Chapter 02: A Growing Interest in Cancer, Cancer Prevention, and First Connections with MD Anderson
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Description
Dr. Foxhall notes that his interest in cancer (and tobacco) began during his private practice; he mentions other professionals in Houston who were also focusing on tobacco. He lists the projects he implemented during this time and notes his involvement in the Texas Academy of Family Physicians and its subgroups focused on prevention.
Dr. Foxhall then explains that he met and worked with Dr. Joseph Painter of MD Anderson was also interested in community outreach at the time. He describes the projects the worked on to educate physicians (part of a national movement). Dr. Foxhall also explains that it was key to demonstrate to physicians the value of collaborating with a large cancer center. He explains the previous mindset physicians held about their relationship to cancer centers.
Identifier
FoxhallLE_01_20140205_C02
Publication Date
2-5-2014
City
Houston, Texas
Interview Session
Lewis Foxhall, MD, Oral History Interview, February 05, 2014
Topics Covered
The Interview Subject's Story - Professional Path; The Clinician; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Professional Path; The Professional at Work; Cultural/Social Influences; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Joining MD Anderson
Transcript
Tacey Ann Rosolowski, PhD:
And you had mentioned specifically cancer. When did your interest in cancer and in tobacco begin?
Lewis Foxhall, MD:
Well, it was during those early years in my clinical practice when I began to be very frustrated with problems that were obviously avoidable problems that were developing in my patients or that had been a result, in particular, of tobacco. There were some other primary care physicians here in Houston, actually, that were very interested in these areas as well. Dr. Allen Blom [phonetic], who was here for several years and worked at Baylor, was one who was really outspoken in his interest in addressing the tobacco problem. So that just kind of spurred me on and I became more interested in how I could help my own patients in the practice to address their use of tobacco [unclear]. At that time, there were not a lot of great opportunities to do that, so it was a frustrating sort of challenge that we faced every day.
Tacey Ann Rosolowski, PhD:
Did people in Houston smoke more than in other areas of the country? What were the cancer rates here?
Lewis Foxhall, MD:
No, everybody smoked more back then, so, you know, this was the time where smoking rates had begun to decline, you know. That really began in the late sixties, but still there were large proportion of the population was smoking, so that included our patients. So it was, I don’t think, a unique problem to Houston, but one that I found frustrating, and when you see people suffering from disease that was totally avoidable, it’s difficult to manage.
Tacey Ann Rosolowski, PhD:
Yeah. So tell me about some of the first steps that you took to address that in your own practice, or what were some projects you worked on?
Lewis Foxhall, MD:
Well, we implemented the processes that were promoted at the time, which were not that different from what we have now. We just didn’t have all the drugs and the nicotine replacement and those sorts of things. So identifying smokers was by asking our patients if they were tobacco users, and then advising them to stop using tobacco and providing counseling services. At that time, there were not telephone quit lines, but we could provide counseling through other sources and encouraging patients to stop smoking as frequently as we could. So in time, additional resources, pharmaceutical support and online counseling and these sorts of things became available so that that was nice, helped a little bit. But anyway, so I started working on that, and during that time I’d been involved in organized medicine through the Texas Academy of Family Physicians, and we had work groups with that organization that were focused on prevention, focused on tobacco control, education in our members’ offices. And Dr. Painter at that time was interested in outreach to community physicians to help them engage in preventive activities, so we eventually met up and had a shared interest in those ideas and the resources of the Cancer Center, primarily in the educational realm, and began to work together on some projects that were related to that. So that was really what kind of led to our collaborations and eventually teasing me out of my private practice and coming over here.
Tacey Ann Rosolowski, PhD:
Do you want to talk about that next? Because I’d also like to hear about some of these joint projects you worked on before actually becoming part of MD Anderson, which—you tell me what you’d like to talk about next.
Lewis Foxhall, MD:
Well, they were primarily educational endeavors that we did with the Texas Academy, so lectures and conferences and things of that sort.
Tacey Ann Rosolowski, PhD:
And this was teaching physicians how to address tobacco-related issues?
Lewis Foxhall, MD:
Mm-hmm, right. So the Academy provides educational programs to the members, so as part of that, we began to address those preventive opportunities with our member physicians.
Tacey Ann Rosolowski, PhD:
What impact do you feel you had?
Lewis Foxhall, MD:
So, well, I often think of the nice chart that shows the cancer mortality rates in the country gradually going up and up and up until the early nineties, at which time I came to MD Anderson, and then they’ve come down ever since. So I’m not saying I was the only cause for that, but it’s an interesting correlation, you must admit. (Rosolowski laughs.) Whatever little bit I’ve been able to contribute, I think is part of a big national movement to try to address some of these things, but the recognition that primary care physicians have a big role in cancer prevention and cancer screening, early detection, in that it is okay to collaborate with a large Cancer Center. To promote those concepts, I think, was one of the major things, hopefully, or messages I was able to get across. And a lot of that I attribute to Dr. Painter’s initial ideas in trying to carry forward his promotion of those concepts. But this connection between the Cancer Center and the oncology world and that of primary care, I think is one that still has opportunities to grow, but at that time was not at all well recognized that those two things kind of went together, and it was, I think, a good opportunity to kind of bring those worlds together and join forces toward a common goal.
Tacey Ann Rosolowski, PhD:
What—well, I have two questions. Let me ask the first one first. Tell me about the shift in perspective. I mean, you said an important thing was to recognize the role of primary care physicians in prevention. Well, what was it like before? I mean, how did primary care physicians address the issue of prevention or intervention in something like smoking?
Lewis Foxhall, MD:
Well, some of that was going on, but the idea of connecting with the Cancer Center and working collaboratively towards those goals, so there’s clearly the idea that, you know, we should address smoking, the idea that these cancer screenings were available was out there. It just wasn’t at all emphasized or prioritized, for the most part.
Tacey Ann Rosolowski, PhD:
What was the attitude of primary care physicians vis-à-vis big cancer centers at first? I mean, was there suspicion? Were there obstacles for establishing collaboration?
Lewis Foxhall, MD:
Well, I can’t speak for every primary care physician, but there was the idea that the cancer center was kind of where you went when you had cancer, and, you know, oftentimes those patients were absorbed in the cancer center sphere of influence and may or may not ever pop back up into your practice again. So this idea that maybe we should be working on this problem proactively and working on it before we had a problem was sort of a different sort of approach, that the cancer center was interested in reaching out to the community physicians to help address the problem at that level. Rather than just waiting for something bad to happen, you did what you could.
Recommended Citation
Foxhall, Lewis E. MD and Rosolowski, Tacey A. PhD, "Chapter 02: A Growing Interest in Cancer, Cancer Prevention, and First Connections with MD Anderson" (2014). Interview Chapters. 851.
https://openworks.mdanderson.org/mchv_interviewchapters/851
Conditions Governing Access
Open
