Interview Chapters

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Chapter 07: Technology and Social Media: Impact on MD Anderson Fundraising

Patrick Mulvey and Tacey A. Rosolowski PhD

Mr. Mulvey talks about the impact of social media on MD Anderson fundraising efforts. He mentions e-philanthropy, Facebook, and email appeals. He notes that the Development Office must take full advantage of all avenues of communication with donors, but proceed methodically, so that gifts can be properly serviced. He also explains that the institution must establish formal policies for such online activities.

Mr. Mulvey also talks about the impact of computer analyses, not available when he began in the eighties, and which now allow manipulation of data for better targeting of donors.
Chapter 08: The Office of Development: What Has Been Achieved and Today’s Focus on the Moon Shots Program

Patrick Mulvey and Tacey A. Rosolowski PhD

Mr. Mulvey reflects on what the Development Office has achieved under his leadership. He notes that the Office has raised over three billion dollars to fund research, care, and capital development. It also has great credibility and understands the MD Anderson’s stakeholders.

Next, he explains that the Office will be expanding from thirty-two fundraisers to fifty-five plus individuals to meet the needs for the institutional priority: Dr. Ronald DePinho’s Moon Shots Program. He explains the process of identifying the best way to communicate with donors about the Moon Shots. He lists individuals involved in this collaborative process today and over the years.
Chapter 09: The Positive Effects of Institutional Growth

Patrick Mulvey and Tacey A. Rosolowski PhD

Mr. Mulvey comments on the growth of MD Anderson since the 1980s and notes the overall positive effects of expansion.

Mr. Mulvey says he has been privileged to work at MD Anderson.
Chapter 01: The Role of the Department of Scientific Publications and Its Editors

Walter Pagel ELS and Tacey A. Rosolowski PhD

Mr. Pagel explains that the Department of Scientific Publications supports faculty in the writing of research articles. This role is key because the reputation of an institution is built on the reputation of its faculty who advance their public stature entirely by publication. Scientific Publications is also responsible for a number of institutional publications, including Cancer Bulletin and Onco-Log, an online newsletter for physicians in private practice. In addition, the Department provides writing programs for faculty and students. Mr. Pagel notes that the Department has a good reputation among the graduate students, who go on to successful careers in part facilitated by their ability to write and publish.

Mr. Pagel defines the purpose of a research article: to disseminate discoveries to peers and those outside a specialty. In his view, an editor’s main role is to help researchers understand the important of providing the context in which a discovery emerges –and to which it contributes. Many are not aware of such background, and it is needed so that articles have meaning to audiences beyond a researcher’s specific field. He notes that sloppy writing often suggests sloppy science, so an editor helps a researcher achieve clear and accurate writing. Editors in the Department of Scientific Publications work primarily on articles. Most books are already under contract with a publisher (who handles editorial work), though they do support faculty who are exploring publications avenues for books. He also notes that though faculty at MD Anderson contribute chapters to books (and Scientific Publications provides editorial support), these matter much less than articles to the evolution of a faculty member’s career. A great scientific article, he explains, tells a story that situates a discovery in the history of a field and also gives a real sense of a scientist involved in a research process that leads to the unveiling of an important answer to a scientific question. He has worked with some great writers at MD Anderson, among them Drs. Isaiah J. Fidler [Oral History Interview], Lester Peter, and Margaret Kripke [Oral History Interview].
Chapter 02: Learning the Editor’s Craft

Walter Pagel ELS and Tacey A. Rosolowski PhD

Mr. Pagel begins this Chapter by quickly sketching his educational path, including his track at Rice University, where he first majored in electrical engineering, then switched to English Literature. A career counselor at Rice suggested he apply for an opening in Scientific Publications at MD Anderson, and in 1971 he became an assistant editor. He describes his activities at that time and notes that he began to learn what it meant to be an editor. There were 6-8 editors in the department at the time, handling about ten articles per month.

Next Mr. Pagel explains that he left MD Anderson in 1974 to become Assistant Managing Editor (then Associate Editor, 1975) for the Quality Review Bulletin published by the Joint Commission on Accreditation of Hospitals in Chicago, Illinois. The Bulletin published narratives of care provided at institutions; frequently review of the details provided would indicate need for a further audit of the institution prior to its accreditation. Mr. Pagel point out that the Joint Commission came to understand that more than physician notes are needed to assess the quality of care.
Chapter 03: The History of the Department of Scientific Publications

Walter Pagel ELS and Tacey A. Rosolowski PhD

In this Chapter, Mr. Pagel explains that he returned to MD Anderson’s Department of Scientific Publications as an Associate Editor in 1976. He notes that he had the reputation of working well with faculty. He managed several projects in his new role, including the Research Report and the General Report.

He then briefly sketches the history of the Department of Scientific Publications, created by R. Lee Clark to provide centralized editorial services on the model of the Mayo Clinic’s in-house services, founded at the end of the 19th or the beginning of the 20th century. Mr. Pagel also recounts how Dr. Russell Cumley came to be the first chair of the Department because of a personal connection with Dr. Clark. Dr. Cumley influenced Mr. Pagel’s leadership style by showing respect for his staff’s abilities.

Mr. Pagel next provides an overview of the people and projects in Scientific Publications. He begins by characterizing his leadership style as more collaborative than authoritarian, a style he learned from Dorothy Beane (the former director), for example, while Melissa Burkett (Associate Director) has taught him how to plan. (He mentions in passing that the Administrative leadership at MD Anderson tends to “admire its own decisiveness” rather than relying on collaboration to make decisions.)
Chapter 04: Developing a New Editorial Perspective for Scientific Publications

Walter Pagel ELS and Tacey A. Rosolowski PhD

Mr. Pagel begins this Chapter by speaking briefly about some changes he tried to make to the General Report. He then covers two main policy changes he instituted during his role as Publications Coordinator (’78 – ’84) and Director (’84 – present). The first was to regularize the pace of editing manuscripts, previously determined by the editorial staff. He worked with staff to reorganize this process so editing could be done more quickly and efficiently. Mr. Pagel speaks briefly with the Interviewer about how editors specialize in different subject areas, but the challenges of editing scientific papers come down to a core set of basic issues. He then explains that prior to the 90s, faculty were required to submit manuscripts to Scientific Publications for editing help (whether they wanted/needed it or not). During the 90s, however, Scientific Publications was inundated with article manuscripts as well as grant proposals, and they switched from a mandatory to voluntary system to better serve those who actually wanted help. Mr. Pagel also talks about the challenges of marketing the services Scientific Publications offers within MD Anderson. One challenge, he points out, is that even though journals provide very poor editing services, researchers often question whether non-scientists (i.e, the editors in Scientific Publications) can truly help them with their articles.
Chapter 05: A Reader-Focused Philosophy: Editing and Teaching

Walter Pagel ELS and Tacey A. Rosolowski PhD

In this Chapter Mr. Pagel talks about how the Department’s approach to editing crystallized under his Directorship. The focus shifted from copyediting as the main task to determining what an article must provide to meet the expectations of a reader (who might not necessarily be a peer within a scientist’s own narrow specialty). The 2000s were a key period in which Scientific Publications began to develop in-house guidelines for structuring a reader-focused article at the same time that they developed focus groups and writing courses (at first to serve the rising numbers of international scientists at the institution). They concluded that they could teach a conventional framework for assembling an article that would communicate effectively. Over a six month period, they set up classes (with a workbook) to demonstrate how to put together an article with a logical sequence of parts, with guidance regarding the contents of each section. Mr. Pagel talks about how important it is for international scientists to be able to participate in “the discourse that drives science.” He also observes that as Scientific Publications taught the writing courses, their experiences fed back and influenced their ability to edit articles effectively.
Chapter 06: Key In-House Publications

Walter Pagel ELS and Tacey A. Rosolowski PhD

Here Mr. Pagel talks about several key activities in the Department. First he notes the move, in the 198s, to a new building and then the shift from an MBI computer to Mac personal computers. He then talks about the key publications the Department produces. The Year Book of Cancer ’56 – ‘88), provided a collection of abstracts of cancer research and was, effectively, a database before the days of electronic databasing. Mr. Pagel himself started the Cancer Care Series, created as a holistic picture of MD Anderson research treating particular care sites. In 1990, Mr. Pagel began talking to clinical leaders about the series, and realized he needed a champion. Dr. Ralph Freedman emerged, offering the idea that the project could be funded by the Alumni Association. Scientific Publications has published “Breast Cancer,” “Gastrointestinal Cancer,” Gynecologic Cancer,” “Lung Cancer,” “Pediatric Oncology,” and “Tumors of the Brain and Spine.” Each is a comprehensive work, heavily edited, he points out, as it is designed to inform non-academic physicians about the latest research. Also planned are volumes on bone sarcoma, head and neck, emergency oncology medicine, and survivorship. Mr. Pagel questions how effectively these books are being marketed. Next he talks about the OncoLog newsletter, first published in ’56. It is now offered in print and as an online publication for non-academic physicians, in both English and Spanish.
Chapter 07: Reports, Changes to the Field of Scientific Publications, and the Challenges of In-House Publications

Walter Pagel ELS and Tacey A. Rosolowski PhD

In this Chapter Mr. Pagel first talks about how MD Anderson was selected by the Texas Department of Health to prepare reports on “The Impact of Cancer on Texas.” This came about through the efforts of Dr. Joseph Painter and the Texas Commissioner of Health. The Department of Scientific Publications prepared three editions of this report between 1977 and the mid-eighties, compiling information on the impact of cancer by disease site. The statistics, he explains, came from ordinary databases. When data management changed (becoming primarily electronic) the publication was stopped.

Next, Mr. Pagel describes how publishing in the sciences has been radically altered in the electronic age, when information is so accessible and the pace of research is so brisk. Books are becoming much less prominent in the biomedical field, he explains, as there is no point in compiling information in a book when the contents will be quickly outdated. This accessibility offers mixed benefits, however, as Mr. Pagel notes. Fewer and fewer individuals browse for information, and he sees this as an indication that researchers tend not to look beyond the limits of information they know they need, a habit that may ultimately narrow their perspective. He gives examples of researchers who take a different perspective and always think about what is going on outside their own field of research: Molecular biologist Arnold J. Levine, who discovered p53, the tumor suppressor gene, and Gigi (Guillermina) Lozano, Ph.D., Professor and Chair of the Department of Cancer Genetics at MD Anderson, who also studies the gene. Dr. Lozano has established herself with great publication and the reach of her grants, he explains, and she has served on panel discussions organized by Scientific Publications. The advice she gave at one session: Don’t expect your funding to be renewed if your work has not evolved by year five.

Mr. Pagel next goes into detail about the Department’s (ultimately unsuccessful) experience with a journal publishing initiative. Molecular Carcinogenesis was first published in 1988, and Mr. Pagel notes the individuals involved in starting up the journal, with the rationale that creating such a publication would facilitate connections with faculty. However, this publication would have to support itself financially, and the Department of Scientific Publications realized that it could not manage a successful journal under those conditions. After publishing one issue, the journal was turned over to Wiley-Liss publishers. Mr. Pagel then talks about Cancer Bulletin, the journal once most closely associated with MD Anderson, broadening his focus to comment on the politics of publication and the questionable value of institutional journals, given the current availability of information. He then talks about the challenges of working on MD Anderson’s “General Report” (which served as a kind of annual report until about 1990.) From an editorial perspective, it was a challenging publication because there were no guidelines for contributors to follow. From another perspective, it was a challenge because no one had defined a clear purpose or audience for the Report. Mr. Pagel notes that it was important to MD Anderson in earlier years to document the caliber of the institution. After 1990, the Department of Public Affairs took over publication of an “Annual Report,” with the function of reporting taxpayer money is spent.
Chapter 08: Offering Support for MD Anderson Writers

Walter Pagel ELS and Tacey A. Rosolowski PhD

Mr. Pagel begins this Chapter reviewing how the Department of Scientific Publications offers editorial and instructional writing support to MD Anderson faculty. He then talks about Words into Print, a book of guidelines for writers published in-house that has evolved through three editions (1983, 1992, 2000). He notes that the Department has learned more with each edition published and expects that it will go through another, two-volume edition in which writing skills and writing process are treated separately. He then summarizes the mission of the Department’s courses: to teach a systematic was of writing an article that satisfies the conventions of a field and meets reader expectations. The practice of teaching how to accomplish this has evolved slowly, but had never altered the basic philosophy established years ago. Mr. Pagel then talks about funding for the Department’s writing courses. He underscores that the courses are a source of great pride for the Department, and that they have worked hard to earn a reputation among a community of researchers who might never believe that a nonscientist could have credibility and authority to aid them in publishing their work.
Chapter 09: Strengthening Biomedical Editing Nationwide and Within MD Anderson

Walter Pagel ELS and Tacey A. Rosolowski PhD

In this Chapter, first briefly notes his involvement with the Southwest Chapter of the American Medical Writer’s Association and the Council of Biology Editors (with a 22-year membership). He then explains that he had his biggest impact while he served on the Board of Editors in the Life Sciences and in the late 80s worked on the Editorial Certification Examination Development Committee. He describes the examination he helped create to certify competence for editors of biomedical articles and explains the significance of certification. He notes that the Department of Scientific Publications at MD Anderson uses its own battery of tests to evaluate editors’ abilities for abstract reasoning, grammar, and other skills and talents.

Next, Mr. Pagel talks about his Department’s blog, “The Write Stuff,” and two significant projects: his role on the Historical Resources Center Steering Committee, and the development of panel discussions for the Department of Scientific Publications. To begin the discussion of the Steering Committee, he notes that Scientific Publications wrote The First Twenty Years, the first history of MD Anderson. Because of this association with the institution’s history, Mr. Pagel was asked to be part of the Steering Committee when the Historical Resources Center was formed and set as its first goal the publication of an updated institutional history. Mr. Pagel wanted the perspective to be broader than the first book, situating MD Anderson and cancer research in a larger context of other cancer institutions and the history of cancer research. Though not alone in holding this view, he says he had something to do with articulating it for the benefit of the Steering Committee. He describes how James Olsen was selected to be the author and notes other Steering Committee activities.
Chapter 10: Initiatives and Committees

Walter Pagel ELS and Tacey A. Rosolowski PhD

In this Chapter, Mr. Pagel reviews several past and ongoing activities for the Department of Scientific Publications. He first talks about the series of panel discussions he established, covering such topics as “Publishing Strategies,” “Grant Strategies,” and a new panel on “Publishing in High-Impact Journals.” In explaining the latter project, Mr. Pagel explains the prevailing assumption that unless a researcher is publishing in high-impact journals, she/he is not successful. Faculty members approached Scientific Publications to address this issue and point out that it is actually a myth –that publication is actually about the quality of science and the writing. He notes there was faculty hostility to the approach Scientific Publications chose to take: to acknowledge that the importance of high-impact journals is simply a reality and that researchers need to learns the skills required to reach these journals. He mentions several people he has invited to speak on this panel, noting that everyone was very willing to participate.

Mr. Pagel next mentions that he must complete his work on the Cancer Care Series prior to his retirement, then he goes on to talk about his work on a committee formed to change the Research Report into an online publication. He explains the strategy of creating general guidelines then inviting faculty to decide the details of the procedure, and notes how proud he was of the committee’s effectiveness. After noting a habit of MD Anderson’s administration to impose plans from the top-down, he explains how the online report came to be incorporated into a database.
Chapter 11: Presidents and a Senior Vice President

Walter Pagel ELS and Tacey A. Rosolowski PhD

In this overview of key MD Anderson administrators, Mr. Pagel first describes R. Lee Clark as a powerful individual who recognized everyone in the institution personally –and who was also feared. Mr. Pagel explains that Dr. Clark was very concerned about his centrality to the institution and would evaluate others’ actions based on how they influenced his position. Dr. Charles LeMaistre, he says, was very supportive of Scientific Publications and had a habit of allowing good people to lead themselves. He says that while Dr. Clark’s leadership was based on charisma, Dr. LeMaistre may have had more affection for MD Anderson people. He describes Dr. John Mendelsohn taught the institution how to be successful in an aggressive way, turning MD Anderson into a business. His style was to “float above everyone else,” Mr. Pagel says. Mr. Pagel describes the warm welcome he received when going to meet Dr. Ronald DePinho, the institution’s fourth president, and speculates the scientific writing may be personally very important to Dr. DePinho, who quickly sent the Department articles to edit and was quick to praise the results. Mr. Pagel then describes Dr. Stephen Tomasovic, with whom he worked for fifteen years. He recalls that it was Dr. Tomasovic who challenged him to “do something” and succeed in the area of education, when it was clear that writing needed to be addressed in the institution. He states that Dr. Tomasovic “gave everything he could to this institution.”
Chapter 12: Paying Attention: A Professional and Personal Habit

Walter Pagel ELS and Tacey A. Rosolowski PhD

In this Chapter, Mr. Pagel first talks about receiving the John P. McGovern Award for Excellence in Biomedical Communication in 2001. He then looks ahead to activities he will take up after retiring at the end of August 2012. He likes to cook and tend orchids and he also writes, he notes. He is a good amateur photographer and may volunteer for the Houston Public Library’s new photography project. He lists some of the authors he respects (e.g. Ernest Hemmingway and Vladimir Nabokov). Observing his own character he says, “I notice that there are people who don’t notice anything,” whereas he feels his is attuned to what’s going on around him. This, he says, is the reason he likes to cook, enjoy wine, and keep orchids. He mentions that he recently received a call from Chapin Rodriguez, Director of Scientific Training at the Association for Multimedia Education (UMNA) in China, who asked him, “How do you do this?” Mr. Pagel says, “What I do is fairly simple, but moderately unusual: I ask questions and pay attention to the answers.”
Chapter 01: The Origin of MD Anderson Land in Research Park, Smithville and Bastrop

James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD
Chapter 02: Working with MDACC President Dr. Lee Clark on Research Science Park, Bastrop

James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD
Chapter 03: Approval and Funding for MDACC Research Science Park

James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD
Chapter 04: Approval for a Laboratory Facility; Naming the Facility; Ensuring Flexibility of the Land Use; R. Lee Clark’s Vision for a Rural Laboratory

James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD
Chapter 05: Pride in the New Laboratory Facility; Key Supporters in the Legislature

James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD
Chapter 06: The Early Leadership of Research Park and Others Who Contributed to the History of Research Park

James "Jake" Jerell Pickle, Clifford Drummond, Lesley W. Brunet, and Earl Walborg PhD
Chapter 01: The First Person to Go to College

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

In this segment, Dr. Podoloff briefly sketches his family background, noting when his family emigrated from Kiev, Russia to the United States. He also explains that he was the first person in his family to go to college. An uncle who was a proctologist was the only member of the family involved in the sciences or medicine.
Chapter 02: Chemistry and an Early Mentor Lead to a Focus on Medicine

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

Dr. Podoloff begins this segment by explaining that he started out in public school, but then shifted to private school. He notes his interest in chemistry, describing the shelf full of chemicals he had in his room. He also talks about the family’s physician, Dr. Lucen, who treated his asthma and inspired his interest in medicine. He explains why, after beginning his undergraduate education at the University of Rochester, he transferred to New York University. He talks briefly about his style of thinking.
Chapter 03: A Switch from Internal Medicine to Diagnostic Imaging (Never Losing the Internist’s Perspective)

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

Next, as part of a discussion of the kind of cognitive work that characterizes nuclear medicine, Dr. Podoloff explains why the field is jokingly referred to as “unclear medicine.” He refers to an image (provided below) to illustrate the fuzzy images he had to interpret.
Chapter 04: Private Practice and an Opportunity to Develop a Radiology Department

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

Next Dr. Podoloff explains how he built a nuclear medicine program at the Diagnostic Clinic. He also explains how nuclear medicine differs from radiology. He notes that he built a very successful department.
Chapter 05: Discovering How to Image a Beating Heart; Reflections on Radiology’s Shift in Focus from Form to Function

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

Dr. Podoloff then comments on his academic connections while he was in private practice: he served as Clinical Associate Professor of Nuclear Medicine and Radiology at the University of Texas Health Science Center in Houston from 1976-1985. He comments on how advances such as the MUGA technique have shifted radiology’s focus from the form of organs to physiological processes.
Chapter 06: An Opportunity for Intellectual Challenge at MD Anderson

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

Next Dr. Podoloff observes that in 1985, the perception was that MD Anderson was a very depressing place where patients went to die. He tells an anecdote about the diversity among the faculty at MD Anderson.
Chapter 07: Building a Clinical Nuclear Medicine Program

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

In this segment, Dr. Podoloff sketches the roles he served once he came to MD Anderson as Deputy Chairman of the Department of Nuclear Medicine. He explains that he ran a small clinical operation that generated income and explains how the system of keeping physicians on salary at MD Anderson leads to good medical practice. He talks about the impact of this shifted role on his own career and how he developed the clinical operation.
Chapter 08: Contributions to the Institution: Leadership and Diversity; A New Research Project

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

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

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

[The recorder is paused for about 4 minutes.]
Chapter 09: Technological Advances that Have Transformed Diagnostic Imaging

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

[The recorder is paused briefly.]

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

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

Finally, Dr. Podoloff comments on how the timeline for the development of new instruments is much shorter than the development period for new drugs.
Chapter 10: Advances in Radiology Continue to Raise Questions about Ethics and Consent

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

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

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

Dr. Podoloff next observes that if you’re purely scientific about medicine, you treat a patient like a test tube, but “we have to be human.” He talks about attitudes of cancer patients when considering issues of consent: they want to feel better and function as they did before their illness. He also notes that it is hard to “sell” imaging to a patient as an experimental element of a treatment plan, as there is no direct outcome. He notes that he is very dependent on patients’ altruism.
Chapter 11: A Brief History of PET Scans at MD Anderson

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

In this segment, Dr. Podoloff explains why PET scans were difficult to offer at MD Anderson. First, financial difficulties at the institution resulted in the PET program being closed between 1988 and 1994. Next, insurers were not reimbursing PET scans because there was no data to document their advantages. Dr. Podoloff discusses insurance and the damaging influence insurance policies can have on treatment. He notes that the PET program was restarted at MD Anderson in 1999 and currently does seventy to eighty scans per day.
Chapter 12: A View of New Collegial Leadership

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

Next he observes that the recruitment of David Pimwica-Worms and Helen Pimwica Worms has been very positive for the institution. David Pimica-Worms, now Head of Diagnostic Imaging, brings a collegial leadership style that contrasts with Dr. Yuri Galivani’s “top down” approach.
Chapter 13: Training Radiology Residents and MD Anderson as an Educational Institution

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

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

Dr. Podoloff then talks about changes to medical education. He observes that MD Anderson offers education to individuals at the advanced fellowship level. He also notes that he talks to students about ethics and economics.
Chapter 14: The Center for Advanced Biomedical Imaging: an Opportunity to Realize a Vision of Imaging for MD Anderson

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

After a brief discussion of his role as Deputy Chair of the Department of Nuclear Medicine, Dr. Podoloff tells the story of the Center for Advanced Biomedical Imaging (CABI). He explains that in 2000 conversations with Dr. John Mendelsohn [Oral History Interview] and Joe Hogan, the head of GE Medical resulted in a deal to develop CABI. This was also a recruitment incentive for him to take on the role as head of the Division of Radiology. Dr. Podoloff explains his vision for imaging at MD Anderson, referring to the image below. Dr. Podoloff then explains why he wanted to take the position of Division Head and create the Center for Advanced Biomedical Imaging. He notes that he had the support of both Dr. Mendelsohn and GE Medical.
Chapter 15: Developing and Opening the Center for Advanced Biomedical Imaging: Challenges and Complexities

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

Dr. Podoloff observes that the centers are located on South Campus for synergy: he lists the departments with strong connections to CABI.
Chapter 16: The Center for Advanced Biomedical Imaging: More on the Story of Establishing CABI

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

Dr. Podoloff He talks about financial challenges of running CABI and legal challenges involved with acquiring instruments from GE Health. He explains the decision to offer standard of care imaging with research imaging tacked on in order to avoid “hemorrhaging money.” Dr. Podoloff talks about the different between a non-profit and a not-for-profit institution.
Chapter 17: The Center for Advanced Biomedical Imaging: Part of the Changing Institutional Vision of Cancer Care

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

After discussing some controversies over establishing CABI, Dr. Podoloff explains how CABI fits in with the visions of cancer care developed by MD Anderson’s presidents. He discusses how CABI fits in with Dr. John Mendelsohn’s view of the “cancer care cycle” and how a system of research centers could offer a comprehensive approach to cancer prevention and treatment (see image next page). He then talks about its relationship to Dr. Ronald DePinho’s approach to research and targeted therapy.
Chapter 18: The Center for Advanced Biomedical Imaging: A View at the Five Year Anniversary and Role as Medical Director

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

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

He briefly sketches his role as Medical Director of CABI.
Chapter 19: Overview of Administrative Roles; The Moon Shots; Translational Research and the Future of Targeted Therapy

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

Dr. Podoloff covers several topics in this segment.

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

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

Next Dr. Podoloff reflects on the evolution of cancer care. He then talks about how the genetic mutability of cancer tumors in relation to tailored therapies and the Moon Shots.
Chapter 20: Administrative Roles, Views on the Multi-disciplinary Environment of Centers and Institutes, and A Radiologist’s Contribution to a Care Team

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

He then explains that the basic sciences are still organized around departments but the clinical functions are organized in multi-disciplinary care centers and environments. He explains the implications of this structure for Radiology, which does not operate in a multi-disciplinary environment. He sketches the pros and cons of this and talks about the importance of having a radiologist on a clinical team.
Chapter 21: Next Steps --for the Division of Radiology and the Field

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

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

He talks about the “spin lab” where living systems can be imaged using new technologies. He explains the process.
Chapter 22: Medical Education, Radiology Researchers, and The Future of Radiology Research (in the Healthcare Economy)

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

Dr. Podoloff speaks broadly of advances in radiology research.

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

He makes final comments on how radiology’s shift in focus from form to function will give rise to entirely different kinds of inquiry in the future. He notes that the biggest influence on research will be changes in the healthcare systems. He talks about healthcare costs and policy.
Chapter 23: MD Anderson Growth as an Impact on Institutional Culture and on Radiology

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

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

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

Dr. Podoloff praises MD Anderson’s method of paying physicians to take the profit motive out of care deliver. He addresses the period of turbulence at the institution since Dr. DePinho became president, noting the he is satisfied with his leadership with one exception.
Chapter 24: Legacy Left at MD Anderson; A Love of French Cooking; Life and Work Fed by Spirituality

Donald A. Podoloff PhD and Tacey A. Rosolowski PhD

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

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

Finally, he talks about his relationship with Judaism and the importance of spirituality in his life and his work.
Chapter 01: Surgical Oncology as a Specialty

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Pollock explains that Surgical Oncology is both a technical discipline (that uses surgical techniques to intervene in cancer) and also a cognitive discipline that requires knowledge of 1) the etiologies of different cancers and 2) the therapies that other disciplines can offer a patient. He summarizes: a surgeon knows how to operate on a cancer, whereas a surgical oncologist knows when it is best to operate. Surgical Oncologists serve in a consultative role with general surgeons, and Dr. Pollock also lists other specialties that partner with surgical oncologists. He summarizes the training the specialty requires and notes that Surgical Oncology was only recognized as a Board-Certified Specialty during this past year. He describes why it took so long for the field to be recognized and says that the field will now be more attractive to bright young surgeons.
Chapter 02: Discovering Burn Surgery

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

Here Dr. Pollock talks briefly about his family background and then describes the path that took him to study medicine. He was born in Hyde Park on the South Side of Chicago, Illinois. He grew up in a family with five siblings. His father was an M.D. Ph.D. in psychiatry and his mother was a social worker. Dr. Pollock also notes that his father had grown up during the Depression and knew poverty and had selected medicine, in part, because of its guarantee of employment. (Dr. Pollock senior grew up in the same area of Chicago as Dr. Emil J Freireich of MD Anderson, and they were friends.) Dr. Pollock recalls wanting to be a physician when he was a child, but became uncertain as he entered his college years, majoring in history instead. He describes how his father found a clever way to demonstrate the lack of jobs in that profession, prompting Dr. Pollock to go medical school instead.

Dr. Pollock recounts how he became interested in surgery during his third-year rotation at St. Louis City Hospital when he treated a patient burned with lye. He says that this “was the first time he ever felt truly needed by another human being,” and threw himself into the study of surgery with a mind to becoming a plastic surgeon. He was particularly gratified, he says, to discover that there were aspects of surgery that would allow him to use his personality in the therapeutic process –this is a continuing theme in Dr. Pollock’s descriptions of this professional values, and he speculates that this value shows the influence of his father on his life.
Chapter 03: From Burn Surgery to Cancer Surgery

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Pollock narrates his shift in focus from burn patients and plastic surgery to cancer surgery. He begins, however, by underscoring that the connections he made with patients reinforced his belief that he had made the right decision in going to medical school. (He tells a funny and touching anecdote about treating the mother of boxer Leon Spinks.) During his residency at the University of Chicago, he did not care for the competitive atmosphere of the program.

[The recorder is paused.]

Dr. Pollock also describes being called to treat two badly burned little girls, a case that taught him he would not be able to endure a specialty where he had to treat burned children without sacrificing a part of himself. He transferred to Rush-Presbyterian-St. Luke’s Medical Center in Chicago, where some surgeons were interested in surgical oncology. He began to see that surgical oncology was about working with other specialties and establishing connections with patients.
Chapter 04: Discovering a Mentor and a Specialty at MD Anderson

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

Dr. Pollock talks about coming to MD Anderson in 1982 for a surgery fellowship, in the process making many observations about the culture of the institution. He begins by describing the process of applying for his fellowship. He made a trip to Houston some months prior to beginning his fellowship to attend an MD Anderson conference (Cancer Care in the Year 2000).

Dr. Pollock tells an anecdote about a security guard who gave him a one and a half hour tour –only the first instance of the culture of care he would come to value. Dr. Pollock says that people at MD Anderson feel they have a calling, and the institution has a mission that people believe in and can act on. He notes that he has been offered positions at seven other institutions and describes why he has always turned them down.

Dr. Pollock next continues with his description of the conference, where he met Dr. Richard Martin (his “hero in modern surgery), with whom he would establish “one of the most important relationships in his professional career.” Dr. Martin was interested in soft-tissue sarcoma, which became Dr. Pollock’s specialty as well.

Dr. Pollock defines sarcomas –a rare type of cancer representing only 1% of adult solid tumors, and “a true teamwork disease,” as he describes it. Dr. Pollock explains that he had no experience of sarcoma as a resident. Just before coming to MD Anderson of Fellowship, he saw one patient with an osteosarcoma in the emergency room at Rush Hospital –and scheduled him for a radical amputation. When he arrived in Houston, he began on the sarcoma service and followed a sarcoma patient’s treatment through chemotherapy, radiation therapy, surgery, and artificial joint implantation.
Chapter 05: Surgical Stress, Natural Killer Cells, A Mentor and a PhD

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter Dr. Pollock covers the period when he became an assistant professor at MD Anderson and explains the research he began to conduct on the link between surgery and immune functions. His fellowship at MD Anderson (extended to three years) included six-months of research work in the laboratory of Dr. George Babcock, who was interested in surgical stress (stress created by surgical procedures). Dr. Pollock was interested in how surgical stress might effect on natural killer cells that could protect against tumor dissemination. He was encouraged to apply for the NCI’s new KO8 Clinical Investigator Program (and was awarded a grant) and also received a grant through the Institutional Grant Program. During the latter grant process, he met immunologist Dr. Eva Lotsova, who became another of his mentors. She told him that in order to learn how to design long-term studies, he would have to get a Ph.D. Though Dr. Pollock was teaching a full load as an assistant professor, seeing patients, and managing his family responsibilities with young children, he began a degree program at the Graduate School of Biomedical Sciences. (He tells an anecdote about being rejected 24 hours after submitting his application.)

At the end of this Chapter, Dr. Pollock talks about how MD Anderson helped (and helps) faculty to grow. “It was Camelot,” Dr. Pollock says when speaking of the intellectual environment he enjoyed in the eighties and nineties.
Chapter 06: Shifting Research Focus from the Host to the Tumor

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter Dr. Pollock gives an overview of the types of studies he has conducted. In response to a question from the interviewer, he begins with his first paper, published with his psychiatrist father in 1974, on the connection between the Cretan myth of the Minotaur and modern bullfighting. He then explains that after working on surgical stress and natural killer cells, he received a FIRST Award (First Independent Research Support & Transition Award) to shift his focus to the molecular biology of sarcoma. He notes that Dr. Josh Fidler and Dr. Garth Nicholson were both instrumental in shaping his thinking in this new research area. He also observes that renewed interest is growing in natural killer cells, and his early papers are being cited again. He insists, however, that the main contribution he has made has been in following a career path that can serve as “a template” for other young surgeons who wish to become surgeon-scientists; he has also provided leadership in his administrative roles to support new scientists. Dr. Pollock explains his belief that researchers also have a responsibility to address problems of technique that arise in the operating room. For ten years he has been involved in refining how sarcomas are staged (how their features are described and how scientists think about them). He notes that in collaboration with three investigators from other institutions, he has received a SPORE grant for sarcoma, the largest award ever granted. At the end of this Chapter, Dr. Pollock underscores how important collaboration is to surgical oncology and talks about how he interviews fellows to determine their willingness to collaborate.
Chapter 07: Sarcoma Studies

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter Dr. Pollock talks about his shift in research focus to the molecular biology of sarcomas, discussing along the way two significant programs built as a result of his work.

He begins by talking about his 8-9 year collaboration with Dr. Dihua Yu, which began as a sarcoma-oriented laboratory, but eventually evolved to be a more encompassing initiative. In 2006, Dr. Pollock explains, he approached John Mendelsohn with the idea of creating a Sarcoma Research Center Program, as those studying the diseased were dispersed over the entire institution. The Program was created so researchers could share researchers and trainees. Dr. Pollock then explains that his study of sarcoma tumors initially looked at the role of the tumor suppressor gene p53, commonly mutated in this disease. He learned that p53 controls or influences many processes, including the regulation of angiogenesis. He explains how p53 regulates angiogenesis. He also sketches a few discoveries: angiogenesis can be reversed by restoring normal p53 genes to the tumor, a therapy that also restores cell cycle regulation and diminishes the invasiveness of the sarcoma. He notes that these studies did not go into clinical trials because of his increasing administrative responsibilities.
Chapter 08: The Largest Sarcoma Tissue Bank in the World

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In an important collaboration, Drs. Pollock and Yu created what would become the largest sarcoma tissue bank in the world, with fifty different cell lines and twenty-five animal models for studying the disease. In this Chapter, Dr. Pollock sketches the value of understanding the molecules the drive nearly 100 sarcoma subtypes and notes the possibility for therapy that come from this research. (He gives an example of how understanding molecular processes in the tumor can lead to physicians to reduce chemotherapy in sarcoma patients, and notes that the Bank has collaborations with several industrial concerns. The research group is made up of about twenty faculty, fellows, and students from the Graduate School of Biomedical Sciences who focus on investigating the basic biology of sarcoma. He underscores the need for such groups, as sarcoma is underfunded even in relation to its incidence in the population and understanding how it works can contribute greatly to the understanding of cancer in general.
Chapter 09: The Elements of a Researcher’s Life: From Research Approaches to Novel Ways of Supporting Patients

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter Dr. Pollock comments on the life of a researcher, beginning with his personal experience of working alongside his (second) wife, Dr. Dina Chelouche Lev, in a laboratory established around a core set of values they share as surgical oncologists. He describes Dr. Lev’s working style and commitment to surgical oncology as both a vocation and avocation, noting shifts in his role vis a vis his field as his administrative demands increased.

Dr. Pollock also mentions an unusual step he has taken to secure support for sarcoma research: bringing interested patients about to have sarcoma surgery into the research laboratory. It’s important, he says, so patients can see how their tissue is actually going to be studied and also so that researchers (some with no clinical training) actually connect tumor tissue to real human beings. In addition, patients can become interested in supporting sarcoma research financially. He tells a touching anecdote about a patient (with metastatic liposarcoma) asked to volunteer in the lab. He eventually died and the entire laboratory was invited to attend his funeral –and did attend. At the end of this Chapter, Dr. Pollock observes that the life of a full-time researcher can be very lonely.
Chapter 10: Chair of the Department of Surgical Oncology: Practicing Servant Leadership

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Pollock discusses the strategies he used to build morale in the Department of Surgical Oncology and build the department’s national reputation after becoming Chair in November of 1993. He begins by noting that in 1986 or ’87, Dr. Charles Balch (his predecessor) changed the name of Department of General Surgery to the Department of Surgical Oncology (a formality that did not express any change in department philosophy or direction).

NOTE: the recorder is turned off for about 15 minutes at this point.

Dr. Pollock gives several examples of choices he made to set the tone for his Chairmanship and address low morale in the Department. (For example, he remained in his own small office rather than take over a large that was earmarked for him, but in use by physician’s assistants.) He points out that he didn’t know much about leadership, but wanted to make connections with department members as people first, and as employees second. For information, he contacted his brother, who had been to business school, for some readings and discovered Robert Greenly’s Servant Leadership. The message that leaders should provide service to people who report to them resonated with Dr. Pollock. He conducted “walk around research,” talking to Department members to find out what was important to them. He secured resources and got out of the way as people put them to use, never taking credit for others’ work. He notes that he also admires the leadership principles of Colin Powell, who advocated respect for the chain of command without being a slave to it.
Chapter 11: Moving the Department of Surgical Oncology into National Prominence

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

Dr. Pollock describes how he led the Department to “bring visibility to this group of young people” who were doing stellar work. In an anecdote, he describes how the Department worked together to “colonize” the Society of Surgical Oncology conference. By helping one another with abstracts and how experiments were conceptualized, MD Anderson’s Department of Surgical Oncology went from having 3 papers accepted per conference, to 27 papers, wresting control from Sloan Kettering researchers and dominating the podium at this major event in the field for 2-3 years. This raised the Department’s national profile and demonstrated its commitment to attracting fellows who could compete for academic positions.

Dr. Pollock points out that during his fifteen years as Chair, 85-90% of the Departments fellows have entered academic positions, with 20% holding positions as department chairs or sections chiefs. This is evidence that the department has had a real impact on academic surgery, and he points out the concurrent commitment to clinical care as well.
Chapter12: The Department of Surgical Oncology: Some History, Accomplishments, and Critical Evaluation

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

Dr. Pollock begins this Chapter by pointing out that acquiring resources was a challenge during his chairmanship, so he convinced established faculty members to set up a pool of their overage dollars to help young professors fund clinical trials –many of which have evolved into major lines of research.

Dr. Pollock reviews contributions of previous chairs: Dr. Richard Martin stressed the importance of excellent clinical care; Dr. Charles Balch understood that the group needed to transition from being a unit in the Texas System to being an academic unit; Dr. Pollock combined the two perspectives, emphasizing that one could do both research and clinical care, as he himself demonstrated by being only the second M.D. on faculty to complete a Ph.D. program at the Graduate School of Biomedical Sciences.

Dr. Pollock expresses his pleasure that his Department has emerged as “a dominant force in American Surgical Oncology.” He also notes that assuming the role of Chair as an assistant professor “short-circuited” his own research opportunities. He then talks about his evolution as a leader over his fifteen years as chair, giving examples of how he would handle situations differently now. He also expresses concern that the current MD Anderson administration is shifting focus away from collaboration between faculty. He tells an anecdote that stresses the value of interaction and collaboration among faculty.
Chapter 13: Becoming Head of the Division of Surgery

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

Dr. Pollock explains the process that led to him assuming the role as Head of the Division of Surgery, noting that the Division’s structure enabled him to remain as Chair of Surgical Oncology. He did not switch offices, to underscore the equality of all units within the Division. He notes that as an individual, he had roles in four administrative levels. This enabled him to bring a broad viewpoint to Division matters.
Chapter 14: Technology in the Division of Surgery

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this section Dr. Pollock explains several Division initiatives that are improving surgical processes for the patient.

Dr. Pollock talks about MINTOS (Minimally Invasive & New Technology in Oncologic Surgery), an interdepartmental program that finds technologies to pair with laparoscopic surgery to make oncology surgery is less burdensome on the patient. He also discusses how advances in surgery had enabled a new field, oncoanesthesiology to emerge (he will be speaking on this subject at a conference).

Next Dr. Pollock explains robotic surgical techniques, describing how it helps surgeons perform more accurately. Robotic surgery can also be performed at a distance (tele-surgery), which could influence care in distant areas of Texas and among the medically underserved. Dr. Pollock mentions that Southwest Bell has given MD Anderson a grant of one million dollars to explore tele-surgery and that NASA is also interested.

Dr. Pollock then talks about BrainSuite, an operating suite that is also an imagining unit: MD Anderson is one of the 1st two places in the world where a surgeon can see an image of a tumor as s/he is operating on it. He describes the benefit of this to the patient and the surgeon and talks about the training processes needed to use these new technologies.
Chapter 15: Removed as Head of the Division of Surgery

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Pollock speculates on why he was removed from his position as Head of the Division of Surgery on October 2012. The ostensible reason, he explains was that the administration was concerned about budgeting issues within the Division. However he believes that upper levels of the institution wanted to replace him with an individual whose leadership philosophy more closely matched the new administration. Dr. Pollock explains that he adheres to a model of servant leadership that has also influenced the matrix-model governance structures he has favored over “command and control” leadership. He cites growth statistics within the Division as evidence of the success of decentralized leadership.

Leadership at MD Anderson is coalescing around the “driving vision” of an individual, Dr. Ronald DePinho, who is organizing resources on behalf of the Moon Shots initiative. Dr. Pollock explains his belief that this program will succeed if the faculty spontaneously embrace the refocusing of resources. He characterizes the spirit of the MD Anderson faculty and reports some faculty reactions to the Moon Shots program.
Chapter 16: Building Excellence and Therapeutic Promise

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Pollock reviews the contributions he feels he has made to MD Anderson and to his field, and also notes the projects he wishes he could have brought to completion. Beginning with his clinical work, he is very gratified that he worked with the Department Chairs to assemble a group of surgeons who are not only the best in the world but can “sublimate their egos” and work together toward larger initiatives, including a very successful research program.

Dr. Pollock notes that he had wanted to shepherd some sections (orthopedics, ophthalmology, dental oncology) to becoming separate departments, but was unable to complete that. He is pleased that tele-surgery initiatives were launched under his leadership, and foresee that MD Anderson is exactly the institution to develop this service and bring it to underserved populations. An outcomes research program was also instituted under his leadership and has yet to reach national prominence. A program in nanotechnology and surgical applications has also been started. Dr. Pollock describes several of the exciting possibilities for treatment that this research will yield, and he also notes the first efforts of tissue engineering research.
Chapter 17: Research and the Future of Surgical Oncology

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In response to a question about areas of cancer research with particular promise for patients, Dr. Pollock cites tumor-based and translational research supported by SPORE grants, as well as Dr. DePinho’s Moon Shots Program addressing specific cancers, includubg melanoma, lung cancer, head and neck cancer, myeloid leukemia and myelodysplastic syndrome, chronic lymphocytic leukemia, prostate cancer, and triple-negative breast and ovarian cancers. Dr. Pollock notes the challenges of sustaining funding to make real progress in all these areas. He then talks about the future of surgical oncology, noting that “we are trying to put ourselves out of business.” Surgery, he explains, will become more localized and increasingly reliant on other specialties. For example, surgery and interventional radiology are on a “confluence course.” He explains the potential use of nano-cameras for tumor surveillance and notes that it will also be possible to radio-tag problem genes to monitor metastasis.
Chapter 18: Surgical Oncology, Board Certification, and Working to Define the Field

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Pollock first explains that the Department of Surgical Oncology is about to move forward with Board Certification. As a member of the Surgical Oncology Advisory Committee of the American Board of Surgery, he has been involved with defining the field of Surgical Oncology and with determining the parameters for certification. Dr. Pollock explains how the training of surgeons at MD Anderson has changed –and will change—as a result of this process. Training periods will be longer, but some of activities that currently generate more income for fellows will be reduced, requiring that the institution hire part time assistants. Dr. Pollock describes the advantages of certification, despite some disadvantages. He then notes that he has been a member of the Committee for the past twelve years: he and his collaborators have successfully defined the role of the surgical oncologist as an orchestrator of multidisciplinary care. The certification process attests to the fact that Surgical Oncology is a full-fledged discipline.>/P>
Chapter 19: A Philosophy of Teaching –and Leadership

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter Dr. Pollock notes the range of situations in which he has taught and states that his philosophy of teaching is based on an informal model of mentoring. In the clinic, he explains, he finds it gratifying to demonstrate by how to build rapport and trust with a patient, how to handle difficult situations and deliver difficult news.

Dr. Pollock explains that he always gives his patients his cell phone number during a first meeting, and Dr. Pollock explains the significance of doing this for patients, and for fellows who see a physician offering support 24/7. He describes at length the importance of listening to patients and notes that this does influence the bottom line, increasing the number of patients who recommend MD Anderson as a caring institution.

As a teacher of researchers, Dr. Pollock explains that he had most impact in a support role, editing papers and teaching researchers how to express their ideas and develop skills in public speaking. He notes that he began to develop these skills while on a debate team in high school and by taking seminars as a history major in college. Dr. Pollock quotes St. Francis: “See yes to listen rather than to be listened to,” and makes the connection between his teaching philosophy and his preferred model of servant leadership.
Chapter 20: A Medical Practice Enhanced by Explorations in History, Religion, and Spirituality

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In response to a question about the link between professional practice and spiritual/religious belief, Dr. Pollock explains his belief that human intelligence is an organic, collective entity “that is getting smarter all the time.” In his small way, he has tried to contribute to that growth and he comments on his own evolution as a person over his lifetime. He also explains that his interest in European and Jewish history had fed a more general fascination with how people have coped historically with extreme circumstances and emergencies. His reading on the experiences of immigrants, Holocaust victims and other groups has made him a more sensitive cancer physician.
Chapter 21: Welcoming Minority and Ethnic Patients to MD Anderson

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter Dr. Pollock explains that African-American and Middle Eastern patients can wonder whether they are truly welcome in a “majority institution” such as MD Anderson. Dr. Pollock tells some anecdotes to show how he has tried to welcome minority patients and further the institutional mission of serving all patients equally

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Chapter 22: Editorial Positions: Cancer and Other Publications

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

In this Chapter, Dr. Pollock describes his role as editor-in-chief of the American Cancer Society’s journal, Cancer, a position he was nominated for and held from 2000-2011. He task was to bring the journal back from some “hard times,” and he notes that the American Cancer Society was pleased with what he accomplished. Under his leadership, Cancer became one of the first biomedical journals to accept submissions electronically. Dr. Pollock notes some of the surgical oncology manuals and textbooks he has editing and explains that editing and writing are another outlet for his educational impulses.
Chapter 23: The MD Anderson Presidents

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

Dr. Pollock reviews the MD Anderson presidents he has worked with. He begins with a few comments on Dr. R. Lee Clark, a visionary who say the promise of multi-disciplinary care. Dr. Charles LeMaistre, he says, had an unparalleled understanding of how central clinical care is to the mission of the institution. He protected and helped the institution grow during difficult times. Dr. Pollock says he was “smitten” by Dr. LeMaistre’s style, particularly his ability to listen, and is grateful to Dr. LeMaistre for his support when he transferred his interests to molecular biology.

Dr. Mendelsohn, he says, was a builder with a strong vision for the institution growth. It was Dr. Mendelsohn who selected Dr. Pollock for the position of Head of the Division of Surgery. He offers an anecdote to demonstrate Dr. Mendelsohn’s style of dealing with differences of opinion within senior leadership. He also recalls a meeting in 2005 that led to the creation of the Sarcoma Research Center and notes the original investment of $400,000 has given rise to $25 million in philanthropy and grants. Dr. Pollock then says that he has not had enough interaction with Dr. Ronald DePinho to comment on him.
Chapter 24: A New SPORE Grant Focused on Sarcoma; Grateful to Work at MD Anderson

Raphael E. Pollock MD and Tacey A. Rosolowski PhD

Dr. Pollock reflects on the fact that he has more time now that he has stepped down from his role as head of the Division of Surgery. He would like to focus on sarcoma for the next decade and describes the $16 million SPORE grant (a SARC grant –Sarcoma Alliance for Research through Collaboration), that he was awarded in October 2012 in collaboration with researchers from many other institutions. He describes the projects included in this grant, explaining that the array of projects represents an integrated and multi-faceted attack on sarcoma.

In the last minutes of the interview, Dr. Pollock expresses his gratitude to MD Anderson for providing a research and clinical career that exceeded his “wildest fantasies.” He notes that “when you are finished changing, you are finished.”
Chapter 01: Emergency Management and Leadership

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

In this chapter, Dr. Porter provides an overview of what leaders will experience by taking part in Emergency Management. She notes the teamwork that can lead to long-lasting relationships. She also explains that emergency management allows a leader to see the “nooks and crannies” of an institution.
Chapter 02 : Experience in Emergency Management

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

Dr. Porter begins this chapter by observing that she was a trauma nurse for ten years before taking on opportunities in emergency management. She notes that trauma parallels emergency situations, and she was intrigued by the need for quick thinking and fast decision-making.

She served as Manager of Emergency Services at Englewood Hospital in Englewood, New Jersey (1991 – 1997), an institution situated near a busy highway. She focused on response strategies around hazardous materials. Next, she was recruited to set up a Trauma Center at Good Samaritan Hospital in Suffern, NY and served as Director of Critical Care and Emergency Services (1997 – 1999). She explains why this hospital needed a trauma center. She also discusses how the hospital worked with the Hasidic Jewish population, to ensure effective healthcare delivery. She also notes that this hospital was located near Indian Point Nuclear Power Plant, necessitating that the hospital conducts nuclear drills.

In 1999, she explains, she was recruited to Lenox Hill Hospital in New York City to serve as Director of Emergency Services, Emergency Preparedness, and also as the Bioterrorism Coordinator. She explains that the hospital was receiving terrorist threats and also dealing with concerns about the impending millennium.

Dr. Porter then returns to her discussion of her work at “Good Sam” and explains that she had the valuable opportunity to work with a military emergency management specialist at this time. She notes that she provided about 300 instructional sessions for dealing with hazardous materials and threats.
Chapter 03: 9/11

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

In this chapter, Dr. Porter talks about her experience as an emergency management leader at Lenox Hill Hospital when the terrorist attacks occurred in New York City on Tuesday, September 11, 2001. She had been recruited to Lenox Hill Hospital in New York City in 1999 and was serving as Bioterrorism Coordinator. She describes the scenario at the hospital as reports of the attacks on the Twin Towers came through. She describes coping with her own knowledge that her son worked in a building across the street from the Twin Towers and her concerns when she was unable to contact him or her daughters.

She explains how the hospital realized there would be no influx of wounded survivors and how they turned their attention to “what can we do for the community?”

Next, Dr. Porter talks about how 9/11 forced her to realize how important it is for a leaders to control her own demeanor –despite personal feelings-- for the sake of the institution she is leading. She underscores how important it is for a leader to identify colleagues she can lean on and how important it is to be able to multi-task and attend to the impact the emergency is having on people.

Dr. Porter talks about how her children handled the emergency.

She then reflects briefly on how the city recovered from the terrorist attacks, holding the New York Marathon. She talks about her participation and how this helped her see the city returning to normal.
Chapter 04: From Mount Sinai Hospital to CNO and VP of Nursing Practice at MD Anderson

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

Dr. Porter begins this chapter by talking about her work as Chief Nursing Officer at Mount Sinai Hospital in New York City. She focuses on her work with the unions, a traditionally adversarial stakeholder, and explains how she was able to build a strong partnership. She notes that after 12 years in that role she was “ready for another adventure.”
Chapter 05: CNO and VP of Nursing Practice at MD Anderson

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

Dr. Porter explains that she received a call from a recruiter for MD Anderson and describes coming to visit the institution for her current role.

Dr. Porter explains that because she had visited MD Anderson in 2010 for a survey, she knew many people and “felt like I worked here.” She explains how she decided to leave Mount Sinai and how she wanted to take on the challenge of seeing how she could contribute to move the MD Anderson bar even higher.
Chapter 06 : Areas to Address as Chief Nursing Officer

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

In this chapter, Dr. Porter discusses areas where she felt she could make an impact at MD Anderson. She begins by summarizing her management style and notes some challenges that arose as nurses became accustomed to her style during rounds.

She tells a story about nursing in orthopedic surgery to illustrate her goal of integrating patient experience and quality scores. She also talks about bringing more use of social media to the institution. She notes that social media was used extensively in NYC, yet MD Anderson was nervous about its use when she arrived. She uses examples to demonstrate the positive impact of social media on perceptions of MD Anderson leadership. She also notes that social media can capture the ‘granularity” of the institution and its culture. She talks about receiving posts from nurses internationally, noting “you become their hope.” She talks about her philosophy and guidelines for using social media in an institutional context.
Chapter 07: Developing Nursing with an Endowment from the Argyros Family Foundation

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

In this first half of this session, Dr. Porter discusses how she is using an endowment of three million dollars from the Agyros Family Foundation to implement her vision for developing the Division of Nursing [Agyros Family Foundation Nursing Research Endowment]. Dr. Porter explains why it is important to develop the key facets of her vision: the academic and research infrastructure. She first notes that she is using funds to bring in nationally recognized nursing leaders to share information and to consult on how MD Anderson can develop nursing. She has submitted a proposal to hire a full professor of nursing research. She explains her logic: to develop nursing practice at MD Anderson and also to develop a community of nursing leadership within the institution and that has a high profile nationally as well.

Dr. Porter explains that the siloed culture at MD Anderson has held back this growth and she talks about her strategies to work around it. She explains the many successes that the division has had recently –all indications that this long term strategy is paying off. As an example, she discusses how she has begun nominating MD Anderson nurses to be fellows of the American Academy of Nursing, noting that Gary Brydges is the first “home grown” nurse to be honored in this way.
Chapter 08: Observations about Nursing and Hurricane Harvey

Carol Porter DNP, RN, FAAN and Tacey A. Rosolowski

In this chapter, Dr. Porter gives an overview of the strong performance of MD Anderson and of nursing during Hurricane Harvey in September 2017.

She notes her background in emergency management, but explains that in the northeast, where she had prior experience she had had no experience with MD Anderson policy, particularly regarding the strategy of having a “ride-out team” [see UT System article below]. She talks briefly about adjusting to this new policy.

Next, Dr. Porter talks about the key activities undertaken to ensure effective delivery of patient care during the period when MD Anderson was isolated and supported only by the ride-out team. She talks about ensuring that people in the Incident Command Center and on staff in the hospital units were relieved periodically so they could sleep. Dr. Porter also talks about the process by which nurses from four other institutions came to support patient care efforts. She explains how quality of care was guaranteed and comments on the excellent team-building that was accomplished, such that after a couple of days it was not possible to distinguish MD Anderson staff from the support staff from outside.

Next, she expands on the ride-out team policy and notes that a key challenge was to keep this staff safe and effective by getting them to take breaks.

She also comments on the impact of the fourth meal provided by Food Services to patients and to the team, as well as the fact that the fitness center was opened so the team could wash and decompress.

Dr. Porter then notes that the experience underscored that the staff and patients felt cared for, and the Incident Command Center operated in a respectful and caring way. She explains that the patient care areas never ran out of supplies.
Chapter 01: Growing Up in a Migrant-Worker Family

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez recalls her early life when her parents worked as migrant workers in the fields of Texas and in California. She talks about the effect of experiences in her neighborhood on her later life and recalls the huge range of illnesses she saw in her community where there was little medical care. Dr. Rodriguez also characterizes her parents as “survivors” who were committed to family. She recalls that her family was very frugal, but she never felts as though she lacked for anything.
Chapter 02: Support from Teachers and Family Leads to a College Education

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez talks about her educational path leading up to medical school in this segment. She says that she was encouraged to study from elementary school, when she took an IQ test and scored very high. She recalls that she was asked if she had cheated on the test. Nevertheless, her parents were advised to encourage her to study. Dr. Rodriguez explains that her mother was concerned about her plans to leave their small town to go to college, though her father supported the idea. She says that coming from her background, going to college “was a miraculous thing.” She had little assistance applying to college, but explains that she was advised to apply for scholarships. She recalls going to San Antonio to meet with the selection panel for a scholarship. She was not awarded that scholarship, but one of the nuns on the panel arranged for a scholarship from Our Lady of the Lake College (BA conferred in 1975). Dr. Rodriguez explains that, for practical reasons, she majored in Spanish with the intention of teaching. However she did very well in the sciences and her advisor, Dr. Rigual, advised her to consider medical school. Dr. Rodriguez recalls the educational environment at Our Lady of the Lake College, including a research program that was available and gave her experience in research methods. She began to think about going to graduate school to do research
Chapter 03: Going to Medical School

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez talks about her decision to go to medical school and describes her experience at the UT Medical School in Houston, Texas (degree conferred in 1979). She recalls that African-American students from Baylor College of Medicine came to Our Lady of the Lake College to talk about summer research projects at Baylor and recruit minority students to medical school. She applied to the research program, was accepted, and the experience encouraged her to consider applying to medical school. Dr. Rodriguez talks about getting a full-tuition scholarship to the Medical School in Houston and recalls the reactions of her family to this new move. She also talks about the unique and grueling three-year program and reviews the pros and cons of the different specialties she considered. Dr. Rodriguez speaks about a rotation at MD Anderson. She talks about the “personality” of cancer patients, who were so appreciative of care, and explains the features of oncology that appealed to her (though she did not decide to go into oncology at this point).
Chapter 04: A Revealing Internship and Residency

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez talks about her residency and her decision to focus on oncology. She explains that she chose to do her internship in internal medicine at te UT Health Sciences Center in San Antonio (1/1979−1980) because she wanted to focus on health issues in the Hispanic population, particularly diabetes. She stayed in San Antonio for her Residency in Internal Medicine (1/1980−1982) and decided during her first year to focus on oncology. Next she decided to do a fellowship and approached Dr. Daniel von Hoff about working in his laboratory. (Research Fellow, Cancer Therapy and Research Center 1/1982−1983.) She explains that she wanted a year to familiarize herself with this new field and to take time for personal reflection. Dr. Rodriguez also describes the research she conducted at the time, relating to Dr. Hoff’s theory that treatments could be personalized to the specific sensitivities of a tumor. She explains the work she did on the research projects and notes that this intellectual environment influenced her thinking about cancer. Dr. Rodriguez then explains why she elected to do her fellowship in hematologic cancers (Fellow of Hematology/Oncology, University of Arizona Cancer Center, Arizona Health Sciences Center, Tucson, 1/1983−1986).
Chapter 05: The Problem of Diabetes among Hispanics

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez explains why she abandoned her original intentions to work with diabetes in the Hispanic population. She explains that obesity is a cultural and medical issue for all patients. She talks about the centrality of (unhealthy) foods in Hispanic culture and the challenges of changing deeply engrained habits.
Chapter 06: Fellowship Research and the Move to MD Anderson

Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

Next, Dr. Rodriguez talks about her mentor, Dr. Fernando Cabanillas, who was passionate about advancing the treatment of lymphoma. Dr. Rodriguez explains that she designed studies and tested drug combinations within Dr. Cabanillas’ laboratory.
Chapter 07: Shifting Focus from Research to Administration

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez sketches how she began to shift away from research as her main focus. She began, she says, by doing administrative work “in a surreptitious way.” Dr. Cabanillas asked her to serve as Director of the Lymphoma Clinic, a role that gave her experience, demonstrated her knack for administration, and her commitment to making things better for patients. She talks about working with clinical pharmacists, a new breed of specialists at MD Anderson, and the roles this connection led to. Dr. Rodriguez then talks about how important grantsmanship is for researchers.
Chapter 08: Research on Lymphoma Treatments

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez describes studies she conducted on lymphoma treatments in collaboration with Dr. Cabanillas. She first explains a study that showed the efficacy of ifosfamide among patients who did not respond to the CHOP treatment. She next talks about use of the same drug for patients awaiting stem cell transplantation. This study is still in regular use. Dr. Rodriguez then says that the current atmosphere at MD Anderson focuses on developing new drugs rather than optimizing older drugs. As an example of the value of retaining older ideas, she mentioned work by Dr. Wilson that shows that continuous infusion of drugs is more effective than bolus administration, an idea that Dr. Cabanillas originally explored.
Chapter 09: Learning Administrative Approaches by Leading the Myeloma Clinic

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez begins this segment by explaining that the Myeloma Clinic was originally jointly managed with Transplant Leukemia services. She served as Clinic Chief of the Lymphoma/Myeloma Section from 1994−1996. Dr. Rodriguez explains what she learned from working in this environment of shared resources and how she acquired basic knowledge of how to assess patient volume and flow and determine hours of clinic operation. Next Dr. Rodriguez explains how the administrative issues shifted once the Myeloma Clinic became autonomous in 2003 and was stressed with challenged of internal utilization of resources. At this point she began her habit of writing reports to ensure transparency. (She notes that she used to have access to downstream revenue reports, but these have since disappeared.) She talks about the biggest lesson she learned at the time: how an individual’s work has an effect on the whole. As an example, Dr. Rodriguez explains that she became aware that the Myeloma Clinic was one of the biggest customers of the CT Scan Unit. She details how this effected operations of the CT Unit and had an effect on other services. She explains that this refined her thinking about how to strategize care delivery in an arena of low resources. Dr. Rodriguez also notes that most physicians tend not to see the big picture in which the deliver care and use resources; she gives examples of stresses to the system that can result. Dr. Rodriguez observes that she began to attend administrator education courses around this time. As an example of slow administrative development at MD Anderson, Dr. Rodriguez notes that she never filled out a for-service charge form until the 1990s. She talks about issues that arose once billing forms were introduced.
Chapter 10: The Role of the Physician-Leader at MD Anderson

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez talks about the important role that physician-leaders can serve in an organization. She explains that a primary responsibility is to explain the need for institutional changes in terms that clinicians can understand. She stresses that physician-leaders must be able to listen, have a toehold in specific services, and demonstrate that they share common experience with clinical peers. She returns to the example of the Myeloma Clinic’s heavy use of the CT Scan Unit and the pressures that created among all services. She notes that she was first made aware of this resource issue by listening to clinicians vent their frustrations about difficult access to the Unit. Next Dr. Rodriguez explains that physician leaders must be able to explain a larger reality to data-driven MDs who generally have a much narrower focus. She talks about why, traditionally, there has been a gap between clinical and administrative levels of an organization. Dr. Rodriguez next talks about the history of physicians and leadership at MD Anderson, beginning with the first president, R. Lee Clark, who went to hire other clinicians with leadership abilities. She explains that in academic institutions, most physicians assume leadership positions that carry academic titles and that reflect their knowledge rather than specific skill at administration or leadership. Dr. Rodriguez believes that today one cannot excel as a clinician and administrator and this is why one is now seeing different titles for physician-leaders.
Chapter 11: Today’s Medical Paradigm Shift

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez provides perspective on what she calls “the medical paradigm shift” that currently challenges everyone in healthcare. She begins by sketching how landmarks in the history of research into causes of disease created paradigm shifts in the pass. She begins with the long period in which doctors learned their craft through apprenticeship to other individual physicians. She then explains that a paradigm shift occurred in the 19th Century, when hospitals became the primary setting for acquiring this training. She notes that the growth of nursing also had an effect on the practice of medicine. She then talks about the technical developments of the 20th century that led to another paradigm shift. Dr. Rodriguez explains that the current paradigm shift is not focused on technology, but on how care is delivered and diseases managed. She stresses that the new paradigm focuses not merely on the doctor-patient relationship, but on the management of relationships between teams of providers and the institution to deliver optimal care. Dr. Rodriguez says that MD Anderson is still in the investigational paradigm and may not have the skills to engage patients in being their own health care advocates. She explains that there is a great deal of data available to help individuals prevent cancer and that nearly seventy percent of patients survive for five years. Dr. Rodriguez cites several MD Anderson initiatives that focus on prevention.
Chapter 12: The Survivorship Initiative

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment Dr. Rodriguez talks about MD Anderson Survivorship initiative, which began to take shape, she explains, after the Institute of Medicine released its presidential report From Cancer Patient to Cancer Survivor: Lost in Transition (November 3, 2005). This report, she says, detailed why care for survivors was lacking. Dr. Margaret Kripke, PhD [Oral History Interview] had been appointed to the president’s Committee on Cancer and became aware of the issues. She brought this information to the president of the institution, Dr. John Mendelsohn, who decided to integrate survivorship into MD Anderson’s care delivery system. A committee was formed and Dr. Rodriguez took on implementation of their plan in 2006. Dr. Rodriguez notes that MD Anderson began transitioning patients to survivorship in 2010. There is now a significant body of patients and Dr. Rodriguez says her next step is to leverage the information that has been collected. Dr. Rodriguez explains the process she and her committee went through to determine how to implement survivorship care, a process that began with listening closely to all constituents. She summarizes: they build the survivor care clinics in the same way they build acute care clinics. Next Dr. Rodriguez sketches why a focus on survivorship was controversial when it was first proposed. She touches on bond that forms between the patient and the physician and notes that a primary concern was survivorship programs would ask the patient to divorce him/herself from the main oncologist. Dr. Rodriguez notes that this break can sometimes be more painful for oncologists, who say they enjoy seeing well patients –often the high point of their day. Dr. Rodriguez explains that they finally settled on a model where one supervising physician determined the activities of mid-level providers in a situation that de-escalates the intensity of visits by focusing on wellness. Dr. Rodriguez sketches the approach. She notes that a key issue they had to consider: at what point does the primary oncologist see the patient as a survivor? This question will be answered differently in each treatment area and the committee built algorithms to determine the transition point to survivor care, when the risk of relapse is nil. The entire care model for each service is built around four common domains: Surveillance, Prevention, Monitoring for Late Effects, Psychosocial Health. Dr. Rodriguez explains how this model works using the example of lymphoma. She confirms that all the survivorship services are amassing a great deal of knowledge about survivor care.
Chapter 13: Aimed Toward an Interest in Survival; Survivorship Care and the Affordable Care Act

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez begins this segment by sketching how the Affordable Care Act has an impact on care for survivors. She focuses on the assumption payers make that it’s most cost effective to transition patients to their primary care physician after treatment, as oncologists are expensive. She says that is premature for patient who have had aggressive tumors or treatments. Dr. Rodriguez notes that she spoke at ASCO about MD Anderson model of survivor care. She communicated that the four domains MD Anderson uses to structure a care plan is relevant at all stages of cancer care. Dr. Rodriguez then explains that her interest in survivorship was a natural extension of her work with lymphoma patients, as lymphoma was one of the first malignancies that could be cured. She understood early the four domains of Surveillance, Prevention, Late Effects Monitoring, and Psychosocial Health.
Chapter 14: Lessons in Administration as Ad-Interim Chair of Lymphoma/Myeloma

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez begins this segment by explaining how her view of the institution changed as she stepped into the role of Ad-Interim Chair of Lymphoma/Myeloma when Dr. Cabanillas retired. She sketches her new areas of responsibility and how this changed her view of operations and the institution as a whole.

Next, Dr. Rodriguez explains that traditionally, a Department Chair is seen as an “erudite expert,” but to be successful a chair must let go of her/his ego and bring forth future leaders in the field.
Chapter 15: Vice President of the Office of Medical Affairs; the Value of Faculty Credentialing

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez begins this segment by explaining how conversations with the outgoing and incoming physicians-in-chief around she came to her role as Vice President of the Office of Medical Affairs. When Thomas Burke, MD [Oral History Interview] became physician in chief in 2004, her role was expanded to include medical affairs functions. She was officially named in 2005 with service to the present. Next Dr. Rodriguez notes that learned a great deal about Texas law and regulations of medical practice. She also had to familiarize herself with the roles of Physicians Assistants and Advanced Practice Nurses.

Next, as an example of a function within Medical Affairs, Dr. Rodriguez talks about the process of documenting the credentials that physicians present for employment. She explains why this process is key to the reputation of MD Anderson. She also notes that employees have occasionally falsified documents.
Chapter 16: The Office of Medical Affairs: Credentialing, Quality Indicators, and Building a Culture of Improvement and Quality Care

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez explains a key function of the Office of Medical Affairs: to credential all individuals at MD Anderson to ensure their competence. She next explains that, since 2009, MD Anderson has been involved in developing performance and quality indicators for professional practice. She explains this history of this focus and the different reactions of clinicians to professional evaluation, given that most evaluation is perceived as adversarial and punitive, rather than part of a culture of self-awareness and self-improvement. She comments on Texas requirements that support a culture of improvement. Dr. Rodriguez then talks about how the Office of Medical Affairs created an infrastructure to shift to quality indicators.
Chapter 17: The Office of Medical Affairs: Patient Concerns, Patient Advocacy, Conflict Resolution

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez discusses another important role of Medical Affairs: to provide support for patient who wish to voice complaints. This segment covers sources of patient complaints and distress, the importance of communication, the role of Patient Advocates and the sources of stress in that role. (She notes that patients can become abusive because they would like a second opinion to be a different, hopeful opinion, but often a lack of options is confirmed.) She notes that having an Advanced Directive conversation is a quality indicator and explains the issues that this raises. She notes that there is more emphasis now on selecting health care providers who have communication skills.
Chapter 18: Creating MD Anderson’s Practice Algorithms; On Blending Art and Science in Medical Practice: Practice Algorithms and Targeted Therapy

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez tells the story of MD Anderson’s 147 Practice Algorithms beginning with the origin of this initiative in the 1990s movement to define “pathways of care.” She talks about the process of establishing an algorithm and discusses the effects. She also notes the different reactions of clinicians, who may immediately adopt the algorithm or who may take convincing. Dr. Rodriguez talks about the dangers of dogmatism in medicine. She notes that medicine is both an art and a science, but the poles need to be harmonized in order to be humane. Dr. Rodriguez notes that limits of targeted therapy and sketches an emerging view that this approach will be replaced by a focus on failures in the body’s surveillance and regulation mechanisms. She notes committees in place to support clinicians as they self-monitor the quality of their practice.
Chapter 19: Integrating Advance Practice Providers into Care Teams; Training Program for Physician Assistants

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez talks about the increasing reliance on advance practice providers in medicine and in oncology. She notes that, at MD Anderson, General Internal Medicine is a hold out. She sketches what an APP can bring to a care team. She talks about her own experience working with a Physician’s Assistant. She explains why she shares oversight of Advanced Practice Nurses with the Division of Nursing. Next Dr. Rodriguez talks about the Physician’s Assistant Oncology Fellowship Program, started in 2008. She sketches differences in the education of MDs and PAs and explains the need for an oncology fellowship. She talks about the impact of the program and an e-course developed for fellows at a distance.
Chapter 20: The Office of Medical Affairs: Job Satisfaction Survey of Mid-level Providers

Alma Rodriguez MD and Tacey A. Rosolowski PhD

After sketching changes to the office of medical affairs in the last ten years, Dr. Rodriguez discusses the purpose and results of the regular survey of mid-level providers at MD Anderson. She notes that, in general, the workforce is very stable, but the institution wants to monitor reasons that pockets of high turnover exist. She notes results of the survey: everyone at MD Anderson is committed to the job; some fear retaliation if they voice complaints; many feel they are not paid enough. Dr. Rodriguez stresses that employees’ pay is in line with other state institutions. She talks about requests for mentoring made via the survey and how that was acted on and to what affect.
Chapter 21: Patient-Centered Care: Formalizing the Practice at MD Anderson

Alma Rodriguez MD and Tacey A. Rosolowski PhD

Dr. Rodriguez talks about the shift in healthcare to a focus on patient-centered care and addresses the specific ways that MD Anderson is putting this approach into practice. She first explains that patient-centered care is a shift in focus and explains the value is shifting from treating disease to treating people (and seeing them as customers). She notes that MD Anderson patients experience the kindness and devotion of providers. She lists some patient centered practices instituted and notes others that need improvement.
Chapter 22: Patient-Centered Care: the Psychosocial Council, Advanced Care Planning

Alma Rodriguez MD and Tacey A. Rosolowski PhD

In this segment, Dr. Rodriguez continues her discussion of patient-centered care. She discusses the work of the Psychosocial Council, in particular on the latter’s work on creating guidelines to talk to patients about advanced care planning, then talking about the Department of Chaplaincy and Pastoral Education. She first talks about the Psychosocial Council and advanced care planning, offering her view that advanced care planning is not a conversation about death, but about health care planning for the future that needs to be integrated into a patient’s treatment plan. She explains strategies for bringing awareness to this at MD Anderson and also notes that this is part of a national conversation. Dr. Rodriguez next talks in general terms about the Psychosocial Council (formed 2007), its roles, and the pushback it has received for treating disease from an emotional perspective.
Chapter 23: Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson

Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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