Chapter 09: MD Anderson Growth and Changes to Institutional Culture
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In this chapter, Dr. Freedman shares his observations about the growth of MD Anderson since he came to the institution in 1975. He notes its particular strength in clinical research and multi-disciplinary approaches (gynecologic oncology being one of the first Departments to put together multi-disciplinary fields). He hopes that MD Anderson will continue to always do the right thing for patients, “since we are there for them, not for ourselves.” In the final minutes of the interview, he talks about going to Galveston, Texas, to fish and enjoy the water, as he did when he was young, in Capetown, South Africa. Since retiring, he has been able to indulge his love of history and travel, talking about his trip to Russia. “It’s a good thing to leave some time,” he says, to have a chance to do other things besides work.
Identifier
FreedmanR_02_20120301_C09
Publication Date
3-1-2012
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Institutional Change; Critical Perspectives; MD Anderson History; MD Anderson Snapshot; Growth and/or Change; MD Anderson Culture; Multi-disciplinary Approaches; Understanding the Institution; The Institution and Finances; Career and Accomplishments; Post Retirement Activities
Transcript
Tacey Ann Rosolowski, PhD:
Okay. We’re running again. We just turned off the recorder for a very brief break. I wanted to ask you just a few final summary questions. Over your long career at MD Anderson, you’ve seen it go from a relatively small cancer center to––I like the phrase Frederick Becker used. He said it’s gone from being a cancer center to being a cancer city, and I’m wondering what your observations are about that transformation and the culture of MD Anderson, the quality of care and the quality of the environment for researchers.
Ralph Freedman, MD:
Well, I think certainly the physical plant has expanded, and I think the number of patients that have been seen––in our case, we see different profiles of patients, whereas years ago, we used to see a lot of patients requiring radiotherapy and the complications related to radiotherapy as we were developing new––
Tacey Ann Rosolowski, PhD:
If you want to wait just a sec ‘til it’s all finished ringing.
Ralph Freedman, MD:
I know. It’s probably my daughter.
Tacey Ann Rosolowski, PhD:
I’ll pause the––okay. We’re recording again after a brief break, so––
Ralph Freedman, MD:
So the physical plant has grown—the numbers of patients seen—the type of patients has changed, the number of faculty has increased tremendously, and the type of faculty is different. I think I mentioned to you last time that a lot of faculty––probably the proportions faculty who are from overseas was probably higher. I don’t exactly know what the numbers were, but it seemed to me, at the time, my perception was that there were many more that came from different parts of the world. Now I think the institution has gotten so well-known, they actually have gone out to bring people in of certain backgrounds and experience. So when the institution started with [Gilbert H.] Fletcher, he––of course, this was the center in the country for radiotherapy. I doubt that there was any other center that had the expertise that we had in radiotherapy. That was a very important decision. We had––surgery and radiation therapy were the two major disciplines, and then you had this developing area for chemotherapy, developmental chemotherapeutics–– Freireich was chair, and Evan Hirsch was involved with biotherapy and Jordan Gutterman. Then, of course, we started getting into areas of new drug development and sudden expansion––clinical trials, infrastructure and actual clinical trials being done at Anderson, so that’s changed. The training programs have expanded, and they now include periods of time in laboratories, and it’s something we’ll go later to academic areas. I think one of the things is when it was smaller, you knew everybody. Now you know just a fraction of people. Even before I retired, it was already like that that you didn’t know––I mean—when we used to get together for our annual dinner, you knew most of the people that were there. They don’t have those anymore, because it’s too big, so it is, in a way, I guess, like Fred said in that you don’t see people from the different departments. I mean, you see individuals. In the IRB, I see people who represent those departments, but I don’t know many of the people that are so––now in those departments, and they don’t know me, so it has changed in that way. Obviously the budget has expanded, and the salary base has improved for faculty. It’s a very good place to work––sources, the supports, all was good. I think there’s still, of course, room for improvement. Our medical record system, we don’t have an electronic record system that’s comparable to what happens elsewhere, but then I’m sure it’ll happen, and we’ll get that in the near future.
Tacey Ann Rosolowski, PhD:
What are some other areas of improvement that you would like to see acted on?
Ralph Freedman, MD:
I’d say it’s hard to tell a number-one cancer center that they need to have––I mean, the basic science area, this institution has always been known for its clinical research expertise and been recognized for it, never been recognized, really, for the basic science. We’ve never had a national academy member. We had one, but he left about the time that was Lenores––and the question is how important that is. I don’t know. The regents have obviously decided that we need to emphasize the basic science area. Can we be everything, and I certainly wouldn’t like to see the clinical research area be diminished in any way because that’s the strength. That’s been the strength of the institution. If we lost that, we may lose something we cannot regain. I mean, we’ve got phenomenal––look at plastic surgery. There are over fifteen plastic surgeons now, and I don’t know if we had one when I started. I remember one part-time, possibly, in those old days, because they’re doing so much reconstruction, so you’ve got specialists now––the clinics, the way they’re organized—you’ve got a lot of subspecialty organization. In fact, the surgeons already do breast. Some surgeons already do GI surgery, and yet you still have this multidisciplinary interaction. Actually, GYN was one of the first departments to develop a multidisciplinary concept because Fletcher was interested in radiotherapy and Rutledge was a very excellent surgeon, and the two of them worked very well together to create a multidisciplinary environment. It was probably the model for multidisciplinary environment at Anderson. A lot of decisions were made—and it wasn’t hip in those days, but it met in the hallways outside of patients’ room—where there was a joint discussion going on about whether it should be radiotherapy or surgery first, and that multidisciplinary concept is very important, especially today. We talk about many conditions that come to Anderson, and you need multimodality. Well, they should be communicating about it right at the beginning, whereas in private practice what often happens is the patient gets surgery first and then sent across to the chemotherapist, and it’s not an orderly seamless process. It’s just depending upon the way the patient gets referred or how they get referred. Renal surgery, we’ve got experts. I knew exactly who to go to, and a renal problem, which is a problem with the urinary tract—bladder surgeons—so even within the fields––the general disciplinary fields––and these individuals have developed a lot of expertise and knowledge, but they still participate in multidisciplinary decisions. So I think in that respect, we’ve continued to grow, develop, and, of course, the regional cancer center’s now something new. I think that it’s going to be very important because a lot of people don’t want to go down to the medical center. Traffic is horrible, and having centers out here that can deal with the more standard types of therapy makes very good sense. And if you have a specialized problem like leukemia and you go to the main hospital, that’s different, but many of the other patients can be treated in the surroundings of their house. Now Jennifer, my wife, had breast cancer, and then she got lymphoma. She went to MD Anderson for the initial consultation, and actually, her surgery was done by the late Dick Martin, who was the head of surgery, but the subsequent treatments were actually done by physicians who work––who lived out here and who worked with the physicians down there. In fact, they were all graduates of MD Anderson appropriate like Arthur Hamburger who, by the way, also had some role in my staying at MD Anderson when I was going to go back to South Africa. He’s a radiotherapist in practice, and he was part of the radiotherapy program. And then there was––she got her chemotherapy at Memorial City. It was a convenience issue, and she had friends around here that could take her if she needed to go. So I think we have to be realistic about that, and I think that’s going to be very successful. They’re doing a certain amount of research out there that’s not too complex. Peter Pisters is in charge of that, and I’ve met with him. I’ve gone out to visit the centers. It’s very impressive. It’s modeled exactly on MD Anderson. They’ve got the same systems and procedures in place, so that’s also changed, and I think that’s for the good. And research, well, we have to see where individualized personalized therapy goes. It’s going to be tested; the concept has to be tested, and it may turn out to be a whole new discipline. At Anderson, it would all––maybe it’ll be a sub-discipline within different departments where it will be done. Everybody’s excited and wants to get into the act, and sometimes it’s too tough to make a decision with what resources it’s got. You don’t want to duplicate or replicate if it’s within the institutions because these things cost a lot of money today, and what else could we have? I think what we badly need is an electronic system which would also work for research, and I know there are people who are working on this now, and as I said, we needed it yesterday, but anyway––
Tacey Ann Rosolowski, PhD:
As you look back over your career, what is something that you’re most proud of having achieved?
Ralph Freedman, MD:
Well, I think I’m most proud of having been chosen to work at Anderson, basically, and to have contributed to many patients, to their outcomes, and also on the national scene, to contribute to public policy––the NCAB and the NCI and FDA. I think being there gives you a feeling that you’re contributing not just locally within the institution, but at a national level. And teaching––being able to teach the next generation and see these people developing their skills, watching how they develop over a period of years, it’s quite fascinating to watch.
Tacey Ann Rosolowski, PhD:
Is there a specific work that you hope they will carry on that was initiated––?
Ralph Freedman, MD:
I just want them to do the right thing. That’s all. Whatever they do, it’s always to do the right thing for your patients because those are the principles I was taught and try to pass on to others. Sometimes we’re not perfect. It’s not a perfect world, and we make some mistakes, and we have to learn from them, but I think to be conscious that we’re here for them and not totally for ourselves—I mean—obviously there has to be some ego––a little bit of egocentricity––to drive you, but in the end, it’s all about the patients.
Tacey Ann Rosolowski, PhD:
I wanted to ask just a couple of final questions that are really more about the flip side of your life, not the professional so much but the private life. I was talking to Dean George Stansfeld, Graduate School, Biomedical Sciences, and he happened to mention that you’re a fisherman, so I’m wondering where do you go?
Ralph Freedman, MD:
Oh, Galveston, because it’s close. I grew up on the eastern side of South Africa, and I remember as a kid, we used to go to the bay to fish. And, undoubtedly, I can remember having a fishing rod that I made out of a piece of bamboo with those little wheels that came out of movie cameras in those days and screwed it in there and put a fishing line on there until my father got me my first glass rod. Glass rods were solid in those days. Now they’re fiberglass or hollow. So we used to go and spend quite a lot of time. I guess that’s the way I got introduced to it. And not long after we came here, we got a house down there. The kids used to come down quite a lot, and they used to go crabbing and boating. Now we may go every other week, and there’s a colleague of mine––I fish with Jim Abbruzzese, who’s chair of GI—and we often go out together on a weekend. I go in his boat; he goes in my boat. We might not catch any fish, but it’s getting out. Having that place was very good because working with cancer patients can be quite stressful, and doing the other things that we had to do was quite stressful, and this was a very good way of sort of separating yourself. I do that and also spend more time reading––reading more for pleasure. I’m interested in history still a lot, so we got to visit a country and then read up about it. We were in Moscow and went to Saint Petersburg. In Moscow, we went to the Golden Ring towns and learned some more interesting facts there––for example, that there’s not just one Kremlin––that there are many of them. Each little town has its own Kremlin. It’s basically a fortified part of the city. Also, red is not originally a political symbol. It had more to do with the ground or whatever, but it became a political symbol.
Tacey Ann Rosolowski, PhD:
Did you visit Russia because your background is Russian?
Ralph Freedman, MD:
No, didn’t go to Lithuania where––we had the opportunity of going on a boat. Because of the boat’s visits in Petersburg, I had previously been––well, I went to Sweden, and we went as far as Finland. I had a South African passport; couldn’t get into Russia because they––so I always wanted to visit Russia and finding what Russia was about, and it was quite an experience––that basically a country has always been ruled, until recently times, by foreigners. So I got Catherine the Great, and I read the latest fascinating story about––I mean—she was German but learned the language––learned Russian—learned to become an Orthodox Christian person where she had been Protestant and bided her time––very clever woman. I don’t know how much you know about her history.
Tacey Ann Rosolowski, PhD:
She was quite an intellect. I know the great amazing supporter of––
Ralph Freedman, MD:
She wasn’t totally 100 percent good, but then who is? And there’s a question whether she had a husband dispatched or whether somebody else dispatched him. It wasn’t Peter the Great; it was another Peter. He left instructions, and if anyone tried to rescue him, he needed to he dispatched. And some fool decided he wanted him to be the czar again, so it’s never quite clear how much involvement she had. And then, of course, she had these relationships including the subsequent King of Poland who’s––what was his name?––and she had a child by him. She had a child by everyone except her husband, who used to like playing with toys. But it was a fascinating story. So anyway, going there and going to The Hermitage and visiting the small towns that are part of the Golden Ring. And it was so interesting to me that the Russians could never get their act together in those early days, and––so visiting, I just wanted––they were only Christian from around a thousand–– I’m not Christian myself, but it’s interesting that they became Christian only a thousand years ago. But they were basically dominated by the Tatars for 300 years, and they basically lost the country because they couldn’t work with each other––the princes—they couldn’t work with each other and defend themselves against the Tatars. That’s probably why they lost and then successively in history, the same, and so they’ve never known any Democratic existence to this present day.
Tacey Ann Rosolowski, PhD:
Definitely struggling with it now.
Ralph Freedman, MD:
You compare with China, who also went through the Cultural Revolution, and they are changing much more rapidly. They are catching on their–– They have a wonderful heritage, but then for 30 years they were in the doldrums. But since then they’re just going up and up and up, whereas the Russians are much slower. And it’s interesting––the roads were not in good repair in those small towns. You see much more when you go inside. Then we visited places like Tchaikovsky’s house. There was a family that killed Rasputin. These are stories, and the history there–– Oh, and then what was fascinating to me was to read about the Siege of Leningrad, which occurred in Petersburg, and we actually went to Stalin’s bunker, which was out of the way. He placed it under a sports field because he didn’t think that Hitler would attack him there, and it was kind of very, very subdued. I had a chance to talk with the curator of the place, and she wanted to know who, of course, won the war, and I said, “Well, I guess it was a contribution of everybody.” She said, “No.” She said, “Do you realize that twenty-five million Russians died here,” and of course I knew that, and the Americans had only come in later. So they still have that strong feeling, and, in fact, what is remarkable is that a very high percentage of Russians still admire Stalin even though he killed twenty-five million of them over that whole period of time. So I–– This is a chance for me to go back and look at these places. We’re going to Normandy in May, and we’re of course going to visit the D-Day beaches there. We’re going with Tauck Tours. They do a very nice tour, so there’ll be some food and cheese––Camembert and all that and Saint-Michel once––
Tacey Ann Rosolowski, PhD:
Oh, Saint-Michel?
Ralph Freedman, MD:
Yeah, we’ve been doing about two––an average of two trips a year since I retired. I never used to be able to––I wasn’t able to go away for too long before. We still don’t go away for very long, but now at least it’s about two weeks at a time. Just did a South American trip and we went to Japan, which is before the tsunami, and that was really interesting. We really liked that. And then we did do a trip up the Danube, which we enjoyed, and visited a postdoc who worked with me from Prague. And also, we went to Vienna. So I’ve enjoyed it and getting a chance to read more. I like non-fiction, as well as fiction, and if I’m in the mood, I’ll start––and for some reason I’ve enjoyed reading Saramago. I’ve probably read more of his books than any single author. He’s the Portuguese Laureate, and I don’t know if you know of him, but he sa––
Tacey Ann Rosolowski, PhD:
No, I don’t.
Ralph Freedman, MD:
He did the–– There was a movie based on one of his books called Blindness and then a subsequent one, Seeing. They hadn’t made it into a movie, but Blindness was about a whole population that suddenly goes blind, don’t know why they do, but almost all of them. And what is interesting, he examines the social interactions between these people who are now blind and have lost one of their most important faculties and how they relate to each other––there are bad people amongst them, and there are good people amongst them––and how they deal with each other. He just died this year. And there was another one that he wrote called The Gospel According to Jesus Christ, which he discusses the two Marys. And he actually got––I think he got excommunicated for that. And the very last one he wrote was––which I just finished—was about Cain, and he tries to––and not in a disrespectful way, but he treats them as perhaps historical things that we don’t know too much about––we don’t know the details—so he provides an opportunity for them to be real people and to connect with each other, and it’s quite interesting. So these are the things that I do these days. I work in the yard, dig holes––well, actually digging too many holes, French drains, and then now, of course, we’ve got a second grandchild on the way.
Tacey Ann Rosolowski, PhD:
That’s exciting.
Ralph Freedman, MD:
But it was good seeing–– Nobody knows how much time you’ve got when you’re in the next chapter, but it’s good thing to leave some time because some people work all the way to the bitter end, and then you wonder how they feel when they just aren’t capable of doing anything. Should I have done this? You don’t want to be in that position. You want to really say, “Well, at least I had a chance to do other things, and we go on trips together and be together.” That’s not always a––suddenly, when you’re away a lot and now you’re at home most of the time, it’s not always good for the spouse.
Tacey Ann Rosolowski, PhD:
No, retirement shock.
Ralph Freedman, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
Well, it sounds like you a have a very productive and pleasant time.
Ralph Freedman, MD:
Yeah, I’m trying to keep comfortably occupied without being busy. I do––I only call it time, but I don’t watch the clock at all and this, but there are times––if they have a meeting at MD Anderson, I may try to link in rather than take a trip down there, because it’s at least half an hour to drive there and maybe longer coming back, especially if it’s late in the day like 4:00-5:00.You have to fit in with traffic, and they have been very helpful in setting those things up.
Tacey Ann Rosolowski, PhD:
Is there anything else you’d like to add at this point?
Ralph Freedman, MD:
Well, I don’t know. Does that cover what you want to know about?
Tacey Ann Rosolowski, PhD:
I’ve covered my questions, and I just wanted to know if there was anything that had occurred to you that you felt you wanted to add at this point.
Ralph Freedman, MD:
Well, I think I’ve covered the most significant events.
Tacey Ann Rosolowski, PhD:
Okay.
Ralph Freedman, MD:
Yeah, I can’t think of anything other than right now enjoying the opportunity to see my family––I used to be home late in the evenings, and there was important––so that I had to do what I had to do, but I think now it’s time for others, so––
Tacey Ann Rosolowski, PhD:
Well, thank you very much for taking the time to be interviewed for the project.
Ralph Freedman, MD:
Well, my pleasure and good luck with that.
Tacey Ann Rosolowski, PhD:
Thank you. The time is three minutes of 5:00, and I’m terminating the interview now. (end of audio 4)
Recommended Citation
Freedman, Ralph MD and Rosolowski, Tacey A. PhD, "Chapter 09: MD Anderson Growth and Changes to Institutional Culture" (2012). Interview Chapters. 949.
https://openworks.mdanderson.org/mchv_interviewchapters/949
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