals, and the only one where I got an enthusiastic response was the very small Penrose Cancer Hospital in Colorado Springs that was run by a radiation oncologist. He gave encouragement to come there, and I went there and spent a year. He had never had a student spend that much time. And it was—when I saw what radiation therapy could do and surgery could do in curing patients with cancer, because I was seeing them come back for follow up having been successfully treated. That was all the more encouragement that not only was there this terrible disease, but you could make it go away. That was pretty exciting.

Tacey Ann Rosolowski, PhD:

And I am thinking too—you know—going back to that topic we were talking about earlier—there was that built in collaboration with the radiologist and then with the surgeon in that marriage very early.

James D. Cox, MD:

Yeah. It was. So we—so after I had been there for about three quarters of the year, I went to Dr. [Juan A.] del Regado, and I said, “I would like to come back here and train in radiation oncology after I do my internship and would there be a place for me?” And of course they didn’t have anything like the match at those times. So he said yes—we would have a place for you. So I went back to the University of Rochester and used the experience that I had in Colorado Springs to—plus additional work that I did at the University of Rochester—to write an honors thesis for medical school. I was able to graduate with a doctor of medicine with honors—there were only two of us in the class. Then I went to the University of Chicago Hospital for internship and then went back to Colorado Springs.

Tacey Ann Rosolowski, PhD:

Why did you choose radiology rather than surgery?

James D. Cox, MD:

I think it was the influence of Dr. del Regado. He was a very charismatic man—a small man. He was probably somewhere between 5’4” and 5’5” tall, but he had an enormous personality. He was a mentor, and then over the years we stayed friends—very close friends—until the time he died. We had one major problem that we disagreed on, the Vietnam War. But we got over that.

Tacey Ann Rosolowski, PhD:

Who was for and who was against?

James D. Cox, MD:

He was for—I was against.

Tacey Ann Rosolowski, PhD:

Okay.

James D. Cox, MD:

I was in the Army at the time. I had volunteered for the draft—no, no—I wasn’t in the Army at that time. Yeah—actually I was. I had volunteered for the draft when I was an intern at his recommendation so that I might be a candidate for what was called the Berry Plan, which was a plan where they would let people go into the service and serve for two years in a specialty that the military needed, and radiation oncology was one of those specialties. So I ended up being—when I went on active duty—I ended up being stationed at Walter Reed in DC.

Tacey Ann Rosolowski, PhD:

So can you sketch for me how your research evolved? I mean—we talked about sort of the hiatus—if you will—that you took when you were, I guess, burdened with administrative responsibilities here at MD Anderson and were really working with the Radiation Therapy Oncology Group in more of an organizational or consultative fashion. So how did your more hands-on—you as principle investigator—research evolve?

James D. Cox, MD:

Well it was very much a part of the RTOG at that time. I did not have any active research program going on at MD Anderson at that time.

Tacey Ann Rosolowski, PhD:

I was actually thinking about earlier—how your research started before you even came here.

James D. Cox, MD:

Well it was also influenced by people in the field that I got to know—del Regado being one of them. I mean—when I was a resident at Penrose we were involved in what subsequently, I think, came to be known as the BO4 trial of the NSABPN—the National Surgical Adjuvant Breast—later Breast and Bowel Project—which was run by a surgeon, Bernie Fisher.[Dr. Bernard] We were injecting patients who had just had a mastectomy—I guess—with drugs in the perioperative period trying to prevent metastasis. That was part of the work that was done. And then there were trials of their getting postoperative radiation to the breast. Then I became interested in the process of how you used the clinical information to pose questions and how you involve the collaboration of patients in the answer of those questions because patients became collaborators too.

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Chapter 03: An Education Leading to Clinical Study

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