In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
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Chapter 12: Expanding the Scope of Cancer Prevention
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin explains that the impetus for the new cancer prevention building arose when more space was needed for the Departments and clinics. The new building has afforded good office space and spacious labs for behavioral research. Dr. Levin also explains that because MD Anderson sees high risk patients, the institution cannot itself generate enough subjects to feed all of the different types of studies conducted on prevention. He then turns to funding issues and talks about how Texas limits on reimbursements for screening procedures has in turn limited the patients who can participate in studies. He notes the institutions that have failed at attempts to set up cancer screening programs.
Dr. Levin explains an initiative spearheaded by Paul M. Cinciripini, Ph.D. in the Behavioral Research and Treatment: Dr. Cinciripini was a pioneer in making a referral to a tobacco addiction specialist automatic for any MD Anderson patient who smokes. This is all paid for by MD Anderson.
Dr. Levin then talks about work done by Ellen Gritz on HIV AIDS and by Lovell Jones in the Center for Research and Minority Health, and David Wetter in the Department of Health Disparities Research.
Dr. Levin describes the lifestyle factors that have an powerful impact on individuals’ health and susceptibility to developing cancer: no access to parks, exercise, good food. He also mentions the power of advertising to promote unhealthy behaviors, noting that the risk for cancer is a combination of behavioral and epidemiological factors.
Next, Dr. Levin outlines the three aims of prevention with respect to smoking. Smoking prevention is a primary aim, followed by the secondary aim of the early detection of cancer and predispositions to determine individuals at risk. The third aim is to minimize harm in those who already have cancer, largely via irradiation of the head and neck. [The recorder is paused for 5 minutes as Dr. Levin takes a phone call.]
Dr. Levin explains that medical oncologists are often too busy addressing cancer to do adequate survivorship follow-up and so the Division of Cancer Prevention took on that role.
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Chapter 13: Cancer Prevention: Expanding into New Departments and Programs
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins this Chapter by explaining how he built the case to include population sciences, health disparities research, and minority health in cancer prevention, despite controversy. He notes that Dr. Andrew von Eschenbach was a great supporter. He then discussed the Cancer Prevention Education Fellowship, noting ;The Administrator;s involved, funding sources, and the numbers of fellows in the early years. He also talks about the Tobacco Treatment Program and the program in Professional Education for Early Detection, noting the missions of these initiatives and the individuals involved.
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Chapter 14: Expanding the Division of Cancer Prevention, Funding Sources, and Public Awareness
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin explains how both state funds and philanthropy (via the Development Office) support faculty and initiatives in the Division, then talks about the important of raising public awareness for prevention. He explains some of the history of colorectal cancer screening, notes his own work in the area, and Katie Kouric’s role as a much-needed a public champion. Dr. Levin then talks about John Mendelsohn’s development activities, explaining that Prevention sent teams of people with Dr. Mendelsohn to speak to potential donors about key elements of prevention.
Dr. Levin notes that the Division has relied heavily on philanthropy to move projects ahead. For example, donated funds allowed the Division to purchase a computer to run population analyses.
Dr. Levin ends this Chapter with observations about why he was unable to start a Department of Health Services Research and comments on the search for his successor.
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Chapter 15: The Culture of the Division and Its Impact
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin explains that during his tenure as Vice President and Head, the Division of Cancer Prevention was a loosely defined entity, but one characterized by a spirit of discovery and a commitment to application of knowledge. He then talks about what is left to be done.
Dr. Levin discusses the impact of the Division and what has contributed to its success.
Dr. Levin responds to the observation that many believe that physicians and institutions do not support prevention because it will put cancer institutions out of business, ending with the comment, “That’s my dream.”
Dr. Levin explains that “cancers survive because they are smarter than we are,” but the many tools included in prevention can help make the disease controllable and turn it into a chronic rather than a deadly disease.
Dr. Levin makes final comments on the notion that cancer can be ‘curable.’
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Chapter 16: Leading a New Division and Lessons Learned
Bernard Levin MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Levin talks about some Division of Cancer Prevention initiatives and makes observations on leading a new and evolving division. He first describes the contributions that Dr. Alvin Tarlov, who specializes in the social determinants of health and helped the Division of Cancer Prevention think through the rationale for a Department of Health Disparities Research. He then talks about examples of Division research translating into interventions for patient care and health. Dr. Levin assesses what was achieved between ’92 and 2007, a period of great growth into virtually a new area and how role of a comprehensive cancer center evolved.
Dr. Levin discusses what he learned about leadership during his years as head of the Division of Cancer Prevention, then comments on the vast resources available throughout the Texas Medical Center and other institutions that have furthered work on cancer prevention.
Dr. Levin next characterizes himself as an ambitious leader, noting that he needed to come up top speed on the subject of cancer prevention and relied heavily on peer experts. He also praises the support that the Legislature and the institution’s administration gave the Division of Cancer Prevention. Dr. Levin then talks about the specific challenge of simultaneously mastering a field and developing a new institutional division from scratch, a situation he describes as “novel, if not unique.”
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Chapter 17: The MD Anderson Presidents
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins this Chapter by reflecting on R. Lee Clark’s “prophetic leadership” of MD Anderson, noting that his time in Paris gave him a world view that gave rise to the Global Education Program. Dr. Levin notes that he met Dr. Clark after his stroke and became friends with him. (Dr. Levin notes Dr. Clark’s charm as well as his poor taste in restaurants.) Dr. Levin also became his physician after Dr. Clark developed colon cancer. Dr. Levin then characterizes Dr. Charles LeMaistre [Oral History Interview], with his broad view of education and historic participation in the first Surgeon General’s report on cancer. He then describes his vision for MD Anderson, his occasional lack of crisp decisiveness, and his difficult involvement with Enron. He then compares the leadership styles of Dr. LeMaistre and Dr. Frederick Becker [Oral History Interview].
Dr. Levin next talks about Dr. John Mendelsohn, who became a strong ally of cancer prevention within the first year of his presidency. He talks about questioning mind and global vision of cancer that Dr. Mendelsohn brought to the institution, as well as a new management style patterned after business. He reviews what Dr. Mendelsohn and his wife, Anne, were able to accomplish through their strong connections within the community and around the country and world. Dr. Levin then reflects briefly on Dr. DePinho, saying that it is too early to draw any conclusions about the lasting impact he will leave on the institution; he notes he will reserve judgment about the Moon Shots Program, as well.
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Chapter 18: Conflict of Interest, MD Anderson Leadership, and Protection for the Institution and Patients
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin reflects on conflicts of interest (which have plagued three of the four MD Anderson presidents), taking first the perspective of a patient and then the viewpoint of the faculty. Patients, Dr. Levin says, must know there is not financial motive behind their treatment, though that does not necessarily mean that innovative and productive individuals have no connections to the pharmaceutical industry. He then observes that the average faculty member or employee must also be protected so his/her choices of research/clinical approach or equipment are only governed by pure motives. Transparency is fundamental to these matters, and academic leaders will increasingly have connections to biotech companies, but there must be mechanisms, such as blind trusts, for insuring that these links do not govern day to day decisions. He notes that he would not want to see the presidents sitting on decision-making boards of biotech companies and that there must be a mechanism for top administrators moving into different roles within MD Anderson, should their external responsibilities reach a certain point. Dr. Levin closes this Chapter with some observations about nepotism.
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Chapter 19: Strategies to Build Public Awareness of Colorectal Cancer
Bernard Levin MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Levin talks about his role as a public representative of MD Anderson, the Division of Cancer Prevention, and colorectal cancer awareness. He mentions that MD Anderson provided him with training for television appearances and also notes that the Department of Public Affairs “embraced cancer prevention,” which was seen as a strong promotion point for the institution. He also mentions his appearance on the Today Show with Katie Kouric and other cancer prevention specialists to increase awareness of colorectal cancer. He says that after that appearance, MD Anderson saw an increase in requests for information about colorectal cancer screening. He also mentions that when Katie Kouric publicly announced her own colonoscopy, there was a measurable increase nationwide in requests for this screening procedure known as “the Kouric Effect.” He mentions the ways in which Public Affairs creatively used these public appearances at Board of Visitor meetings and other situations to advance the cause of cancer preventions.
Dr. Levin talks about what he learned about leadership from his appearances on television and at other public events. He also talks about his admiration for Katie Kouric and her ability to overcome hardship and make a national difference for cancer prevention.
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Chapter 20: Leading the Section of Gastrointestinal Oncology
Bernard Levin MD and Tacey A. Rosolowski PhD
[Because of a recorder malfunction, some material is lost.] Dr. Levin speaks about his role in establishing the Section of Gastrointestinal Oncology. He speaks about the his dream of creating a multi-disciplinary service by recruiting younger gastroenterologists interested in medical oncology, then explains some of the practical limitations that impeded movement to that goal at the time. He felt that sharing and communicating about patient care across disciplines would move the field forward. He mentions the linkages he built between MD Anderson and the UT Health Sciences Center to expose fellows to the full array of oncologic problems.
Summary of lost material:
Dr. Levin looks at the period when the Section transitioned to a new status as a Department, evaluating what he might have done differently in his role as outgoing head. He describes MD Anderson was reorganized, with departments splitting into a variety of medical specialties; with gastroenterology becoming part of the Division of Medicine, as that split from Medical Oncology. Dr. Levin saw this as a natural evolution that “emboldened” individuals to develop valuable skills and interests. He evaluates his own contributions to this shifting structure: he “straddled the fence,” in his words, developing skills in oncology and patient treatment as well as the laboratory and he understood the language and motivations of many different communities in the institution. He explains that his “one unfulfilled dream” was that he was not able to establish a Houston-wide fellowship training program that would enable fellows to work at many different institutions in the city.
[Note, recorder malfunction at end of Chapter: At explanation of what this training program would provide.]
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Chapter 21: Service to National and International Organization and a Small Cancer Center
Bernard Levin MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Levin describes his service on various national and international organizations. He begins by describing the structure, mission, and funding of the World Gastroenterology Organization and briefly explains the value of bringing together professionals who can compare notes on how training and patient care are approached in regions around the world with very different resources. He describes how funding for this organization began to dry up, at which point he was invited to Chair the first Foundation that would continue the work of the WGO, specifically funding training programs around the world. He doesn’t feel he was effective as a fundraiser and glad to hand the job over to Haman Quigley from Cork after four years. He explains that the organization has online materials, thirteen training centers around the world and “Teach the Trainers” session held regularly to train gastroenterologists around the world.
Dr. Levin then talks about his role as president of the Society of Gastrointestinal Carcinogenesis, describing the focus of the organization and the reality that a lack of resources limits its activities. Next, he briefly describes his role on the American Cancer Society Task Force as well as his service, in 2008, as interim Director of the Vermont Cancer Center.
[NOTE: there is a period of silence here while Dr. Levin takes a call and the recorder remains running.]
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Chapter 22: The Division of Cancer Prevention, Awards, and an Active Retirement
Bernard Levin MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Levin first talks about the importance of receiving the Charles LeMaistre Outstanding Achievement Award and the American Society of Clinical Oncology Award for Cancer Prevention. He then talks about the Betty B. Marcus Chair that was created for him. [The recorder failed during Dr. Levin’s reflections on receiving honors/awards.]
Dr. Levin next explains how pleased that the paradigm for cancer prevention at MD Anderson has been established, with new people pushing the field ahead. He wishes that he could have had more of an impact on inefficiencies and overutilization of clinical resources at MD Anderson. He observes that new blood in leadership is important, and that it is a mistake for leaders to stay in any position for more than ten years.
Dr. Levin then lists the professional organizations he continues to participate with and notes his role in colorectal screening activities in New York City by way of the C-5 Coalition (he is on the steering committee). He serves on advisory boards for companies that screen for colorectal cancer and as still assistant editor of the Journal of the National Cancer Institute. He enjoys the cultural activities in New York City and the beauty of the region.
Dr. Levin says how grateful he is to MD Anderson for his opportunities, his colleagues, and the institution’s leaders.
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Chapter 23: Developing Training Opportunities in Gastroenterology
Bernard Levin MD and Tacey A. Rosolowski PhD
In a continuation of the discussion of the fellowship in the Department of Gastroenterology (see Chapter 21) Dr. Levin first talks about the existing fellowship program run in collaboration with the Medical School and the fact that there needed to be more input from MD Anderson faculty. Dr. Levin brought in more faculty to broaden the scope of the program; however, it could not be sufficiently developed because of lack of good will from people in other programs. He notes that there were discussions about setting up a fellowship program with the University of Texas Medical Branch in Galveston, but this was never developed. Dr. Levin next notes that he was head of the combined Gastroenterology and Medical Oncology program, and he describes how the two faculties have different foci and roles. A training program for gastroenterology people will involve principles of early detection, prevention, and the management of the disease.
Dr. Levin notes that in 1994, when he became Vice President of Cancer Prevention, he substantially expanded the fellowship program with NIH support given to Dr. Robert Chamberlain. Dr. Levin explains that this was a nationally competitive program in which fellows were very deliberately mentored by chosen faculty. He discusses the content of the training and observes that fellows went on to become very successful academics. He also mentions that he received funds from a patient, to train international students.
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Chapter 24: Early Research; Research Blocked at MD Anderson
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin explains that his research path began when he received a grant (during his post-doctoral fellowship at the University of Chicago) to study the effect of drugs on liver cells (but stopped working on this area). He describes his next research area: the effects of fatty acids on the walls of yeast cells. He explains the research question he was working on and the challenges. He also looked at the effect of fatty acids on the respiratory components of mitochondrial enzymes in normal cells. Dr. Levin notes that he was unable to complete this work as a post-doctoral fellow, and it was completed by another of Dr. Goetz’s fellows.
Dr. Levin next takes up his interest in cancer, with a specific focus on genetic changes in colon cancer cells. He explains his work on large adenomas and that support from the Melamid Foundation enabled him to equip a small lab. Though he published on this work, he was unable to draw many conclusions. In addition, when he was offered a position at MD Anderson, he was unable to move this work.
Dr. Levin next talks about his interest in the treatment of metastatic colon cancer using an infusion pump invented by Dr. Bill Ensigner. Dr. Levin explains that he wanted to bring this work to MD Anderson. He had received a multi-institution RO1 and wanted to conduct a randomized trial, but investigators at MD Anderson blocked it because of internal controversies about such studies. Dr. Levin explains the environment of debate and also considered what might have been done to work to a positive outcome.
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Chapter 25: The Celebrex – Colon Cancer Study
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin next discusses a famous study in which he took part: the study of celecoxib (Celebrex) on polyps and adenomas of the colon. He explains how the study originated when an Israeli colleague approached him in the late 90s to be part of a large-scale, international trail based on original work conducted by MD Anderson scientist, Dr. Ray Dubois. Dr. Levin explains Dr. Dubois’ discovery that aspirin inhibited the overexpression of cyclooxygenase 1 (which can lead to a proliferation of cells). The study in which Dr. Levin took part had over 1500 patients: he organized the studies and quality control. Dr. Levin explains that the study was going very well until a sister study by the NIH linked celecoxib to an increased risk of myocardial infarction. Though celecoxib was shown to reduce adenoma formation by thirty to forty percent, both studies were immediately halted. At the end of this Chapter, Dr. Levin discusses special uses of celecoxib.
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Chapter 26: Chemoprevention and the Celebrex Study: Some Background
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin sketches the work on which his studies of Celebrex and colorectal cancer were based. This study was based on the idea that pharmaceutical agents, when taken regularly, might influence the formation of lesions in the colon. Work by Dr. Gideon Steinbock (at MD Anderson) had provided early evidence that Celebrex could influence inherited cancers, leading to the study of the drug’s influence on un-inherited carcinomas. Dr. Levin lists the studies and participants. He then notes that the discovery that Celebrex caused heart problems put a damper on research into chemo prevention in colon cancer and all cancers, shifting the emphasis to safety above all else when dealing with healthy patients. He notes that in the early 90s, the discussion focused on how to approach preventative measures, concluding that risks to a healthy patient must be very low in order to undertake chemo-preventative measures. He briefly discusses a peer review group from Pfizer and the NCI which added to the sense of caution about chemo-prevention.
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Chapter 27: A Study of Colorectal Cancer in Egypt
Bernard Levin MD and Tacey A. Rosolowski PhD
In this Chapter Dr. Levin discusses a study of colorectal cancer among young people in Egypt. As background, he explains that Dr. Palmer Beasley, Dean of the University of Texas School of Public Health, was conducting studies that would prove that the Hepatitis B vaccine with reduce cancer. When he was invited to Egypt to speak about these findings, he was told about the high incidence of colorectal cancer among individuals under 50 years of age and passed this information on to Dr. Levin, who went to Egypt to confirm the observation. Dr. Levin notes that it is rare to find young people with advanced colorectal cancer. He explains some possible reasons for the rarity and then explains his interest in cataloguing the young Egyptians with the disease and conducting epidemiological studies. He lists the other investigators involved and explains the multiple approaches taken to come up with explanations for the high incidence (eg. exposure to DDT, toxins in water, consanguinity), though no definitive cause was ever determined. Dr. Levin and the other researchers also found an increased incidence of pancreatic cancer in the Nile Delta. His studies began in Egypt in the late 90s, peaking in 2003, by which time it was clear that colorectal cancer was becoming more common around the world –in the Far East and even in the U.S.
Dr. Levin comments on the challenging process of doing research in a developing country and notes that he met very dedicated surgeons and pathologists working in Cairo. He also comments on the value of doing such research overseas, which is consistent with his personal commitment to global health. He notes how important it is to sort out the ethical issues to prevent any possibility for exploitation. Dr. Levin discusses the benefits the Egyptians received from the study. In particular, he notes that the Egyptian scientists and statisticians were able to participate in a very high-level study.
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Chapter 28: The Portable Infusion Pump: Some Background on Intra-arterial Therapy
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin sketches the beginnings of intra-arterial therapy, noting that there was no good systemic therapy for colorectal cancer that had spread to the liver. 5-Fluorouracil had been studied, and researchers at MD Anderson and other institutions were interested in delivery high doses of drugs, such as floxuridine (FUDR) to the liver by placing a catheter in the hepatic artery. Dr. Levin sketches the technical problems with this, noting that this method was a precursor to the design of a portable infusion pump.
[Technical problems with the audio recording are briefly discussed and the interview is terminated, to be resumed in another session.]
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Chapter 29: Work on Ulcerative Colitis and A Growing Interest in High-Risk Patients
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins this Chapter by recalling that his interest in high-risk patients began with his work with his mentor at the University of Chicago, Dr. Kirsner, who was interested in the relationship between ulcerative colitis and colon cancer. Dr. Levin set up a very fruitful study (between 1977 and 1983), taking random biopsies in four Chapters of the colon to find dysplasia. (It turned out that the patient pool included mostly moderate risk individuals.) He explains that the methods of study available were not sophisticated in comparison to today’s technologies. He explains the weaknesses of the study, its findings, what could have been learned with more sophisticated approaches, and the lessons learned from this experience. Dr. Levin also notes that even though this study did not provide “robust conclusions,” it laid the groundwork for later work on the relationship between dysplasia and cancer. He also defines dysplasia as an abnormality in cellular and tissue architecture that can lead to pre-cancerous conditions.
Dr. Levin emphasizes that this work strengthened his interest in high-risk patients, and he believed that this kind of study to lead to greater understanding of colorectal cancer, work he continued when he came to MD Anderson, when he began to study Lynch Syndrome (hereditary nonpolyposis colorectal cancer). He explains that this work was enhanced when he was able to recruit Patrick Lynch and Bruce Boman, both experts in high-risk individuals. Dr. Boman started to DIFI cell line with a high expression of epithelial growth factor (used eventually by Dr.John Mendelsohn in studies leading to discovery of monoclonal antibody 225). Dr. Levin describes the support he provided both researchers in his capacity as Department Chair.
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Chapter 30: The Intra-Arterial Therapy Pump
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin explains that there was a void in studying the treatment of advanced GI cancer when he began his career, and he stepped in to fill this need despite (discouraging advice from mentors) and wanted to set up multi-disciplinary teams to treat patients. He then speaks about the problem of managing people with metastatic colon cancer in the liver. The drug available at the time, 5 Fluorouracil, had low response rates. A derivate, FUDR, could be delivered via catheter into the liver: Dr. Levin sketches the disadvantages of the drug and the methods, then goes on to explain that William Ensinger developed the concept of the portable infusion pump that could be inserted under the skin of the abdomen, a technique that aroused the interest of Dr. Levin and his colleagues at the University of Chicago. He narrates the story of going to Ann Arbor, Michigan, so see the pump inserted and coming back to Chicago to use the method. Dr. Levin explains that evidence of toxicity made it necessary to conduct a multi-center study of the device. In 1984 he was awarded an RO1 to administer a large study that would pool the data. He explains the negative attitude at MD Anderson toward randomized studies, making it necessary for him to give up the grant. He explains that there is still controversy over the value of delivering drugs directly into the liver.
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Chapter 31: Combination Treatments and the Value of Collaboration
Bernard Levin MD and Tacey A. Rosolowski PhD
Here Dr. Levin focuses on the study of combination approaches to gastrointestinal cancers –studies made possible because, by 1986-7, he had realized Dr. Krakoff’s goals of establishing a multi-disciplinary team of basic scientists, medical oncologists and others in the Department of Gastroenterology. Dr. Levin lists some of the people studying combination approaches via phase 1 and 2 programs and explains how he contributed. He also comments on the collaborative studies with the GI Tumor Study Group.
Dr. Levin explains that the milieu was very conducive to collaborative study. He then evaluates the multi-disciplinary environment he was able to create, exploiting the intra and inter-institutional affiliations of faculty members. He explains that he viewed the department as a nucleus for interdisciplinary research and tried to enhance the value of collaboration by making it part of the yearly evaluation process. He explains that collaboration was most successful for medical oncologists and basic scientists, not so successful for gastroenterologists. He explains where biases against collaborative research come from.
Dr. Levin then evaluates how he might have created a more collaborative environment if he had been successful in setting up the training program for gastroenterologists, in recruiting more senior gastroenterologists, and recruiting different basic scientists. He ends this Chapter with comments on the kinds of studies possible in the past. Researchers studied innovative approaches, but they were nothing like the targeted therapies of today. The treatment of advanced disease was “relatively futile,” but there were lessons to be learned about the value of both local and systemic treatments.
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Chapter 32: Occult Blood Testing and Public Awareness of Colorectal Cancer
Bernard Levin MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Levin first talks about the large comparison of occult blood tests conducted by MD Anderson in the early eighties. He explains that he was aware of work done in the sixties to show that blood in the stools could be a sign of colon cancer. He was approached by a company to test the effectiveness of an occult blood test which would be distributed by pharmacies and mailed back to MD Anderson. Dr. Levin talks about the researchers involved and notes the collaboration of Public Affairs. (See also Steve Stuyck, Chapter 8.) He talks about the outcome of the study, noting that the team never had the ability to follow up with patients. The study looked at the relative effectiveness of different types of tests and the potential interference of diet and medication. The results were published [Levin B, Hess K, Johnson C. Screening for colorectal cancer. A comparison of 3 fecal occult blood tests. Archives of Internal Medicine. 1997 May 12;157(9):970-6] and Dr. Levin comments on the finding that providing evidence of an abnormality did not guarantee that patients and practitioners would act on the information.
This finding leads to a discussion of the challenges of creating public awareness of colorectal cancer and Dr. Levin sketches his activities in these areas. He talks about an event organized by Hilary Rodham Clinton at the White House in 1996 to raise awareness. He also notes Katie Kouric’s efforts, including her founding of the National Colorectal Cancer Alliance. He explains that the Alliance partnered with the Entertainment Industry Foundation to fund basic research, community outreach and community education and is still active. Dr. Levin’s study of occult blood tests was partially funded through this group. He makes some final comments on this study, which resulted in a model for predictors of risk.
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Chapter 33: Congressional Testimony about Colorectal Cancer Screening, The Economics of Testing, and Public Awareness
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins by explaining why he was selected to speak before Congress in support of Medicare coverage of screening for colorectal cancer (6 March 2000). He notes that he was prepped by people at the American Gastroenterological Association and worked with them on the script he read. The testimony had an impact and led to Medicare legislation to fund screening of colonoscopy and occult blood testing, though not of the double contrast barium enema which Dr. Levin believed should also be covered. He notes the change in public attitudes about screening: now about 60% of Americans get screened. He also explains why physicians are more likely to order a colonoscopy than an occult blood test, though the latter is much less expensive. He then discusses colonoscopy costs (relatively and sometimes unnecessarily high) and what is involved in providing a quality product for a reasonable charge. He notes the other tests that could be done to determine whether a patient needs a colonoscopy. Dr. Levin then explains why it might be difficult to increase the 60% number of Americans screened and notes that the most effective way to educate the public about screening is through a primary care physician or nurse.
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Chapter 34: Advocating for Chemoprevention, Lifestyle Changes and Cancer Prevention
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins by mentioning his support for the work of Dr. Michael Wargovich, PhD.on the chemo preventative effects of natural compounds related to garlic and derivative products. He explains that Dr. Waravick added a facet to the Department of Gastroenterology. He also notes that in animal models the sulfur compounds of the derivatives protect against colon cancer. He then talks about the Division of Cancer Prevention’s focus on lifestyle issues. The Division provided nutrition advice and assessment: he lists the people involved with studies of selenium and vitamin E derivatives. He touches on the importance of tobacco, another “ingested” compound, and the importance of physical activity. He notes the challenges to setting up studies of activity, as people needed to have cardiac monitors while exercising.
Dr. Levin then comments on diet, including his own ethically based choice to be a vegetarian. He states his belief that attempts to isolate chemo-protective elements of diet will be fruitless. He cites the study of carotene, which harmed patients, as an example of how misguided it can be to insert nutrients into a diet. He advocates a moderate diet that can even include moderate amounts of meat and processed food.
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Chapter 35: The GI Tumor Study Group and the Early Detection Research Network
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins this Chapter with a discussion of the GI Tumor Study Group, beginning with the individuals who came together to form the group in the mid-seventies, when it became obvious that GI cancers did not receive enough attention. The study group formed under the auspices of the NCI’s Division of Cancer Treatment and Dr. Levin explains how they met to discuss potential studies to receive NCI funding. He sketches how the group ended in the early eighties.
Dr. Levin begins to talk about the Early Detection Research Network, formed in about 1981 under the Division of Cancer Prevention at the NCI to fund innovative ideas for early detection—the beginning of today’s understanding of the underlying genetic mechanisms of cancer. The Network also established the Goodman Research Conferences.
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Chapter 36: An Interest in Biomarkers Spurs the Creation of the Early Detection Research Network and Its Services
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins this Chapter by noting that his interest in biomarkers began when he worked on a Johns Hopkins University study of oncogenes in stools. As further background, he notes that in the eighties he worked with a Philadelphia-based company studying the elevated levels of CA 19-9 in patients with pancreatic cancer. Through this work he attempted to establish a group of individuals around the country interested in biomarkers. He explains why interest waned and why interest in CA 19-9 also diminished. He notes that the ability to find genetic markers and identify cellular and biochemical mechanisms of cancer has come of age and that this has revived interest in early detection, prognosis and therapy. He recalls that when the Early Detection Research Network was established, it was viewed skeptically and funding waxed and waned, depending on the leadership of the NCI and its Division of Cancer Prevention. He also notes that, today, all component of the NCI are suffering financially. Nevertheless, there are more investigations into early detection and the EDRN continues to grow intellectually. He also says that the EDRN has created an “elegant infrastructure” of relationships with other organizations. It continues to amass samples and analyze them using statistical techniques developed by NASA’s Jet Propulsion Laboratories.
Dr. Levin then talks about the Gordon Conferences, created through the EDRN, explaining that it is a forum for scientists to gather and share research ideas in a very relaxed forum. He describes his own experience at the Gordon Conference as a graduate student.
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Chapter 37: Founding the National Colorectal Cancer Roundtable; Service on the Colorectal Cancer Committee; Perspectives on Bias in Research
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins with Chapter by describing how, in the late nineties, he talked with Robert Smith of the NCI about the need to create a forum to discuss activities related to screening. These talks resulted in the creation of the National Colorectal Cancer Roundtable in 1998. Dr. Levin and Dr. Smith co-chaired the Roundtable from 1998 to 2005 (when Dr. Levin stepped down). Dr. Levin talks about the organization and activities of the Roundtable, including the creation of the “Blue Star,” a lapel pin to indicate support for screening, and anti-discrimination support for people with hereditary cancer and for minorities.
Next Dr. Levin talks about his work as chair of the American Cancer Society’s Colorectal Cancer Committee from 2000 to 2008, particularly the Committee’s creation of a set of guidelines for managing patients with average risk for colorectal cancer. He explains the “precedent setting” group of organizations represented on the committee as well as the controversial nature of the guidelines published in 2008 after a year and a half of work. (Critics said that procedures outlined on the guidelines were influenced by the specialties of the individuals on the Committee.) The guidelines are still in existence but are due for revision following a new procedure established by the Institute of Medicine. Dr. Levin explains this procedure, designed to eliminate professional bias from the process. At the end of this Chapter, he explains how attitudes about professional bias in developing guidelines has changed over the past decade.
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Chapter 38: The Future of Cancer Prevention
Bernard Levin MD and Tacey A. Rosolowski PhD
Dr. Levin begins this Chapter of final comments by stating how privileged he has been to know Lee Clark, Charles LeMaistre, and John Mendelsohn, each of whom brought important leadership to MD Anderson.
Dr. Levin then states that the future of cancer prevention is very promising. He offers the view that the treatment of cancer is very difficult and expensive, and so preventing cancer through lifestyle, nutrition and the avoidance of tobacco and alcohol is very important.
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Chapter 01: MD Anderson’s Blood Bank and Transfusion Services
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
Here Dr. Lichtiger describes the scope of work handled by MD Anderson’s Transfusion Medicine Section/Blood Bank. In a practical sense, the Bank handles patients’ specialized needs for platelets, plasma, white blood cells, and other blood elements, delivering, for example, 12,000-15,000 units of platelets per month. The Section also performs all the infectious disease testing for the institution. Dr. Lichtiger also describes how the Service’s clinical staff participate in planning treatment for patients. All requests for blood products are individually reviewed to make sure they are appropriate for a patient, and clinical staff also meets with patients. Dr. Lichtiger asserts that Transfusion Medicine is a “critical element” in patient care, and he believes that the service has earned the respect of MD Anderson clinicians.
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Chapter 02: A Commitment to Medicine and the Path to Pathology
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
Dr. Lichtiger explains that he made the decision to study medicine as he saw his father’s heavy smoking and health problems lead to an early death. He sketches his educational path in Argentina. During his third year of medical school at the University of Buenos Aires, he decided to specialize in pathology ( M.D. conferred in 1964), and came to the U.S. for a fellowship at Michael Reese Hospital in Chicago, Illinois.
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Chapter 03: A Pathology Lab Fellow
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
In the early seventies, Dr. Lichtiger saw that MD Anderson’s reputation was growing and he decide to make the move to Houston. He speaks glowingly of Dr. James Butler, whom he worked under in pathology, and describes how he was the only fellow trusted enough to be left in the frozen section surgical. He notes how Pathology was working on accelerating the diagnosis process, first using electron microscopy. Dr. Lichtiger compares the Pathology Departments at Michael Reese Hospital and MD Anderson, and the unique environment at Houston’s institution convinced him to stay. At this time, he also realized that he missed contact with patients and switched from a purely laboratory path, to a clinical one.
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Chapter 04: A New View of Blood Banking
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Lichtiger explains the vision for blood banking that he made a reality at MD Anderson. He begins by explaining that when he decided to stay at MD Anderson, the only position available was as Acting Chief of the Blood Bank Section and, as he says, “I hated blood banking.” Nevertheless, he decided to take the job for a year (which has turned into a “Biblical year,” in his words). His first mission was to change the Bank’s mentality and determine what the “customer’s needed.” By the end of 1974, transfusion services were offered 24/7. He also determined that surgeons wanted to use whole blood during procedures when, paradoxically, they only needed specific blood components. Dr. Lichtiger describes how he “cracked that nut” and improved the therapeutic value of the blood products delivered in the process.
Next Dr. Lichtiger explains that he always took a business approach to problems and realized in the nineties that he needed to deepen his understanding of strategic planning, budgeting and information systems to fully address pressing issues in Transfusion Medicine. Dr. Lichtiger earned an M.B.A. in 1998 from the Lady of the Lake University, Houston TX. He notes that his family was in the clothing manufacturing business in Argentina. (His parents were disappointed with his choice of career, as they expected him to enter the family business.)
Dr. Lichtiger then talks about the financial challenges that MD Anderson faced in the 1970s and describes working with Dr. R. Lee Clark, Dr. Denton Cooley, Dr. Michael DeBakey, and Dr. Richard Eastwood, all of whom wanted to form an integrated Texas Medical Center Blood Bank. He shares recollections of Dr. Clark (who always said, “Don’t make small plans, your enemies will cut them down”) and describes his working relationship with this first president of MD Anderson. The initiative to create an integrated blood bank resulted in the formation of the Gulf Coast Regional Blood Center, but Dr. Lichtiger explains how MD Anderson remained separate (the only independent blood bank in the region) so that they could be flexible.
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Chapter 05: The Boutique Blood Bank and the Details of Transfusion Medicine
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
Here Dr. Lichtiger details many facets of the Blood Bank’s operations. He first talks about the challenges of running blood drives to acquire necessary blood, noting plans to expand the laboratory and increase the number of community recruiters. He notes that the MD Anderson name inspires many individuals and organizations to respond to blood drives. (He describes conducting drives at the Houston Chronicle at 2 am or 4 am, when the night staff is there to donate.) Dr. Lichtiger next talks briefly about the history of blood banking and describes how the field of Transfusion Medicine transformed it into a clinical practice (in the late 80s). He notes that working with patients over the years has taught him “tricks” for treating patient and offers the example of treating RH disease in pregnant women. He then talks about cases in which the field’s wisdom about blood transfusion either cannot work well at MD Anderson or does not apply because of patients’ special conditions. For example, research shows that patients do well with the freshest blood possible, and Dr. Lichtiger describes how quickly blood breaks down and loses its therapeutic power. In addition, though patients are encouraged to bank their own (autologous) blood for procedures whenever possible, cancer patients are often too ill to do so. Autologous blood is recommended to protect the patient from receiving (allogeneic) transfusions from other people whose blood may carry infection. Dr. Lichtiger explains how the Blood Bank guarantees the safety of the blood products made available, going beyond the standard guidelines for safety. They also carefully screen donors and do not accept blood from anyone with a history of cancer.
Next Dr. Lichtiger describes the technological advances that the Blood Bank has adopted to speed up collection of blood from donors (using a device based on an invention by Dr. Emil J. Freireich [Oral History Interview], the continuous flow blood separator). He also explains the ways that MD Anderson surgeons succeed in reducing transfusions during surgery (including using surgical instruments that coagulate blood as they cut). Outpatient services consume 30% of the Blood Banks stores. At the end of this Chapter, Dr. Lichtiger describes how Transfusion Medicine designed a special transfusion process for a Jehovah’s Witness, whose religion dictated that an individual can never be separated from his/her blood.
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Chapter 06: Blood as a Commodity
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
Dr. Lichtiger first explains how he thinks about blood as a “commodity” that has a fluctuating price. He goes on to talk about the support that MD Anderson presidents Charles LeMaistre and John Mendelsohn showed Transfusion Services, then comments briefly on the new president, Ronald DePinho. He then sketches the relationship between the Blood Bank and the Blood Center, confirming that they are part of the same service.
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Chapter 07: Chair of Laboratory Medicine: Bringing Automation, Customer-Based Services, and Transfusion Guidelines
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Lichtiger outlines his role as Chair of Laboratory Medicine from 1999-2008. He begins by sketching his responsibilities, noting how difficult it was to make decisions about assigning salary raises to faculty, dilemmas that gave him “many sleepless nights” because of their human dimension. He then talks about bringing automation to the Department and developing a concept of a de-centralized laboratory that would be more appropriate to MD Anderson than the centralized system in use. He was not successful in effecting this change, but notes that it is coming: the new operating room and ICU will both have laboratories, for example. From this discussion, Dr. Lichtiger again affirms that Transfusion Medicine services operate from the question “What do customers want and when?” He talks about the frustrations of dealing with new faculty at MD Anderson who do not understand that this institution’s Transfusion Medicine service operates as a collaborative clinical specialty, rather than a lab that blindly fills orders. He mentions the Transfusion Guidelines, created by the Transfusion Committee. He also speaks about his own concept of the “Prospective Review,” a process by which all of a patient’s information is examined to determine which blood products will integrate most therapeutically into the patient’s treatment. At the end of this Chapter Dr. Lichtiger talks about the Fellowship Programs he administers, the difficulty of selecting Fellows with real drive, and the challenge of teaching Fellows clinical interactive skills.
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Chapter 08: Clark, LeMaistre, Mendelsohn: Leadership Styles
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Lichtiger compares the leadership styles and talents of the first three presidents of the institution. He describes R. Lee Clark’s creativity and big-vision thinking in very detailed terms. He notes Dr. LeMaistre’s [Oral History Interview] ability to operate in political scenes at the state and national levels and Dr. Mendelsohn’s [Oral History Interview] talent for fundraising and building. Dr. Lichtiger also describes how the structure of MD Anderson changed to a more corporate structure after R. Lee Clark retired, making it more difficult to speak directly and at length with the institution’s top administrator to get projects underway. He gives some historical background about the blocks that were thrown in the way of MD Anderson’s growth and confirms that the Blood Bank was part of R. Lee Clark’s vision for MD Anderson.
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Chapter 09: Research Projects and the Future of Blood Banking
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Lichtiger first notes his collaborations with Dr. Emil J Freireich [Oral History Interview] in the Department of Developmental Therapeutics and the Adult Leukemia Research Program. He describes Dr. Freireich and explains that his work is part of Dr. Ronald DePinho’s Moon Shots initiative that involves the work on leukemia.
Dr. Lichtiger next evaluates Dr. DePinho’s plan to treat cancer by developing drugs that target the molecular structures of the different cancers. This “very imaginative” plan that moves toward personalized care, he says, will require a complete shift in thinking and practice at MD Anderson. He states that success in this plan will dramatically reduce the need for transfusion services, for example, but Dr. Lichtiger predicts that the patient need will not disappear, as most therapies have an impact on bone marrow and, thus, blood products. Transfusion Medicine will concentrate on generating better products and “shelf products” for patients. He predicts a major transformation in blood banking in the next ten years. He describes the exciting and promising example of harvesting stem cells from a patient, growing platelets, and then transfusing them back into the patient.
Dr. Lichtiger next sketches his own research, noting that he always worked collaboratively with others, providing equipment for blood banking, as well as sampling and processing services. He made a conscious decision not to aggressively pursue a research career, because he needed time to spend with his family and had watched as colleagues’ families broke up.
In the last portion of this Chapter, Dr. Lichtiger again talks about working with Fellows and the importance of mentoring.
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Chapter 10: Lean Manufacturing and Informatics in Transfusion Medicine
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Lichtiger talks about two significant changes instituted while he was Chair of Laboratory Medicine. He first talks about his participating in the selection of the Informatics System that enables Transfusion Medicine to handle all information about a unit of blood from the moment it is contributed by a donor, through all of the production and testing, to its final delivery to a patient. This system facilitated automation of the services, accelerating the handling of all blood products. Wireless connections also mean that some laboratory services can be made available on patient floors. Next he talks about how in 2004/’05 he spearheaded the move to redesign Transfusion Medicine around the principles of Lean Manufacturing, a series of principles for efficiency and quality derived from the Toyota auto manufacturers in Japan. He describes how every process in the lab was analyzed and most revamped. (For example, analysis revealed that technicians working among various stations walked over a 1 mile/day. Lab redesigns reduced that to 400 feet, saving time.) Each change was analyzed statistically to confirm that it would be a valid change. The result has been hundreds of thousands of dollars of savings. Dr. Lichtiger next talks about adopting strategies to reduce variation from the Sic Sigma program, very important in a laboratory that performs over one million tests per year. He talks about the situation that led him to undertake these redesign project and the $250,000 of support he received from the administration to complete it.
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Chapter 11: An Unbelievable Journey at MD Anderson
Benjamin Lichtiger MD, PhD and Tacey A. Rosolowski PhD
In this final Chapter, Dr. Lichtiger reflects on the exciting and unexpected career path that MD Anderson gave him. He talks about how he was transformed from a laboratory scientist looking at samples into a clinician who works with “the human element.” Dr. Lichtiger retired in 2008, though he has continued to work nearly full time in the Transfusion Medicine Section. As he looks ahead to genuine retirement, he says he is thinking of getting a law degree or studying Mandarin, to keep his mind active. He sees himself as “one more soldier” at MD Anderson, noting that the institution allowed him to develop a passion for his work. He hopes that the next generation of faculty in Transfusion Medicine will carry on the tradition of seeing the field as a clinical discipline. His personal philosophy, he says, is simply to contribute to efforts to create a world that’s better for everyone.
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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: MD Anderson Presidents: Continuity and Sustained Institutional Growth
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn first talks about his predecessors, Drs. R. Lee Clark and Charles LeMaistre. He then discusses the challenges that confronted him when he took over presidency of MD Anderson and reflects on what long presidential tenures have enabled each president to accomplish.
Dr. Mendelsohn describes Dr. Clark as ambitious and anxious to create a special medical institution in Houston, given his understanding of where medical oncology was going. Dr. LeMaistre brought his strength in organizing and leading medical operations at a time when the institution needed a broader management team. Dr. Mendelsohn credits Dr. LeMaistre with expanding MD Anderson’s interactions with the community and setting up a pattern of growth that he would build on during his own presidency.
Dr. Mendelsohn says he came to MD Anderson during a “wonderful time to be president of an academic, medical institution”, because of the country’s economic strength and growing public awareness of the sophisticated measures needed to treat cancer. It was therefore ironic, he notes, that the institution was downsizing and fearful that managed care systems would not cover treatment costs at “specialty hospitals.” He says the MD Anderson faculty realized that cancer could only be pioneered at a place like MD Anderson. He also notes that the retrenchment mentality did not take account of the American public’s willingness to pay for the best treatment.
In the last minutes of this Chapter, Dr. Mendelsohn comments on the long presidential tenures at MD Anderson. Duration, he explains, gave him time to build trust within the institution so growth plans were not top-down. Growth could also go on unperturbed, evolving through a process. He notes that each MD Anderson president was fortunate to have time and resources to develop action plans that could evolve over years.
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Chapter 02: Role Models
John Mendelsohn MD and Tacey A. Rosolowski PhD
Here Dr. Mendelsohn talks about his believe that an individual can actively create his/her personality through contact with role models. He begins the Chapter talking about his gift for taking a vision and putting it into action. After a brief description of his high school and family, he talks about important role models, beginning with his parents, his father modeling a gentlemanly demeanor and a passion for books, his mother demonstrating how to organize activities for the benefit of others. Through friends he discovered families organized differently from his own, and discovered that he enjoyed lingering around the dinner table, “solving the world’s problems” (a lifestyle he created in his own marriage). He also mentions his uncle, who was a frustrated doctor, and built heart valves for the University at Cincinnati.
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Chapter 03: Working with Dr. James Watson
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn speaks about a key experience that led him to medicine. Though focused on science in high school and early college, Dr. Mendelsohn had never thought about becoming a doctor (and admits that the thought of blood and the responsibility scared him). He had the luck, he says, to be at Harvard when the structure of DNA has just been unraveled and found an opportunity to work in the lab of Dr. James Watson. There he discovered the excitement of research, of designing experiments to build new knowledge, and the thrill of working with the latest scientific equipment. (He tells a funny anecdote about a centrifuge.) He characterizes Dr. Watson as a researcher with a very clear vision of what would happen in the areas of genetics and molecular biology, but notes that he was not a detail person. Alfred Tissieres, a second individual in the laboratory, influenced Dr. Mendelsohn’s understanding of experimental design. Dr. Mendelsohn explains that Dr. Watson encouraged him to go to graduate school, but he wanted to work with people. It was at this point in his college career that he began to formulate the then unusual idea that laboratory science could help people –an early inkling of the translational approach he would later develop.
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Chapter 04: Early Experiences with Administration
John Mendelsohn MD and Tacey A. Rosolowski PhD
Here Dr. Mendelsohn gives an overview of experiences that helped shape his administrative skills and put him on track to a good fit with MD Anderson. He first recalls watching and learning as a high school friend used interpersonal skills to get elected to president of a fraternity. Dr. Mendelsohn then reflects on administrative lessons gleaned from the Harvard Medical School. He first saw how a “complex arrangement of prima donnas put together a program.” During rotations through four teaching hospitals, he was also exposed to very different ways of organizing clinical care and learned to see through different lenses. He felt most affinity to the arrangement at Beth Israel Hospital, which was very focused on caring, an attitude he found at MD Anderson as well and an important quality that made MD Anderson a good fit for him. At the end of this Chapter, Dr. Mendelsohn recalls his Fulbright year in Glasgow, Scotland, in 1959, when he recorded his personal passion in a diary. He wrote that he wanted to devote his life to science in order to improve medical care.
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Chapter 05: An Overview of a Research Career
John Mendelsohn MD and Tacey A. Rosolowski PhD
Here Dr. Mendelsohn provides a synopsis of his work on epidermal growth factor (EGF) and the discovery of monoclonal antibodies up to the point of joining MD Anderson. “Things fell into place between 1964 and 1974,” he says, noting as well that at the beginning of that period, there were no medical oncologists. By 1970, there was a greater understanding of cancer. From research focused on the mechanisms of cell division, some scientists were beginning to think about cancer as a loss of control over cell division. In 1980, during the period when Dr. Mendelsohn was at the University of California-San Diego, he became interested in epidermal growth factors and, in partnership with Gordon Soto, began to see if blocking the binding site for EGF would influence cancer. He explains the mechanism of EGF in tumors and describes the role of tyrosine kinases (one kind of protein that stimulates growth and can become stuck in the “on” position) and how understanding of these processes let to the discovery of monoclonal antibodies that would block the sites where growth factors could bind and stimulate tumor growth. He talks about the first grant proposal he submitted –and how it was turned down (and eventually funded by private money), noting that public grantors are often risk averse and wait until an experimental theory shows promising results. This work was eventually lavishly funded. Dr. Mendelsohn ends this Chapter by explaining that he came to MD Anderson with a laboratory and four grants. However he had to devote all his efforts to the institution and so closed his laboratory –a very difficult action to take.
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Chapter 06: Institution Building at UCSD and Memorial Sloan Kettering
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn discusses the two major roles in institution building that prepared him to assume leadership of MD Anderson. First, in 1970, he was invited to start a new medical school at the University of California-San Diego. It began, he recalls, with twenty people, two rooms, and a “teeny clinic.” He talks about the challenges of creating a school from scratch, but notes that it was a “dream school” where the students wanted to combine science and medicine. He also discusses why it was important for the Medical School to add a cancer center and explains why he was asked to create the center –an initiative that gave him his first experience running a capital campaign. He lists the administrative lessons UCSD taught him, then briefly describes his experience working under Paul Marks at Memorial Sloan Kettering, where he was hired to expand the Department of Medicine and integrate laboratory science into the clinical departments.
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Chapter 07: Responding to Immediate Challenges
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn talks about the process of applying for the position of president of MD Anderson and then explains the economic situation he discovered when he assumed the position. Dr. Mendelsohn was invited by the search committee to apply, and he was pleased at that point in his career to have the opportunity to head an entire cancer center and notes that when his wife, Anne, first saw the Texas Medical Center, she asked, “Is this Oz?” Dr. Mendelsohn was impressed with MD Anderson because he saw an institution-wide passion for clinical care based on research. He did not know about all of the institution’s economic problems before his arrival, nor did he know of plans to downsize beds by fifty percent, for example. It was clear that there was a faculty of physician scientists who were looking for a leader. Dr. Mendelsohn gives some examples of the challenges he saw when he arrived. (The hospital and the cancer center had different chief financial officers, for example. ) He received good advice from a friend: Don’t do anything for one hundred days. Dr. Mendelsohn spent the time talking to departments about what they needed. He discovered, for example, that a new phone system had been installed and users had to push nine buttons before hearing a live human voice, a frustration that caused twenty percent of callers to hang up. He heard complaints about how long it took for x-rays to be read and pathology reports to be generated. These conversations led to concrete action: new hires in pathology and radiology, and putting back the old phone system, for example. Dr. Mendelsohn also observes that quickly doubling the size of the institution also sped up the process of reorganization. He gives the example of how moving faculty offices (and their secretaries) out of the clinics, there was more room for clinical services. Teams were set up to study efficiency and cut costs by twenty percent. He states that this process will again be important if insurance companies bundle services (reimbursing a total of $75,000 to treat leukemia, for example, instead of reimbursing for individual treatments and services required).
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Chapter 08: A New President Takes MD Anderson into Growth Mode
John Mendelsohn MD and Tacey A. Rosolowski PhD
Here Dr. Mendelsohn gives more detail on how he set up to use good business management models to turn around MD Anderson’s trend toward reduction in services just at a time when the field was developing exciting therapeutic possibilities for patients. The Board of Visitors, he explains, was key to the process, being comprised of excellent businessmen, and he told them, “I’m going to pretend you are my fiduciary board.” The Board advised him to hire a chief financial officer who knew how to make deals (resulting in the hiring of Leon Leach) and to develop business plans based on very clear balance sheets.
Next, Dr. Mendelsohn explains that the first four or five years of his presidency were devoted to making MD Anderson a more user-friendly place. He notes some of the accomplishments of the period: reducing wait times, scheduling appointments by hours (instead of less precisely as morning or afternoon), and working to reduce the wait time for an intake appointment to 8-10 days. The first year, in particular, he says was a difficult time as he and his advisors got rid of 80% of management people and also embarked on the project of writing a very bold mission statement. He brought in the Richards Group to design a new logos and theme-line, “Making Cancer History,” both of which enabled the institution to stop being inward looking and embrace the goal of becoming the premier cancer center. The institution’s values were also articulated, which also helped solidify the culture and community.
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Chapter 09: Defining the Mission that Shapes MD Anderson Growth
John Mendelsohn MD and Tacey A. Rosolowski PhD
Dr. Mendelsohn explains how the unprecedented growth accomplished during his presidency was not growth for growth’s sake, but guided by the MD Anderson mission. First he explains the three factors enabling growth in the mid and late nineties. First the public was beginning to understand the complexity of cancer care. Demand for sophisticated treatment was building and patients wanted access to an outstanding facility. Second, MD Anderson had one hundred research programs in existence and they were producing knowledge about what cancer care might be. The faculty wanted to expand research dramatically. Third, growth was managed through discussions with the Board of Visitors and Leon Leach (Executive Vice President and Chief Financial Officer), so that growth occurred in accordance with the institution’s mission. The planned parallel expansion in four areas: Research, Patient Care, Education, and Prevention.
Dr. Mendelsohn then focuses on the area of patient care, noting that expansion of clinical services increases profit margins that can support research. He reviews some growth statistics for the institution and points out the importance, during this period of improving efficiency and streamlining clinical research programs. He also explains that he asked his son (enrolled at the Wharton School of Business) to draw up a reading list for him and he discovered Michael Porter’s Competitive Advantage. (He became friends with Michael Porter, who is now involved in the business management of medical care.) Competitive Advantage underscored the importance of a business understanding what it wanted to be: Dr. Mendelsohn uses Southwest Airlines to explain the concept and explains that decisions about institutional identity were made quickly at MD Anderson, given agreement that the institution should be the best. He notes that it was a ‘gutsy move’ at the time to add twenty million to the budget and he gives the Board of Regents credit for having the faith that MD Anderson knew what it was doing. He then turns to the subject of excellence, noting that physicians at MD Anderson want to be the best in their fields and that they are uniquely positioned to achieve this goal: MD Anderson physicians are “sub-subspecialists” in a team of similar individuals, a situation, Dr. Mendelsohn says, that breeds excellence, and that had the potential to actually be what the mission statement articulated. He then explains that this is why he did not combine MD Anderson with the Health Science Center –an idea entertained early in his presidency.
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Chapter 10: Growth in Research and Clinical Care
John Mendelsohn MD and Tacey A. Rosolowski PhD
Dr. Mendelsohn clarifies the vision for changing the organization of the basic sciences. In creating the vision for change, his strategy was to appoint individuals on the front lines to define what was needed. The basic sciences, he says, were integrated in comparison to other institutions, but there were problems with their resourcing and management. Dr. Mendelsohn briefly explains these problems and the solutions instituted. Change was also made in the chain of responsible parties that faculty and staff would go to for resolution of problems or requests for resources. He describes the Executive Committee (Leon Leech, Kevin Wardell, David Hone, and Margaret Kripke) and their working style. He gives an example of how research was developed: by putting up the new faculty center and the Mays Clinic and expanding resources for imaging. The major limiting factor in research growth is space, and the Executive Committee planned which programs should migrate to Research Park.
Dr. Mendelsohn states that major growth occurred in research and clinical care, and this built on the consensus about developing ambulatory care, grouping physicians by cancer. He notes that the average hospital could not accomplish what MD Anderson has been able to because of competition within the institution between cardiology and cancer, for example. He notes that the reorganization of clinical services began under Dr. LeMaistre and continued to be led by the faculty. Returning to the subject of research, he notes that there were infinite possibilities for growth when he arrived. The Executive Committee targeted areas in which MD Anderson could become a leadership and that showed promise for patient care.
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Chapter 11: Growth in Education and Prevention
John Mendelsohn MD and Tacey A. Rosolowski PhD
Dr. Mendelsohn outlines MD Anderson’s faculty-driven efforts to improve its educational programs and attract top students, noting that the institution has one of the top programs in radiation physics. MD Anderson recruits from its own programs to staff diagnostic laboratories. He sketches the histories of how the Health Sciences Center and MD Anderson were given degree-granting status, noting that MD Anderson is now in a position to have some of the world’s leading scientists. (He also comments on why it has taken MD Anderson so long to get to this stage.) Next, Dr. Mendelsohn talks about the institution’s cancer prevention initiatives inaugurated by Dr. Charles LeMaistre and implemented by Dr. Bernard Levin, who was head of the new prevention division. He evaluates why prevention was so slow to get started –and has been slow to evolve: the prime reason is that healthy people do not think to come to a cancer center for education or testing. What’s needed, Dr. Mendelsohn explains, is a prevention clinic such as the Mayo Clinic has, but he also points out features of that model that don’t work with MD Anderson’s culture. Dr. Mendelsohn points out that each area had the responsibility to create funds for its own growth.
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Chapter 12: Marketing and Fund-Raising
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn talks about change in business strategy that enabled MD Anderson to grow at an unprecedented rate. First he discusses shifts in how MD Anderson was described to the public –and to faculty-- as a cancer center that will treat individuals at any stage in their disease. He points out that two thirds of patients will not be research subjects, but faculty had to provide services to such patients to ensure the institution’s viability. He describes the changes in services this requires and then shifts in the marketing of the institution to the public. The original marketing budget was ‘miniscule.’ More money was directed to marketing and a firm hired to create the log, theme-line, and also to develop a strategy to put MD Anderson in people’s minds before they are diagnoses, so they already know that MD Anderson offers them hope. Next, Dr. Mendelsohn talks about the importance of private money for supporting institutional growth. He points out that patient care generates a small margin of income that helps support research, but funds for large growth initiatives in the physical plant and research must come from capital campaigns. Dr. Mendelsohn explains that the director of Development, Patrick Mulvey, raised the goals for fundraising every year until they reached 200 million per year. He praises the development team and tells an anecdote about Mr. Red McCombs’ gift to the institution.
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Chapter 13: MD Anderson’s Institutes: Transforming Cancer Care Through Research
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn explains how the research foci and services of MD Anderson’s institutes (The Institute for Basic Science, the Duncan Family Institute for Cancer Prevention and Risk Assessment, The McCombs Institute for the Early Detection and Treatment of Cancer, and the Institute for Personalized Cancer Therapy, and the Institute for Cancer Care Excellence) interlock in “cancer care cycle.” [Note: during this discussion, Dr. Mendelsohn refers to a diagram he developed, “Transforming Cancer Care through Research.” That image is provided below.] Dr. Mendelsohn explains that he worked out this overall vision of the relationship between the institutes and created the diagram to give potential donors a clear idea of how research has an impact on patient care. He anticipates that that Dr. Ronald DePinho’s research focus on specific cancers will generate optimism for raising money. At the end of this Chapter, Dr. Mendelsohn comments on MD Anderson’s development initiatives and notes that it is amazing for a public institution to raise money at the levels of a private institution, a process that could only happy through the combined efforts of the Board of Visitors, Development, and the Faculty.
Diagram designed by Dr. John Mendelsohn, provided with his permission.
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Chapter 14: The George H.W. Bush Support MD Anderson Fundraising
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter Dr. Mendelsohn explains the important role of former president George H.W. Bush and his wife, Laura Bush in MD Anderson’s fundraising efforts. He begins by explaining that the Bushes were interested in cancer because they had a child who died of leukemia. Dr. Mendelsohn’s wife, Anne, came up with the idea to ask the Bushes to use MD Anderson as a setting to celebrate George Bush’s seventy-fifth birthday for an awareness and fundraising event. He describes the impact of that large event –raising money and awareness of MD Anderson. Dr. Mendelsohn was interviewed by the Wall Street Journal and other periodicals and the institution was ranked #1. He then explains how George Bush was asked to be on the Board of Visitors, and Dr. Mendelsohn offers an anecdote about his skill at running meetings.
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Chapter 15: The Global Programs and Research Park
John Mendelsohn MD and Tacey A. Rosolowski PhD
Dr. Mendelsohn begins this section by briefly describing his global program designed to foster training and research exchange with other cancer institutes around the world. His explains that his goal was to strengthen MD Anderson’s global presence and there is no question that sister institutions abroad helped increase the institution’s name recognition, though international traffic to MD Anderson dropped after 9/11. Dr. Mendelsohn next talks about the expansion of South Campus, or Research Park, on one hundred acres of land owned by the Health Science Center. He sketches the sequence of buildings constructed, noting that there was no master plan, but a plan evolved, and Dr. Margaret Kripke negotiated many of the details. Dr. Mendelsohn then explains that he had envisioned that Research Park might serve as the hub of a new “Silicon Valley” of biotech companies around MD Anderson. He then sketches the kinds of relationships that could be forged between MD Anderson and biotech companies.
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Chapter 16: Patients: from the Wealthiest to the Indigent
John Mendelsohn MD and Tacey A. Rosolowski PhD
Dr. Mendelsohn begins this Chapter with a brief description of a gift of 150 million dollars from Abu Dhabi designed to invest in making cancer care even better. He turns to the subject of MD Anderson’s international patients, noting that there have been fewer since 9/11 and represent only 3% of patients. He MD Anderson could do better in this area. International patients need a concierge service, for example. They pay in cash as they go out the door and billing needs to work differently for them. However, he stresses that despite some special accommodations, it is important to MD Anderson’s mission that all patients receive the same level of care. He recalls the rules the Executive Committee adopted to help decide how to make institutional change: Is this something we do for the sake of our mission; can it be done in a way we can be proud of; can we avoid losing money doing it; and do we have the resources and skills to do it. Dr. Mendelsohn explains that he has not looked at the changes made under his leadership as corporatization, but as responsible management. He then speaks about the indigent patients MD Anderson serves (about 8%) and the difficult cases of individuals who are not technically indigent, but who are very economically stressed. (Patient Services works out payment plans for them.) He states that the U.S. has to work out a system in which everyone is covered.
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Chapter 17: MD Anderson and the Texas Medical Center
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn clarifies the relationship between MD Anderson and the Texas Medical Center, beginning with a brief sketch of the history of the TMC. He points out that the TMC is run by a not-for-profit board that controls the use of land originally donated by George Hermann. Some MD Anderson land is leased from the TMC. Dr. Mendelsohn reviews the regulations for use of the land and lists the institutions within its limits, noting that it is a mixture of groups related to care delivery. Dr. Mendelsohn explains that he met with the leadership of the TMC fifteen years ago to create more collaboration between the institutions within the TMC, raising its profile as the largest medical center in the world. He offers an example of collaboration between neurosurgery at Baylor and MD Anderson (for five years the two institutions have shared a chair of neurosurgery) and explains the advantages of collaboration.
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Chapter 18: MD Anderson, the Texas Medical Schools, and the Graduate School
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter Dr. Mendelsohn talks about the linked history of four educational institutions, MD Anderson, the Baylor College of Medicine, the UT Medical School, and the Graduate School of Biomedical Sciences under the administration of the Health Sciences Center. He goes back in history and recalls that in 1941, the Regents of the University of Texas System made the “amazing decision” to create a branch of the medical school that was a cancer center, with the MD Anderson Foundation providing the money. He recounts the linked history of how Houston acquired by the Baylor College of Medicine and the UT Medical School, then talks about creation of the Graduate School and the move to allow MD Anderson degree granting status on Graduate School degrees. Dr. Mendelsohn then moves to an evaluation of the Graduate School, which he believes should be smaller and focused on admitting only the best students. He discusses several ways in which the Graduate School could be academically stronger, particularly in building up its curricula in computer analysis-informatics, areas that will be key for the biotech workforce in the next ten years.
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Chapter 19: Prevention and Care Become Academic Fields
John Mendelsohn MD and Tacey A. Rosolowski PhD
Here Dr. Mendelsohn talks about the significance of building dimensions of MD Anderson’s mission (Care, Research, Education, Prevention) into academic fields, in particular patient care and cancer prevention. He notes that Dr. Ronald DePinho’s Moon Shots Program includes prevention. He mentions a new program in prevention and the fact that nursing has become a more academic field with the granting of Ph.Ds.
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Chapter 20: Growing Research and Faculty Careers
John Mendelsohn MD and Tacey A. Rosolowski PhD
Here Dr. Mendelsohn focuses on his leadership style and its application to academic growth at MD Anderson. His aim, he states, is to “build what I’m working on into the best.” He does this by building units internally and also by building collaboratively, “when there is excellence nearby.” MD Anderson, he notes, is a very top-down institution, and so it was important to set up a structure with clear leadership for different operational areas: the CFO and vice presidents for education, care, and research. He also talks about the importance of involving faculty when undertaking new initiatives and uses the example of the growth of South Campus. He admits that the sheer size of MD Anderson has been a challenge as his experience was with much smaller environments. He maintained personal contact with faculty during his presidency and talks about individuals coming to him for career advice, giving an example of a discussion about taking a chairmanship at another institution. He states that a leader of MD Anderson needs to state and restate his/her vision “like a mantra” and confirms that Dr. DePinho has stated a very clear vision, one that he classifies as “a big hairy goal.”
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Chapter 21: Building Translational Research
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter Dr. Mendelsohn reviews the ambitious goals of the four (full time) MD Anderson presidents. He explains that he himself built on the achievements of Dr. R. Lee Clark and Dr. Charles LeMaistre with the aim of linking research to bedside care. He notes the research advantages of the legislation passed in the 90s that allowed patients to self-refer to MD Anderson. A broader range of patients enabled faculty to see patients at all phases of the disease cycle and to give complete care from diagnosis throughout the course of the disease, a goal that has required implementation of multidisciplinary care teams.
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Chapter 22: Sister Institutions
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn talks the lessons learned by creating two sister institutions, MD Anderson Espana in Madrid (originally a for-profit institution) and Banner Arizona. He explains that it is important to select institutions that have the resources and will to operate in the “MD Anderson way,” and that it is important to visit the locations and spend the time necessary to offer on-site instruction and support. (He notes that the head nurse in leukemia spend three months in Madrid for this purpose.) Dr. Mendelsohn lists the benefits of these inter-institution relationships and explains that an aim is to raise standards at centers that may not originally offer the best quality of care.
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Chapter 23: The New Personalized Care
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter Dr. Mendelsohn defines personalized care and offers an historical sketch of its development. Originally, Dr. Mendelsohn explains, doctors had few tools to treat cancer, so they offered care. Now it is possible to profile a disease in individual patients at the molecular and cellular level so physicians can hand-tailor care to what is wrong with an individual.
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Chapter 24: The Institute for Personalized Care
John Mendelsohn MD and Tacey A. Rosolowski PhD
Here Dr. Mendelsohn discusses the mission and activities of the new Institute for Personalized Care, which he directs. Through the Institute faculty are studying the molecular, chemical, and genetic profiles of tumors in order to tailor care. He explains that the procedures under study are not reimbursed by insurance so Institute activities currently require philanthropic support so the mechanisms can be scientifically proven and admitted to the roster of “standard of care” procedures. He goes on to explain that this kind of personalized care requires a sophisticated infrastructure of support fields such as pathology and radiology. He also notes that it is a challenge to shift the thinking of clinicians and researchers so they understand that profiling tumors along the course of treatment can influence the treatment prescribed. Dr. Mendelsohn describes two protocols currently underway. The Clearing House Study of individuals with advanced cancer profiles tumors to insure these individuals are receiving the correct therapy. The Unusual Responders protocol focuses on patients who receive an experimental drug and seem to respond, but then no longer react positively to the drug. These tumors are sequenced a second time to investigate why responsiveness ceased. Dr. Mendelsohn notes that Institute protocols are currently examining forty-six genes, but will expand to two hundred. He notes that he will soon be meeting with the group that handles lung cancer to integrate tumor sequencing into their course of treatment so the results can tailor therapy.
He explains that this pioneering work will insure that MD Anderson continues to be the number one cancer center. The Institute is developing instructional tools so that physicians can quickly take advantage of discoveries. He stresses how important it is to build a medical informatics system to process the complex data from these studies. The Institute is currently talking to IBM about means of tracking and packaging data.
Next, Dr. Mendelsohn outlines future plans for the Institute for Personalized Care. The Institute will continue to build up training, particularly in data-interpretation. (One challenge is creating programs to account for the genetic degradation of samples, for example.) He notes that a project on the genomes of survivors will be linked to Dr. Ronald DePinho’s “moonshots.” There are also many areas for further research. The tools are all available, he explains, to discover how the genes of a tumors influence RNA and protein expression. It will also be important to examine the role of patients’ immune systems and eventually the immune profile will form part of what the Institute for Personalize Care provides. Dr. Mendelsohn explains that it is important to investigate less invasive ways of getting to a patient’s tumor and explains a blood test that will eventually yield information about the tumor profile. He then explains tumor heterogeneity –tumors change genetically at a very rapid pace.
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Chapter 25: Creating Growth and Supporting Values
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter Dr. Mendelsohn discusses his most meaningful accomplishments as MD Anderson’s third president. He is very pleased that the number of patients served doubled during his tenure and that he build up the institutions research, education, and prevention initiatives in parallel with patient care. MD Anderson, he says, is saving a lot more people and doing a lot more research. He is pleased that the institution is rated number one by rating agencies and by the cancer community. He is also pleased at the levels of grant supported research and the increase in the research budget. MD Anderson is number one in receiving funds from the National Cancer Institute and especially strong in grants supporting translational and clinical work. This means that the institution can attract patients and also attract excellent faculty. He is also pleased that MD Anderson is “a happy place to work” and that he had a part in formally articulating the institution’s values. Finally he says that he is pleased with the spirit of collaboration that he had a part in developing, particularly as collaboration is so important in bad economic times.
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Chapter 26: Life Partnership with Anne Mendelsohn
John Mendelsohn MD and Tacey A. Rosolowski PhD
In this Chapter, Dr. Mendelsohn speaks about his wife, Anne, who has been an important “intellectual and action partner in everything” he has done. (He notes that they just celebrated their fiftieth anniversary.) As examples he explains that Anne Mendelsohn created the equivalent of the Board of Visitors at the University of California –San Diego. At MD Anderson she started the yearly Christmas party for faculty and was also instrumental in building relationships with Board of Visitor members and other potential donors. He notes that they have been honored as a couple seven times, which is very rare. Dr. Mendelsohn explains that he and his wife are a part of the Houston community. They have friends from all parts of life. When he retires, they will stay in Houston, which is now home. He is now chairman of the board of the Houston Grand Opera.
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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." -
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. -
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. -
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. -
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. -
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. -
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] -
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.
