Chapter 09: The President's Panel and Post Retirement Activities

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Chapter 09: The President's Panel and Post Retirement Activities

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In this segment, Dr. Kripke discusses the "great and unexpected honor"of serving for two terms on the President's Cancer Panel (2003 and 2006, appointed by George Bush). This experience, she says, taught her that cancer research does not necessarily serve patients, a discovery (after a career in research labs) that turned her into an advocate for changing the balance of how research is funded. She believes that the Panel's report on cancer survivorship ('03 term) helped to bring attention to the need for follow up plans when patients leave the hospital, as well as the necessity of providing them with complete medical records. She would like to see the Panel address issues of cancer prevention, noting that the most important report she contributed to was on the effects of the environment on cancer ('06 term) and how little we know about the cancer causing properties of agents in our food and environment and how agents banned in other countries are still in use in the U.S. She notes that "the government doesn't want to deal with it"and this kind of study has lagged behind everything else. The Panel took a lot of criticism for its "strongly worded report"(including from the American Cancer Society). She explains why the Cancer Panel elected to focus on environmental factors, given that only 6% of cancers are attributable to the environment. Dr. Kripke then turns to her post-retirement activities. She first talks about serving as Special Assistant to Provost Dr. Raymond DuBois to ease him into the culture and institution. She also served as ad interim department chair at the Smithville remote facility when the head stepped down. She also explains how she came to serve on the Mayor's Advisory Council on Health and Environment for the city of Houston (one project on the CEO Roundtable; one developing a resolution on obesity).

Identifier

Kripke,M_02_20120329_S09

Publication Date

3-29-2012

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Service beyond MD Anderson Overview; Career and Accomplishments; Beyond the Institution; MD Anderson and Government; Information for Patients and the Public; Professional Practice; The Professional at Work; Post Retirement Activities

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:


Could we shift gears a bit now? I’d like to ask you about your two terms of service to the President’s Cancer Panel. You were appointed by George Bush in 2003 and then reappointed in 2006, and I’m wondering if you could talk about your role and what that experience was like, what you feel was achieved.

Margaret L. Kripke, Ph.D:


Well, first of all, it was a huge honor, an unexpected—great and unexpected honor. In fact, I was so stunned when I got a call from the White House saying that they would like to know if I would be interested in serving on the President’s Cancer Panel, I almost started laughing. I did Berkeley in the 1960s, and at the time President Bush, 43, was being criticized by filling all of his committees with like-minded people. If you were pro abortion, you couldn’t get appointed to a committee, so there was a lot of public criticism about who he was appointing to various things, and so I actually asked the staff person who called, I said, “Do you know that I went to Berkeley in the 1960s?” And he said, “Did you ever get arrested?” and I said, “No,” and he said, “You’re fine.” I felt that it was really quite anomalous because we couldn’t be farther apart in terms of the political spectrum then where I came from and where he came from. And I know that Andy von Eschenbach was really very instrumental in getting me appointed to that position, and he had gone on by then to be head of the National Cancer Institute, and so I owe that to Andy. It was just a fantastic opportunity for me, and I learned so much from being in that role. It was really an incredible experience. The first probably 4 or 5 years on the panel, Lance Armstrong was the public member of the panel, and of course, that was very exciting because there were always cameras and hordes of people following him around wherever he went, but he was also extremely engaged in this activity. I think people were surprised at that, but he, of course, is very committed to the agenda of furthering life for cancer survivors and has done wonderful work in that arena, and so several of the studies that we did—the President’s Cancer Panel is required to look at a particular issue and write a report every year on some aspect of the cancer issue, and so the first year I was on the panel they did cancer survivorship and what were the issues and problems and so on and then a couple of years later there was another—we did a volume on lifestyle factors and cancer, diet and exercise and tobacco use and so on, and again, both of those were really big issues for Lance, and so he was quite participatory in that time. It was fun. That was part of the fun part. But I must say, I learned a tremendous amount about cancer research and about how cancer research doesn’t necessarily serve the needs of cancer patients.

Tacey A. Rosolowski, Ph.D:


Tell me more about that.

Margaret L. Kripke, Ph.D:


Well, one of the talks that I have given in recent years has to do with if you want to cure cancer, there’s more to it than the science part. There’s more to it than discovering a new gene or a new pathway or whatever, that if you don’t have access to medical care, it doesn’t benefit you. All this research in the world does not benefit you, and something that everybody knows intuitively, so everybody thinks we don’t have to talk about it anymore. If you wanted to cure or prevent 80 percent of lung cancer deaths and 30 percent of all cancer deaths you would get rid of tobacco. I mean, it’s huge. If someone said they had a research result that would result in that kind of an outcome that would be on the front page of every newspaper in America, in the world, but yet we all know this, but somehow it’s old news. Didn’t we fix that problem already? Aren’t smoking rates coming down? It’s something—so those kinds of things were really a revelation to me because I had spent my entire career in the research laboratory worrying about science and whatever, and the idea that very little of this makes a difference to cancer patients was quite eye opening for me, and so I really became an advocate for changing the balance of how we fund cancer research and what we fund in cancer research. Not that it’s made any difference but—

Tacey A. Rosolowski, Ph.D:


What’s the process of the committee—the cancer panel prepares this report, which then goes to the White House and is there any mechanism—have you seen any of this information put to use at a very high level?

Margaret L. Kripke, Ph.D:


It varies. I think it’s varied depending on what the subject matter was. For example, when the survivorship issue was done—this was quite some time ago. This was 10 years—8 or 9 years ago. At the time, there wasn’t really any focus on cancer survivors. They were worried about curing cancer, not about what happens at home. They’re cured. Who needs to worry about that? I think partly as a result of the attention that we brought to that issue and people who looked at the report and heard the press releases and so on things did begin to change. It may have just been fortuitous, but I think our pointing that out really helped facilitate the agenda of doing things about cancer survivors. For example, ASCO, the American Society for Clinical Oncology, started a new focus on survivorship in their organization. There was a new emphasis on developing care plans. When you leave cancer treatment—I mean, one of the things survivors said was that they felt abandoned. They had been getting treated and whatever, and all of a sudden it’s finished, and they’re kind of left with nothing, not a good transition back to their community physician, and so one of the things that we advocated for were 2 things that have been taken up in a major way by the Lance Armstrong Foundation. One is to get a complete record of the treatment that you’ve had because we heard testimony from people who had cancer as children. They had no idea what they were treated with. They’re subject to late effects of their cancer treatment such as heart problems, infertility problems, second cancers, and they have no idea, and it’s very treatment dependent, and so many of them had no idea what they were treated with. Their parents didn’t tell them or didn’t pay attention. Everybody wants to be done with it.

Tacey A. Rosolowski, Ph.D:


Yeah, especially with a child.

Margaret L. Kripke, Ph.D:


Yes, and so getting people to leave the hospital with a complete record of their treatment is a big deal, and the second thing is a plan for followup, what resources are available. If you need psychosocial help, for example, where do you go? Where can you get help? How often should you be screened for certain conditions that might come as a result of your cancer treatment? Those kinds of things, and those are major things now of survivorship, and again, Lance’s foundation has been very instrumental in furthering that agenda.

Tacey A. Rosolowski, Ph.D:


What do you feel is—what do you feel the cancer panel needs to address now?

Margaret L. Kripke, Ph.D:


Well, it’s not my call anymore.

Tacey A. Rosolowski, Ph.D:


Right, but I’m just thinking if you were still on the panel, what would you like to see done?

Margaret L. Kripke, Ph.D:


I would like to have seen them do in this next year something major on prevention, cancer prevention, for 2 reasons. One is probably the most notorious report that we did was on cancer-causing agents in the environment, environmental carcinogens, and it was very controversial. It was an eye-opening experience for me to find out how little we know about the stuff that we put in our environment, pesticides, fertilizers, household pesticides, stuff you put on your food, whatever, how little we know about the cancer-causing properties of those agents, and the fact that there are agents that are known carcinogens that are banned in other countries that are still in widespread use in the workplace, particularly in the workplace in the United States. We wrote a fairly bombastic, flamboyant report about the evil—the difficulties of—and the fact that no attention has been paid to this issue. The government doesn’t want to deal with it. There’s no money for doing environmental carcinogenesis. It’s just lagged behind. Scientifically, that field has lagged behind everything else. It’s all about genetics these days. It’s not about anything in your environment. We wrote a fairly strong—strongly worded report about that for which we took a lot of criticism from the American Cancer Society.

Tacey A. Rosolowski, Ph.D:


Really?

Margaret L. Kripke, Ph.D:


Yes. They thought that focusing on environmental chemicals detracted from the issues that people could control like lifestyle, obesity, exercise, tobacco.

Tacey A. Rosolowski, Ph.D:


It seems they’d be interested in having a complete picture.

Margaret L. Kripke, Ph.D:


Well, it was annoying because 2 years before we had written a report on lifestyle factors in cancer, and they kind of didn’t notice that, and also their major message these days is in fact the lifestyle factors and cancer, so they were not at all happy with that, nor were lots of other people.

Tacey A. Rosolowski, Ph.D:


Who makes the selection about what the panel focuses on?

Margaret L. Kripke, Ph.D:


The panel.

Tacey A. Rosolowski, Ph.D:


What was the discussion among you that led to this focus on environmental factors?

Margaret L. Kripke, Ph.D:


That’s another thing that I’ve given several lectures on in the last few years, so it’s a long answer. The staff suggested that—and when we did the volume on lifestyle factors someone—people do make public comment, and somebody wrote to the panel afterwards and said, “But you didn’t include—under lifestyle factors—anything about stuff in the environment.” And we had deliberately not done that because it’s a huge issue unto itself, so that was one of the ways that that got on the list as a potential topic. There’s a statistic in the literature that says that only 6% of all cancers in the United States are attributable to environmental causes, and that figure has been quoted since 1940—1950—well, 1970 maybe. And it’s widely quoted, and even the people who made the quotation originally said that it’s really an underestimate. We didn’t include smoking. We didn’t include all these other things. And so I wasn’t too excited about looking at something that was only responsible for 6% of cancers because this is—should we really elevate it to the level of the President’s Cancer Panel? But several things persuaded us to do it. One is that that topic had never been looked at by the President’s Cancer Panel. The second was that if you go to a cancer meeting, a scientific meeting on cancer, you never hear anything about it. It’s an absolutely understudied area, and the people who have healthy lifestyles and don’t smoke, some of them still get cancer, and they’d like to know if there’s anything in their environment that is contributing to that. We looked at the subject and it turned out—I think we were convinced that 6%—and I think we said in the cover letter to the president—it is a gross underestimate of what actually is out there. And of course, we took a lot of criticism for that because people said, “Oh, you don’t have any evidence for that. You’re supposed to just report the facts, and you have no evidence for that.” It turns out that the World Health Organization came out a couple of years later estimating that the cancer burden—about 15 percent of the cancer burden worldwide is due to environmental contaminants, so I feel justified anyway in having drawn—I think it was very important to draw attention to that. But that, again, is one of the reasons that I think prevention is very important because when most people think of cancer prevention they think of lifestyle factors and screening for breast cancer and prostate cancer and so on. But prevention also includes getting stuff out of your environment and reducing your risk of even developing cancer in the first place, so it was a way to kind of integrate what was going on. Also, it’s so much more cost effective to prevent cancer than to treat it once you get it, and in terms of research, if you want to do research, where there’s the biggest impact, the biggest impact is if you prevent cancer or detect early rather than treating late-stage disease, which is what we do now. Most research is on treating established, late-stage cancer. That would have been my choice.

Tacey A. Rosolowski, Ph.D:

Can I ask you about your role in 2007—and this would have been after you retired, I assume, when you were a special assistant to the provost.

Margaret L. Kripke, Ph.D:


Yes. When Dr. DuBois came, my promise to him and to Dr. Mendelsohn was that I would stay on for 2 years and help integrate him into the institution because by the time he came in my role, the institution had doubled in size, and so it was a very different job than it was when I started with Mendelsohn 9 years earlier. And also, I had kind of grown up scientifically at MD Anderson. I knew the people, I knew the history, I knew the culture, I knew the problems, and he was coming from completely outside of the institution, and I think that’s also very difficult, particularly with the size of the organization that he had to deal with. I agreed to stay on for a couple of years and be there as a consultant or whatever, whatever he needed, and so that’s what I did.

Tacey A. Rosolowski, Ph.D:


What were some of the issues you helped him navigate?

Margaret L. Kripke, Ph.D:


Well, a lot of it was—the first thing that happens when someone steps down is that everybody raises the old issues. The people who got told “No, you can’t do this,” or “No, you can’t have that” now see an opportunity to ask the same question again of somebody new, so I think my major role and my major benefit to Dr. DuBois was he could call me up, and he said, “So and so told me they were promised X. Is that true?” And I’d say, “No, actually, and it’s in the file, and it’s here, and here’s the paperwork” and whatever, so that was, I think, a major thing. I did do a couple of projects during that 2-year period. One was when the head of the carcinogenesis department stepped down I actually went out to Smithville and spent time helping manage that. It’s a remote facility, and so I commuted to Smithville a couple of days a week.

Tacey A. Rosolowski, Ph.D:


And what did you do there?

Margaret L. Kripke, Ph.D:


I was the ad-interim department chair. The department chair there has a very different role because you’re in charge of the whole facility. You’re not just running a department. You’re running an enterprise, a free-standing enterprise, so there’s a lot more responsibility associated with that kind of an operation than a department that’s located within MD Anderson.

Tacey A. Rosolowski, Ph.D:


Is there anything else you want to say about that or about the special assistant role?

Margaret L. Kripke, Ph.D:


No. I mean, I was really there as a sounding board, a backup, whatever was needed.

Tacey A. Rosolowski, Ph.D:


I wanted to ask about your membership both on the Mayor’s Advisory Council on Health and Environment for the City of Houston.

Margaret L. Kripke, Ph.D:


Yes, one of the things that I did when I retired was to—well, actually I was serving on a board of directors for a non-profit organization for Hermann Park, and I had a friend who was the CEO of an organization called Neighborhood Centers, and when she found out that I was retiring she said, “I’d like to have you on my board,” and so I joined her board of directors for Neighborhood Centers. This is an organization that is over 100 years old. It was started by James Baker’s grandmother, I think, and it’s an organization that today deals with the same issues. Also it still deals with the resettlement of immigrants in Houston, of which there are many, but it also tries to provide resources and educational materials and opportunities for people in under-served neighborhoods in the city. I started doing that, and then the CEO said, “You know, you probably should be doing something at the level of the city of Houston, and would you be amenable?” And I said, “Sure.” I had nothing else to do. She really somehow or another managed to have me appointed as the head of the Mayor’s Advisory Council on Health and Environment, and there was no previous advisory council of that kind, and it was just go forth and do wonderful things, and so we have a very small group of people, and we’ve done 2 major initiatives. One was to—you know about the CEO Roundtable for Cancer?

Tacey A. Rosolowski, Ph.D:


No, I don’t.

Margaret L. Kripke, Ph.D:


It was something that was started actually by Andy von Eschenbach and George Bush, 41, President George Herbert Walker Bush, and it’s an organization that engages CEOs of major corporations to institute policies and processes to reduce the incidence of cancer. If you belong to the CEO Roundtable, and you have gold certification for the CEO Roundtable, your company provides cancer screening, provides smoking cessation help. It provides opportunities for good nutrition and exercise, and it provides assistance if you have a diagnosis of cancer. MD Anderson I think was the first organization in Houston to attain gold standard status. They have a website. You can look them up on the website, if you’re interested. Anyway, so one of the things that we did in collaboration with MD Anderson, the mayor’s office, an organization—I don’t remember what the organization is called—there’s kind of a healthy lifestyle group in Houston that was appointed by the previous mayor and that still exists, and so they were also partners, as was the Lance Armstrong Foundation. And so we put together a kind of cocktail party and reception for the CEOs within the city of Houston to explain to them about the CEO Roundtable and what it was doing to try to engage people in joining that force. That was one initiative, and we’ve just finished a second one on developing a resolution for the city of Houston on obesity and how to deal with it, so we convened this very large task force of various stakeholders and have just put on the mayor’s desk a resolution that we believe she will adopt for the city about instituting things to increase availability of fresh food, dealing with food deserts, increased exercise, opportunities for physical activity and some of those things.

Tacey A. Rosolowski, Ph.D:


When you say food deserts, what do you mean?

Margaret L. Kripke, Ph.D:


I’ve learned a lot about food in the last year. If you map—say in the city of Houston you do a map, and you plot the supermarkets, availability of fresh meat and produce, you find that there are large areas of the city that have nothing, and they correspondingly generally have lots of fast food opportunities and little bodegas, which is where people shop, but they have almost no access to fresh food whatsoever, and that’s a food desert. And the difficulty is that people who live in those areas often don’t have a car or don’t have access. They can’t go to a supermarket. It’s a 2-hour bus ride, etc., and so part of the obesity problem is not just lifestyle. It’s not personal choice. It’s the lack of availability of a safe place to walk, safe neighborhoods, decent sidewalks, availability of fresh food, etc.

Tacey A. Rosolowski, Ph.D:


How do you think the city of Houston ranks in terms of its interest in solving those kinds of—or see that as a civic challenge?

Margaret L. Kripke, Ph.D:


The current mayor is extremely interested in that issue, and the previous mayor was also interested in that issue, partly stimulated by a magazine article—and I believe the magazine was Men’s Health—which said that Houston was the fattest city in America, and that happened under Mayor White. And so he put together a group to try to deal with that issue, and the current mayor is extremely interested in this. She’s actually doing quite a lot in that arena already. They started a vegetable garden next to city hall, and they’re doing container gardening for the people who work in city hall. They started a very successful, phenomenal farmer’s market on the grounds of city hall. It’s there once a week.

Tacey A. Rosolowski, Ph.D:


They make very good crepes.

Margaret L. Kripke, Ph.D:


Yeah, it’s really quite good, so she is extremely supportive, and I think she will hopefully adopt the resolution.

Tacey A. Rosolowski, Ph.D:


What are some of the issues you hope they’ll address, the advisory council?

Margaret L. Kripke, Ph.D:


Well, we really take our clues from what the mayor is interested in. I mean, we didn’t just say we’re going to deal with obesity. We asked the mayor if we could have her permission to convene a group to look at this issue, and the answer was yes, so that’s on the basis of which we proceeded. It depends on what other issues she’s interested in. I think there was some thought that she might be interested in childhood immunization, so that may be another issue that we would look at, but really we’re trying to respond to her interests in what we take on. We have no mandate. We have no timeline. We’re kind of at the beck and call of the mayor.

Chapter 09: The President's Panel and Post Retirement Activities

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