Interview Chapters

Processing Information:

In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.

The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.

Printing is not supported at the primary Gallery Thumbnail page. Please first navigate to a specific Image before printing.

Switch View to List View Slideshow

Chapter 03: A High-Pressure Ph.D. Program and Research in Protein Biochemistry

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung explains the competitive and high-pressure atmosphere at Brandeis and explains the six rotations through laboratories required of first year graduate students. He describes his work isolating hormone regulation genes. He explains why it is important for scientists to understand how to perform all stages of an analysis or research process as they create new knowledge and comments on graduate education today.

Dr. Hung then talks about his mentor, Pieter Wensink, who was researching the new processes of cloning. He explains that Dr. Wensink’s lab was very small, friendly and supportive, and that Dr. Wesink and his wife, Dorothy, often hosted social events for the lab. He observes that he learned a lot about American culture as a result. He also explains that he has replicated this culture in his own laboratory. He also concludes that a laboratory is much like a family and explains how he acts on this idea in his own laboratory: “Once you are in my laboratory, you are my people and I take care of you.”
Chapter 04: Post-Doctoral Study at MIT and Work on Oncogenes: the neu oncogene and c-erbB2 gene

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung observes that he was always interested in how biochemistry research could connect to human disease. He explains that key scientific discoveries were made in 1982 that made the time perfect for someone in molecular biology to begin working on disease, particularly Dr. Robert Wienberg’s work on oncogenes. Dr. Hung describes his interview with Dr. Wienberg, which took him to MIT for post-doctoral work (’84 – ’86).

He next discusses project cloning an oncogene from the neuroblastoma of the offspring of pregnant rats. Dr. Hung cloned the gene in six months.

He next talks about how this work expanded into his work on breast cancer, using the oncogene model to predict mortality. He explains that the overexpression of genes resulted in breast cancer and many other cancers.
Chapter 05: The Right Time in the Biochemistry to Move into Cancer Studies

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung explains that he was attending a symposium and he heard about a job at MD Anderson form some junior faculty members. He talks about the reasons he wanted to leave Boston. Dr. Garth Nicholson recruited him in 1986. He notes that he knew very little about cancer at the time, nevertheless, in the aftermath of genetic and molecular studies made in 1982, he knew that this was the right time for someone with his specialty to take on the challenge of cancer.

At the end of the session, Dr. Hung comments on the importance of collecting the stories of key researchers and others who have contributed to MD Anderson.
Chapter 06: Recruited to Bring Cutting-Edge Oncogene Research to MD Anderson

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung explains that Dr. Garth Nicholson recruited him to MD Anderson because of his focus on tumors.

Dr. Hung jokingly tells about all of the colleagues how said, “Don’t go to Houston.” He tells a joke from a scientist’s perspective that compares China’s long history with the US’s very brief one. This joke, Dr. Hung explains, tells why Houston’s supposed lack of history and culture did not matter to him.

Dr. Hung explains that, when he was recruited, his work was considered ‘very modern and cutting-edge” because of his focus on oncogenes and cloning.
Chapter 07: Early Work on Oncogenes and Adenoviruses: The First Gene Therapy

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung first describes how he set up his lab to have an impact on research into human oncogenes. His goal was to identify a transcription suppressor and his work on clarified that the EIB gene has oncogene activity, whereas EIA does not. Dr. Hung explains how “over-interpretation of data” can result in these types of assumptions about molecular and genetic function. His next move was to take this knowledge to breast cancer.

Next Dr. Hung explains that he and others formed an MD Anderson-based biotech company in the 90s to take therapy using EIA to (successful) clinical trials. He then explains how he began to think in new ways about the HER2/neu gene, looking for transcription factors.

Dr. Hung describes a clinical trial: the first trial of gene therapy for breast cancer and ovarian cancer. He explains the implications of this study.

He talks about controversies over gene therapy, then explains practical challenges of gene therapy research, many relating to the vector used to transport the gene-related agents to cancer cells.
Chapter 08: The Rationale Behind Translational Research and Why MD Anderson Provides a Good Environment

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung describes meeting Dr. Waun Ki Hong, then explains what it means to think in a translational way, where a researcher works purposefully for a clinical outcome (rather than allowing these to spring accidentally from work not explicitly conducted with clinical issues in mind). Dr. Hung also notes that, as MD Anderson, “important clinical colleagues” are dealing with significant clinical questions, creating an environment conducive to solving the most important clinical questions in cancer. Dr. Hung points out why the overexpression of the HER2 neu oncogene is a great example of the translational model of research.

Dr. Hung expresses how happy he is to work at MD Anderson, where he can pursue his passion for clinical research questions. He explains why he loves the song, The Impossible Dream.

Dr. Hung describes the mindset of researchers involved in translational questions, where basic science outcomes can influence patients. He notes that scientists are part of the human community and can make a contribution to human issues.
Chapter 09: Training Basic Scientists: Grasping the Field and Preparing for the Future

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung notes that his laboratory graduates more Ph.D.s than any other at MD Anderson and that his mentees go on to solid careers. He next explains the unique features of the Department’s Journal Club, which meets on Saturday mornings and gives the department an opportunity to review fifteen to twenty journal articles. Dr. Hung explains that is it usual to review a much smaller number of articles in great detail, but he wants his faculty and graduate students to learn how to assess articles for new concepts in the field that might be exploited. He also notes that this practice enables graduate students to learn how to present concepts to peers and colleagues, and is part of his pedagogic approach to broaden graduate students capacities to assess concept and make research decisions based on a view of activity in a field. He explains the important of training graduate students to address “diseases we do not know about.”
Chapter 10: Research into Receptors, Pathways, Cross-Talk and the Utility of Existing Drugs

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung begins this chapter by explaining the structure of receptors and how explosion of knowledge about signal transduction set the stage for targeted therapy.

He talks about his work on tyrosine kinase and interventions in signaling cross talk, explaining this concept. Throughout this chapter, Dr. Hung explains that he focuses on investigations into how existing drugs can intervene in molecular and genetic processes, as this avoids time-intensive drug research.

Next Dr. Hung talks about trials involving the HER2 gene and head and neck and colon cancers. He explains that his work on kinases addresses the needs of the twenty percent of breast cancer patients who are “triple negative” and whom clinicians simply don’t know how to help.

“There are twenty thousand proteins in a cell,” Dr. Hung says. “But we only need fifty” to make a difference to cancer patients. He explains the “huge paradigm shift” that has occurred and talks about the future of research on cancer, breast cancer, and pancreatic cancer.
Chapter 11: Co-Director of the Women’s Cancer Moon Shot Program: An Environment of Team Science and Translational Research

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung discusses Dr. Ronald DePinho’s Moon Shot programs. He explains that ovarian cancer and breast cancer have been paired in one Moon Shot because of similarities in their molecular profiles. He explains how the Moon Shots Program is structured administratively and practically with leaders and researchers drawn from surgery, gynecology and other specialties. He notes that fundraising is taking place now.

Dr. Hung next talks about the collaborative mindset the Moon Shots require, creating changes to MD Anderson. He compares the Moon Shots and SPORE grants (Specialized Programs of Research Excellence, administered by the NIH).
Chapter 12: A Move into Administration and Developing Translational Research at MD Anderson

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hung discusses his first administrative experience as Director of the Breast Cancer Basic Research Program (1996 – 2008) and discusses translational research.

He notes that he worked with Dr. Gabriel Hortobagyi (Interview # 29), knowing little about clinical work on the time. He explains that in the early 1990s, the leadership at MD Anderson wanted to foster interactions between clinicians and basic researchers, a culture of collaboration began to develop and have an impact on patient care. Next Dr. Hung explains what he learned about himself as a leader who could have “a different level of impact” as an administrator. He observes that the timing for expansion of translational research was very good, as the field has amassed a critical amount of information. Dr. Hung then talks about the impact of a translational focus on research. He explains communication gaps between clinicians and basic researchers. He concludes with comments on MD Anderson’s translational focus and the evolution of translational perspectives nationally.
Chapter 13: A Twenty-Year Study that Promises a Paradigm Shift: The Yeast Two-Hybrid System

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hung describes his involvement in controversial research on the Yeast Two-Hybrid System. He sets the context by explaining the prevailing theory about how cell receptors interact with proteins, noting unexpected discoveries linking a receptor to activity inside a cell nucleus. Dr. Hung has built on this discover and traces the history of publishing his findings. He speculates on why they have not been accepted. He explains that he has always been convinced that there is something significant in this finding and notes that his laboratory has continued to work on the mechanisms of how the signals move from the surface receptor to the nucleus of a cell. His laboratory has demonstrated that these signals influence DNA repair and transcription and therefore have implications for anti-cancer therapy. He notes that his laboratory has been able to link the Yeast Two-Hybrid system to functions involved in liver regeneration. In the remainder of this chapter, Dr. Hung makes general statements about how basic scientist must focus on the reproducibility of data, rather than accepted dogma, to guide the discovery process.
Chapter 14: The Department of Molecular and Cellular Oncology

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hung describes the history and development of the Department of Molecular and Cellular Oncology, a Department he has headed since 2000.

He sketches the history of the department’s leadership and reporting structure. When Dr. Hung became Chair, he reported to Dr. Margaret Kripke [Oral History Interview]. He describes the very bold goals he set for the new department to quickly raise standards and the profile. He then explains how he was able to convince faculty to rise to this challenge. He affirms that his is a “model department,” demonstrating collaboration between basic scientists and clinicians.

Next Dr. Hung briefly talks about a major lesson he learned about leadership after taking on the Chair of the Department: “never confront” and argue or become angry with faculty.

Next Dr. Hung briefly talks about MD Anderson’s Mentorship Committee Program for junior faculty.

Finally, Dr. Hung shares his aspirations for the bright future of the Department under the new leadership of Dr. Ronald DePinho and his Moon Shots program. He says, “My dream is to go to CVS for cancer drugs,” and explains that basic research is already helping the right patient to choose the right drug.
Chapter 15: Vice President of Basic Research; The Institute for Basic Science

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung begins this chapter explaining how he was offered the position of Vice President of Basic Research and accepted to have more impact at MD Anderson. He explains his roles, working with Dr. Robert Bast [Oral History Interview] and Provost Raymond DuBois on virtually every basic science activity. Dr. Hung explains their recruiting philosophy: “We need to hire people that are better than you and better than me!”

Dr. Hung next explains that the new president, Dr. Ronald DePinho, wanted a great deal of recruitment and Dr. Hung was involved in those activities. He shares impressions of Dr. DePinho and explains the positive points of Dr. DePinho’s Moon Shots program.

Dr. Hung next talks about the Institute for Basic Science, created to raise funds for basic science research, an area that traditionally doesn’t do much fundraising. He explains the administrative structure and changes and talks about the Institute’s impact.

Dr. Hung summarizes the Institute’s fundraising accomplishments and goals.
Chapter 16: Leaving a Legacy in Research, Education, and MD Anderson Culture

Mien-Chie Hung PhD and Tacey A. Rosolowski PhD

Dr. Hung begins this chapter with comments on how happy he has been at MD Anderson during his twenty-eight years at the institution. He is gratified to know he is “really part of a team” and that he has been able to sustain his basic-science focus while working on patient-related issues. Dr. Hung next notes that he would like to be recognized for his research that has yielded patient outcomes. He also notes the challenges that have come with running a large laboratory of forty to fifty people, and how he also is very active training and educating members of his laboratory. He talks about the importance of training the next generation of scientists –for MD Anderson and to apply knowledge at other institutions and in other scientific arenas. He also talks about how important it is for researchers to “learn science and how to behave.” He notes that the Department’s Ph.D. program is second in the nation.
Chapter 01: Cancer in Pediatric Patients

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter, Dr. Jaffe provides sketches the problem of treating cancer in children, a disease with dramatic effects on all family members. He concludes this brief (seven-minute) section with the statement that cancer in children is tragic because “children are our most precious commodity.”
Chapter 02: A Clinician Who Seeks Broad Knowledge and Connections with Patients

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter, Dr. Jaffe describes his family life and education in Johannesburg, South Africa. He expresses his gratitude to his parents, who ensured that he (and five siblings) got a good education, despite the family’s modest means. He also speculates that his caretaking role as the oldest child pointed him toward pediatrics, though he took the opportunity to rotate through all four specialties to round out his experience once he qualified as a physician. He talks about his roles (residency and Chief of Pediatrics) at Bagwanath Hospital for Black South Africans, where he had broad experience of diseases. When asked, Dr. Jaffe confirms that he was deeply affected by Apartheid in South Africa, noting that as a Jew, he felt compassion for the persecuted Black South Africans. He also briefly describes how other Jewish doctors were involved in anti-Apartheid activism. Dr. Jaffe next describes his commitment to working with his patients, noting his insistence over the years that he be called anytime a patient died so he might comfort the parents and assure them they could not blame themselves for their child’s death. Medicine, he notes, is “a hard mistress.”
Chapter 03: Working for Sidney Farber

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter, Dr. Jaffe discusses his move to the U.S. and his roles at the Stanley Farber Cancer Institute (Fellow in Tumor Therapy) and the Children’s Cancer Research Foundation (Fellow in Pediatrics). Dr. Jaffe was disappointed to discover no real fellowship program under Stanley Farber. He was also distressed by the state of treatment for cancer and had not desire to treat dying children. He tells an anecdote about Farber blocking him from resigning his fellowship. He describes Stanley Farber’s character and his strategy of moving Dr. Jaffe into administration. Dr.Jaffe very candidly says that Farber “took advantage” of him and he felt locked in the “vice” of the job, though he and Farber became close over the years. This section closes with his recollections of testifying in the House and Senate on behalf of funding for the Children’s Cancer Research Foundation on Farber’s death.
Chapter 04: An Important Contribution to Treatment: Eradicating Metastasis with Methotrexate

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter, Dr. Jaffe talks about building upon Dr. Farber’s work with methotrexate to treat pulmonary metastases from osteosarcoma. He first reviews Dr. Farber’s work with Wilms’ Tumor and the discoveries that led him to his own research on treating metastasis. He also reveals that he went into oncology because he had no choice at the time, working with Dr. Farber. Next Dr. Jaffe talks about osteosarcoma. At the time there was no treatment for osteosarcoma but amputation. Dr. Jaffe describes the process of discovering how to eradicate the metastasis with high doses of methotrexate combined with leukovorin to mitigate high-dose toxicity –still a recognized treatment. Dr. Jaffe asserts that this work represents his greatest contribution to the treatment of pediatric cancers.
Chapter 05: MD Anderson and The Department of Pediatric Oncology in the Late Seventies

Norman Jaffe and Tacey A. Rosolowski PhD

In the last twenty minutes of this session, Dr. Jaffe talks about his decision to leave the Farber Institute and his recruitment to MD Anderson in 1978 to replace Wataru Walter Sutow, who was retiring as Chief of the Section of Solid Tumors. He was also to step in as a new Chief of the Long Term Surveillance Clinic for Pediatric Patients Cured of Cancer and to develop the service along the lines of a similar program created at the Farber Institute. (He describes how he maintained an enduring relationship with the latter service’s Chief at the time, Dr. Hugh Ried.) In this section Dr. Jaffe tells some funny anecdotes about the people he met at MD Anderson; he comments on the leadership styles of Dr. Charles LeMaistre and Dr. John Mendelsohn.
Chapter 06: Survivorship: A New Section of Pediatrics I

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter Dr. Jaffe explains that he was recruited to MD Anderson to replace Dr. Wataru Walter Sutow because of his deep experience in pediatric oncology. He also notes that he left Harvard because of the limited opportunities for promotion.
Chapter 07: Survivorship: A New Section of Pediatrics II

Norman Jaffe and Tacey A. Rosolowski PhD

Dr. Jaffe explains that he was recruited to MD Anderson to expand the solid tumor section in the Department of Pediatrics and to develop new initiatives to work with survivors of childhood cancer, based on his previous work at the Dana-Farber Institute. He lists complications that patients develop after cancer treatment: reproductive issues, effects on growth and cognitive function (for children given head and neck treatments). He notes that the new survivorship initiative at MD Anderson produced twenty publications, and that it was a unique entity, an entirely new section of pediatrics.
Chapter 08: Solid Tumors and the TIOS Protocols (Treatment and Investigation of Osteosarcoma)

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter, Dr. Jaffe describes one of his major roles as Chief of the Solid Tumor section in Pediatrics: establish new protocols for treatment of cancers in children. He notes that this was an assignment he was given by the Department, but also one he assigned to himself. His main work was in the treatment of osteosarcoma. He named his series of protocols TIOS (Treatment and Investigation of Osteosarcoma), and developed three protocols before shifting focus to support a colleague’s study of a promising drug. He then goes on to give more details on the TIOS protocols, which used thee three main drugs for treating osteosarcoma. The first protocol used high-dose methotrexate, and Dr. Jaffe explains that the treatment –and its results—were not accepted at first. He says that “it is almost as if doctors couldn’t accept that osteosarcoma could be cured.” With the protocols he has designed, he explains, survivorship has increased from about 20% to 65%, and when his protocols are combined with multidisciplinary interventions the survivorship increases to 75-80%. He explains why no progress has been made beyond that point. Dr. Jaffe gives more detail on his procedure: they rely on intra-arterial drug delivery to destroy the sarcoma at its site –an essential step in limb salvage procedures.
Chapter 09: The Chiefs of Pediatrics at MD Anderson

Norman Jaffe and Tacey A. Rosolowski PhD

At the beginning of this chapter, Dr. Jaffe explains that when he began as Chief of the Solid Tumors section, he had responsibility for musculoskeletal tumors, Wilm’s tumors and a number of others, including neuroblastoma, which he eventually ceded to a colleague. As a leader, he notes, he believes that “if you are doing a good job, continue,” and he is very proud that the Solid Tumor section “ran like a well-oiled machine.”

Dr. Jaffe then describes the sequence of Chiefs of Pediatrics, beginning with the first chief, Grant Taylor, who developed a comprehensive pediatric department, focusing on clinical initiatives and benchwork. He continued to check in on the progress of the Department after he retired and Dr. Jordan (Dan) Wilbur took over. Dr. Jordan is known for the VAC (vincristine, actinomycin, cyclophosphamide) chemotherapy protocol for soft tumors in children that has not changed in the past forty years. Dr. Jan Van Eys took over from Dr. Wilbur and brought a different outlook. This was when Dr. Jaffe was recruited: Dr. Van Eys enhanced the solid tumor section. He also focused on the psychosocial and religious aspects of patient care. He believed religion was a major mechanism of support for patients. Dr. Pat Sullivan was Chief for one year, then Dr. Ka Wa Chan served as interim director for 5 years, until Dr. Archie Bleyer took over and attempted to change the department in ways that Dr. Jaffe feels were not well received. Dr. Eugenie S. Kleinerman then assumed the position of Chief of Pediatrics and enhanced investigation of sarcoma. Dr. Jaffe notes Dr. Kleinerman’s laissez-faire approach toward department members who are performing well. He then talks about the areas in which the Department of Pediatrics has made particular contributions to pediatric oncology, going into particular detail about value of conventional therapeutic therapies and the rapid, intra-arterial deliver of chemotherapy developed by the Department.
Chapter 10: The Ski Rehabilitation Program

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter Dr. Jaffe speaks in detail about MD Anderson’s Ski Rehabilitation Program, an innovative initiative run yearly in Winter Park, Colorado, to build the long-term confidence and competence of amputees. He describes criteria for selecting the patients for the first week-long program (health mattered more than age), as well as the decision to have a parent accompany each child. Parent participated in conferences during the week, providing MD Anderson staff with their evaluation of their child’s treatment. The main problems mentioned were communication and the timing of treatments, and Dr. Jaffe notes that this information was valuable in improving patient care. The costs of the trip for the children and parents were funded by MD Anderson. Later the trips were funded by the Children’s Art Project. Dr. Jaffe notes that there are not enough funds for the 2013 trip, but many parents and children are paying their own way, because the trip is so important for them. Dr. Jaffe also describes the effects of the week long experience on the children –notably a dramatic increase in their sense of “prowess.” He also goes into detail about the activities provided and how these have changed over the years to include one-on-one training, races, and prizes. He reports that children who have participated in this program mainstream easily, and have gone on to become very successful. (Ten have become physicians.)
Chapter 11: A Satisfying Career and Children who are Physicians

Norman Jaffe and Tacey A. Rosolowski PhD

Dr. Jaffe looks back at a very satisfying career at MD Anderson (though he originally wanted to be a surgeon). He explains why his sons and his daughter chose not to go onto oncology. He expresses his deep regret at the patients he lost over the years.
Chapter 12: The Long-Term Surveillance Clinic

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter, Dr. Jaffe talks about his work with MD Anderson’s Long Term Surveillance Clinic. The Clinic was already in existence when he came to MD Anderson in 1978, however he was recruited in part to expand the Clinic, based on his experience with a similar unit at the Dana-Farber Cancer Institute (established in ‘72/’73). (Dr. Jaffe wrote the first paper on radiation and survivorship [published in ’75] and he suspects this was instrumental in the creation of a number of survivorship clinics.) He notes that with the use of radiation and chemotherapy, the numbers of pediatric cancer survivors grew exponentially, and they also exhibited many complications from their treatments. The Clinic monitored all the complications and referred patients to the service that could address them. Dr. Jaffe then talks about the many people involved in the Clinic. When Dr. Jaffe arrived, Dr. Hubert Ried directed the Clinic with the assistance of nurse practitioner, Hallie Zietz (whom he describes as “the heart and soul” of the Clinic). The three of them worked together to expand services and write papers. Dr. Jan Van Eys, he explains, was an advocate of monitoring nutrition in survivorship. He explains why nutrition is and issue and how his experience with patients with such afflictions as kwashiorkor in South Africa sensitized him to malnutrition in cancer patients. Dr. Jaffe also credits Dr. Van Eys with establishing psychosocial support as a key element in the survivorship clinic. Donna Copeland was Chief of Psychosocial Services. Dr. Jaffe gives several examples of the kinds of challenges children face. He also explains that Dr. Van Eys developed the position of the Child Life Worker to help children adjust. He describes the role of the Child Life Worker –who might, for example, go to a child’s school to sensitize other children to why a cancer survivor might not look like other children or might have some kind of disability. This kind of support role owes a great deal, Dr. Jaffe explains, to Dr. Sidney Farber’s concept of total care. He talks about how pediatric patients are dealt with differently now than in the past: for example, efforts have to be made now to obtain a child’s permission for treatment, and he gives examples of how a procedure might to explained to a very small child of four or five. He also returns to the example of the Ski Program, run through the Survivorship Clinic, and notes that the video, Amputation is no Barrier, was produced to showcase the Ski Program and the activities it offered to survivors.
Chapter 13: Building Collaborations and Treating Patients from Around the Globe

Norman Jaffe and Tacey A. Rosolowski PhD

Dr. Jaffe quips that when he realized he wasn’t going to win the Nobel Prize he began to turn his mind to how to ensure that what he had learned about treating pediatric sarcoma and survivorship would be passed on. In this chapter he speaks about the many collaborations he has sustained with physicians internationally over the last fifteen or twenty years. For the past ten years, for example, he has helped physicians in many cities in Mexico establish programs for solid tumors and survivors. Many hospital programs in different nations in South America have requested his expertise. He has many contacts across Europe, has been involved in EURAMOS, the European and American Osteosarcoma Study group, and for the past fifteen years has sustained contacts in Germany, Norway and Sweden. He tells an interesting anecdote about hosting several doctors from Slovenia who contacted him about coming to observe practices at MD Anderson. Dr. Jaffe hosted them at his home during their visit of 6-8 weeks. One physician noticed how many surgical instruments MD Anderson discarded, and it was arranged that she could take home a crate of instruments for use in their hospital. In another anecdote, Dr. Jaffe describes he was invited to Egypt several times and then asked by an ambassador to write a report about the poor treatment for cancer in that country. That document resulted in the creation of the Friends of Egyptian Children with Cancer group, which hosts various fundraisers to provide children with improved care. [redacted] In another anecdote, Dr. Jaffe talks about his hesitancy to accept an invitation to Saudi Arabia because of his (Jewish) faith. He was very impressed at his treatment, however, and surprised that they offered him a position.
Chapter 14: Healing Children: An Emotionally Complicated Task

Norman Jaffe and Tacey A. Rosolowski PhD

In this chapter, Dr. Jaffe reflects on the fact that he has practiced medicine for fifty years, finding the career both enjoyable and devastating. He reflects on the opportunities he has had to train many talented individuals, most of whom have succeeded in their fields. He explains that his own faith has been important in shaping his attitudes toward his work, citing the sanctity of life in the Jewish faith. He ends this chapter by paraphrasing a Talmudic expression that counsels never to deprive any individual of mercy.
Chapter 01: An Interest in Estrogen and an Important Discovery

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Jones talks about the graduate research that brought him to MD Anderson. He sketches the story of how he left the University of California, San Francisco to join MD Anderson to develop a research lab in endocrinology. He describes the research he conducted at on combined therapies for gynecologic diseases. In particular, his research had to do with the long-term impact of DES (diethylstilbestrol -synthetic estrogen) in promoting cancer, the work for which he is best known. He explains how his interest in medicine and oncology developed. He lists the individuals he worked with and describes the state of the field at the time. Next Dr. Jones explains that at MD Anderson he was hired to develop a pioneering model of a department with collaborative research connections supported by clinicians. Dr. Jones explains that the Endocrine Research Program was elevated to a Section, which him as head. He explains the reporting structure.
Chapter 02: A Conversation with Dr. R. Lee Clark

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones tells about a conversation he had with the first president of MD Anderson, Dr. R. Lee Clark, in the faculty restaurant of the Mayfair Hotel on the MD Anderson campus. He explains that Dr. Clark lived on the top floor of the hotel and had "his own table" at the restaurant. Dr. Jones was accidentally seated at that table, and Dr. Clark joined him. Dr. Jones recalls asking Dr. Clark how he came up with the idea for MD Anderson. Paraphrasing in his own terms, Dr. Jones says Dr. Clark was as concerned as he was about "linking discovery and delivery." He also recalls Dr. Clark speaking about decisions he would have made differently: relations with the UT System; dual appointments for faculty; the tenure system. Dr. Jones offers his own, negative view of the term tenure system.
Chapter 03: Coming to MD Anderson to Link Discovery to Delivery of Care

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Jones explains that his mother's breast cancer diagnosis motivated him to leave the University of California and come to MD Anderson. He comments on attitudes toward breast cancer in the African-American community. He recalls his realization at the time: "No matter how many discoveries I made, it's hollow if there's no impact on people I love." He looked for an institution with more connection and was also interested in being closer to Baton Rouge, where his mother lived. He notes that he knew about the history of racism in Houston. He recalls his conversation with mentor, Dr. Pentti K. Siiteri about MD Anderson.
Chapter 04: The First African-American Basic Researcher at MD Anderson

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Here Dr. Jones talks about race-related experiences at MD Anderson. He observes that he was one of five black clinicians at MD Anderson when he was hired. He explains that because of Dr. Charles LeMaistre's support, there was a protective "bubble" around him. He tells about establishing a rapport with the janitorial staff, who didn't believe he was black because "MD Anderson doesn't hire black doctors." Dr. Jones notes that a "˜bubble of protection' could make diversity hires much more vulnerable when their sponsors left. He says he was required to present eighteen letters of support for his promotion from assistant to associate professor (as opposed to the usual three). He explains challenges in his tenure and promotion processes.
Chapter 05: The Minority Faculty Association; What Health Disparities Can Mean

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones talks about his work in the late eighties to address inequities in the treatment of minority faculty members. He tells how the Minority Faculty Organization was formed and discusses controversies surrounding it and its impact. He tells the story of the Association's push for the first survey of salary equity. He discusses the severe salary inequities discovered and the changes it led to. Dr. Jones next talks about the demographics of MD Anderson's patient population in comparison to the demographics of cancer patients beyond the institution. He mentions working with Dr. Martin Raber on a strategic plan to integrate a broader patient population into MD Anderson. He demonstrates the idea of health disparities with a story about the son of a wealthy Houston family whose son died because there was no acute care center within easy distance to treat his injury.
Chapter 06: The Effect of Estrogen on Cancer

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones talks his role in the Department of Gynecologic Oncology: to bring reproductive endocrinology back into the conversation about cancer. He talks about "turf wars" that prevented him from pursuing some topics. He explains that he began looking at benign diseases (fibroids, endometriosis) to consider how these might be connected to cancer, as they are over-present in women treated at MD Anderson. He next talks about his studies of the early effects of steroid on cancer, focusing in particular on DES (diethylstilbestrol). He talks about creating the first culture of an immature mammary gland cell line with a functioning estrogen receptor (describing the innovative features of this work). Dr. Jones talks about the mechanisms of cell membranes and indicates that, at the time, researchers were not focusing on the mechanisms of normal tissues. He next outlines the treatments that came from his discoveries.
Chapter 07: Research on Cancer in Diversity Populations

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones outlines several studies he has conducted on cancer patients from different ethic/racial groups. He begins with the Tri-Ethnic study conducted in partnership with the Kellogg's Company. He talks about setting up the partnership then talks about the Healthy Friends initiative that focused on screening Hispanic women for cancer and his involvement in trials in South American focused on secondary and tertiary prevention of breast cancer via diet. He showed that intervention with diet had the same effect as treatment with Tamoxifen. Dr. Jones then returns to the Tri-Ethnic Study and explains nuances in the results: the media reported that the results showed no influence of diet on cancer rates, but he explains how this was an extreme oversimplification and, in fact, they discovered very positive results.
Chapter 08: Initiatives to Foreground Minority Populations and Diversity

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones reviews several of the initiatives he took on to bring minority populations into the conversation about cancer at MD Anderson. He first talks about the Center for Minority Research and Health, which created a holistic approach to doing research. Next he talks about starting the Biennial Symposium Series on "˜Minorities, the Medically Underserved and Cancer' (begun in 1987). He explains that the Biennial figured into a plan to change how MD Anderson addressed minority health issues. Dr. Jones then mentions establishing the National Minority Cancer Awareness Week: he explains why this was needed. Dr. Jones tells the history of how the Biennial was established, beginning in 1985 when the NCI began looking at cancer disparities. He talks about the challenges securing funding, noting MD Anderson's lack of support for this initiative and for him.
Chapter 09: A Stressful Relationship with MD Anderson Administration

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones sketches many tensions in his relationship with MD Anderson's administration. He mentions a Houston Chronicle article that stated "Lovell Jones was a boat-rocker and a malcontent." Dr. Jones explains why he was determined to stay at the institution, building on his solid research record: no one could accuse him of focusing on minority issues and discrimination because he couldn't make it as a researcher. Dr. Jones mentions Dr. Fred Conrad's murder at MD Anderson. Dr. Jones recalls that in the early eighties he took safety precautions and his staff feared for his life. He talks about his attitude toward any danger, noting that his connections with powerful people in the field helped protect him.
Chapter 10: Early Experiences with Race and Civil Rights Instill a Commitment to Equity

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones talks developing his commitment to work for equity. He describes the unusual features of Baton Rouge, Louisiana, where he was raised. This community was isolated and unusually integrated, characteristics that gave him a false sense of the country's integration. He was never told that he couldn't succeed. Dr. Jones then tells a story of disobeying his grandmother, who had told him never to take the bus downtown. He recalls sitting in the front of the bus only to be pulled to a seat in the back. Next he talks about how South University (a Black college) has a school on the campus of the laboratory school that Dr. Jones attended at the time. He was "adopted" by some college students and through them was introduced to civil rights activities. He then had the opportunity to attend the Robert E. Lee High School that was being integrated. He recalls being shot at and attacked during this period. Nevertheless, he explains, when he enters a room he never sees race. At the end of this chapter Dr. Jones explains why his mother threw him out of the house when he was thirteen.
Chapter 11: The Intercultural Council; the Biennial Symposium, The Center for Research on Minority Health

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones begins with stories to demonstrate the positive impact of the Biennial and how it advanced awareness of the health disparities movement.

Next, he tells how he met with Arlan Specter (Senator, Pennsylvania) and eventually convinced him to appropriate money for a study that showed the lack of focus on health disparities, a precursor to the creation of a new NIH institute, the Office on Research on Minority Health. Dr. Jones next tells the story of forming the Center for Research on Minority Health. He describes how the Center was set up and positioned within MD Anderson. He explains its mission and initiatives directed at closing the gap in health disparities through science and education. Dr. Jones explains difficulties in sustaining his connection to the Department of Health Disparities Research after his retirement.
Chapter 12: Race at MD Anderson: Slow to Make Real Changes for Minorities

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Jones provides a portrait of MD Anderson's approach to race and diversity during his tenure. Dr. Jones explains how race became a focus for him then shares his view of racism in America and racial inequality in Houston. He recalls segregation at MD Anderson still had separate eating areas for blacks and whites and observes that when he arrived, there was still a "psychological separation" between the races. He describes a conversation with Dr. Ronald DePinho about race. He notes resistance in leadership at MD Anderson and the Texas Medical Center to seeing race as an issue. He notes that there is "visible diversity" at lower levels of the institution but not in top leadership. Dr. Jones makes a comparison with the situation for women at MD Anderson, a situation that leadership addressed in ways that changed the climate. He observes that this has never been done for minorities at MD Anderson.
Chapter 13: MD Anderson Leaders and Diversity

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones evaluates MD Anderson and discusses the ability of key leaders to recognize race as an issue within the institution. He notes that Dr. Ronald DePinho, the fourth full-time president of MD Anderson, can empathize with, but not fully relate to the experience of African-Americans. He explains how important it is to make individuals aware of their biases without putting them on the defensive. He talks about Fred Levine, president of UT Medical Branch in Galveston, then compares Dr. Charles LeMaistre [Oral History Interview] and Dr. John Mendelsohn [Oral History Interview]. He talks about Dr. Emil J Freireich [Oral History Interview], Dr. Waun Ki Hong [Oral History Interview], Dr. Andrew von Eschenbach, and Dr. Bernard Levin [Oral History Interview].
Chapter 14: The National Black Leadership Initiative on Cancer: Developing Grassroots Action for Health Equity

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Here Dr. Jones tells the story of The National Black Leadership Initiative on Cancer. He defines "health disparities and health equity" (using the World Health Organization's definition). He then tells the story of helping to start the National Black Leadership Initiative on Cancer after the publication of a report on minority cancer. He explains the scope of the Initiative's activities (and notes MD Anderson's lack of support and criticisms). Dr. Jones tells anecdotes about his stressful relationship with MD Anderson that made him consider leaving Houston.
Chapter 15: Minority Experiences in Healthcare: The Origins of Health Inequity

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones begins by saying that it is important to see health issues from a patient's perspective. He describes how gaps between patients and healthcare systems develop. He gives an example of how African-American patients are inappropriately labeled "difficult" and so they are excluded from clinical trials. Dr. Jones next recounts a story about the NCI and bias. This leads to a discussion of hoe individuals respond to the information that bias exists. Dr. Jones emphasizes that he uses the term "bias" instead of "racist." He notes that there is little bias in dealing with pediatric cancer, but once children turn sixteen, bias begins to be evident in their treatment.
Chapter 16: Evolution of Thinking About Race and Inequity

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Jones talks about his upbringing and the evolution of his thoughts about race. He talks about his "sheltered" upbringing and fluid experience of race in a community where blue-eyed, blond classmates were racially black and he himself was often identified as white. Dr. Jones notes aspects of Louisiana history that helped support this experience and taught him to be cautious about assumptions he made about race and how he interacted with others. Dr. Jones explains that he considers himself and optimist and a realist about race issues in this country. He compares his style with that of Harold Freeman, MD, a prominent African-American physician and friend.
Chapter 17: Staying at an Institution Because They Want You To Leave

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones first talks about the creation of C-Change, a "white version" of the InterCultural Council (of which he was a member) and a forum for a national dialogue on cancer, arising from the 1998 March on Washington for Cancer.. Next Dr. Jones notes that he stayed at MD Anderson because individuals at the institution wanted him to leave. He finally decided to leave when his resources were increasingly being turned off. He also notes Dr. Raphael Pollock's comment that "you can say more by leaving than by staying." Dr. Jones notes that nothing was being done to retain him at MD Anderson. Dr. Jones talks about his attempts to find post-retirement connections, given his reputation as an agitator. He notes that he has just received an official appointment letter from Texas A and M at Corpus Christi.
Chapter 18: The Health Disparities Education, Research and Training Consortium and Program

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Jones discusses the creation of the Health Disparities Education, Research, and Training Program in 2002. He gives context, traces reasons for speedy implementation and covers political dimensions of this process. He describes how the goals of the course, how it worked, and various presenters. He emphasizes that the overall goal of the course is to change how people think about health, so they include economics, housing and wealth distribution in their understanding of what has an impact on health.He then talks about the impact of the first year's success, resulting in forty institutions now involved. He explains why MD Anderson pulled out of the project.
Chapter 19: Creating the SECURE Project

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones talks about the SECURE project begun in 2010 to address community needs for healthcare support in regional emergency situations. He explains that it grew out needs that became evident in the aftermath of Hurricane Katrina. Dr. Jones invited many institutions to participate, including Meharry Medical College. He offers some context, explaining how the Flexner Report reduced the number of African-American medical schools, and Meharry was able to survive the closures. He explains why it was important that Meharry be represented in the SECURE project. He explains the projects developed, including the Texas Partnership for Addressing Health Disparities, and notes that now that he is retired, the SECURE consortium will be housed at Texas A & M University, Corpus Christi.
Chapter 20: The Dorothy I. Height Center for Health Equity and Evaluation Research

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones explains his work with the Dorothy I. Height Center for Health Equity and Evaluation Research (CHEER). He talks about meeting Dr. Height in 1992. He then discusses approaching Congress in 1997 for funds to start a research center --the Center for Research on Minority Health (CFRMH). Dr. Jones approached Dr. Height about renaming the center in her honor and explains the criticisms Dr. Height has of MD Anderson, leading her to decline. He then talks about how he resumed this discussion with relevant parties after DR. Height's death, including making a "passionate plea" to family members at Dr. Height's funeral. Dr. Jones explains the process whereby the family first agreed, but then withdrew the name after a few years. He notes that, at this time, the Height Center is "no longer functional." Dr. Jones notes that MD Anderson is more interested in the discovery of new knowledge rather than its delivery to patients.
Chapter 21: Obstacles to Improving Healthcare in Texas

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones reflects on the poor healthcare in Texas and on factors that prevent improvement. He discusses Leonard Zwelling, MD, who writes a controversial blog about cancer issues and MD Anderson and their points of agreement expressed in a blog post. Dr. Jones talks about the negative reaction that followed. After talking about a documentary about former Texas governor, Ann Richards, Dr. Jones notes the power of the media in creating a picture of leaders at the city and state level. He goes on to affirm that "No one talks about how Texas has one of the worst health situations." He explains the factors leading to this situation.

Next, Dr. Jones explains how individuals are able to protect themselves from the reality of the healthcare situation by creating "bubbles" around themselves.
Chapter 22: Denied Privileges as an Emeritus Professor; MD Anderson's Administrative Structure

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

He begins by noting that he has been talking the University of Texas System about the treatment of emeritus professions and has been able to acquire statistics about the numbers of minority professors and the privileges extended to them. He notes that unlike the other institutions in the University of Texas System, MD Anderson has not formal process for assigning privileges. He speculates on why MD Anderson has this procedure, providing context by explaining the history of term tenure. He goes on to describe governance at MD Anderson: a system with "no checks and balances," though prior to the current administration there was an "air of checks and balances." He discusses the current controversy over faculty members being denied tenure by Dr. Ronald DePinho, despite unanimous tenure committee votes. He then returns to a discussion of his own emeritus status.
Chapter 23: Writing, Teaching, and A Legacy Left

Lovell A. Jones PhD and Tacey A. Rosolowski PhD

Dr. Jones talks about post-retirement projects not addressed in earlier chapters; working on a Texas A & M University grant for $21 million to educate STEM scientists; stabilizing the InterCultural Council and the Heath Disparities Education, Research, and Training (HDEART) Consortium. He lists venues for his writing and summarizes the points he makes in them. He notes his work with Louisiana State University and other institutions to support minority students and create a pipeline of people interested in health disparities. Next Dr. Jones talks about the demographic shift in the United States with regards to economics and education and explains how this has an impact on healthcare. He gives an overview of wealth distribution in the United States, noting that a large percentage of the have-nots are white Americans. At the end of the interview, Dr. Jones says that he would like to be remembered as a person who tried to make a difference and for his impact on education. The talks about students he remembers and the effect he was able to have on the direction of their careers. He recalls his mentor, Howard Bern. He regrets that MD Anderson did not offer him a true academic home to engrain change in next generations.
Chapter 01: Defining ‘Innovation’ and the Role of an Innovation Officer

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

In this chapter, Ms. Kaul discusses her definition of the term “innovation” and describes the relatively new role of the innovations officer in organizations. She also discusses the need for this kind of role in the context of healthcare organizations.

She begins by defining the role of an innovations officer as “driving transformational change” and notes that her role as the first innovations officer at MD Anderson is evolving. She explains that a great deal of her work will involve planning how the institution can take advantage of information technology and medical devices to keep pace in the evolving healthcare environment and attract and serve “customers” well. She comments on using the word “customer” for patients.

Ms. Kaul says she is increasingly impressed with MD Anderson since her arrival in July 2016: it is “really a special place.”

She notes that the institution must become more “digital” in its operations at a micro level. She explains that innovation means using data and technology to optimize performance at all levels of the organization. She explains that the “holy grail” of innovation is the integration of all levels of data.

Next, Ms. Kaul explains her growing reluctance to use the word “innovation,” since it is so often misconstrued as something that is “new and sexy” and has become a buzzword even at MD Anderson.
Chapter 02 : Early Experience with Healthcare Leadership

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

In this chapter, Ms. Kaul explains some of her early experiences with health and healthcare. She first explains that she was exposed early to dealing with big organizations and the drive to build things because her father built UPMC and was (and continues to serve as) CEO of that institution. She saw early what it took to “be out in front” of an institution. She talks about UPMC then discusses childhood experiences that taught her to be self-reliant and independent.

HIPPA Next, Ms. Kaul talks about the prevalence of breast cancer on her mother’s side of the family due to the BRCA-1 gene, and how that inspired her to focus on healthcare and eventually come to work at MD Anderson. She explains that her mother died of breast cancer and she herself has the gene. She recalls her early experiences and memories of her mother, who died when Ms. Kaul was very young.

[The recorder is paused.]
Chapter 03: A View of Innovation Rooted in Personal Experience

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

In this chapter, Ms. Kaul talks about more about her view of innovation, noting that her father shaped her perspective.

She begins by sharing his lesson that “if the crowd is with you, you’re probably not thinking ahead” and that it’s important to be future oriented, seeing “today as a jumping off point.” She explains the challenges of educating individuals about this new role, which is focused on “designing tomorrow.” She talks about difficulties in documenting the contribution of an innovation officer.
Chapter 04: Multiple Majors Train a Problem-Solver

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

Ms. Kaul traces her educational track, noting the evolution of her interests in high school, the impact of an internship she had in an artificial lung laboratory, and her initial interest in becoming a physician. Her father talked her out of it, spurring her toward an alternative interest in “being in the driver’s seat of healthcare.” She explains how her college major in chemical engineering (Carnegie Institute of Technology, Carnegie Mellon University, B.S. conferred in 2000) taught her how to approach and solve problems. She also talks about her additional majors in English and Public Policy, the latter providing a framework for her study of Information Technology. (She worked on her Master of Information System Management, conferred 2001, while she was finishing her undergraduate work.) She discusses the lessons she learned through this cross-disciplinary work, stressing her interest in applying her knowledge to the complexity of real business applications.
Chapter 05: International Study and Work after Graduation

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

Ms. Kaul begins this chapter with a discussion of her first job working as a consultant for the insurance company, Swiss Re. She then talks about her decision to return to school for an MBA (conferred in 2006 by New York University’s Leonard Stern School of Business) and her creation in 2004 of the independent consulting firm, Panacea.

Next, Ms. Kaul talks about the impact of her summer internship studying at the Hebrew University of Jerusalem in 1999. She talks about family reasons for wishing to study in Israel.

[The recorder is paused.]

She notes that this international experience reinforced her native interest in big-picture thinking and its impact on real people and real processes.
Chapter 06: Directing Strategic Business Initiatives at UPMC

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

In this chapter, Ms. Kaul describes her work as Senior Director of Strategic Business Initiatives in the International Commercial Services Division at UPMC in Pittsburgh, Pennsylvania. This was a new, entrepreneurial venture for UPMC, and it involved creating opportunities to work with other companies to develop and sell technology. She explains one project that involved developing computer-assisted medical coding. She explains why this is a challenge and why the technology is valuable in healthcare. She managed the eventual joint venture between UPMC and A-Life Medical and she tells the story of how the project evolved and explains the lessons learned.
Chapter 07: Developing an Innovation Center at UPMC

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

In this chapter, Ms. Kaul talks about the next phase of her work at UPMC, establishing the Technology Development Center at UPMC. She explains how the national economic climate at the time influenced the projects they took on. She talks about developing a clinical documentation improvement system that saved the institution $28 million.

Ms. Kaul talks about lessons she learned while spurring innovation at an academic medical center. She comments on leadership issues, including team building and providing incentives.

Next she discusses information technology differs from innovation, which includes product development and taking the product to market. She sketches challenges that arise during this process. Then she tells the story of developing a free app that helped helicopters find emergency locations and send EKGs to hospitals in advance of patient arrivals.

Ms. Kaul observes that it takes an organization’s entire culture, rather than individuals working separately, to create innovations.

Ms. Kaul returns to the story of the records coding software and talks about working with the UPMC health plan to develop risk assessment coding. After mentioning a few other projects she worked on, she notes that UPMC wanted to change the focus of the Innovation Center to external investments.
Chapter 08: A Commitment to Working in Healthcare –and Addressing Cancer

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

Ms. Kaul begins by noting that she began thinking about leaving her role at UPMC as the focus of the Innovation Center began to shift to investment banking. By July 2014 she had left the institution and began doing some consulting work. Through a colleague she met at a conference, she was introduced to individuals in the Texas Medical Center and was invited by Dan Fontaine to interview as the new CIO of TMC/X. She tells the story of how her focus shifted from the Medical Center to MD Anderson explicitly.

Ms. Kaul explains that she was attracted to MD Anderson because of her personal connection to cancer, the commitment that the executive leadership had to innovation, and her attraction to Houston, where she can offer a good lifestyle to her family and children.
Chapter 09: A New Role in the Department of Strategy and Innovation

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

Ms. Kaul explains the scope of her job and her strategy of learning about MD Anderson and how innovative solutions might serve it. She explains her philosophy of learning about institution culture, building relationships before introducing change, and learning why individuals find innovation threatening. She talks about her findings after several months at the institution.

Ms. Kaul assesses that MD Anderson is “way behind” the industry in developing technology and infrastructure, a situation connected to the institution’s status as a comprehensive cancer center. She goes on to explain that patients currently factor cost/care transparency into their selection of a healthcare institution.
Chapter 10: Projects and Next Steps in Building a Culture of Innovation

Rebecca Kaul MBA and Tacey A. Rosolowski PhD

Ms. Kaul sketches projects she is currently pursuing: how to use technology to expand the MD Anderson network and scale the standard of care optimizing clinical time developing a culture of innovation.

Next, Ms. Kaul gives her view of the launch of EPIC, which she says does not quality as “innovation” as she understands it. She comments on EPIC as a company.

Finally, Ms. Kaul talks about cultural values she hopes to instill at MD Anderson. She talks about a project under development that will help MD Anderson people with innovative ideas present and find support to develop their ideas.
Chapter 01: An Australian Education; Inspired by Patients and Service More than Disease

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating briefly sketches his family background and talks about the important his Catholic faith in his life and medical practice.

He traces his educational path and explains the Australian educational and scholarship system.

Dr. Keating talks about deciding to become a physician when he was in high school, recalling instances when he observed physicians at work and sorting out family dynamics and complex problems.

He next talks about his medical education in Australia. He explains the system of clinical education in Australia and how this fostered a sense of altruism among physicians which was eroded through changes to the system in the 1970s.
Chapter 02: MD Anderson in the Seventies; Developing a Focus on Hematology and Leukemia

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating recalls the culture of MD Anderson when he first joined the institution as a Fellow in 1974 and notes that Dr. R. Lee Clark set up at MD Anderson to ensure that physicians were not motivated by monetary gain.

Next, he steps back in time, and talks about his previous medical experience at Saint Vincent’s Hospital in Melbourne when he came to focus on leukemia research. He tells an anecdote about the importance of respect for the dignity of a patient. He briefly describes the conditions of the fellowship that brought him to MD Anderson in 1974, then talks about his valuable experience setting up a database at Saint Vincent’s. He talks about his shift in interest to hematological malignancies.

Dr. Keating explains his concept of translational research, likening it to “falling in love.” He describes the process of learning a different research language while working as a collaborator.

Dr. Keating talks about his research collaborator, William Plunkett, Ph.D. [interviewed for the oral history project, 2013), who taught him to think about disease.

[The recorder is paused for about 3 minutes]
Chapter 03: Looking for Research Opportunities at MD Anderson

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating begins this chapter by explaining that, in Australia at the time, chemotherapy was first being used to treat solid tumors. He explains his decision to come to the United States and the financial conditions of his fellowship.
Chapter 04: A Fellow at MD Anderson: A View of Developmental Therapeutics in the Early Seventies

Michael Keating MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Keating gives an overview of the state of research into blood malignancies in the early seventies and the exciting environment for research he discovered when he came to MD Anderson in 1974 as a fellow in the Department of Developmental Therapeutics. He then tells an anecdote about Dr. Emil J Freireich (interviewed for project, 2012), notes his charisma, then explains that he created the first “translational scenario” in the Department of Developmental Therapeutics. He explains that because there was no established treatment for most diseases at the time, the Department often used an “n of 1” study, “making it up from first principles,” an approach that was very exciting to him. He notes that the NCI controlled the direction of research at the time, as it controlled the drugs.
Chapter 05: A Faculty Associate: Research and Clinical Responsibilities

Michael Keating MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Keating explains how fellows became involved in research projects and notes that he took on leukemia research about nine months after arriving at MD Anderson, when he also became a Faculty Associate. He explains the responsibility for patients that this new status allowed, allowing for more continuity of care. He describes his fellowship as a “baptism of immersion.” He notes that he read Cancer Medicine to fill in his knowledge gaps.
Chapter 06: Investigating Remission Percentages, Expanding Research Interest in Leukemia, and Developing Databases and New Research into Blood Malignancies

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating tells the story of setting up the first large scale database at MD Anderson in the mid-seventies. He begins with his suspicion that remission results were inflated leading to a natural history study he conducted to gather actual percentages. He describes the database of nine thousand acute patients and databases compiled for chronic lymphocytic leukemia and all the acute leukemias. He describes the studies that came out of the database project.

He next explains why the medical community was resistant to believing the information they presented.

Dr. Keating then discusses Dr. Emil J Freireich’s view of randomized trials and his belief that MD Anderson should develop new concepts and leave it to other institutions to confirm these ideas. Dr. Keating describes Drs. Frei and Freireich and goes on to talk about the latter’s innovative platelet transfusions to treat childhood leukemia. He explains how Dr. Freireich came to be accused of fraud and the outcome.
Chapter 07: Faith and a Loving Family Support a High-Stress Career

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating talks about the challenges of burnout in a career where “medicine is your mistress.” He then explains how his faith helps him work with patients with CLL and his sense that he was destined to be a leukemia physician. He compares faith in everyday life in the United States and Australia. He tells a funny story about a patient shouting for Jesus’s help during a procedure.

Next Dr. Keating explains why he and his family returned to Australia in 1977−1978, then returned to MD Anderson in 1978. He describes a conversation with his sister, Maureen, who helped him make the difficult decision to leave Australia. Dr. Keating observes that he has never had a sense of not being loved, an important element of his ability to stay on his evolving career path.
Chapter 08: R. Lee Clark’s Vision and Changes in MD Anderson Culture

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating begins this chapter with a brief description of his return to MD Anderson. He then describes MD Anderson as a unique place where it was as important to study the operation of cancer in humans as in the lab. He explains that the institution’s first president, Dr. R. Lee Clark, wanted to increase cross-fertilization between physicians and researchers. He also describes Dr. Clark’s “genius” for establishing a work structure that would relieve the faculty of worry so they could concentrate on cancer. He compares that environment to the situation today, in which health care is governed by corporate entities. He notes the problems with ethics that this can breed and the loss of a sense of altruism among physicians. Looking at MD Anderson, he notes the difference between the “luxury” of the public spaces, and the problems that faculty have getting basic material to support their work. He shares that he “prays for wisdom in our executive leadership.”
Chapter 09: A History of Translational Research at MD Anderson

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating sketches the history of translational research at MD Anderson beginning with the “pioneers” Dr. Emil Frei, III and Dr. Emil J Freireich.

He begins with context: NCI support of research into the biology of cancer and the role of drugs in treatment and their impact on DNA. He explains Dr. Freireich’s understanding of cancer, what led him to study the phenomenon of hemorrhage in leukemic patients and platelet transfusion. He lists other lines of research that evolved to sketch the areas of knowledge converging at MD Anderson. He notes that he found it “stunning” to come to the institution and find people who “knew diseases back to front.”

Dr. Keating then compares translational research in these early days with today’s push toward targeted therapy focused on genetic changes in all of the cancers.

Dr. Keating next talks about MD Anderson patients and their willingness to try almost anything in the hands of experienced clinicians who are creating new knowledge. He praises the Texas State Legislature for creating the institution. He notes that MD Anderson has made an enormous impact by training physicians who carry their knowledge out into Texas and the world.
Chapter 10: Studying Fludarabine (Part I)

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating explains that he came to focus on chronic lymphocytic leukemia because of a disagreement with Dr. Deisseroth over the mission of MD Anderson. He notes that, at the time, it was impossible to eliminate CLL cells from the body and he began to examine the effectiveness of Fludarabine –the first investigator to do so.
Chapter 11: Institutional Restructuring under Charles LeMaistre and the Effect on Research

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating explains that he came to focus on chronic lymphocytic leukemia because of a disagreement with Dr. Deisseroth over the mission of MD Anderson. In this chapter, Dr. Keating next explains the administrative restructuring that took place under Dr. Charles LeMaistre, who divided the Department of Developmental Therapeutics into a number of different departments. Dr. Emil J Freireich (former head of DT) became head of Hematology, and “apostles” from Developmental Therapeutics filtered throughout MD Anderson, bringing a “try anything” attitude to other departments. Dr. Keating expresses his sadness at the loss of the Department of Developmental Therapeutics and says that the “silo-ing” effect at that time had created a special environment for collegiality and research.
Chapter 12: Research Advances with Fludarabine and Cytarabine

Michael Keating MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Keating explains how he became interested in Fludarabine, which had been tested for use with rapidly dividing cells. He explains how his studies (early eighties) with the drug worked against acute leukemia and slow-growing CLL and hairy cell leukemia, and notes toxicities, the relatively small number of patients involved in trials, and the remarkably short time frames in which results were obtained. Dr. Keating notes how much he learned from his collaborator, William Plunkett, Ph.D. (interviewed for project, 2013), particularly regarding the effects of the drug inside the cell. [[CLIP Dr. Keating tells an anecdote that illustrates in very practical terms how the clinical and basic science sides of their collaboration worked in obtaining results and creating a molecular portrait of the disease.]] Dr. Keating sketches the research questions behind his studies and briefly explains work integrating the drug Cytarabine into his trials. He notes that the research into these drugs led to a very sophisticated understanding of molecular processes, leading to a targeted therapy approach to CLL. He also lists some challenges that arose in understanding how to block enzymes and pathways, noting that concepts are continually being developed and added.

Dr. Keating then lists the milestone discoveries emerging from his work on Fludarabine, noting that the drug created remission with CLL, with twenty to thirty percent of patients manifesting complete remission. He then explains how the drug regimen was expanded to include Cyclophosphamide, resulting in a new standard of care. He explains that Dr. Plunkett demonstrated that Fludarabine prevented the DNA damage created by other drugs. He notes that he has a small percentage of patients who have survived for twenty years beyond treatment.
Chapter 13: Drug Treatments, Stem Cell Transplants, and Immunology Issues

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating then sketches the principle of combination therapy: use drugs with different mechanisms of action. He talks about Dr. William Plunkett and his contributions to these efforts and also explains that antibodies use a very different mechanism and do not damage the patient’s immune system or DNA: he explains results with the FCR regimen.

Dr. Keating next explains another feature of Fludarabine that allows its use in conjunction with stem cell transplants, preventing tissue rejection and allowing transplants to be done on elderly and fragile patients. [[CLIP Dr. Keating recalls a patient in her mid-thirties and tells a story demonstrating how grueling the transplantation process is for patients. He explains what he says to patients about the worst-case scenarios, noting that patients must be “pretty heroic” to undertake transplantation “in hopes that you win the war.”]] He then talks about the financial burden that transplants (six to seven hundred thousand dollars at MD Anderson) and cancer place on patients and how he suggests that some patients go to Israel for transplants. He compares insurance coverage in different nations.
Chapter 14: Viruses, Genetics, Designer Drugs, and other Advances

Michael Keating MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Keating talks about discoveries about viral control of cancer and work that shows how genes control enzymes, leading to development of designer drugs to turn off enzymes. Other studies explore how to expand the patient’s immune system. Dr. Keating says he discovered that second cancers are driven by viruses, and he developed a program that takes a patient’s cells, modifies them, then returns them to the patient. He talks about an unusual collaboration with Baylor College of Medicine, where researchers are developing virus-specific immune cells that may target CLL cells lingering after other treatments.

Next, Dr. Keating sketches his other research studies with Rituximab, Lenalomide [Revlimid®], an inhibitor that work on B-cell signaling pathways. He explains how the latter are involved in pathways that can kill CLL cells. He also talks about drugs that interfere with “survival proteins” that keep CLL cells alive. [ [CLIP These are the “new building blocks” in treatment, he says. He anticipates doubling the cure fraction in the next few years and notes how quickly patients respond, with their faces shining like a healthy person’s (in comparison with the sickly appearance of chemotherapy patients). Dr. Keating notes that patients who receive targeted therapy feel sorry for chemo patients with acute leukemia.]

Dr. Keating notes that in the future he wants to write a book on CLL and plans to hand his practice over to his daughter, Dr. Anna Franklin. He expresses his pleasure that his children are happy in their work.
Chapter 15: Leading Initiatives to Improve Research Quality

Michael Keating MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Keating discusses his roles as Associate VP for Clinical Investigations (1990−1995). He begins the chapter noting the lack of formal administrative structure in the Department of Developmental Therapeutics, where there were no real heads for the different types of solid cancers: once the Department was dissolved, Dr. Keating headed the leukemia family.

Next, Dr. Keating describes his work as Associate VP for Clinical Investigations, which involved examining protocols from all departments in the institution. He looked at the quality of research, the treatment of patients, and how each project fit in with the mission of the institution, setting up committees to improve research and guarantee patient safety. Dr. Keating explains why he accepted this role, sketching in the process a difficulty that Dr. J Freireich had with a clinical trial and the administration’s lack of support for the research project. Dr. Keating expresses his believe that “bureaucracy kills.” He sketches recent changes at MD Anderson that have increased bureaucracy and elevated the cost of running clinical trials.

Next, Dr. Keating talks about his passion for improving the quality of research and lists the areas in which he feels he had the biggest impact during his role in Clinical Investigations. He talks about the high cost of running clinical trials because of the price of drugs.
Chapter 16: Associate Head for Clinical Research in Leukemia; The Global Research Foundation

Michael Keating MD and Tacey A. Rosolowski PhD

Dr. Keating begins this chapter by explaining that he left his role with Clinical Investigations because the Leukemia group needed more leadership and he disagreed with the new emphasis Dr. David Hone was placing on randomized trials. He wanted a more inventive way of doing things and accepted the role of Associate Head for Clinical Research in Leukemia (1995−1999). He sketches his leadership principles of allowing individuals free rein and lists the areas in which he had an impact of research, providing a “more free-flowing environment” for research innovation. Dr. Keating expresses his dissatisfaction with following rules: he tells a story about a patient running into difficulties with getting information about clinical trials and notes that it demonstrates how excessive adherence to rules “betrays the intelligence of the institution.”

Dr. Keating next discusses how he set up the CLL Group, hiring Susan Lerner as research coordinator. He explains how effective she was at creating a humane work environment. He then goes talks about a group he founded about a decade ago, The CLL Global Research Foundation, which awards about three million dollars yearly in research grants. He explains that the money comes from former patients and that he is a “schmoozer” who offers a good product. He describes the unusual environment of transparency at the bi-annual meetings when the researchers share their research and results.
Chapter 17: Changes in MD Anderson Culture with a New Administration

Michael Keating MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Keating offers his views on how MD Anderson has changed since Dr. Ronald DePinho took over as the institution’s fourth president in 2011.

He begins by talking about the CLL Moon Shots Program, noting that it has become increasingly evaluated by individuals with little experience with clinical research and who are primarily concerned with generating income. Dr. Keating states that MD Anderson finds itself at a crossroads following the transfer of leadership to Dr. DePinho. To set context for his evaluation, he first speaks about the institution as Dr. R. Lee Clark, MD set it up and changes that come when Dr. Charles LeMaistre (interviewed for the oral history project) and Dr. John Mendelson (interviewed for the oral history project) were each installed as presidents. Under Dr. Mendelsohn, he states, the institution became very legalistic and self-protective, and a corporate mentality evolved. He tells a story related to the donation of funds by T. Boone Pickens, who gave funds to be matched: Dr. Keating states that Dr. Mendelsohn drew the matching funds from the Physicians Referral Service. He talks about the purpose of the PRS. Next, he talks about the growth of institution bureaucracy and compares it to Memorial Sloan-Kettering Cancer Center.

Next, Dr. Keating talks about the shift in perspective on research, stating that Dr. DePinho stresses science over clinical perspectives. He also mentions an ongoing controversy of awarding tenure.

Dr. Keating then evaluates the progress of the Moon Shots Program, noting that the expectation for success was too high at the outset. He provides an example from the Lung Cancer Moon Shot to illustrate. He recalls his first impressions on meeting Dr. DePinho during his interview process.
Chapter 18: Retirement Plans and a View of “The Crown Jewel” of the Texas Medical Center

Michael Keating MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Keating then talks about his intention to retire with a twenty percent appointment, as this will enable him to avoid coping with the institution’s bureaucracy but expresses his optimism that the institution will survive. He praises the support staff and states that people at the institution are driven to maintain MD Anderson as the “crown jewel” of the University of Texas.
Chapter 1: MD Anderson Culture and Faculty

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins this chapter by explaining that she came to MD Anderson from the NCI in the early eighties because she was interested in running clinical trials with children diagnosed with osteosarcoma and was unable to do so at the NCI. She recalls her colleagues’ reactions when she said she was going to Texas and notes that despite the growth of MD Anderson’s reputation, there is a lingering perception that the institution is not as good as those in the East and in California. She tells an anecdote that indicates the perception that “we’re yokels.” She notes that MD Anderson never aspired to have the same structure as an academic institution because of the strong focus on cancer and translational research. “We don’t want to be a Harvard, a Yale, a Stanford.”
Chapter 2: MD Anderson Culture and Faculty: In Transition with a New Administration

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman offers observations on how the culture of MD Anderson has been changing since the arrival of MD Anderson’s fourth president, Dr. Ronald DePinho. She sets context by describing the impact of a change instituted by Dr. John Mendelsohn, M.D. [Oral History Interview]: requiring faculty to derive 30% of their salaries from grants, with this rising under the new administration.

She discusses concerns that the institution is no longer distributing value equally between basic science research, clinical research, teaching and mentoring. She also fears the loss of a “special atmosphere” of collaboration and collegiality as well as innovation that the older system fostered. She demonstrates the support for innovation using her own innovative study of immune-therapy in children, an atmosphere that allowed her to conduct research impossible at the NCI.

Dr. Kleinerman next explains that today the institution is more rigid and rule-governed, with a strong focus on genomics.
Chapter 3: Focused on Medicine; Navigating Institutions without Mentors

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman traces her educational path up to medical school.

Dr. Kleinerman begins by sketching her family background and notes her father’s role as her first mentor. She describes experiences that inspired her to be a physician-researcher from the age of five.

She next sketches her path to Washington University (St. Louis, Missouri, BA 1971, Biology). She describes instances of gender bias that left her without a mentor to help her navigate the college environment. She notes that she became accustomed to not being taken seriously and credits her mother with providing her with determination. She also sets her experience in the context of the cultural environment of the 1960s. Dr. Kleinerman notes that she married Leonard Zwelling, MD (while in medical school) in 1972, describing the assumption on the part of colleagues that she would then become less serious about her career.
Chapter 4: Medical School, A Fellowship, and A First Research Project

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman traces her path to medical school and into her clinical fellowship (1974−1975 Clinical Fellowship, Rheumatology, Duke University).

She first explains the process of getting into medical school at Duke University, Durham, North Carolina (MD 1974). She describes the curriculum and notes that the small number of women. She explains her view of different specialties and her selection of pediatrics. She recalls instances of gender bias encountered, then describes how she met Dr.Ralph Snyderman, who was instrumental in introducing her to immunology and setting up her collaboration on a research project conducted during her clinical fellowship in the rheumatology laboratory.She then talks about how her research results were controversial. She concludes with additional memories of gender bias.
Chapter 5: Bringing Clinical and Laboratory Experience Together and Identifying a Research Focus

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman notes that her fellowship in clinical research had enabled her to secure national recognition. She then spent three years focusing on clinical practice at Children’s Hospital National Medical Center in Washington, DC. She explains how this helped her later research career when it came to identifying treatment for patients. She also describes going to see the film, “Promises in the Dark,” an experience that influenced her decision to focus on oncology.

Dr. Kleinerman then explains how she took a position as a Clinical Associate in the Metabolism Branch of the NCI Bethesda (1978−1981), where she met Isaiah Fidler, DVM, PhD [Oral History Interview], who was working on immune therapy for lung metastasis, research she felt could work for osteosarcoma. Dr. Fidler would become her mentor.
Chapter 6: Leaving the NCI for Research at MD Anderson

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins with stories to demonstrate that she was not taken seriously as a researcher at the NCI. She explains that when Dr. Fidler left the NCI for MD Anderson, he brought her with him. She recalls interactions with Norman Jaffe, MD (Oral History Interview), and notes that she never had to prove herself with him. She also notes that she was the first person to do clinical research in pediatrics.

Dr. Kleinerman next describes the climate for women in the institution when she arrived in 1984.

[The recorder is paused for 2 minutes.]

Dr. Kleinerman notes the absence of women leaders at MD Anderson. She then talks about the benefits of living in Houston. She tells stories to demonstrate the support she had as a working mother and the welcoming attitude of the Jewish community in Houston.
Chapter 10: A Pioneering Attitude at MD Anderson: The Nature of Translational Research and The Physician-Scientist --a ‘Dying Breed’

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins by explaining that she looked at problems differently because of her basic sciences background. She then explains her view that physician-scientists are a dying breed, and goes on to explain her definition of translational research and important a physician’s perspective is to it.

Picking up a thread of the discussion about MD Anderson culture in Session I, she explains that closing clinicians out of research is a “national tragedy” created by the decreases in money available for funding. She observes that before Dr. Ronald DePinho assumed the presidency of MD Anderson, the institution held the attitude that it was unique and did not want to rely on external systems to validate the research conducted within the institution.
Chapter 11: A Successful Phase III Trial and European Approval, But No FDA Approval for MEPACT

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Kleinerman brings the MEPACT story to a close.

She first describes how the Pediatric Oncology Groups of the NCI first had a very negative reaction to the results of the Phase II trial, then explains why this turned around. Dr. Kleinerman worked with collaborators to design a Phase III trial. She describes practical and political complexities that resulted in the FDA not approving MEPACT, despite its efficacy.

Dr. Kleinerman next explains the process that won approval for MEPACT from the European Medical Association, where her work defined has become standard of care in the United Kingdom.

Dr. Kleinerman discusses FDA approval processes.

In the final moments of this Chapter, Dr. Kleinerman talks about the impact that clinical trials can have on faculty careers, when it takes years to achieve results.
Chapter 7: An Introduction to MEPACT and a New Research Collaborator for Study of Osteosarcoma Treatment

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman speaks in detail about her pioneering work on the immunotherapy agent, liposomal muramyl tripeptide–MTPE.

She describes the drug and the mechanisms of its interaction with macrophages, as well as the technique she used to sheath the drug in lipids that would result in attacks on cancer cells. She sketches Dr. Isaiah Joshua Fidler’s [Oral History Interview] work on this agent in mice and describes her “Eureka moment” in understanding the implication of his results for osteosarcoma. She also talks about her first interaction with Dr. Fidler, whose reaction to her idea was “Let’s collaborate.” She explains why she was a good partner for him in translational research.

Next Dr. Kleinerman explains why the NCI was resistant at the time to running clinical trials on children. Sketches her own experience with osteosarcoma and how she discovered that the disease, though rare, is a big problem.
Chapter 8: Putting the Pieces in Place to do a Phase I Trial with MEPACT

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins the MEPACT story by discussing her growing collaboration with Dr. Fidler.

She explains the preliminary work required before running a human trial involving the immunotherapy agent, MEPACT. She talks about partnering with Ciba Geigy.

Next, Dr. Kleinerman explains how an individual at the NCI blocked her attempts to develop a trial, noting possible gender bias, followed by Dr. Fidler’s invitation for her to come with him to MD Anderson.

Dr. Kleinerman explains her strategy of constructing “the ultimate clinical protocol.” She describes the ethical issues that arose and research challenges in determining the Optimal Biological Dose (OBD). She notes that she and Dr. Fidler were the first to design a study around this concept and that they have not been adequately recognized for this contribution. She notes that they also ran studies to demonstrate that human patients could respond to the drug.

Next Dr. Kleinerman notes that in 1986 with support of colleagues at MD Anderson. She describes the results and some surprising discoveries.
Chapter 9: Designing a Phase II Trial for MEPACT, and the Characteristics of Translational Research

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Kleinerman tells the next part of the MEPACT story: designing a Phase II trial. She sketches the practical elements of submitting a proposal and notes ways in which it was innovative.

Dr. Kleinerman explains how she designed the Phase II trial and the unusual parameters she set for selection patients. “I was one of the cowboys at MD Anderson.” Dr. Kleinerman explains that MD Anderson had a culture of using pioneering approaches to treat cancer.

Dr. Kleinerman describes the protocol and some surprising initial results that came from the Phase II trial and demonstrated the effectiveness of MEPACT on pulmonary metastases.
Chapter12: Innovative Aerosol Therapy for Bone Metastasis to the Lung and an Overview of Translational Research

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Kleinerman describes her work on a novel aerosol therapy for bone metastasis to the lung, weaving in explanations of biological and genetic processes as well as overviews of work in the field.

She explains that her research approach begins with understanding the disease and then she looks for novel alternatives to chemotherapy. She outlines the science involved in this study then sketches the phases of research she developed.

Dr. Kleinerman summarizes how she took basic science and clinical knowledge to development treatment, then gives an overview of her philosophy of translational research and the evolution of this kind of work at MD Anderson.

At the end of this chapter, Dr. Kleinerman talks about the advantages of aerosol therapy for patients.
Chapter 13: Mesenchymal Stem Cell Treatment for Ewing’s Sarcoma; Harnessing Autophagy to Reduce Tumors

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Kleinerman talks about her interest in the rare cancer, Ewing’s sarcoma. She first sketches the research questions she poses, based on the tumor’s reliance on blood vessels. She sketches how she focused on mesenchymal stem cells and a pathway to block to successfully prevent angiogenesis, turning this cancer into a chronic disease. Dr. Kleinerman notes some challenges to doing clinical trials, then comments on her approaches to clinical problems and the importance of funding for basic research.

Next Dr. Kleinerman talk about a new area of research she has undertaken harnessing the process of autophagy.
Chapter 14: Challenges to the Division of Pediatrics

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Kleinerman talks about her activities as Head of the Division of Pediatrics.

She explains how she came to be Division Head in 2001. She sketches the history of pediatric care at MD Anderson. She says that when she arrived at MD Anderson in 1984, it was challenging to care for pediatric patients in an adult facility. Dr. Kleinerman provides an overview of what is needed for pediatric care.

Next, Dr. Kleinerman talks about measures she first took as Division Head: holding a strategic planning retreat, developing a vision, hiring critical care staff. She talks about the process of gaining the trust of the faculty, then goes into more detail about the retreat and her strategies for developing the strength of the faculty. She gives an example of shifting the responsibilities of a faculty member who was suffering from burnout, enabling him to perform more effectively. She also notes that, with the new administrative (and billing) structures in place, it is not possible to use such creative approaches to problems
Chapter 15: The MD Anderson Children’s Cancer Hospital; Creating a Successful Training Program

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins this chapter by discussing her working relationship with Dr. John Mendelsohn, MD [Oral History Interview], who supported her efforts to develop pediatric care. She notes that Dr. Mendelsohn formed an Advance Team composed of Board of Visitors members to advise Dr. Kleinerman on strategy to develop Pediatrics. Their main advice: “You need a separate name,” and in 2005 Pediatrics received their designation of the Children’s Cancer Hospital. She describes initiatives arising from this.

Next, Dr. Kleinerman explains that at the same time, she was building the faculty. She acknowledges that faculty were leaving because of conflict with her new focus on innovative research and research productivity. She notes that she recruited about 75% of the current faculty and describes the active networking required to identify good candidates.

Dr. Kleinerman next sketches her vision for the future of the Division then talks in more detail about the successful Fellowship program that she initiated twelve years ago.
Chapter 16: Developing the Division of Pediatrics

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman discusses the growth of the Division of Pediatrics and the need to further develop services for adolescents and young adults.

She explains the business plan she developed at Dr. David Callender’s request when she assumed leadership of the Division.

Next she discusses the design of the Children’s Cancer Hospital opened in 2013 and the four advisory councils created to help guide the design and staffing.

Next, Dr. Kleinerman explains the need to develop services for adolescents and young adults (particularly in the area of fertility counseling) and explains why pediatrics is attuned to the special needs of patients. She talks about a failed attempt to open a special lounge area for this group.
Chapter 17: Plans to Develop The Division of Pediatrics

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman talks about several areas she is working on to build the Division.

She notes challenges in developing research areas. She explains difficulties in enrolling children in Phase I clinical trials and the need to develop the Survivorship Program. Dr. Kleinerman then talks about her desire to have an impact on Supportive Care.

Next Dr. Kleinerman talks about the Family Advisory Council and gives specific examples of how the Council provides guidance as programs and units are developed. She observes that the Division of Pediatrics is attempting to preserve a primary care model of care delivery while also working for more efficiency. She notes the influence of institutional silos on survivorship and family-centered care issues.

Next Dr. Kleinerman talks about the need to develop translational research on cell therapy and transplantation. At the end of this Chapter, Dr. Kleinerman comments on lessons about leadership she has learned.
Chapter 18: Women at MD Anderson and Becoming a Leader

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins this chapter by talking about the respective responsibilities of mentors and mentees. She tells a story about a regular dinner support-group of women faculty. Dr. Kleinerman describes the different ways that male and female faculty members approach her for mentoring.

Next, she talks about efforts to develop the visibility of women at MD Anderson around the time when she arrived. She describes issues she wanted to push forward: a day care center and a four-day work week option. She observes that the community of woman at MD Anderson has become stronger, but otherwise there is no movement to change the culture for women at the upper levels of the institution.

Dr. Kleinerman next sketches what women bring to leadership. She quotes Dr. Isaiah “Josh” Filder [Oral History Interview] who says that it will take men recognizing the situation to change it.
Chapter 19: Leadership, Leaders, and Concerns For MD Anderson

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins this chapter by talking about how her view of her self as a leader has evolved through lessons learned. She talks about how she identifies and develops potential leaders. She also cites wisdom she has learned: “You have to be ready to bask in reflected glory,” and offers the view that president of the institution, Ronald DePinho, MD, is a “negative example” of that kind of leadership. Next Dr. Kleinerman talks about changes in MD Anderson culture under Dr. DePinho’s leadership and expresses concerns that “we are losing a lot of our soul.” Dr. Kleinerman then offers perspectives on Dr. Charles A. LeMaistre [Oral History Interview] and Dr. John Mendelsohn [Oral History Interview].
Chapter 20: Privileged to Work at MD Anderson; An Active Life and Family

Eugenie S. Kleinerman MD and Tacey A. Rosolowski PhD

Dr. Kleinerman begins by talking about the “privilege” she feels to work at MD Anderson. Next she lists the initiatives she would like to be remembered for. She then talks about her family life and active personal life.
Chapter 01: Attempt to Join the Navy Leads to Medical School

Albert G. Knudson, Jr. MD, PhD and Tacey A. Rosolowski PhD

Education: Dr. Knudson discusses his switch from physics to genetics in his second year at the California Institute of Technology. He humorously notes that he made the change because "they already knew everything" in the field of physics. He mentions that Thomas Hunt Morgan, a pioneer in genetic research, was the head of the Biology department at Cal Tech at the time.

Military Experience: Dr. Knudson then explains that at the start of World War II, Cal Tech encouraged its students to join the military, so he enlisted in the navy. However, a person in the navy encouraged Dr. Knudson to go to medical school instead because they "didn't need PhDs in the military." He took their advice and went to Columbia Medical School. Dr. Knudson says that he enjoyed the first two years more than the second because they were based on problem solving rather than memorization.

Mentoring: In the last moments of the chapter, Dr. Knudson provides some advice to young people on how to approach unexpected events in life.

Search

Browse

Contribute to OpenWorks