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  Chapter 01: A Medical Family

  Mary Catherine McGready and Tacey A. Rosolowski PhD

  In this chapter, Mrs. McGready sketches her family background and the tradition in her family of working in the medical profession. Her father was a pharmacist and three of her four brothers became physicians. Mrs. McGready shares memories of working in her father’s pharmacy, of segregation in Texas in the early part of the 20th century, and her father’s commitment to racial equality.

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  Chapter 02: Becoming a Medical Librarian

  Mary Catherine McGready and Tacey A. Rosolowski PhD

  Mrs. McGready recounts how her brother helped her get into medical archiving by introducing her to Miss Elizabeth Runge at the University of Texas Medical Branch archives. She talks about the conflict with her parents over wanting to leave her studies at North Texas College to take a position as a medical librarian at UTMB. Daughter Cathy Bacon mentions a story about exposure to library work in Waco, during college. Mrs. McGready tells an anecdote about the "scholarship she gave to herself." She talks about her parents attitudes toward education.
  

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  Chapter 03: Working as the First Medical Librarian at MD Anderson

  Mary Catherine McGready and Tacey A. Rosolowski PhD

  Mrs. McGready explains (with the help of daughter Cathy Bacon) how she came to the attention of Dr. Ernst Bertner, who was establishing the new MD Anderson. She shares memories of the young institution and a much smaller Houston, Texas. She explains some of her duties, including compiling the library and collecting duplicate books from the Medical School in Galveston and having them bound for the MD Anderson library. She shares a few memories of working at the Baker Estate.

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  Chapter 04: An Opportunity to Work at the New Cancer Hospital, MD Anderson

  Mary Catherine McGready and Tacey A. Rosolowski PhD

  Mrs. McGready sketches how she was working as a medical librarian at University of Texas Medical Branch when she was offered an opportunity to work at MD Anderson. MD Anderson had just come in to Houston, housed in Baker Estate. Dr. Bertner, in charge, everything comes through him. Repeat of story of MD Anderson’s one car, a Ford station wagon.

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  Chapter 05: One of Five Employees at the New MD Anderson

  Mary Catherine McGready and Tacey A. Rosolowski PhD

  Mrs. McGready notes that she was one of the first five employees at MD Anderson, and she shares memories of the others: Dr. Coogle, John Musgrove, Zuma Krum, and Florence Hanselman. She recounts that the MD Anderson library was housed in the dining room of the Baker Estate. She talks about the first set of books acquired, a series of medical texts by Rudolf Virchow, the basis of medicine. Mrs. McGready tells several stories that illustrate the social environment among the first employees of MD Anderson. She tells the story of getting her driver’s license so she could drive the MD Anderson Ford station wagon to downtown Houston so Dr. Bertner could sign papers.

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  Chapter 06: Working for Dr. Bertner and the New MD Anderson

  Mary Catherine McGready and Tacey A. Rosolowski PhD

  Mrs. McGready recalls taking papers down to Dr. Ernst Bertner's "private physicians'" office in the Second National Bank Building on Main Street in downtown Houston. She notes that she was with MD Anderson for nine months, until her fiancé was finished w medical school. She was asked to stay on, but made it clear she was "not a career person" and wanted to leave to be married.

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  Chapter 07: A Fun Job, But Choosing to Focus on Family

  Mary Catherine McGready and Tacey A. Rosolowski PhD

  Mrs. McGready acknowledges that she didn't realize how special her position was at the time, working for a brand new cancer institute. She saw the job as really fun, and she worked with people she liked. She shares stories of their pleasant interactions. She next talks about attitudes toward cancer at the time and reflects on advances that have been made. She expresses satisfaction with her choice to marry and have a family. She sketches what her children are doing now. At the end of the interview, Mrs. McGready says, "I've just always been very proud of the fact that I did see the nucleus of it. And then when I went back and saw the Virchows all in this air-conditioned room, that was impressive. I positioned them. Well, I felt very, very lucky to have been in it at that stage."

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  Chapter 01: An Education Designed to Keep Options Open

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills begins this chapter by sketching his blue-collar roots and noting that he was the first person in his family to graduate from college. He talks about his early interest in science, setting it in the context of broader interests. He explains that his aim in college (1975, Bachelors of Medical Science, University of Alberta, Edmonton, Canada) was to "keep as many options open as possible," which he accomplished by majoring in biochemistry and minoring in political science. He notes how this sensibility of preserving breadth influences his current strategy of recruiting broadly so the department "gains by integrating across areas."

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  Chapter 02: Medical School with a Path to Research and Team Science

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills discusses the Canadian system in which he received his Bachelors of Medical Science in 1975 at the University of Alberta (Edmonton, Canada), leading to his MD in 1977. He also explains how he approached medical training with the intent of going into research: medical training gave him the breadth he needed for research by providing an understanding of how the body worked; he decided to specialize in obstetrics and gynecology because the question of why the mother's body does not reject a fetus is an analogue to the question of why a host does not reject a tumor. Dr. Mills also explains that he wanted to go into research in order to have a greater impact on patients. He notes that medical school at that time was very clinically focused and that he felt some tension with other students and faculty with that mindset.
  

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  Chapter 03: Developing a Researcher's Approach; Observations on the Current Job Market and Team Science

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills sketches his next phase of professional training, beginning with his fellowship at Flinders Medical Center (Adelaide, Australia, 1/1976-1/1978), where he focused on immunology and beta-cell immune responses and worked with Warren Jones. He also notes that he experienced a very different "and positive"approach to professional training that he has tried to emulate. He compares the Canadian and Australian healthcare systems.
  
  Next, Dr. Mills talks about his work at the Toronto Hospital for Sick Children (Research Fellow, Division of Immunology, The Hospital for Sick Children, Toronto, Canada, E. Gelfand, 1/1982-1/1985). This program, he explains, solidified the conceptual and administrative framework he now uses to approach research and also his attitudes toward mentoring. Dr. Mills explains some difficulties in replicating the situation at Toronto Hospital at MD Anderson. He notes that "science needs to come from the bottom up, not the top down."

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  Chapter 04: The Challenging Job Market for Researchers and for Team Scientists

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills says that one of the most exciting things about being a department chair is having a hand in helping trainees mature. Here he reflects on several issues. He begins by observing that it is "painful" that there are so few jobs for talented scientists and explain what the challenges are, including how the focus on team science has created obstacles for individual scientists.

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  Chapter 05: From Immunology to Targeted Therapy; More Observations about Team Science; Research on Interleukin-2 About 16 minutes

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills talks about the evolution of his work once he took a position in the Department of Immunology (Hospital for Sick Children University of Toronto, Toronto, Canada, 1/1982- 1/1985) where he shifted his perspective from immunology to signal transduction as a therapeutic target. He describes his promotion track leading to his final role as Director of the Department of Oncology, Oncology Research (1/1990-1/1994). He talks about his relationship with Lou Siminovitch with whom he would discuss management and team building issues. He talks about team science in the biological sciences in the early nineties, explains that the system of allocating grant money influences how science took shape, and gives a definition of translational research.
  
  Next, Dr. Mills talks about research he conducted "at the interface between breast and ovarian cancer." He talks about studies he conducted during his PhD program looking at how IL-2 could regulate leukocytes, leading to clinical trials targeting pathways regulating a novel growth factor.

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  Chapter 06: Recruited to MD Anderson; A History of Translational Research at MD Anderson

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills first tells how he was recruited to MD Anderson by Robert Bast, MD, VP of Translational Research, to set up "the best ovarian research center." He explains why he left Toronto Hospital and cites the fact that "no other institution has more potential to make a difference."
  
  Next, Dr. Mills sketches the history of translational research at MD Anderson. He begins with the 1970s, noting that the patient driven clinical research at that time was "not real team science." He talks about the context for research under Charles LeMaistre and the VP of Research, Frederick Becker [oral history interview] and the vestiges of their approach still lingering. He explains that the institution has now embraced the concept that research is a driver in patient outcomes. Dr. Mills explains that leaders need to function as change agents and set in place processes that allow the success of research. He then compares the approach of John Mendelsohn, who allowed institutional change to be driven from the bottom up, with Ronald DePinho, who has taken the opposite approach as he framed the question, Is research progress an engineering and implementation question or do we lack the basic research to make progress at this time.

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  Chapter 07: Major Roles Building Translational Research

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills begins sketching his approach to rebuilding the Department of Systems Biology. He discusses problems that departments have when they are built around "a cult of personality." Next he talks about his work as Deputy Head of the Division of Research, tasked with building and improving translational research across the institution.
  

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  Chapter 08: Department Names Reflect Shifts in an Institution and in Cancer

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mill's discusses the organization of departments and connects the naming of departments to shifts in cancer medicine. He begins by explaining that Dr. Robert Bast recruited him to MD Anderson by asking the question, Would you like to build the preeminent ovarian cancer center in the world? Permission was secured from the Regents in 1994/1995 to create the Department of Molecular Oncology: Dr. Mills explains why this name was selected then talks about why the name was changed to Molecular Therapeutics after Dr. Mien Chie Hung [oral history interview] was recruited.
  
  Next, Dr. Mills explains why so many department names include the word "molecular" and discusses why the molecular focus was tied to a "great convergence" of technological advances and exploration of DNA and RNA.
  

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  Chapter 09: The World's First Cancer-Directed Department of Systems Biology Emerges from a Shift in Approach to Cancer

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills begins this chapter by explaining that as cancer research evolved in the nineties, it became clear that the usual "reductionist" approach to studying molecules was insufficient and he and others decided to found what turned out to be the world's first cancer-directed Department of Cancer Systems Biology. Dr. Mills explains the shifted mindset reflected in this department and its research.

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  Chapter 10: A Controversial Department Evolves: On Recruitment, Flexibility, and the Value of Failure

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills first lists the faculty he recruited to develop a breadth of perspectives in the Department of Systems Biology.
  
  Next, he sketches the research "precept" at work in the Department: when a researcher builds a model, its failure to work can be as revealing as a model that does work. He gives an example of a model built for the pi3 kinase pathway. Dr. Mills then follows up with an anecdote about the most challenging lecture he ever had to give: a lecture on the theme of failure at Rice University in which he stressed, If we do not fail, we are not doing work that is high-risk. He talks about the conservatism of current funding agencies. He then talks about how founding a Department of Systems Biology was risky and controversial, but notes that over the past ten years acceptance has grown and that the Department's approaches are well accepted now, with many collaborative relationships outside the department. He talks about his own role as a representative of the Department.

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  Chapter 11: The Cancer Genome Atlas and the Positive Side of Serving as Department Chair

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills discusses the Department's work on the Cancer Genome Atlas, leading to over one hundred papers. He talks about what has been accomplished and comments on the satisfaction he derives from mentoring and developing junior faculty.

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  Chapter 12: The Kleberg Center for Molecular Markers

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills begins this chapter on the creation of the Kleberg Institute for Molecular Markers by commenting that, as an administrator, he has been repeatedly asked to develop an area and then step away. His ability in this area gave MD Anderson leadership confidence in him and he was asked to develop a proposal for the Kleberg Foundation for a Kleberg Center for Molecular Markers. He talks about the sources of funding at MD Anderson, noting that the Kleberg Foundation's philanthropy funded the Kleberg Center (which was the basis for the Institute for Personalized Cancer Therapy). He describes a major Center initiative of characterizing ten thousand tumors (information that fed the Cancer Genome Atlas), now expanded to include 20 thousand patients. He describes the technology used for this project, developed from an idea he encountered in a lecture. He notes, We have incredible power to leverage what we are doing.
  
  Next, Dr. Mills talks about how the focus of the Kleberg Center has shifted slightly after the founding of the Institute for Personalized Cancer Therapy, concentrating on discovery and on rare cancers, such as mall cell ovarian cancer.
  
  Next, Dr. Mills talks about the intellectual context for this new focus and describes the knowledge that can be generated from the study of rare cancers, giving examples of studies that have led to clinical trials of new drugs. He talks about using models to rationally select drug combinations.

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  Chapter 13: The Zayed Institute for Personalized Cancer Therapy, Part I

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills begins the story of his role in managing the The Zayed Institute for Personalized Cancer Therapy in 2006/2007. He notes that he was first asked to manage the Institute with pilot funding. He talks about the first efforts to hire an Institute director leading to the decision that he and John Mendelsohn would serve as co-directors.
  
  Next, he talks about developing a plan for the Institute's growth, relying on significant philanthropic support. [the recorder is paused]

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  Chapter 14: On Leadership, Leading, and Dealing with Kids

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills begins this chapter by telling the story of a pot he has on his office bookshelf that carries the title, "Ashes of Problem Employees." He says that a senior administrator needs to inspire a little fear in order to lead effectively, telling the story of serving in the Endowed Positions Committee to demonstrate.
  

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  Chapter 15: The Zayed Institute for Personalized Cancer Therapy, Part II

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills returns to the story of the Zayed Institute in this chapter. He begins by talking about the new Zayed Building, designed to facilitate collaborations.
  

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  Chapter 16: Creating Support for Team Science: The Challenges and Possible Solutions

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills first observes that one of his major contributions to MD Anderson and to the field has been to facilitate the research of other people. He then shifts to a discussion of the issues arising from the increasing focus on and need for team science strategies to adequately leverage the potential of current science and technology. In particular, he notes the challenge of adequately acknowledging the contributions of multiple researchers when the reward system is designed for individual investigators. He also mentions the challenge of building a career in a team science context and notes that the current model of the physician-scientist is not sustainable, nor is the current model for training individual investigators.
  
  Next, Dr. Mills sketches the sources of resistance to changing the research culture to one more supportive of team science. He tells an anecdote to demonstrate how culture works in favor of individual investigators and he notes some personality qualities that team scientists share.

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  Chapter 17: The Challenges of Big Data; Developing "Clinical Trial Grade" Data to Foster Data Use

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills talks about some of the practical and intellectual challenges that big data poses for research. He begins by explaining that it is a big challenge to create mechanisms and funding to simply sharing massive quantities of data (most generated from patient samples). He notes the costs of not sharing data. Dr. Mills states that this amount of information "has unbelievable promise," but it has to be linked to new strategies of collecting data in clinical trials and shared in "curated" formats in order to be meaningful. He defines the concept of "clinical trial grade" to define trials specifically designed to leverage their data. Dr. Mills also talks about the energy wasted in repeating work, giving the example of research studies that require documentation of cell lines whose pedigree is already proven. He talks about the idea of "curating" data
  
  Next, Dr. Mills gives specific examples of strategies for data collection and use. He talks about his own research group's activities developing their own cell lines with a known pedigree. He then talks about the institution-wide effort to sequence patient tumors and discusses what is involved in putting this information into a usable format, noting that MD Anderson currently has a program in place to accomplish this.
  

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  Chapter 18: Educating, Hiring and Retaining Team Scientists: A Challenging Time

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills continues his discussion of how a team scientist must be trained differently from the traditional individual researcher. He lists some challenges to creating a culture of team science. He also explains that currently there are more molecular biologists for the number of positions available, a situation that has evolved over the past five years. In addition, financial challenges have gotten in the way of fostering a strong team science culture. He tells some anecdotes that demonstrate the situation.

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  Chapter 19: About the Moon Shots: Philosophy, Timelines, and Challenges

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills sketches Dr. Ronald DePinho's Moon Shots program. He explains that he embraces the philosophy of identifying where the obstacle to improving an outcome lies and then devoting resources to address that specific problem point. He develops the analogy between John F. Kennedy's Moon Shot program and Ronald DePinho's. He explains program implementation challenges, such as the fact that when one builds a new facility, "nothing happens for four to five years." He explains how this natural timeline created some problems, since the technological platforms were not completely ready when the research teams needed them.

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  Chapter 20: The "Unholy Triad Moon Shot" and the Women's Cancer Moon Shots

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  Dr. Mills begins this chapter by explaining the intellectual foundation for the "Unholy Triad Moon Shot" he currently heads. This discussion also provides a snapshot of the organic process by which a new research area takes shape. First he lists the three "untarget-able mutations" included in the "unholy triad" --p53, Ras oncogene, and amplification of Myc. He explains that the executive leadership suggested combining the examination of all three of these mutations in a single Moon Shot. (He notes that the investigation of them will have relevance for all the Moon Shots.)

  
  
  Next, Dr. Mills talks about the organization and aims of the Ovarian Cancer and Breast Moon Shots, originally included in one single, Women's Cancer Moon Shot. He tells the story of the evolution of these Moon Shots that address cancers in which inherited abnormalities of BRCA 1 and 2 play significant roles. He explains the process by which the diseases were separated into distinct initiatives.

  Dr. Mills next talks about how the approach taken in these Moon Shots has intrigued many observers. He gives the example of Astra Zeneca, a company which has agreed to supply drugs and funds for clinical trials in order to study how the drugs work. He sketches the importance of this kind of partnership and mentions that another company stepped forward to supply technology.

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  Chapter 21: The Moon Shots at a National Level

  Gordon B. Mills MD, PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Mills discusses the national Moon Shots initiative organized by Joe Biden in (starting May 2015) under instructions from President Barack Obama. He explains the pilot study conducted, notes the bi-partisan support shown for the initiative to date, and explains MD Anderson's interest in taking part.

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  Chapter 01: The Origin of MD Anderson Land in Research Park, Smithville and Bastrop

  James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD

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  Chapter 02: Working with MDACC President Dr. Lee Clark on Research Science Park, Bastrop

  James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD

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  Chapter 03: Approval and Funding for MDACC Research Science Park

  James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD

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  Chapter 04: Approval for a Laboratory Facility; Naming the Facility; Ensuring Flexibility of the Land Use; R. Lee Clark’s Vision for a Rural Laboratory

  James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD

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  Chapter 05: Pride in the New Laboratory Facility; Key Supporters in the Legislature

  James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD

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  Chapter 06: The Early Leadership of Research Park and Others Who Contributed to the History of Research Park

  James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD

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  Chapter 01: The First Person to Go to College

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  In this segment, Dr. Podoloff briefly sketches his family background, noting when his family emigrated from Kiev, Russia to the United States. He also explains that he was the first person in his family to go to college. An uncle who was a proctologist was the only member of the family involved in the sciences or medicine.

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  Chapter 02: Chemistry and an Early Mentor Lead to a Focus on Medicine

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff begins this segment by explaining that he started out in public school, but then shifted to private school. He notes his interest in chemistry, describing the shelf full of chemicals he had in his room. He also talks about the family’s physician, Dr. Lucen, who treated his asthma and inspired his interest in medicine. He explains why, after beginning his undergraduate education at the University of Rochester, he transferred to New York University. He talks briefly about his style of thinking.

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  Chapter 03: A Switch from Internal Medicine to Diagnostic Imaging (Never Losing the Internist’s Perspective)

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff talks about how he switched from his original focus on being an internist, with an interest in psychiatry. Dr. Podoloff tells the story of joining the Air Force after his residency, an experience that tracked him into radiology. He was stationed at the Clinton-Sherman Air Force Base in Clinton, Oklahoma. Though interested in psychiatry, he explains, he changed specialties because radiology services were contracted to external providers. Dr. Podoloff then explains how he got into a residency program in diagnostic imaging at the Wilford Hall Medical Center at the Lackland Air Force Base in San Antonio,TX (’70-’73). There he became interested in nuclear medicine.

  Next, as part of a discussion of the kind of cognitive work that characterizes nuclear medicine, Dr. Podoloff explains why the field is jokingly referred to as “unclear medicine.” He refers to an image (provided below) to illustrate the fuzzy images he had to interpret.

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  Chapter 04: Private Practice and an Opportunity to Develop a Radiology Department

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff begins this segment by noting that his dual focus in internal medicine and diagnostic imaging would be very important to the evolution of his career. He then talks about his years in private practice at the Diagnostic Clinic of Houston, Houston, TX, where he served as Director of the Department of Nuclear Medicine with responsibilities for building a new program (8/1975-5/1986). He then explains why internal medicine enhanced the diagnostic imaging perspective, enabling him both to work with patients and understand the science of disease from a physiological perspective.

  Next Dr. Podoloff explains how he built a nuclear medicine program at the Diagnostic Clinic. He also explains how nuclear medicine differs from radiology. He notes that he built a very successful department.

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  Chapter 05: Discovering How to Image a Beating Heart; Reflections on Radiology’s Shift in Focus from Form to Function

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff first notes that the Diagnostic Clinic conducted more cardiac scans than MD Anderson at the time he joined the institution. In the remainder of this segment, Dr. Podoloff explains how he conducted a bone scan on a patient and then a brain scan shortly after, and this led him to discover a process to image a beating heart. The brain scan showed not the brain tissue, but the vessels. Researchers at Harvard University published this technique –the MUGA labeling technique-- however he was recognized as an innovator.

  Dr. Podoloff then comments on his academic connections while he was in private practice: he served as Clinical Associate Professor of Nuclear Medicine and Radiology at the University of Texas Health Science Center in Houston from 1976-1985. He comments on how advances such as the MUGA technique have shifted radiology’s focus from the form of organs to physiological processes.

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  Chapter 06: An Opportunity for Intellectual Challenge at MD Anderson

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Here Dr. Podoloff tells how he decided to leave private practice in 1985 for a position at MD Anderson. At this time. Nuclear Medicine was splitting off as a separate department. He notes that he took a substantial salary cut, but lists the benefits of working in this new context. He notes that Drs. Marv Chasen and Gerald Dodd served as his mentors.

  Next Dr. Podoloff observes that in 1985, the perception was that MD Anderson was a very depressing place where patients went to die. He tells an anecdote about the diversity among the faculty at MD Anderson.

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  Chapter 07: Building a Clinical Nuclear Medicine Program

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  In this segment, Dr. Podoloff sketches the roles he served once he came to MD Anderson as Deputy Chairman of the Department of Nuclear Medicine. He explains that he ran a small clinical operation that generated income and explains how the system of keeping physicians on salary at MD Anderson leads to good medical practice. He talks about the impact of this shifted role on his own career and how he developed the clinical operation.

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  Chapter 08: Contributions to the Institution: Leadership and Diversity; A New Research Project

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  In this segment, Dr. Podoloff explains that his has made his most important contributions to MD Anderson through involvement in leadership. He talks about his service on committees, particularly the Credentialing Committee. He explains the important of this committee and then notes that one of his biggest contributions was to increase the number of women on the committee from zero to fifty percent. He comments on what women bring to leadership roles.

  Next, Dr. Podoloff notes that committee work helped him understand his own leadership abilities. He notes that he trained four out of the five department chairs in the Division of Radiology at MD Anderson.

  Next, Dr. Podoloff briefly explains a clinical trial using the radiotracer, IPQA, to image a genetic mutation.

  [The recorder is paused for about 4 minutes.]

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  Chapter 09: Technological Advances that Have Transformed Diagnostic Imaging

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  In this segment, Dr. Podoloff explains the major technological breakthroughs that transformed the practice of diagnostic imaging. He begins with CT scans, which became usable in 1972, covering advantages and challenges.

  [The recorder is paused briefly.]

  Next, Dr. Podoloff explains how imaging aids in drugs treatments. He notes that the MUGA scan enabled MD Anderson researchers to adjust the dosages of Adriamycin.

  Dr. Podoloff explains the next big advance, the PET-CT scan. He notes that cancer is a systemic disease, with the tumor representing the “tip of the iceberg.” The PET-CT scan enables oncologists to look functions within a patient’s physiology that indicate cancer activity beyond that localized area. There is a discussion of how “imaging” must be understood in a very new way as scans do more than visualize concrete anatomical structures.

  Finally, Dr. Podoloff comments on how the timeline for the development of new instruments is much shorter than the development period for new drugs.

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  Chapter 10: Advances in Radiology Continue to Raise Questions about Ethics and Consent

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  little oversight over doses of radiation administered. In 1986, however, the institution created new consent forms for oblating patients. Dr. Podoloff explains that this instituted a new process that eventually “humanized” radiology research by building in a view of the patient receiving experimental treatment.

  As part of this discussion, Dr. Podoloff talks about the ethical complexities in Dr. Emil J Freireich’s work [Oral History Interview] and work in Developmental Therapeutics, where researchers often gave extremely high doses of drugs.

  Dr. Podoloff says he faces a current dilemma in his own research, and he is considering whether questions about dosages of IPQA will prevent him moving forward with clinical trials.

  Dr. Podoloff next observes that if you’re purely scientific about medicine, you treat a patient like a test tube, but “we have to be human.” He talks about attitudes of cancer patients when considering issues of consent: they want to feel better and function as they did before their illness. He also notes that it is hard to “sell” imaging to a patient as an experimental element of a treatment plan, as there is no direct outcome. He notes that he is very dependent on patients’ altruism.

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  Chapter 11: A Brief History of PET Scans at MD Anderson

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  In this segment, Dr. Podoloff explains why PET scans were difficult to offer at MD Anderson. First, financial difficulties at the institution resulted in the PET program being closed between 1988 and 1994. Next, insurers were not reimbursing PET scans because there was no data to document their advantages. Dr. Podoloff discusses insurance and the damaging influence insurance policies can have on treatment. He notes that the PET program was restarted at MD Anderson in 1999 and currently does seventy to eighty scans per day.

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  Chapter 12: A View of New Collegial Leadership

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff begins this segment by observing that he didn’t seek his current job as Head of the Division of Radiology, but has built clinical program to handle the workload and is now working on developing the research program.

  Next he observes that the recruitment of David Pimwica-Worms and Helen Pimwica Worms has been very positive for the institution. David Pimica-Worms, now Head of Diagnostic Imaging, brings a collegial leadership style that contrasts with Dr. Yuri Galivani’s “top down” approach.

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  Chapter 13: Training Radiology Residents and MD Anderson as an Educational Institution

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  In this segment, Dr. Podoloff discusses his role as Education Coordinator of Resident Training for the Department of Nuclear Medicine and related issues in education.

  He begins by emphasizing the apprentice-style education of residents and the difference between looking at a radiology film and interpreting the images there. He notes that he became Education Coordinator because residents requested that he serve that role. He talks about developing a template for evaluating education effectiveness. He also explains why MD Anderson’s education of residents is unusual because they don’t interpret films and talks about the pros and cons of this.

  Dr. Podoloff then talks about changes to medical education. He observes that MD Anderson offers education to individuals at the advanced fellowship level. He also notes that he talks to students about ethics and economics.

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  Chapter 14: The Center for Advanced Biomedical Imaging: an Opportunity to Realize a Vision of Imaging for MD Anderson

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  After a brief discussion of his role as Deputy Chair of the Department of Nuclear Medicine, Dr. Podoloff tells the story of the Center for Advanced Biomedical Imaging (CABI). He explains that in 2000 conversations with Dr. John Mendelsohn [Oral History Interview] and Joe Hogan, the head of GE Medical resulted in a deal to develop CABI. This was also a recruitment incentive for him to take on the role as head of the Division of Radiology. Dr. Podoloff explains his vision for imaging at MD Anderson, referring to the image below. Dr. Podoloff then explains why he wanted to take the position of Division Head and create the Center for Advanced Biomedical Imaging. He notes that he had the support of both Dr. Mendelsohn and GE Medical.

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  Chapter 15: Developing and Opening the Center for Advanced Biomedical Imaging: Challenges and Complexities

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  In this segment, Dr. Podoloff explains why it took ten years to open the Center for Advanced Biomedical Imaging, despite strong support from the institution and partners. He explains legal issues that emerged between MD Anderson and GE Health. He describes the process of finding a location for CABI.

  Dr. Podoloff observes that the centers are located on South Campus for synergy: he lists the departments with strong connections to CABI.

• 

  Chapter 16: The Center for Advanced Biomedical Imaging: More on the Story of Establishing CABI

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff begins by explaining that the Center for Biomedical Imaging is ready to begin promoting its services within MD Anderson. He notes the importance of talking to clinicians and researchers about their imaging needs. He gives the example of how a research project in the Department of Head and Neck Surgery led to a new standard of care.

  Dr. Podoloff He talks about financial challenges of running CABI and legal challenges involved with acquiring instruments from GE Health. He explains the decision to offer standard of care imaging with research imaging tacked on in order to avoid “hemorrhaging money.” Dr. Podoloff talks about the different between a non-profit and a not-for-profit institution.

• 

  Chapter 17: The Center for Advanced Biomedical Imaging: Part of the Changing Institutional Vision of Cancer Care

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  After discussing some controversies over establishing CABI, Dr. Podoloff explains how CABI fits in with the visions of cancer care developed by MD Anderson’s presidents. He discusses how CABI fits in with Dr. John Mendelsohn’s view of the “cancer care cycle” and how a system of research centers could offer a comprehensive approach to cancer prevention and treatment (see image next page). He then talks about its relationship to Dr. Ronald DePinho’s approach to research and targeted therapy.

• 

  Chapter 18: The Center for Advanced Biomedical Imaging: A View at the Five Year Anniversary and Role as Medical Director

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff lists some of the immediate issues that have to be addressed in developing the Center for Advanced Biomedical Imaging and then discusses major accomplishments in the first five years of the Center’s operation, summarized in the McCombs Report. He first notes some financial issues must be resolved involving the cyclotron. Next he explains that the Center is considering working with inpatients. He explains how this came about and issues that will arise as they move ahead.

  Next Dr. Podoloff talks about the difficulties of securing philanthropic dollars to support imaging studies. He uses the example of his own research and notes the altruism of patients.

  He briefly sketches his role as Medical Director of CABI.

• 

  Chapter 19: Overview of Administrative Roles; The Moon Shots; Translational Research and the Future of Targeted Therapy

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff covers several topics in this segment.

  He first sketches his role as Director of Clinical Research and his related work on the Institutional Executive Research Committee. He then sketches his role as Director of Clinical/Translational Research for the Division of Diagnostic Imaging (role assumed in 2010).

  Dr. Podoloff then sketches the evolution of translational research under Dr. Ronald DePinho and gives his impressions of the Moon Shots program. He talks about early data produced a multi-disciplinary group of diagnostic studies conducted within the Lung Cancer Moon Shot.

  Next Dr. Podoloff reflects on the evolution of cancer care. He then talks about how the genetic mutability of cancer tumors in relation to tailored therapies and the Moon Shots.

• 

  Chapter 20: Administrative Roles, Views on the Multi-disciplinary Environment of Centers and Institutes, and A Radiologist’s Contribution to a Care Team

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff first talks about his role as Chair of the Department of Nuclear Medicine and his related work as Chair of the Executive Committee of the Medical Staff. He explains that as Head of the Division of Radiology he was helped plan occupancy of the Alkek Hospital and the Mays Ambulatory Clinic. He was helped develop strategies to structurally integrate the Centers and Institutes in the Cancer Care System.

  He then explains that the basic sciences are still organized around departments but the clinical functions are organized in multi-disciplinary care centers and environments. He explains the implications of this structure for Radiology, which does not operate in a multi-disciplinary environment. He sketches the pros and cons of this and talks about the importance of having a radiologist on a clinical team.

• 

  Chapter 21: Next Steps --for the Division of Radiology and the Field

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff sketches what’s on the horizon for radiology at MD Anderson and for the development of the field.

  He first talks about “big data” advances made via the Quantitative Image Analysis Core by linking molecular and computational imaging. He observes that as Radiology’s focus has shifted from form to function, it is serving a data storage function for many fields. To demonstrate the form to function shift, Dr. Podoloff uses examples from the Lung Cancer Moon Shot and his own research.

  He talks about the “spin lab” where living systems can be imaged using new technologies. He explains the process.

• 

  Chapter 22: Medical Education, Radiology Researchers, and The Future of Radiology Research (in the Healthcare Economy)

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff speaks broadly of advances in radiology research.

  He first states that conservatism in medical education is the major reason that medicine does not advance rapidly. He talks about the qualities that an innovative researcher must have, reflecting on his own curiosity.

  He makes final comments on how radiology’s shift in focus from form to function will give rise to entirely different kinds of inquiry in the future. He notes that the biggest influence on research will be changes in the healthcare systems. He talks about healthcare costs and policy.

• 

  Chapter 23: MD Anderson Growth as an Impact on Institutional Culture and on Radiology

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  Dr. Podoloff talks about the need for growth at MD Anderson and sketches expansion has had an impact on how radiology is conceptualized as a practice.

  He first talks about the need for regional care centers to better serve patients, then sketches changes to the institution as it has grown, with particular attention to the increases in regulation.

  Dr. Podoloff then notes that the field of radiology is addressing a question: Is radiology a legitimate field of medical study or a technology? He gives background on why radiology can be seen as superflouous, and notes that other specialties have their methods of reading films. He talks about strategies for integrating radiologists into multi-disciplinary teams.

  Dr. Podoloff praises MD Anderson’s method of paying physicians to take the profit motive out of care deliver. He addresses the period of turbulence at the institution since Dr. DePinho became president, noting the he is satisfied with his leadership with one exception.

• 

  Chapter 24: Legacy Left at MD Anderson; A Love of French Cooking; Life and Work Fed by Spirituality

  Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

  When asked about the legacy he will leave at MD Anderson, Dr. Podoloff immediately lists the individuals in leadership positions whom he trained or recruited. He sketches what he wishes to accomplish prior to retirement and expresses his views of a working with MD Anderson.

  Next, Dr. Podoloff talks about favorite activities: he loves to cook French food, for example.

  Finally, he talks about his relationship with Judaism and the importance of spirituality in his life and his work.

• 

  Chapter 01: Growing Up in a Migrant-Worker Family

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez recalls her early life when her parents worked as migrant workers in the fields of Texas and in California. She talks about the effect of experiences in her neighborhood on her later life and recalls the huge range of illnesses she saw in her community where there was little medical care. Dr. Rodriguez also characterizes her parents as “survivors” who were committed to family. She recalls that her family was very frugal, but she never felts as though she lacked for anything.

• 

  Chapter 02: Support from Teachers and Family Leads to a College Education

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez talks about her educational path leading up to medical school in this segment. She says that she was encouraged to study from elementary school, when she took an IQ test and scored very high. She recalls that she was asked if she had cheated on the test. Nevertheless, her parents were advised to encourage her to study. Dr. Rodriguez explains that her mother was concerned about her plans to leave their small town to go to college, though her father supported the idea. She says that coming from her background, going to college “was a miraculous thing.” She had little assistance applying to college, but explains that she was advised to apply for scholarships. She recalls going to San Antonio to meet with the selection panel for a scholarship. She was not awarded that scholarship, but one of the nuns on the panel arranged for a scholarship from Our Lady of the Lake College (BA conferred in 1975). Dr. Rodriguez explains that, for practical reasons, she majored in Spanish with the intention of teaching. However she did very well in the sciences and her advisor, Dr. Rigual, advised her to consider medical school. Dr. Rodriguez recalls the educational environment at Our Lady of the Lake College, including a research program that was available and gave her experience in research methods. She began to think about going to graduate school to do research

• 

  Chapter 03: Going to Medical School

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez talks about her decision to go to medical school and describes her experience at the UT Medical School in Houston, Texas (degree conferred in 1979). She recalls that African-American students from Baylor College of Medicine came to Our Lady of the Lake College to talk about summer research projects at Baylor and recruit minority students to medical school. She applied to the research program, was accepted, and the experience encouraged her to consider applying to medical school. Dr. Rodriguez talks about getting a full-tuition scholarship to the Medical School in Houston and recalls the reactions of her family to this new move. She also talks about the unique and grueling three-year program and reviews the pros and cons of the different specialties she considered. Dr. Rodriguez speaks about a rotation at MD Anderson. She talks about the “personality” of cancer patients, who were so appreciative of care, and explains the features of oncology that appealed to her (though she did not decide to go into oncology at this point).

• 

  Chapter 04: A Revealing Internship and Residency

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez talks about her residency and her decision to focus on oncology. She explains that she chose to do her internship in internal medicine at te UT Health Sciences Center in San Antonio (1/1979−1980) because she wanted to focus on health issues in the Hispanic population, particularly diabetes. She stayed in San Antonio for her Residency in Internal Medicine (1/1980−1982) and decided during her first year to focus on oncology. Next she decided to do a fellowship and approached Dr. Daniel von Hoff about working in his laboratory. (Research Fellow, Cancer Therapy and Research Center 1/1982−1983.) She explains that she wanted a year to familiarize herself with this new field and to take time for personal reflection. Dr. Rodriguez also describes the research she conducted at the time, relating to Dr. Hoff’s theory that treatments could be personalized to the specific sensitivities of a tumor. She explains the work she did on the research projects and notes that this intellectual environment influenced her thinking about cancer. Dr. Rodriguez then explains why she elected to do her fellowship in hematologic cancers (Fellow of Hematology/Oncology, University of Arizona Cancer Center, Arizona Health Sciences Center, Tucson, 1/1983−1986).

• 

  Chapter 05: The Problem of Diabetes among Hispanics

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez explains why she abandoned her original intentions to work with diabetes in the Hispanic population. She explains that obesity is a cultural and medical issue for all patients. She talks about the centrality of (unhealthy) foods in Hispanic culture and the challenges of changing deeply engrained habits.

• 

  Chapter 06: Fellowship Research and the Move to MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  To begin this segment, Dr. Rodriguez sketches her research while a Fellow at the University of Arizona Cancer Center. She recalls that is was an exciting time in cancer research, given the availability of DNA analysis and new techniques in molecular biology. Dr. Rodriguez says she knew she wanted to be in a research environment. Her mentors in Arizona eventually connected her with colleagues at MD Anderson. Dr. Rodriguez recalls that when she came to MD Anderson in 1986, the institution was undergoing a reorganization that made times difficult in the Division of Cancer Medicine. She explains that the turbulence made it difficult for a junior faculty member to settle in, as her mentors kept changing. Over the course of her first four years, Dr. Rodriguez says she realized she would not be successful as a researcher and explains the importance of having an anchor point in the institution as a basis for becoming a truly independent researcher.
  
  Next, Dr. Rodriguez talks about her mentor, Dr. Fernando Cabanillas, who was passionate about advancing the treatment of lymphoma. Dr. Rodriguez explains that she designed studies and tested drug combinations within Dr. Cabanillas’ laboratory.

• 

  Chapter 07: Shifting Focus from Research to Administration

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez sketches how she began to shift away from research as her main focus. She began, she says, by doing administrative work “in a surreptitious way.” Dr. Cabanillas asked her to serve as Director of the Lymphoma Clinic, a role that gave her experience, demonstrated her knack for administration, and her commitment to making things better for patients. She talks about working with clinical pharmacists, a new breed of specialists at MD Anderson, and the roles this connection led to. Dr. Rodriguez then talks about how important grantsmanship is for researchers.

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  Chapter 08: Research on Lymphoma Treatments

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez describes studies she conducted on lymphoma treatments in collaboration with Dr. Cabanillas. She first explains a study that showed the efficacy of ifosfamide among patients who did not respond to the CHOP treatment. She next talks about use of the same drug for patients awaiting stem cell transplantation. This study is still in regular use. Dr. Rodriguez then says that the current atmosphere at MD Anderson focuses on developing new drugs rather than optimizing older drugs. As an example of the value of retaining older ideas, she mentioned work by Dr. Wilson that shows that continuous infusion of drugs is more effective than bolus administration, an idea that Dr. Cabanillas originally explored.

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  Chapter 09: Learning Administrative Approaches by Leading the Myeloma Clinic

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez begins this segment by explaining that the Myeloma Clinic was originally jointly managed with Transplant Leukemia services. She served as Clinic Chief of the Lymphoma/Myeloma Section from 1994−1996. Dr. Rodriguez explains what she learned from working in this environment of shared resources and how she acquired basic knowledge of how to assess patient volume and flow and determine hours of clinic operation. Next Dr. Rodriguez explains how the administrative issues shifted once the Myeloma Clinic became autonomous in 2003 and was stressed with challenged of internal utilization of resources. At this point she began her habit of writing reports to ensure transparency. (She notes that she used to have access to downstream revenue reports, but these have since disappeared.) She talks about the biggest lesson she learned at the time: how an individual’s work has an effect on the whole. As an example, Dr. Rodriguez explains that she became aware that the Myeloma Clinic was one of the biggest customers of the CT Scan Unit. She details how this effected operations of the CT Unit and had an effect on other services. She explains that this refined her thinking about how to strategize care delivery in an arena of low resources. Dr. Rodriguez also notes that most physicians tend not to see the big picture in which the deliver care and use resources; she gives examples of stresses to the system that can result. Dr. Rodriguez observes that she began to attend administrator education courses around this time. As an example of slow administrative development at MD Anderson, Dr. Rodriguez notes that she never filled out a for-service charge form until the 1990s. She talks about issues that arose once billing forms were introduced.

• 

  Chapter 10: The Role of the Physician-Leader at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez talks about the important role that physician-leaders can serve in an organization. She explains that a primary responsibility is to explain the need for institutional changes in terms that clinicians can understand. She stresses that physician-leaders must be able to listen, have a toehold in specific services, and demonstrate that they share common experience with clinical peers. She returns to the example of the Myeloma Clinic’s heavy use of the CT Scan Unit and the pressures that created among all services. She notes that she was first made aware of this resource issue by listening to clinicians vent their frustrations about difficult access to the Unit. Next Dr. Rodriguez explains that physician leaders must be able to explain a larger reality to data-driven MDs who generally have a much narrower focus. She talks about why, traditionally, there has been a gap between clinical and administrative levels of an organization. Dr. Rodriguez next talks about the history of physicians and leadership at MD Anderson, beginning with the first president, R. Lee Clark, who went to hire other clinicians with leadership abilities. She explains that in academic institutions, most physicians assume leadership positions that carry academic titles and that reflect their knowledge rather than specific skill at administration or leadership. Dr. Rodriguez believes that today one cannot excel as a clinician and administrator and this is why one is now seeing different titles for physician-leaders.

• 

  Chapter 11: Today’s Medical Paradigm Shift

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez provides perspective on what she calls “the medical paradigm shift” that currently challenges everyone in healthcare. She begins by sketching how landmarks in the history of research into causes of disease created paradigm shifts in the pass. She begins with the long period in which doctors learned their craft through apprenticeship to other individual physicians. She then explains that a paradigm shift occurred in the 19th Century, when hospitals became the primary setting for acquiring this training. She notes that the growth of nursing also had an effect on the practice of medicine. She then talks about the technical developments of the 20th century that led to another paradigm shift. Dr. Rodriguez explains that the current paradigm shift is not focused on technology, but on how care is delivered and diseases managed. She stresses that the new paradigm focuses not merely on the doctor-patient relationship, but on the management of relationships between teams of providers and the institution to deliver optimal care. Dr. Rodriguez says that MD Anderson is still in the investigational paradigm and may not have the skills to engage patients in being their own health care advocates. She explains that there is a great deal of data available to help individuals prevent cancer and that nearly seventy percent of patients survive for five years. Dr. Rodriguez cites several MD Anderson initiatives that focus on prevention.

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  Chapter 12: The Survivorship Initiative

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment Dr. Rodriguez talks about MD Anderson Survivorship initiative, which began to take shape, she explains, after the Institute of Medicine released its presidential report From Cancer Patient to Cancer Survivor: Lost in Transition (November 3, 2005). This report, she says, detailed why care for survivors was lacking. Dr. Margaret Kripke, PhD [Oral History Interview] had been appointed to the president’s Committee on Cancer and became aware of the issues. She brought this information to the president of the institution, Dr. John Mendelsohn, who decided to integrate survivorship into MD Anderson’s care delivery system. A committee was formed and Dr. Rodriguez took on implementation of their plan in 2006. Dr. Rodriguez notes that MD Anderson began transitioning patients to survivorship in 2010. There is now a significant body of patients and Dr. Rodriguez says her next step is to leverage the information that has been collected. Dr. Rodriguez explains the process she and her committee went through to determine how to implement survivorship care, a process that began with listening closely to all constituents. She summarizes: they build the survivor care clinics in the same way they build acute care clinics. Next Dr. Rodriguez sketches why a focus on survivorship was controversial when it was first proposed. She touches on bond that forms between the patient and the physician and notes that a primary concern was survivorship programs would ask the patient to divorce him/herself from the main oncologist. Dr. Rodriguez notes that this break can sometimes be more painful for oncologists, who say they enjoy seeing well patients –often the high point of their day. Dr. Rodriguez explains that they finally settled on a model where one supervising physician determined the activities of mid-level providers in a situation that de-escalates the intensity of visits by focusing on wellness. Dr. Rodriguez sketches the approach. She notes that a key issue they had to consider: at what point does the primary oncologist see the patient as a survivor? This question will be answered differently in each treatment area and the committee built algorithms to determine the transition point to survivor care, when the risk of relapse is nil. The entire care model for each service is built around four common domains: Surveillance, Prevention, Monitoring for Late Effects, Psychosocial Health. Dr. Rodriguez explains how this model works using the example of lymphoma. She confirms that all the survivorship services are amassing a great deal of knowledge about survivor care.

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  Chapter 13: Aimed Toward an Interest in Survival; Survivorship Care and the Affordable Care Act

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez begins this segment by sketching how the Affordable Care Act has an impact on care for survivors. She focuses on the assumption payers make that it’s most cost effective to transition patients to their primary care physician after treatment, as oncologists are expensive. She says that is premature for patient who have had aggressive tumors or treatments. Dr. Rodriguez notes that she spoke at ASCO about MD Anderson model of survivor care. She communicated that the four domains MD Anderson uses to structure a care plan is relevant at all stages of cancer care. Dr. Rodriguez then explains that her interest in survivorship was a natural extension of her work with lymphoma patients, as lymphoma was one of the first malignancies that could be cured. She understood early the four domains of Surveillance, Prevention, Late Effects Monitoring, and Psychosocial Health.

• 

  Chapter 14: Lessons in Administration as Ad-Interim Chair of Lymphoma/Myeloma

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez begins this segment by explaining how her view of the institution changed as she stepped into the role of Ad-Interim Chair of Lymphoma/Myeloma when Dr. Cabanillas retired. She sketches her new areas of responsibility and how this changed her view of operations and the institution as a whole.
  
  Next, Dr. Rodriguez explains that traditionally, a Department Chair is seen as an “erudite expert,” but to be successful a chair must let go of her/his ego and bring forth future leaders in the field.

• 

  Chapter 15: Vice President of the Office of Medical Affairs; the Value of Faculty Credentialing

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez begins this segment by explaining how conversations with the outgoing and incoming physicians-in-chief around she came to her role as Vice President of the Office of Medical Affairs. When Thomas Burke, MD [Oral History Interview] became physician in chief in 2004, her role was expanded to include medical affairs functions. She was officially named in 2005 with service to the present. Next Dr. Rodriguez notes that learned a great deal about Texas law and regulations of medical practice. She also had to familiarize herself with the roles of Physicians Assistants and Advanced Practice Nurses.
  
  Next, as an example of a function within Medical Affairs, Dr. Rodriguez talks about the process of documenting the credentials that physicians present for employment. She explains why this process is key to the reputation of MD Anderson. She also notes that employees have occasionally falsified documents.

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  Chapter 16: The Office of Medical Affairs: Credentialing, Quality Indicators, and Building a Culture of Improvement and Quality Care

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez explains a key function of the Office of Medical Affairs: to credential all individuals at MD Anderson to ensure their competence. She next explains that, since 2009, MD Anderson has been involved in developing performance and quality indicators for professional practice. She explains this history of this focus and the different reactions of clinicians to professional evaluation, given that most evaluation is perceived as adversarial and punitive, rather than part of a culture of self-awareness and self-improvement. She comments on Texas requirements that support a culture of improvement. Dr. Rodriguez then talks about how the Office of Medical Affairs created an infrastructure to shift to quality indicators.

• 

  Chapter 17: The Office of Medical Affairs: Patient Concerns, Patient Advocacy, Conflict Resolution

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez discusses another important role of Medical Affairs: to provide support for patient who wish to voice complaints. This segment covers sources of patient complaints and distress, the importance of communication, the role of Patient Advocates and the sources of stress in that role. (She notes that patients can become abusive because they would like a second opinion to be a different, hopeful opinion, but often a lack of options is confirmed.) She notes that having an Advanced Directive conversation is a quality indicator and explains the issues that this raises. She notes that there is more emphasis now on selecting health care providers who have communication skills.

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  Chapter 18: Creating MD Anderson’s Practice Algorithms; On Blending Art and Science in Medical Practice: Practice Algorithms and Targeted Therapy

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez tells the story of MD Anderson’s 147 Practice Algorithms beginning with the origin of this initiative in the 1990s movement to define “pathways of care.” She talks about the process of establishing an algorithm and discusses the effects. She also notes the different reactions of clinicians, who may immediately adopt the algorithm or who may take convincing. Dr. Rodriguez talks about the dangers of dogmatism in medicine. She notes that medicine is both an art and a science, but the poles need to be harmonized in order to be humane. Dr. Rodriguez notes that limits of targeted therapy and sketches an emerging view that this approach will be replaced by a focus on failures in the body’s surveillance and regulation mechanisms. She notes committees in place to support clinicians as they self-monitor the quality of their practice.

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  Chapter 19: Integrating Advance Practice Providers into Care Teams; Training Program for Physician Assistants

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez talks about the increasing reliance on advance practice providers in medicine and in oncology. She notes that, at MD Anderson, General Internal Medicine is a hold out. She sketches what an APP can bring to a care team. She talks about her own experience working with a Physician’s Assistant. She explains why she shares oversight of Advanced Practice Nurses with the Division of Nursing. Next Dr. Rodriguez talks about the Physician’s Assistant Oncology Fellowship Program, started in 2008. She sketches differences in the education of MDs and PAs and explains the need for an oncology fellowship. She talks about the impact of the program and an e-course developed for fellows at a distance.

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  Chapter 20: The Office of Medical Affairs: Job Satisfaction Survey of Mid-level Providers

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  After sketching changes to the office of medical affairs in the last ten years, Dr. Rodriguez discusses the purpose and results of the regular survey of mid-level providers at MD Anderson. She notes that, in general, the workforce is very stable, but the institution wants to monitor reasons that pockets of high turnover exist. She notes results of the survey: everyone at MD Anderson is committed to the job; some fear retaliation if they voice complaints; many feel they are not paid enough. Dr. Rodriguez stresses that employees’ pay is in line with other state institutions. She talks about requests for mentoring made via the survey and how that was acted on and to what affect.

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  Chapter 21: Patient-Centered Care: Formalizing the Practice at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez talks about the shift in healthcare to a focus on patient-centered care and addresses the specific ways that MD Anderson is putting this approach into practice. She first explains that patient-centered care is a shift in focus and explains the value is shifting from treating disease to treating people (and seeing them as customers). She notes that MD Anderson patients experience the kindness and devotion of providers. She lists some patient centered practices instituted and notes others that need improvement.

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  Chapter 22: Patient-Centered Care: the Psychosocial Council, Advanced Care Planning

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Rodriguez continues her discussion of patient-centered care. She discusses the work of the Psychosocial Council, in particular on the latter’s work on creating guidelines to talk to patients about advanced care planning, then talking about the Department of Chaplaincy and Pastoral Education. She first talks about the Psychosocial Council and advanced care planning, offering her view that advanced care planning is not a conversation about death, but about health care planning for the future that needs to be integrated into a patient’s treatment plan. She explains strategies for bringing awareness to this at MD Anderson and also notes that this is part of a national conversation. Dr. Rodriguez next talks in general terms about the Psychosocial Council (formed 2007), its roles, and the pushback it has received for treating disease from an emotional perspective.

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  Chapter 23: Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez discusses the Department of Chaplaincy and Pastoral Education and its focus on spiritual concerns. She lists the kinds of issues that arise for cancer patients. Dr. Rodriguez explains that, historically, MD Anderson has sustained linkages with spiritual/religious organizations and communities. This is one reason the Department of Chaplaincy at MD Anderson is so robust. She then talks about the future of psychosocial approaches at MD Anderson, looking ahead to the creation of a Division of Psychosocial Oncology. She list some research studies the faculty are conducting in this area.

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  Chapter 24: Transitional Moments in MD Anderson History

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez sketches key moments of change in MD Anderson history since her arrival. She first talks about the eighties and the “growing consciousness that MD Anderson is an economic entity,” moving on to the nineties and the complexities that evolved with more billing forms, rules, and concern for downstream revenue generated from patient care. She gives an example of chemo therapy orders and talks about pros and cons. Dr. Rodriquez then talks about the MD Anderson’s physical expansion to the point where she “can’t embrace” the institution. She notes that the physicians and nursing staff have preserved their dedication and pride.

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  Chapter 25: Change Under Ronald DePinho: The Balance Between Research and Clinical Care

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez states that MD Anderson has shifted away from its mission as a care facility since Ronald DePinho assume the institution’s presidency in 2011, moving toward a research-generating facility. She sets context by discussing the growth of research under Dr. John Mendelsohn, noting that research still served patient care despite accelerated industry-sponsored research. She next talks about MD Anderson’s focus on new drug development and the implications, specifically in the demand for financial and intellectual resources this requires.

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  Chapter 26: Turbulence During Dr. DePinho’s Early Presidency; MD Anderson’s Future

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez comments on the changes created at MD Anderson under Dr. DePinho’s early presidency then talks about the future of MD Anderson under the Affordable Care Act. Dr. Rodriguez first comments on the magnitude of institutional change that Dr. DePinho’s administration has brought to MD Anderson. Making reference to literature from the field of organization transformation, she notes that change on such a scale requires a “message of urgency” that was not verbalized by the administration. Change has felt imposed from outside, creating tensions in the institution, she observes. She notes that the Board of Regents was slow to recognize problems.

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  Chapter 27: Creating a Future Under the Affordable Care Act

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez explains that MD Anderson’s future will be determined by changes to healthcare under the Affordable Care Act. She first talks about the loss in revenue anticipated, then describes initiatives that the Office of Medical Affairs is setting in place to help address anticipated problems. She talks about the need to document all care processes in the spirit of moving toward more evidence-based care and shifting the mindset of providers away from an expert mentality to a spirit of self-reflection and improvement. She also talks about the importance of examining and optimizing all of MD Anderson’s resources.

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  Chapter 28: Women and Leadership at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez provides her views of women and leadership at MD Anderson. She cites statistics in support of her view that “the workforce in medicine is about women.” She stresses that women have to know systems in order to succeed in leadership positions. She offers her view of coming up through the ranks when there were many fewer women and notes that MD Anderson does not have clear processes for filling leadership positions or establishing a pipeline of leaders. She talks about her own strategy for cultivating leadership.

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  Chapter 29: Accomplishments, Retirement, and a Love of Cosmology

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez begins by listing her most significant accomplishments: launching the concept of survivorship; imbedding into MD Anderson culture the role of quality officers; integrating Advanced Care Planning into treatment planning; serving as champion for the Physician Assistants Program; helping everyone who has reached out to her as a role model. Next she talks about the interests she plans to pursue in retirement: psychology, art, reading, and cosmology. She notes that she minored in philosophy as an undergraduate and her thinking has been very influenced by process philosophers who believe that reality self-creates. She believes that the Universal Mind is also self-creating and explains that this spiritual component of her belief system helps her cope with change.

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  Chapter 01: Multidisciplinary Care at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Rodriguez provides an overview of MD Anderson’s multidisciplinary approach to patient care. She defines the approach and notes that it began with R. Lee Clark’s vision for cancer care. She gives examples of the specialties that collaborate to provide comprehensive management of a patient’s disease throughout treatment. She also offers observations on how the tradition of multidisciplinary care has had an influence on the culture of the institution.

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  Chapter 02: The Important of Clinical Leadership at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Rodriguez about the important role that clinical leadership has played in developing the institution and that it continues to play in the current healthcare environment. She sketches the qualities that leaders must have to steward institutions in the current climate and connects that to the culture of the institution.

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  Chapter 03: Leadership in a Period of Change

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Rodriguez comments on the period of change the institution is experiencing, stemming from changes in the healthcare system, financial stressors, and internal turbulence stemming from Dr. Ronald DePinho’s resignation as president in March 2017.

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  Chapter 04: Multidisciplinary Care and the MD Anderson Algorithms

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Rodriguez defines the MD Anderson algorithms of care and explains how they were created and are continually evolving, based on current research. She explains how they are connected to multidisciplinary care, and how important they are for standardizing care at MD Anderson’s partner institutions.

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  Chapter 05: Envisioning the Next Period of Leadership

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Rodriguez talks about the qualities that the next president of MD Anderson will need to confront successfully the institution’s fiscal and other challenges. She comments on the stability that MD Anderson’s tradition of physician leadership has provided.

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  Chapter 01: Inspired By Work at a Medical Institution

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  Mr. Stuyck explains that he came to work for MD Anderson's Department of Public Information and Education in 1975. (Prior to that he worked in a University of Texas Medical School Information Office that served both the Medical School and MD Anderson.) He then offers some background information, including how he came to spend his "formative years" in Houston. He notes that he spent his undergraduate years at University of Texas at Austin majoring in advertising and journalism. He secured a job in public information at the University of Texas Medical Branch in Galveston after graduation. Seeing the caring dimension of medicine inspired him to continue to work with the medical field, however he was drafted in 1969, going to Vietnam in 1970 as a public information specialist who wrote for the Army until his discharge in 1971. Though he returned to the University of Texas at Austin for graduate work, he left because for a job in the Public Affairs office at the University of Texas Houston.

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  Chapter 02: Public Affairs: Working Closely with MD Anderson Presidents

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  Mr. Stuyck describes the work he did promoting awareness of the new medical school (University of Texas Medical School) until 1975, when he was made Director of MD Anderson's Department of Public Information. He explains why the rapidly growing institution needed such a Department at that time and why Dr. R. Lee Clark offered him the job [the letter mentioned is reproduced in Steve Stuyck: The MD Anderson Years]. He talks about Dr. Glen Knots, to whom Mr. Stuyck reported, and the lessons he learned from him about management and leadership. He then explains why, in 1981, Dr. Charles LeMaistre arranged for Mr. Stuyck to report directly to him. He tells a story about a speech he volunteered to write for Dr. LeMaistre when he had to testify in Washington D.C. about the deaths of several patients, and how pleased Dr. LeMaistre was with his work.

  Mr. Stuyck explains the particular abilities he was able to bring to MD Anderson and to the institution's presidents. In addition to being a good editor of others' work, Mr. Stuyck describes himself as a strong writer about MD Anderson and about cancer, with a skill to commit issues to paper. He had a special sense of Dr. Charles LeMaistre's way of expressing himself and could capture it. (Mr. Stuyck says that "I could hear him saying the words from the podium.) He notes that the archives have about 700 speeches that he wrote over the course of his career.

  Mr. Stuyck describes the exhausting schedule of working with Dr. LeMaistre's speech trips and notes that, when Dr. John Mendelsohn arrived, it was agreed that Mr. Stuyck would not write his speeches.

  Mr. Stuyck then tells several anecdotes to demonstrate what he learned about leadership from Dr. Charles LeMaistre. In particular, he mentions Dr. LeMaistre's habit of encouraging people who worked for him.

  Mr. Stuyck recalls that Governor Bill Clemmons shouted at him during a visit, and Dr. LeMaistre phoned him later in the evening to tell him not to worry about it. Next he speaks briefly about Dr. John Mendelsohn, noting that he was just what the institution needed at the time. Dr. Mendelsohn promoted Mr. Stuyck to Vice President of Public Affairs.

  Mr. Stuyck notes that he had thirty years of working with great bosses and great leaders.

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  Chapter 03: Early Developments in the Department of Public Information and Education

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  This chapter opens with the interviewer providing an overview of the three story threads told in Mr. Stuyck's interview: the story of his career, of the Public Affairs at MD Anderson, and a story of what public affairs encompasses.

  Mr. Stuyck asserts that he had a direct effect on the broad scope of Public Affairs, citing the gradual absorption of Volunteer Services into the Department.

  Mr. Stuyck next explains that he was able to secure a contract to set up the Cancer Information Service in 1974. This was the first NCI-funded initiative to create a public information call-in line, and it was controversial, as most professionals did not believe that laypersons could be sufficiently trained to provide medical information.

  Mr. Stuyck explains how he became principle investigator, and what was involved in setting up the service on this grant, which has run for 30 years for a total of twenty-six million dollars. Mr. Stuyck then provides historical context. He notes that the CIS was part of a larger national effort to open up communication about cancer, to develop advocacy for many groups, and to increase the role patients could play in their health decisions. He also notes that the President Nixon signed the National Cancer Act in 1971 and that knowledge in the sciences was growing at a tremendous pace during this time. He also cites the culture of excellence that existed at MD Anderson in the seventies.

  Mr. Stuyck gives several examples to demonstrate how far cancer treatment has come since the seventies: the first BCG (Bacillus Calmette-Guerin) trials that required patients to be scarified; "gruesome" chemotherapy treatments; and treatments that required extreme surgical damage to a patient. He also recalls the first outpatient clinic at MD Anderson, which was very primitive by today's standards.

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  Chapter 04: The Faculty: The Intellectual Engine of MD Anderson

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  Mr. Stuyck expresses his appreciation for the MD Anderson faculty who are the "intellectual engine" of the institution even though they represent only twenty percent of employees. He says he has always tried to understand faculty issues and "speak their lingo." He traces his support for faculty back to his experiences at University of Texas Medical Branch, where he loved attending Grand Rounds. He sketches how issues have changed for faculty and lists the pressures upon them. He also characterizes MD Anderson faculty as possessing great intellectual curiosity.

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  Chapter 05: Expanding the Scope of Public Affairs: Increasing Services for Faculty, Patients, and the Public

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  In this chapter, Mr. Stuyck talks about the expansion of the idea of public affairs at MD Anderson.

  Mr. Stuyck explains that after he secured the NCI contract for the Cancer Information Service, "Public Education" was added to the name of the Department of Public Information, going on to detail what education can do for an institution.
  
  Next, Patient Education came under the scope of Public Information, and he explains what sorts of educational materials the department produced. Volunteer Services was next folded into Public Affairs, and Mr. Stuyck explains that he wanted to bring together in one unified division all the functions that would reach out into the public. Next he explains why Public Affairs was sequentially identified as a Department, then an Office, and finally a Division. He comments on the perception of Public Affairs within the institution then goes on to explain some of the many services provided to MD Anderson. He begins by explaining Creative Services then talks about the role Public Affairs played when Dr. Jordan Gutterman [Oral History Interview] and his work on Interferon attracted tremendous media attention. He explains that Dr. Gutterman received 7,000 to 8,000 letters from people begging to participate in his trials. Public Affairs set up a service to answer all of these letters.

  Mr. Stuyck talks about preparing faculty to deal with media appearances. Then he identifies the sections within Public Affairs and notes that he and his management team produced both monthly and annual reports to document the contributions they made to the institution. At the end of this chapter, Mr. Stuyck notes that MD Anderson has generally received very good press. Most of the negative press has come during the last year.

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  Chapter 06: Public Affairs: External Communications

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  Mr. Stuyck explains the changing role of Public Affairs since the seventies. At that time, physicians were not concerned about public relations. He then points to Dr. John Mendelsohn's arrival as a turning point in the institution's dealings with the public: Mr. Stuyck explains how he and others worked with Dr. Mendelsohn to draw greater attention from national and international media, eventually hiring a New York public relations firm, The GabbeGroup (which still works for MD Anderson). He also explains that the single greatest factor to change the institution's media needs was the passing of the self-referral legislation in 1994.

  Mr. Stuyck describes the challenges created when the bill went into effect in 1995 and forty percent of patients could suddenly request their own appointments. He explains that the information service, Ask MD Anderson, was created to help patients navigate the complex institution: it takes 100,000 calls per year.

  Mr. Stuyck next describes several strategies used to raise the institution's profile. He describes the trips that Public Affairs planned for Dr. Mendelsohn, designing them to create more exposure for cancer and the institution. The GabbeGroup suggested that Public Affairs submit profiles on cancer issues to the US News and World Report website. Public Affairs also published surveys on attitudes about cancer and attitudes about breast cancer in Prevention Magazine.

  Mr. Stuyck explains that departments that heavily use Public Affairs services fund positions within the Department. This insures that Public Affairs serves their needs.

  Mr. Stuyck points to the important and productive link between Development and Public Affairs. He then identifies some key moments in the institution's relationship to the public: achieving status as a cancer center; the change in the institution's name in the 1980s; the impact of the Internet.

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  Chapter 07: Public Affairs: Internal Communications

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  In this chapter, Mr. Stuyck gives an overview of internal communications in the institution. He notes that, in 2001, MD Anderson was at a crisis point in communications and Public Affairs hired the management group, Deloitte &Touche, to analyze the issues. At this time he proposed to the Management Committee of Public Affairs to establish a section for internal communication. As an example of communication difficulties, he talks about the mistrust created by layoffs in the early to mid-nineties, describing the publications created to address the issue. He compares the paper communications of past decades with the online communications of today. He then talks about new technologies that communications specialists must master today, noting that "it's fun to be around" the new media specialists and to strategize how to use new technologies. He notes that Communications has "reinvented itself" six or seven times in the past decades.

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  Chapter 08: Public Affairs: Writing the MD Anderson Mission Statement and the Code of Ethics

  Steve C. Stuyck MPH and Tacey A. Rosolowski PhD

  In this chapter, Mr. Stuyck next talks about his work on two key documents: the Vision and Mission Statement and the MD Anderson Core Values. He explains why there was controversy over the core values.

  Mr. Stuyck gives an example of why the word "hope" was controversial in the Core Values, saying that he was "never a fan of hope," but other committee members convinced him it was key to MD Anderson. He then talks about the impact of the two documents, citing a survey of employees that revealed almost 100% satisfaction with the institution values. Next Mr. Stuyck briefly compares Public Affairs at MD Anderson to analogous departments at other institutions. He comments on the role of the Management Group within Public Affairs and its strategic work in guiding the departments activities and evolution. He briefly comments on how Public Affairs is working with the current controversies surrounding Dr. Ronald DePinho.