Interview Chapters

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  Chapter 01: An Interest in Moments of Turbulence Feeds an Approach to Leadership

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny begins by explaining that she is in the midst of writing a new job description for herself so she can begin to focus more exclusively on her major interest, leadership development. She mentions author Linda Hill's description of the transition into leadership positions as the equivalent of a big life transition. She goes on to reflect on her own qualities as a leader and an individual who has had to make many transitions, leading her to be "interested in moments of turbulence."

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  Chapter 02: Establishing a New Department of Faculty Development

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny sketches how she came to MD Anderson in 1999 to establish a new Department of Faculty Development at a time when there was little research and literature on this new area. She mentions MD Anderson's reputation in the eighties as the "terminal hospital," where patients came to die, a feeling that persisted into the nineties. She sketches the history of unsuccessful leadership development offerings at the institution.

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  Chapter 03: The First Successful Leadership Retreat Demonstrates Need for Faculty Development

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny explains that, in 2001, a team was put together to make a "last try" to set up a successful initiative. She discusses how the team went about creating a new faculty leadership program that would prove such an initiative could be effective and relevant to MD Anderson faculty. She sketches the process of finding the Executive Development Group. She explains that the team handpicked the sixteen people who would participate in the first retreat, held in The Woodlands. She notes that the response was immediate and unanimously positive and that the curriculum is still largely the same. She sketches other programs that came from that: the Administrative Leadership Program and the Heart of Leadership Program. Ms. Yadiny also begins to sketch how leadership initiatives at MD Anderson evolve within a politicized environment.

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  Chapter 04: Faculty Development in a Politicized Context

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  In this chapter, Ms. Yadiny talks about the political environment in which Faculty Development was established and has evolved. She shares anecdotes to illustrate.

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  Chapter 05: Reflecting on Leadership Qualities

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  In this chapter, Ms. Yadiny reflects on her own leadership qualities and discusses leadership in general. She tells another story of Marshall Hicks, head of the Division of Diagnostic Imaging, as an example of someone who has used the coaching services of Faculty Development to help him through leadership transitions and life transitions. She notes that the Executive Coaching service was established in 2008 to support new chairs and that Ethan Dmitrovsky is expanding coaching services. She notes that she earned her coaching certification. She lists her leadership traits (noting that she is a good idea person, "but this doesn't mean I'm a good manager") then talks about models of leadership she has discovered in her reading of literature. Ms. Yadiny then explains that, even though self-reflection is a key element of leadership training, many people "are terrified of it." She tells an anecdote that demonstrates how seemingly small issues can have a big impact on initiatives. Ms. Yadiny then notes that MD Anderson has had a "case study of leadership" over the past years, since Ronald DePinho came on a president. She notes that she would love to have a conversation with him about what he has learned about leadership and shares an anecdote that suggests he has been thinking about the subject.

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  Chapter 06: A Wide Range of Interests Leads to Library School

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  In this chapter, Ms. Yadiny talks about her family background and her educational path to Library School at McGill University. She talks about her love of reading, her skills with drawing and sports, and her love of life outdoors. She talks about the interests that led her to study literature at the University of Guelph in Ontario, Canada (BA in 1970) and her decision to go to McGill University in Montreal for her MLS (conferred 1973).

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  Chapter 07: International Work and an Interest in Power Dynamics

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny discusses her early jobs with the Royal Society in London, then with the World Health Organization in Geneva, then in Tunisia. She tells anecdotes of the interesting characters she met in London; one of the stories allows her to demonstrate how she became interested in the master/slave relationship and how power factors into communication and power. She notes that she has encountered leaders who can be submissive or sadistic in their relationships with others. She describes the work she did in Geneva with the WHO, the lessons learned from her international experiences, and her reasons for leaving international work.

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  Chapter 08: An Evolving Focus on Leadership Development

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  In this chapter, Ms. Yadiny discusses the series of positions she held that solidified her focus on leadership development. She first talks about her work at the Houston Academy of Medicine in the Texas Medical Center Library ('79 - '90) where she did staff development programming and came to love working with leadership issues. She describes this as a "turning point in her life." She describes the positive work situation and the experience in leadership development she gained. [The recorder is paused.]
  
  Next, Ms. Yadiny talks about her work at the University of Michigan in communications ('90 - '99). She was able to complete a year-long "Planned Change Internship" that enhanced her skills. She talks about meeting Larry Lippitt, whose at the time work provided a basis for the understanding of organization development and how individuals behave within groups.

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  Chapter 09: Faculty Development: Offering Support in a Stressful Environment

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny discusses the stressful work culture at MD Anderson and the challenges that leaders face. She tells a story about a department chair who shed tears during a coaching session and a meeting with his department. She notes that the culture makes faculty members feel unsupported, and they come to Faculty Development for support. She also discusses cross-cultural issues that contribute to the stress, touching on issues that international faculty face and also on issues that arise because of U.S. regional, north/south, differences. She notes that the staff wields informal power, and gives examples of faculty women who have problems with staff members, who call them rude and demanding and often raise enough issues that the female faculty member "ends up in front of a Chair or HR." Ms. Yadiny notes that Faculty Development and the institution in general has not done enough to orient faculty to the southern dimensions of MD Anderson culture. She comments on the fact that 70% of employees are female, but MD Anderson "is a male institution." She comments on her own experience of gender issues and the slow progress made on addressing them since she began her professional life.

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  Chapter 10: Changes in Academic Medicine over the Past Decades

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  After reflecting briefly on the discussion in Interview Session one, Ms. Yadiny sketches how academic medicine has changed in the past decades. She notes the increase of expenses, patient volume, and structural changes to the healthcare system as well as the increasing competition for research money. She gives examples of how these contextual issues play out in the lives of faculty and leader. Ms. Yadiny comments on the challenges of mentoring faculty in this environment. She states that Dr. Ronald DePinho has positively "raised the level of the discussion" about research at MD Anderson, noting that this is threatening to those who aren't of the highest caliber. Ms. Yadiny comments on the challenge of balancing a commitment to compassionate care with a forceful pursuit of hard-driving science. She notes that MD Anderson is a unique institution because it is an academic-corporate hybrid.

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  Chapter 11: The First Several Years of the Faculty Development Initiative

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny fills in details about the evolution of the Department of Faculty Development. She explains why Margaret Kripke, the VP of Academic Affairs in 1999, supported a leadership development initiative. Ms. Yadiny then talks about her activities as Director of Faculty Development between 1999 and 2001, when the first formal course of the Faculty Leadership Academy was put together by a collaborative committee. Ms. Yadiny explains that in 2001, academic medicine trailed the corporate world by about 15 years in understanding leadership. She explains why leadership is so important and notes that MD Anderson had no succession planning and no real culture of leadership. She explains the success of the Leadership Academy and discusses the coaching sessions that are provided to participants and new leaders.

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  Chapter 12: Creating the Faculty Health and Well-being Program

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny recounts the story of how the Faculty Health and Well-being Program was established. She tells the story of the suicide of plastic surgeon, Steve Kroll, in 2001. She notes that when the institution did nothing to address this event, a group of individuals approached then-president John Mendelsohn about doing something for the faculty. This group included: Walter Bayle, MD; Warren Holleman, PhD; Ellen Gritz, PhD; Janis Apted, MLS. This group formed a committee and they set in place a response plan for addressing trauma. Ms. Yadiny next recounts how this initiative evolved into a program. She mentions groundbreaking work the Ellen Gritz and Warren Holleman did on burnout. [The recorder is paused] Ms. Yadiny then talks about several initiatives in Faculty Development. First she talks about Dr. Walter Bayle's use of Interpersonal Communication and Relationship Enhancement to teach communication and leadership. She then talks about Faculty Development's sponsorship of the Houston production of the play, "Wit." Focus groups with clinical faculty related to this production were audio taped and used to produce of the video, "On Being an Oncologist."

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  Chapter 13: Preparing for Coming Challenges to Faculty Development

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny briefly comments on the goals she envisioned for Faculty Development when she became Executive Director in 2002. She then sketches the large-scale changes that MD Anderson will face as national demographics and the healthcare system continue to shift. She reflects on working with new staff members. She explains that she went back to school to earn her certification as a coach so she could be a better support to faculty.
  
  Next, Ms. Yadiny lists the faculty's fears and frustrations and notes that most people who need help are not asking for it.

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  Chapter 14: An MD Anderson Way of Leadership Training

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  In this chapter, Ms. Yadiny characterizes the "MD Anderson way of leadership training." She explains that in 2002 her office settled on a skill-based approach that differed from the theoretical focus of earlier programs. She notes that Dr. Margaret Kripke advocated adoption of this approach and that the program for women faculty, Executive Leadership in Academic Medicine [ELAM], served as a model and was enthusiastically welcomed by all faculty. She next gives examples of challenging situations that MD Anderson leaders can find themselves in (e.g. emotional blackmail and manipulation). She notes that a psychologist at Rice University introduced her to the idea that transition into leadership is a turbulent process akin to an identity crisis. She talks about the learning curve for developing as a leader and emphasizes that MD Anderson is a very complex culture: some leadership consultants have characterized it as the most challenging and toxic they have encountered.

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  Chapter 15: Faculty Development: Directions for Future Growth

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny explains that programs in Faculty Development will increasingly be organized around the idea that transition into leadership catalyzes an identity crisis. She explains a plan to conduct assessments for leadership potential (that could not come to fruition). She discusses motivations that individuals may have for aspiring to leadership roles and notes that most leaders say they get the most satisfaction from training the next generation of leaders or professional in their field. She notes that MD Anderson chair people have demanding roles with more responsibility than their colleagues at other institutions. She explains the growing number of populations that Faculty Development serves at the institution, noting that the faculty is not required to take mandatory classes in leadership (unlike staff people). She discusses preliminary efforts to offer leadership programming for fellows and graduate students. She discusses the advantages of having outside consultants conduct programs and offers a personal anecdote about offering tough feedback.

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  Chapter 16: Growth as a Leader

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  Ms. Yadiny evaluates her own growth as a leader since she "began as a freshman" in Faculty Development at MD Anderson in 1999. In this Chapter she also talks about the importance of emotional intelligence. She begins by discussing what she learned about herself by handling challenging leadership situations. She talks about her (excellent) working relationship with Robert Tillman [Associate Director, Faculty Development] and describes how some problems arose because of her strong working relationship with Janet Simon. She notes a theory that in workplaces, individuals recreate their family of origin around them. Ms. Yadiny then talks about the importance of the emotional brain to leadership development. She notes that she reads a sacred literature to learn more about this and that MD Anderson can "shrink" this dimension of self. She talks about conversations she has with a psychologist who is also a practicing shaman, José Luis Stevens, when she senses distance from her emotional brain. She tells an anecdote about discussing a work challenge with Provost Ethan Dmitrovsky, MD. She lists the serious consequences leaders face if they do not cultivate the emotional dimensions of themselves.

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  Chapter 17: Faculty Development: Caring for the Soul of MD Anderson's Faculty

  Janis A. Yadiny and Tacey A. Rosolowski PhD

  In this chapter, Ms. Yadiny characterizes the essential role of the Department of Faculty Development: to caretake the soul of MD Anderson's faculty. She begins by talking about a retreat held recently to help a department deal with issues of retaliation. She discusses her own experience consulting with this department and recounts an anecdote she heard Bill Johnson (CEO of Heinz) tell about coach.
  
  Next, Ms. Yadiny explains her goals in the years remaining before her retirement: she would like the institution to "understand the full scope of what Faculty Development does." She says that the department is "like a shaman" that brings in the whole person and provides a place of hope for faculty. In the final minutes of the interview, Ms. Yadiny discusses why her work has a spiritual dimension. She acknowledges that she has "played a pretty significant role" at MD Anderson, setting up programs and services to minister to faculty however they require.

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  Chapter 01: Education and Family in Hong Kong

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung talks about his family background, education, and the challenges of growing up in Hong Kong during the recovery period in the aftermath of World War II. He first explains that his parents came to Hong Kong from China during the War. He describes the family's financial situation and the strong work ethic he gained by working in his father's business. Dr. Yung explains the educational system in Hong Kong. He talks about the origin and growth of his faith. He talks about meeting his wife, Susie Yung, in high school. Dr. Yung next recounts his early educational experiences under the British style, "pyramid" system education in Hong Kong and notes his transfer from a community school to the Jesuit-run Wah Yen College, a "vigorous" and well-funded school where all the teaching was in English. He notes that he became interested in medicine while he was in high school. Dr. Yung recounts how he came to the United States for college.

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  Chapter 02: Medical Education and Laboratory Research Solidifies an Interest in Molecular Analysis

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung talks about his college and medical education and his interest in working at MD Anderson. He begins with his arrival in the United States to attend college at the University of Minnesota (f 1968), a "defining moment" in his life, because of the culture shock. Dr. Yung notes that he began as a sophomore and that his research career began during his undergraduate years as he worked on a project that gave him an interested in cancer: he quantified radiation damage to tissue with different types of radiation.
  
  Next, Dr. Yung talks about how his decision to focus on neurology and attend medical school at the University of Chicago, where he kept working on his own research. He talks about his residency and his fellowship at Memorial Sloan Kettering, where he framed his primary research interests: "How do we go from chromosome analysis to molecular analysis?"

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  Chapter 03: Developing a Brain Tumor Clinic at MD Anderson

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung talks about his first impressions of MD Anderson and his early efforts to develop the neurology offerings at the institution. He begins by explaining his decision to come to MD Anderson (in 1981) after his fellowship at Memorial Sloan-Kettering. MD Anderson contacted him because the institution needed a neurologist to handle neuro consults. Dr. Yung describes the neurological complications that he would see normally see during consults and explains why he wanted to start the first designated brain tumor clinic at MD Anderson to treat complications and offer but care for primary tumors. Dr. Yung notes that he wanted to continue his research at MD Anderson. He established his laboratory at the Medical School, but relocated to MD Anderson in 1983.

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  Chapter 04: A Reputation For Experimentation and the Impact of Shifting to a Division System in the Eighties

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung connects MD Anderson's reputation for radical research in the 1980s to the move to reorganize the institution by Divisions in order to foster collaboration. He sets context by noting that MD Anderson struggled with a reputation for experimenting on people as well as with limits imposed on its growth. Dr. Yung explains how in 1982 the second president, Dr. Charles LeMaistre, reorganized the institution according to a division system to foster collaboration between departments and services and created a more systematic environment for promoting clinical research. The division system also fostered a more systematic approach to patient care and more structure in services by focusing on disease type. Dr. Yung next explains that, with that administrative reorganization, many new faculty were hired to provide a platform to enhance the quality of research and research driven patient care.

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  Chapter 05: Stepping Down as Chair of Neuro-Oncology

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  The recorder is started during a conversation in progress. Dr. Yung offers brief comments on his decision to step down as Chair of Neuro-oncology. (He stepped into the role as interim chair in 1999 and became permanent chair in 2002.)

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  Chapter 06: Looking at Chromosomal Patterns in Brain Tumors; Chromosomal Heterogeneity, Chemo-Sensitivity, and EGFR

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung discusses the evolution of his research, beginning with work on chromosomal patterns at Memorial Sloan-Kettering in the late 70s. He sets this work in the context of the science at that time and its development into the entirely new field of genomic medicine. Next he explains the evolution of his work to include epidermal growth factor receptors (EPGR) and their importance in cells, discussing connections to work of other MD Anderson faculty. He describes the relationship of the gene to kinase and EGFR functions. He then talks about his shift into translational research since 1997. Dr. Yung then sketches the history of translational research at MD Anderson, noting that in the Eighties and Nineties, the institution became a forerunner in applying translational research to clinical questions.

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  Chapter 07: Research Pathways and Research Issues that Emerge from EGFR Work

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung talks about the research paths that evolved from his work on EGFR, though he has been unsuccessful so far in discovering how to render glioblastoma sensitive to the receptor. He goes on to describe the lines of research that have opened up and also discusses controversies that have arisen around the issue of sequencing the cancer genome. He notes that MD Anderson is one of the suppliers of tissue to The Cancer Genome Atlas project -and he is involved in this. Dr. Yung also explains how the body of knowledge growing from this project and the International Cancer Genome Continuum has influenced how researchers look at tumors. Dr. Yung explains that the fundamental question is Can we understand the evolution of a tumor? He notes the special technical and ethical difficulties that arise with examining brain tumors.

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  Chapter 08: Brain Tumor Research: Translational Studies in Progress and the NCI Study Section

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung sketches his other research activities on glioblastoma. He first talks about his activities with the NCI and other groups focused on developing clinical, translational studies of brain cancer. He talks about the challenges of setting up such studies. Dr. Yung next talks about his clinical trials with the drug, BKM 120. He explains how this study also demonstrates the difficultly of attracting attention to a "small cancer" and how MD Anderson can partner with drug companies.

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  Chapter 09: The Challenges of Glioblastoma; MD Anderson's Moon Shot Program; No Low-Hanging Fruit for Neuro-Oncology Research

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung explains the challenges that glioblastoma presents to the researcher then sketches the work he is doing to build collaboration among the brain tumor community. He notes that Dr. Charles A. LeMaistre [Oral History Interview] started the Brain Tumor Group, now the largest in the country and the world. Dr. Yung next talks about MD Anderson's Moon Shots Program, now expanding to include more than the six cancers. He talks about the structure of the Moon Shots program and evaluates the lessons learned from its early years. He notes the aim of the Program to focus on "low hanging fruit" that can lead quickly to treatment advances, and explains that there are no such quick remedies on the horizon for treating glioblastoma.

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  Chapter 10: Creating a New Department of Neuro-Oncology in 1983

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung tells the history of the Neuro-oncology Department from 1983 to 1988. The Department was formed around the same time as the structural reorganization of MD Anderson according to a division system. Dr. Yung talks about the autonomy that the Department was given within this new system. He notes the functions of the new Department: provide neuro consults, manage the Brain Tumor Clinic and Pain Management Section, and provide psychiatry services. Dr. Yung notes that his vision from the beginning was to build brain tumor research. He talks about milestones: the creation of the Brain Tumor Clinic, then the Fellowship Program, and the Department's growing patient load and reputation. Dr. Yung then explains that he and others created joint meetings and rounds cutting across departmental and division boundaries. He also explains that he took advantage of this collaboration to work with the NCI's Cancer Therapy Evaluation Program to develop clinical trials. Members of the Department joined the Brain Tumor Committee within the Radiation Therapy Oncology Group.

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  Chapter 11: Creating Networks for Clinical Trials

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung begins this chapter by observing that, in 1988, the new Department had expanded and Dr. Field was ready to retire. Dr. LeMaistre wanted to expand neuro services and recruited Dr. Leaven to chair Neuro-Oncology and provided him with a large package to expand the research and clinical operations. Dr. Yung notes that he was still continuing to run his own research. He also took advantage of the NCI's desire to stimulate brain tumor research and he created a network of institutions for running Phase I clinical trials. He describes what he did to create the consortia under NCI guidelines and the lessons learned as the networks were reorganized. Dr. Yung observes that this project resulted in the NCI adding pediatric brain tumors to clinical trials. He explains that brain tumors are the second most common cancers in children. He also provides an overview of the limited array of drugs available for treating brain cancers, with focus now moving from cytotoxic agents to targeted therapies and immunotherapies. He notes that as the Department grew, there were more opportunities to take advantage of patient philanthropy to support research.

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  Chapter 12: Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung explains that in 1990, Neuro-Surgery became a department and Dr. Raymond Sawaya [Oral History Interview] was recruited to head it. He describes the period of expansion that began for both departments at that time. Dr. Yung gives examples of research in Neuro-Oncology and their ties to the institution's status as a comprehensive cancer center. Dr. Yung explains Dr. John Mendelsohn's [Oral History Interview] continued support the combined activities of Neuro-Oncology and Neuro-Surgery, known as the Brain Tumor Program. He stresses that he and Dr. Sawaya shared a commitment to building multi-disciplinary research and care initiatives and he describes the "blessing" for this group that faculty work well together. He describes his goals at the time and his continued commitment to work with Neurosurgery and related fields to develop a cohesive program in patient care and research. He talks about collaborative projects, including development of an oncolytic virus -a rare example of a successful brain tumor drug.

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  Chapter 13: Focusing on Work, Faith, and Hope During Cancer Treatment

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung talks about his experiences as a patient after his 1999 diagnosis with a rare bladder cancer. He sketches the medical dimensions of the disease, the slow process of diagnosing it, and his choice to have chemotherapy followed by radical surgery. He talks about his faith and his choice to have treatment at MD Anderson and have a true patient experience, not special treatment for an MD or VIP. Dr. Yung observes that his patient experiences have made him a better caregiver and advisor to the department when changes to the clinics and care deliver are planned. Dr. Yung talks about the different ways patients cope with a cancer diagnosis. He notes the special case of brain cancer patients, who lose cognitive function and their independence. Dr. Yung says that he advises patients that accepting their diagnosis early will help them avoid depression and other complications. Dr. Yung notes that he took on the Chairmanship of the Department of Neuro-oncology during his treatment. He felt he had been given extra time to use for his department. He lists the projects he wanted to push forward.

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  Chapter 14: Building the Advanced Practice Nurse Program

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung talks about the expansion of the Advanced Practice Nurse program once he became department chair. He first notes how important support staff are to extending clinical care and then explains why he elected to expand APNs in particular. Dr. Young says that most institutions do not have the rich resource of nurses that MD Anderson has: research nurses, APNs, clinic nurses, and in-patient nurses. He sketches the roles that the APN services in assisting patients' caregivers and building quality of life for patients.

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  Chapter 15: The Collaborative Ependymoma Research Network (CERN); Funding Research

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung describes his efforts to support research into the rare cancer, ependymoma and talks about the challenges of funding innovative research in a time of fiscal conservatism. He begins by giving an overview of the four types of brain cancers then recounts how the Collaborative Ependymoma Research Network (CERN) and now serves as model for using private funds to fund research. Next Dr. Yung offers his perspective on the conservatism of government funding of research versus private systems that can take risks. Innovative clinical trials require collaboration of government, the drug industry, and private foundations. Dr. Yung then describes a plan now being implemented to bring these forces together to look at the molecular characteristics of different types of glioblastoma to determine which drugs might target them, sharing the financial risk of running the trials. He notes that this approach has some features in common with MD Anderson's Moon Shots Program.

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  Chapter 16: MD Anderson's "Horizonally-Organized" Brain Tumor Center

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Yung focuses on the Brain Tumor Center, created via the working relationships and shared resources that link sixty members from Neur-oncology, Neuro-surgery, Imaging, Neuro-pathology and other services. Dr. Yung explains that these working relationships enable neuro-focused members to get individual and multi-investigator funding, and that the SPORE grant is "a triumph of the Brain Tumor Center." Dr. Yung next comments on the difficulties of formalizing the Brain Tumor Center as a self-contained unit within MD Anderson. (This discussion refers to the fact that the head of Neuro-Surgery, Dr. Raymond Sawaya, is an advocate of such independent status. Dr. Sawaya discusses this at length in his oral history interview.) Dr. Yung cites the enormous cost of running an independent Center, given the expense of the technology required. Dr. Yung says that the Brain Tumor Center will enter a new phase when a new chairman of Neuro-Oncology replaces him. He also feels that the Center currently offers a solid platform to expand immunotherapy with a new emphasis on T-cell function.

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  Chapter 17: The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung first describes the The Defeat Glioblastoma Initiative, an inter-institutional collaboration he has established between UCSD, UCLA, Memorial Sloan-Kettering Cancer Center, and MD Anderson to address glioblastoma. He notes that the Initiative is poised to expand and add international collaborators. Dr. Yung next describes his service on the NCI Brain Malignancy Steering Committee, set up in 2001 response to the request from National Institute of Medicine to provide more review of applications for research funds. The aim is to identify high-value concepts, prevent duplication of efforts, and create collaborations. Dr. Yung explains that this committee's role reflects the new reality of team science and limited resources. Dr. Yung then comments on the challenges of creating collaborations between scientists who originally thought they would run projects independently.

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  Chapter 18: Key Periods of Change at MD Anderson

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung offers his perspectives on periods when MD Anderson has undergone large changes. He first discusses Dr. Charles LeMaistre's role in handling the HMO crisis in the early nineties. He next talks about Dr. John Mendelsohn's in setting the institution on "an upswing" of growth and corporatization. He describes how hard it is to manage growth so the institution remains true to its mission of delivering research-driven care, rather than deviating and increasing patient care to generate income to sustain the institution. He notes the pressure and debates that come each year with requests to see more patients, cut back on expenses. Dr. Yung then talks about Dr. Ronald DePinho, who came in "with a good heart and an insightful" view of how to elevate MD Anderson to a position of making an impact on specific cancers. He explains that Dr. DePinho has brought in necessary change, notable addressing complacency and a lack of productivity among the faculty. He says that Dr. DePinho has yet to address the need for investment in infrastructure for clinical research.

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  Chapter 19: Stepping Down as Chair; Accomplishments in Perspective; A Sunday School Teacher

  Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD

  Dr. Yung begins this chapter by sketching the activities he will focus on after stepping down as chair. He next says that he is gratified to see how the Department has grown under his leadership, particularly in the areas of research and psychiatry. He talks about initiatives that have not advanced sufficiently, notable training of physician-scientists and providing a culture for their success. He shares what he would like the department to achieve in the next ten years, notably advances in brain metastasis. Finally, Dr. Yung talks about teaching adult "Sunday school" classes at his church, where he trains the next generation of church leaders. Dr. Yung says that his own faith enters into his work with patients, whom he encourages to have hope.