Interview Chapters

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez begins this chapter 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.

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

  Dr. Rodriguez begins this chapter 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.

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 24: Transitional Moments in MD Anderson History

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 27: Creating a Future Under the Affordable Care Act

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 28: Women and Leadership at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 01: Multidisciplinary Care at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 02: The Important of Clinical Leadership at MD Anderson

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 03: Leadership in a Period of Change

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 04: Multidisciplinary Care and the MD Anderson Algorithms

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 05: Envisioning the Next Period of Leadership

  Alma Rodriguez MD and Tacey A. Rosolowski PhD

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

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  Chapter 15 : Global Academic Programs: Building Research Partnerships

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Next Dr. Bogler explains the benefits that MD Anderson derives from such collaborations, specifically an opportunity to research rare cancers or research questions not ordinarily funded by American sources. MD Anderson also can take advantage of the expertise of researchers trained in other contexts.

  Dr. Bogler explains how some of these projects have matured, being awarded NIH grants and yielding prestigious publications. He explains the criteria the Network uses to select grantees. He explains that his goal (and the goal of GAP) is to maximize inclusivity of researchers and institutions and to activate partners in all areas of research, not just the cutting edge trends. He explains that some partners are not in a situation to take advantage of the latest cancer treatments. He explains why many are very interested in palliative care, for example. He notes that partners do research in areas that American funding sources tend to ignore –alternative medicine, for example. He stresses that the range of research at MD Anderson is very broad.

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  Chapter 17: Global Academic Programs: The Big Picture and New Partnerships in Africa

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler begins this Chapter by explaining the working philosophy of Global Academic Programs: GAP is part of the MD Anderson infrastructure, a platform where collaborations are facilitated without determine exactly what activities take place.

  He then briefly mentions two institutions in Thailand that will become partners and explains the strategic opportunities they can afford MD Anderson. He also explains that they put into action Dr. Ronald DePinho’s idea of “lives touched.”

  Dr. Bogler next explains that international activities at MD Anderson are integrated through an International Advisory Board.

  He goes on to explain that with partnerships, MD Anderson is developing cancer initiatives in Africa, where there was no previous activity. He explains the “gap” that exists between MD Anderson and African institutions and that he has been long working on the “puzzle” of how to build collaborations. With the recent development of the African Cancer Network, Dr. Bogler feels the institution can look forward to a strong and active program.

  Dr. Bogler says that “this is the power of MD Anderson—the ability to motivate, concentrate, and focus in a way that’s almost magical.”

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  Chapter 19: A Survivor of Male Breast Cancer

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler begins this Chapter by talking about his surprising diagnosis of stage three male breast cancer in September 2012. He notes that he delayed being examined for a long time “because I’m a guy” and because he couldn’t believe he’d gotten such an “absurdly rare” disease. He describes his course of treatment.

  Dr. Bogler then talks about how his perspective changed when he began to experience treatment and the institution from the perspective of a patient, noting how “amazing” MD Anderson is and how many individuals are involved in a single patient’s care. He describes the energy in the patient areas as “sustaining” and communicating a “can-do optimism.”

  Next Dr. Bogler talks about the ways in which cancer changed his life, expanding his connections with people with cancer, and giving him a keener sense of his own mortality, since there are no good longevity figures for men with the disease. He explains that he and his wife take more interesting vacations now. He talks about the effects that the cancer diagnosis had on his marriage.

  Dr. Bogler says that “you never quite come to terms with cancer,” which “robs you of your innocence.” He explains his own anxieties about recurrence, but notes that working at MD Anderson provides a great deal of meaning in his life. He says his “personal mission” is to support the people who see patients.

  Dr. Bogler then discusses work as an advocate for patients with male breast cancer. He is proud of his current work with photographer, David Jay, on “The Scar Project,” a series of photos of male and female survivors of breast cancer. He also notes that he is creating visual art as a form of self-therapy. He says that as a professional in oncology, there are things he cannot say about dealing emotionally with cancer.

  Dr. Bogler talks about David Jay’s exhibition of photographs of cancer survivors at MD Anderson and the impact of seeing these images that gave patients a new presence. He notes that David Jay’s photo of him appeared in the New York Times (see below). He talks about his own work on a project called, “Tumor in a Box.”

  Photo by David Jay, from New York Times article, “When Men Get Breast Cancer,” 25 February 2014.

  Dr. Bogler then discusses his blog, “Entering the World of Pink.” He explains that he knew he would never “keep this quiet” at a cancer center and wanted to use his disease as an opportunity to raise awareness, since men with breast cancer “stand in the shadow of the world of pink.” He stresses the need for research on men, then explains the content of his blog, written from the perspective of a scientist about the biology of cancer. That activity spurred his interest in advocacy for more funding and clinical trials focused on male breast cancer. He explains several issues around funding and clinical trials, explaining the ethical necessity of including men in breast cancer studies.

  Dr. Bogler then explains why he uses social media to get his message out, citing his love of technology and the fact that he is an introvert. He talks about some memorable responses to his posts on Twitter and Facebook. He explains that he has been using social media to recruit men for David Jay’s “Scar Project,” saying “there’s some comfort in that.”

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  Chapter 09: Global Academic Programs: Organization

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  In this Chapter, Dr. Bogler sketches the history of Global Academic Programs (GAP) and its connections with other global initiatives at MD Anderson.

  He begins by explaining why education is part of MD Anderson’s mission and how GAP links to this mission. He notes that GAP began in 2002 to evaluate and manage the many requests to work with the institution. He notes that GAP was one part of the Center for Global Oncology –also included were the Global Clinical Programs and Global Business Development. Dr. Bogler says that GAP still partners with these two initiatives, but explains how their reporting structures have been altered. He now also serves on joint international advisory board he co-chairs with Amy Hay [Oral History Interview], head of Global Business Development.

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  Chapter 10: MD Anderson’s Global Programs Collaborate to Deliver Support to International Partners

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler explains the coordinated functions of Global Academic Programs and Global Business Development, headed by Amy Hayes. He describes the process involved when a prospective partner contacts MD Anderson and how they receive the support they need to be successful. He uses the example of the Peruvian institution, Oncasolud, whose most effective support would come from GBD. Dr. Bogler explains the different relationships that GAP and GBD establish with partners; GAP offers consultative support for no fee to an institution that wants to develop collaborations; GBD offers business development consultancy services for a fee.

  Dr. Bogler notes that these programs were established by Dr. John Mendelsohn [Oral History Interview] to respond to specific requests from international institutions.

  Dr. Bogler states that he is “excited about the international possibilities” at this time and that MD Anderson has over seventy years of accumulated knowledge to share with other institutions.

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  Chapter 11: Global Programs Devoted to Spreading MD Anderson’s Multi-Disciplinary Care Models

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler begins by noting that because the MD Anderson model involves evidence-based, research driven care, MD Anderson also requires that partners include research (clinical trials) in their operations. The institution also requires that partner provide monthly metrics to track clinical quality.

  Dr. Bogler then discusses the challenges of implementing these requirements in domestic versus international partners and the differing expectations of quality that can result. At the end of this Chapter, Dr. Bogler stresses how excited he is about the prospect of bringing MD Anderson’s experience and knowledge to international centers. He says that the expansion is so much more than a commercial venture. “We can’t implement programs for free.”

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  Chapter 12: Global Academic Programs and other Global Initiatives

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  In this Chapter, Dr. Bogler explains the structure and function of Global Academic Programs.

  He explains that GAP was housed administratively in the Center for Global Oncology when he began as Vice President in 2010. He also sketches the structural changes to this organization as other programs focused on domestic partnerships and were then absorbed in the The Cancer Network.

  He stresses that GAP is designed to support the international work of MD Anderson’s faculty. He sketches distinguishes GAP’s way of operating with that of The Cancer Network. Dr. Bogler notes that the faculty select the institutions that will become connected to MD Anderson. He explains that if no strong faculty commitment exists to build the connection, then nothing results.

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  Chapter 13: Global Academic Programs: Two Examples of Collaboration

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler discusses MD Anderson’s collaboration with two institutions, the German Cancer Research Center in Heidelberg and the Instituto de Cancerologia–Clinica Las Americas (IDC) in Medellin, Colombia.

  He first characterizes institutional collaborations then talks about the specific support that Global Academic Programs provided these two institutions. The Instituto de Cancerologia needed help establishing clinical trials for surgical procedures, and Dr. Bogler explains the differences between trials focused on drugs versus surgery. He also underscores the importance of reciprocal visits between institutions to solidify the relationships and mutual trust.

  Next, Dr. Bogler explains the two-phase process an institution must go through to become a sister institution. He lists the criteria that MD Anderson uses to determine the viability of a prospective partner: program infrastructure, status in the health care environment, research capabilities, the strategic opportunities a partnership would offer MD Anderson, the institution’s capacity for commitment.

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  Chapter 14: Global Academic Programs: Activities and Services Offered to Partners

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  In this Chapter, Dr. Bogler talks about several services GAP offers to bring faculty together with partner institutions.

  He first describes the annual conference that brings faculty and international partners together. He talks about unique features of the conference. Then he discusses a conference held in Oslo early in Dr. Ronald DePinho’s presidency: Dr. Bogler explains how it helped demonstrate the “power of the GAP network”.

  Dr. Bogler underscores that Dr. DePinho has a strong vision of international collaboration and translation of research.

  Next, Dr. Bogler explains what MD Anderson derives from partnerships. He gives an example of the partnership with the National Cancer Institute of Mexico, which is working on a Federal program of smoking cessation.

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  Chapter 16: Global Academic Programs: Building Collaborations Using SciVal

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler first discusses the Research Retreat scheduled shortly after he became Vice President of Global Academic Programs. He then explains how Collexis –eventually renamed SciVal—helps researchers find collaborators. Sci-Val has helped GAP build an international database of experts with areas of specialization identified with keywords. He explains how MD Anderson implemented SciVal and notes that faculty in sister institutions are also listed on a voluntary basis in this very effective system. (The University of Texas System is adopting it.) Dr. Bogler notes that SciVal includes many excellent clinical partners. Discussions are underway to increase the numbers of research partners.

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  Chapter 18: Global Academic Programs: Changes Under Dr. Ronald DePinho and The Future

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler begins this Chapter by observing that, as a laboratory scientist, he does not have the expertise to fully develop clinical possibilities in Global Academic Programs. He began to transition out in 2012 when he was diagnosed with cancer and Dr. Kian Ang, who had a clinical focus, led GAP until June of 2013. He notes that he returned to lead GAP at Dr. Ethan Dimitrovsky’s [Oral History Interview] request.

  Dr. Bogler talks about the new expectations Dr. Ronald DePinho brought to GAP once he assumed the presidency of the institution. He then talks about the Prevention Moon Shot and points out that GAP is serving as a platform to link MD Anderson to partners. He describes a trip that executive leaders at MD Anderson have made to Lisbon to talk about partnerships.

  Dr. Bogler states that Dr. DePinho has a clear and courageous vision. He understands concerns that academics might have regarding the short timeline of the Moon Shots Program. However, speaking as a patient, he says, it’s a profoundly courageous message.

  Dr. Bogler then summarizes future directions for GAP. He mentions the need to develop international clinical trials and his hopes that the Sister Network Research Fund will remain strong. He notes that the originally academic connection created with the Albert Einstein Hospital in Sao Paolo was transformed into a Business Associate relationship with clinical interactions and an opportunity for co-branding. He notes that other GAP partnerships could follow suit.

  Dr. Bogler ends this Chapter with observations about how MD Anderson needs to balance concerns with maintaining its reputation with its mission and need to have strong international impact. He summarizes what partnerships can mean to MD Anderson.

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  Chapter 01: A Stimulating International Education with a Focus on Science

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  In this Chapter, Dr. Bogler describes the unusual international focus of his early education. He was born in Germany (and continues to hold German citizenship). He first describes the International School in Frankfurt, Germany, where he received a “U.S.-style” education focused on creativity and individuality. He notes that he is himself a creative person and exercises this characteristic in administration and the sciences, as well as through such hobbies as painting and photography.

  Dr. Bogler next talks about attending a boy’s public school [Oundele School] in Northamptonshire, England at the age of twelve. He describes the difficulties of adjusting to the new, more rigid school culture after the freedom of an American style education and also discusses his parents’ (Helmut and Helga) reasons for sending him abroad for his education.

  Dr. Bogler states that, at age 12, he knew he wanted to be a biologist as he was fascinated by the DNA replication and other cellular mechanisms he was learning about from excellent teachers. He talks about one influential teacher.

  He then notes that he majored in biochemistry in college and also talks about his habits of visual thinking. The “inner pictures” that came into his mind as a young person studying molecular mechanisms inspired him.

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  Chapter 02: Some Challenges of Boarding School; A Black Sheep Scientist in the Family

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler continues his discussion of the difficulties adjusting to the Oundle School. He also notes the excellent teachers and resources the school offered. He talks about playing English sports (he “loathed” rugby).

  He then talks about his growing abilities in the sciences and mentions a summer botany project he worked on with a professor in Frankfurt. He then talks about his family background, noting that no one else in the family has been involved in the sciences, calling himself a “black sheep.” He explains why his family was so open to a son exploring a career path that was unusual in family culture.

  He then explains a little about the English system of exams.

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  Chapter 03: Nationality and Nationalism: An Internationally-Focused Perspective

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  In this Chapter, Dr. Bogler responds to a question about how his early international experience helped track him to his current position as Vice President of Global Academic Programs.

  Dr. Bogler explains that his observations about differences in German and English attitudes to national identity helped him understand that any individual needs to assume an objective attitude about the characteristics of his/her own nation. He explains why he has not taken American citizenship despite living in the United States for twenty years. He then tells a story of struggles he and his wife, Irene Newsham, have had securing German citizenship for their adopted children, Owen and Anna Bogler.

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  Chapter 04: College Provides Exposure to Many Disciplines

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler talks about the path that took him to Sydney Sussex College, Cambridge University. He first explains that he took a year off before going to university, working at pharmaceutical companies in Strasbourg, France, and in New Jersey.

  Dr. Bogler notes that he was “completely committed to doing research” when he began college. He sketches the advantages that a Cambridge education offered, as it exposed him to many disciplines and offered close contact with professors. He explains why he was “never drawn to medicine.”

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  Chapter 05: Training a Researcher’s Mind: Ph.D. Research

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  In this chapter, Dr. Bogler talks about his process of selecting his PhD program.

  First, to explain how his intellect was being trained during college, he explains a college research project for which he studied 2-D proteomic gels, leading to his fascination with cell differentiation. He notes that this was a cutting edge topic at the time.

  Next, Dr. Bogler explains the English system for selecting a PhD program: a student selected a laboratory to work with, not a school. He ended up at the Ludwig Institute for Cancer Research in a neuro-laboratory focused on the study of oligodendrocyte precursor cells (’88 – ’91). Dr. Bogler explains some administrative issues that arose with his degree from this institution. He also notes that work at this cancer institute did not fire his interest specifically in cancer at this time.

  He explains his research, then his move to the Salk Institute for a post-doctoral program (’92 – ’93), noting that he learned a lot of molecular biology. He explains why some departmental tension held back his research.

  Next, Dr. Bogler explains that at the time, the Ludwig Institute was opening new branches, one eventually in San Diego where he did his second post-doctoral fellowship (and also met his wife, Irene Newshaw). His cancer-focused work began at that time with research on the effects of the p53 gene on astrocytes.

  Dr. Bogler also notes that some groundwork for his administrative perspective was established during this time. He explains that in becoming proficient at bench work, a laboratory researcher also comes to understand that there are limits to the type of work he can accomplish alone. This drives a researcher to collaboration and established his own commitment to a collaborative perspective.

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  Chapter 06 : Coming to MD Anderson to Help Craft a SPORE Grant

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Dr. Bogler begins by explaining how his PhD and fellowship work set some groundwork for his administrative perspective and focus on collaboration. He then sketches his positions after his post-doctoral fellowships, then talks about the series of events that brought him to MD Anderson. He comments on opportunities that gave him experience with leadership in the area of education.

  Dr. Bogler explains that he was hired primarily to work with Dr. Alfred Yung [Oral History Interview] on coming to MD Anderson to insure that the institution was awarded a SPORE grant, a goal achieved.

  Dr. Bogler notes that he was always collaborative in approach throughout this training and that most researchers are “built that way.” He describes his leadership style.

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  Chapter 07: Gaining Experience in Education Leadership at MD Anderson

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  Here Dr. Bogler talks about the series of events that led him to leadership roles in developing educational initiatives at MD Anderson.

  Dr. Bogler first describes the Odyssey Program, an internally awarded post-doctoral fellowship for emerging, gifted researchers. Dr. Bogler explains how he reorganized the Program (in particular its finances). Next, he talks about his work on the Annual Symposium and the Trainee Recognition Day. He then explains what he learned from these experiences that prepared him to apply for the position of Vice President of Global Academic Programs.

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  Chapter 08: Transitioning from Research to Administration

  Tacey A. Rosolowksi PhD and Oliver Bogler PhD

  In this Chapter, Dr. Bogler explains his decision to shift more fully into administration when the opportunity to lead Global Academic Programs arose in 2010. He explains that in addition to administrative experience, he had relevant intercultural experience to offer. He sketches the vision statement he submitted with his application.

  He also sketches the situation in the Department of Neuro-surgery that contributed to his decision to shift away from work centered on that Department.

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  Chapter 05: The New Division of Cancer Prevention and Department of Epidemiology

  Tacey A. Rosolowksi PhD and Margaret R. Spitz MD

  In this chapter, Dr. Spitz talks about the creation of the new Division of Cancer Prevention and Population Science under Dr. Charles LeMaistre and her role heading the new Department of Epidemiology. She notes that she suggested Dr. Bernard Levin [oral history interview] to head the Division. She also notes that MD Anderson had three population sciences programs at the time, which was “unheard of” in a cancer center.

  Dr. Spitz then talks about why the Department of Epidemiology was formed at this time she then talks about her activities as Acting Chair and then Chair of the Department (1992 – 1995; 1995 – 2008). She lists her recruits and tells an anecdote about securing laboratory space for them.

  Dr. Spitz notes that the Department was “my baby.” She talks about intentionally creating an environment to provide a good quality of life. She notes that many of the supports for staff and faculty that she instituted are no longer in existence.

  Next, Dr. Spitz notes some particular achievements in the Department. Lung cancer research became a focus and the Department created a Lung Cancer Database that continues to serve as a great resource. She lists several activities that focus on lung cancer.

  Dr. Spitz next explains why she stepped down as Chair in 2008.

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  Chapter 01: A Unique Institution: The Michale E. Keeling Center for Comparative Medicine

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Satterfield explains that the Michale E. Keeling Center for Comparative Medicine provides a variety of resources and services to physician-scientists at MD Anderson and the Texas Medical Center. He focuses in particular on the animal models using mice, sheep, chimpanzees and many other kinds of animals that enable experimentation with drugs, the mechanisms of cancer, and many other studies. These, in turn, provide the basis for translational research leading to therapies useful for human patients. In addition, the Center provides medical and surgical expertise for handling research animals as well as expertise in the many guidelines researchers must follow to comply with FDA regulations. He notes that the Keeling Center is a unique institution where veterinarians do more than provide clinical care and advance science. As an example, he describes his collaborative work with the Department of Neurosurgery studying the treatment of neuropathic pain in cancer patients.

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  Chapter 02 : Why Animals are Important in Cancer Research: Controversy Over Using Animals

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Satterfield explains some basic terms and describes how biological and genetic similarities make it possible for animals to serve as stand-ins for humans in experiments. He also notes some of the characteristics scientists look for to determine whether a particular animal will offer a good model for a specific disease or condition presents itself in humans. He then explains that animals are critical to the study of cancer because the disease is so complex and expresses itself in so many ways. He notes that rhesus monkeys, for example, can spontaneously develop colon cancer just like humans, whereas other animals do not. There is tremendous individuality in animals, just as there is in cancer. He says that if computers can eventually create a replica/model of a living organism, perhaps animal studies will no longer be needed. But he doubts that a computer could ever model anything so sophisticated. One of his roles, he says, is to help investigators select the correct animal models for their studies in order to most effectively lead to treatments for humans.

  Dr Satterfield next acknowledges that many people believe that animal experimentation –particularly with higher primates- is controversial and perhaps even immoral. He says he appreciates the controversy, but states that “it’s ok if we inconvenience a few animals to help millions of people.” The death of one of their research animals is a personal loss, and the staff cares deeply for all the animals at the Center. He then talks about studies of hepatitis C using chimpanzees (the only animals other than humans who can carry the disease), noting that a year and a half ago they cleared a chimp of hepatitis C. Dr. Satterfield then details the many ways that the Keeling Center cares for experimental animals: with yearly check ups, cardiac exams, and even geriatric medicine for the aging chimpanzee population. (In 1995, the NIH placed a moratorium on breeding chimpanzees, so the population is aging. IN addition, chimpanzees are not euthanized at the end of studies, as are other animals.) He also notes a case in which an experiment with a monoclonal antibody killed a chimpanzee, thus preventing that drug from being tested on human beings.

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  Chapter 03: Broad Experience and an Interest in Immunology Creates a Path to MD Anderson

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Satterfield briefly sketches his educational path and notes that when he assumed the position of Veterinarian at the Boston Zoo, he was one of the few fully employed zoo vets at the time. He also talks about his family background, noting that he elected to go into veterinary medicine because of his mother’s love of animals and her support for his habit of bringing home strays. He then lists his unique professional experiences. During his postgraduate training through the School of Veterinary Medicine at Harvard, for example, he worked with basic scientists who were looking at the transmission of disease. He acquired wide clinical experience working on animals as varied as fish, elephants, and primates. All this experience kindled his interest in basic biology and immunology. This will put him in a unique position to be recruited for MD Anderson’s Keeling Center.

  Dr. Satterfield describes how he was offered the opportunity to come to MD Anderson in 1983 to study the very poorly understood disease, AIDS, and try to develop treatments based on the model of hepatitis B. He worked with chimpanzees and tells the story of how the NIH was looking for a place to transfer its community of primates. R. Lee Clark found a donor to give one million dollars to bring the chimpanzees to MD Anderson, and he worked with Dr. Michale Keeling and Dr. Kenneth Riddle to create the chimpanzee program. He concludes this section with a brief discussion of research he conducted with the Department of Defense: this led to the discovery of a monoclonal antibody that defends against smallpox and that is now part of the anti-bioterrorism “National Stockpile.”

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  Chapter 04: The Keeling Center and Research on HIV and Hepatitis C

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  Dr. Satterfield recalls how small the Keeling Center was when he arrived in Bastrop and the many challenges he faced caging animals. He recalls the urgent need to create adequate bio-security provisions, as no one knew how AIDS was transmitted. He also notes that because Bastrop is a remote facility, many researchers in Houston didn’t know of their existence (and still do not) but are grateful to discover all the resources they offer. He describes how the faculty grew and became an incubator for collaboration. As an example, he talks about the over 40 protocols conducted with the NIH on hepatitis C and AIDS, which led to the discovery that AIDS is a retrovirus. Dr. Satterfield then goes into detail about his work on hepatitis C, talking about how he and collaborators tested clones of the six strains of the virus to develop a resource for future testing of vaccines. He also notes his work on hepatitis B and D. He returns briefly to talk about the “watershed” hepatitis C study that resulted in a chimpanzee being cleared of the disease. He closes this Chapter by talking about medical conditions that will disqualify an animal from being included in a study.

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  Chapter 05: A Father Who Beats Cancer

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this very personal Chapter, Dr. Satterfield recalls that in 1987 his father was diagnosed with lymphoma and all the physicians he had seen “had written him off.” Dr. Satterfield was able to have his father seen at MD Anderson and was still doing well in 1995. (Mr. Henry C. Satterfield died in an auto accident.) Dr. Satterfield explains that when he arrived at MD Anderson in 1983, he thought he would stay four years or so and move on. However, this personal experience with cancer galvanized his commitment to cancer research. “We do a little,” he says, “but everybody does, and it adds up to a lot.” He also recalls MD Anderson neurosurgeon, Dr. Samuel Hassenbusch, who died of cancer (the same cancer he studied). Dr. Satterfield collaborated with Dr. Hassenbusch and recalls him very fondly. Dr. Satterfield again says that the Keeling Center offers faculty a tremendous opportunity to enjoy work, stimulating colleagues, and a sense of purpose.

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  Chapter 06 :The Cattlemen for Cancer Research --Community Philanthropists

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Satterfield describes how in the late nineties, Dr. Keeling had a plan for raising seed money for new studies. Using his own strong connections to the community, he approached local ranchers to donate livestock for auction, and the Cattlemen for Cancer Research was born. They raised over 1 million dollars and give a percentage to an MD Anderson fund to help patients from a five-county area to pay for cancer treatment. Dr. Satterfield then talks about the Center’s connection to the community, noting that it is a major employer, purchases much of its supplies locally, and also brings students from Austin Community College in for educational experiences. He then notes that the auction has become a yearly event held in the fall, with a gala being held in the spring. This cancer related fund raising has become a community tradition.

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  Chapter 07: The Veterinarian as Research Collaborator

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  Dr. Satterfield here talks about the role he has served as Attending Veterinarian. He explains that this title was established as a result of FDA’s and the animal welfare act administered by the Animal Care and Use Committee. Though an Attending Veterinarian must report all violations of guidelines to the committee, Dr. Satterfield sees his role as a problem solver who helps investigators to think through protocols and clearly define their purposes and methods. He stresses that he sees his role as a facilitator who develops teams and fosters effective collaboration. He then describes how the FDA animal welfare regulations were set in place because of very public instances in which animals were mistreated –in some cases in the course of practicing poor science. At the time, the public also believed that pets were being used for research; he insists that MD Anderson has never used any dogs previously owned as pets for research. He notes the Tumor Referral Program, begun prior to his arrival in 1983, and run in both Bastrop and Houston, which enables the public to bring dogs suffering from canine lymphoma for treatment. He tells a touching story of a mother who brought in a dog that had belonged to her 10-year-old son who had been killed. The animal was all she felt she had left of her son. Dr. Satterfield notes that the Program’s purpose is to extend the life of pets.

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  Chapter 08: The History of ‘Good Laboratory Practice’ at the Keeling Center

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In the beginning of this Chapter, Dr. Satterfield notes that in his role as Attending Veterinarian for the Keeling Center he works for the good of human health and also for the highest standard of care for the animals he oversees. He underscores that research animals are “unsung heroes” in the long process of conducting research and taking drugs to the market; in his view, the FDA has a difficult job in regulating this process, and it has done a good job.

  Dr. Satterfield next goes into detail about the FDA’s Good Laboratory Practice [GLP] program and how the Keeling Center work to meets its criteria for quality insurance, training, documentation, and data storage –all to insure a secure and unbroken chain of experimental evidence so that other researchers can have confidence in reported methods and results and replicate experiments. As a contained unit within MD Anderson, Keeling is uniquely positioned to guarantee secure storage of data, for example, and also security of practices by providing in-house pathology services. Dr. Satterfield also explains describes the economic context in which The Keeling Center adopted the GLP standards: the GLP program enabled MD Anderson to retain control over the discoveries (intellectual property) of its researchers, derive royalties from them, and use those funds to fuel the “engine of development.” The Keeling Center, he explains, provides a piece of that development by providing animal models of use to MD Anderson researchers, as in the case of his collaboration with researchers in Plastic Surgery to engineer bone tissue. He then describes how working on projects with very high-quality research practices led him (in partnership with DR SASTRY) to propose that The Keeling Center make the investment to adopt the full GLP program.

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  Chapter 09: The Challenges of Collaboration and Proprietary Research

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Satterfield mentions his collaboration with Dr. Samuel Hassenbusch, M.D. in the Department of Neurosurgery to study in a study of alternatives to opioids in the treatment of neuropathic pain. He then diverts into career issues created when a researcher works on studies with proprietary devices and compounds. He explains that when work is proprietary, it cannot be published, a serious problem when publications are one of the main criteria used at MD Anderson for tenure and promotion. Dr. Satterfield notes that he “struggles with this as a career issue.” He also notes that veterinarians frequently contribute intellectually to the investigations they help support, but because they don’t have laboratories, their contributions are not as easily documented. The solution, he says, is sensitivity and awareness on the part of individuals who sit on the Promotions and Tenure Committee. He mentions that Dr. James Bowen and Dr. Stephen Tomasovic [Oral History Interview] have both been aware of the problem and helpful. He also anticipates that Dr. Ronald DePinho will appreciate the contributions that veterinarians make to drug research. At the end of this Chapter, he underscores that the faculty at The Keeling Center are collaborators in research more than service providers and that he enjoys working with others and seeing the work translated into patient-relevant practices.

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  Chapter 10: A Career of Collaborative Studies from HIV to Tissue Engineering

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  Dr. Satterfield discusses his research in this Chapter, beginning with his collaboration with Dr. Samuel Hassenbusch, M.D. in the Department of Neurosurgery to study midazolam, an alternative to opioids in the treatment of neuropathic pain (as opioids create small tumors that add to pain and obstruct the spinal cord). He describes the tests conducted on sheep and the subcutaneous pump used to deliver the drug, a highly sophisticated device that can be controlled by telemetry. He notes that study of this system went to clinical trials several years ago.

  Next, he talks about the hepatitis and AIDS research conducted on chimpanzees since his arrival at MD Anderson, though he notes that it is very difficult to meet the criteria to use great apes in studies, a great loss to science in his view. At this time there is only one animal in the study of a drug that successfully cleared hepatitis C. There is also a study in progress to determine the safety of a monoclonal antibody used to treat rheumatoid arthritis and autoimmune diseases. This topic leads to an explanation of “orphan products,” drugs used very selectively for a small number of patients with rare conditions.

  Dr. Satterfield then turns to his work with two gynecologic oncologists using rhesus monkeys to successfully demonstrate that oral contraceptives reduce markers for ovarian cancer. He notes that he helped the investigators select animals with ovarian cycles similar to humans as well as providing the physical services such as performing the biopsies and making slides. This discussion leads Dr. Satterfield to note that Keeling’s chimpanzee community is on oral contraceptives because of the FDA moratorium on breeding.

  The next study described is the work with Dr. Miller, Chair of Plastic Surgery, who was looking for a way of recreating bony body parts using molds. Dr. Satterfield describes the process of recreating a mandible for a sheep by filling a mold with crushed bone, attaching it to the body wall so it could regenerate and grow a blood supply, then transplanting it to the jaw. This process would address clinical mandible problems in humans created by tobacco use. (The process has been used on humans in Germany.) Dr. Satterfield notes that the study was stopped 3-4 years ago. He then talks about the difficulties that physician-scientists face in sustaining a demanding research project while attending to clinical responsibilities. Dr. Satterfield explains that he sees his role as setting up a “turn-key” project where everything is prepared, saving time for the investigator who comes to Bastrop for essential tasks.

  Dr. Satterfield then speaks briefly about his collaboration on a project developing cartilage surfaces for joint surface replacements. A private orthopedic pharmaceutical company funded this study in which sheep and goats were used to explore alternatives for artificial knee replacements. Finally, Dr. Satterfield talks about an ongoing NIH-funded study of a possible HIV vaccine that uses a conserved peptide to stimulate T-cells to kill the virus.

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  Chapter 11: Managing Animals, Research, and Disasters

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Satterfield reviews his administrative roles. He describes his responsibilities as Chief of Livestock and Land Management (1986 – present), noting he has been primarily involved with caring for the Center’s sheep and goats, including providing surgical and radiology services, training technicians, and organizing programs that provide the State with these animals’ blood products. He gives an overview of the Center’s land holdings of 380 acres, most of which is pasturage. He talks briefly a Master Plan drawn up in 2004 and CIPRIT grants that have enabled the Center to serve as a research resource for drug development.

  Next Dr. Satterfield describes his work with the Center’s chimpanzee program. He first explains that chimpanzees are difficult to maintain because they are so intelligent, strong, and social –though they do not necessarily coexist harmoniously. The Center has a Ph.D. behavioral psychologist on staff to organize social groupings. Each chimpanzee also has a name, a medical history and a behavioral profile so the animals can be placed in healthy groupings. In his role on the External Advisory Committee (2006 – ’08) Dr. Satterfield explored funding and research opportunities from outside MD Anderson, including NIH studies, and studies of aging, diabetes, and cardiac disease. His Internal Advisory Role (2007) involved reviewing programs, chimpanzee health, and the facilities. Dr. Satterfield tells a dramatic and moving story about a male chimpanzee [Tony] who escaped and was ultimately shot by an off-duty University of Texas police officer. Dr. Satterfield is clearly still upset by this memory, and he notes this was “a dark period in our history.” It also resulted in the Keeling Center offering raining to the UTPD for chimpanzee escapes, 99% of which occur through human error: Dr. Satterfield notes that there has been no problem in the last 4-5 years.

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  Chapter 12: Roles that Protect Animals and the Institution

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Satterfield notes that his goal in working with the chimpanzees was to understand autoimmune responses and to advance the understanding of chimpanzees as a species. The care of this aging colony, however, has taken on a life of its own. The United States is the only country left in the world that maintains research colonies of chimpanzees. He notes that other countries outsource their research on great apes to the U.S. so they can claim that they do not experiment on animals. Dr. Satterfield notes that the Keeling Center has been under pressure from animal rights extremists, who “data mine” –request vast amounts of information under the Public Information Act in order to disrupt the Center’s operations. Dr. Satterfield underscores that great apes all over the world are so threatened that there may not be wild communities in a few generations. The colonies in captivity are irreplaceable. He believes that the NIH’s ban on breeding the colonies is shortsighted and indicates that it has submitted to public pressure.

  Dr. Satterfield then talks about his work on the Institutional Animal Care and Use Committee (2005 – present). He notes his work protecting MD Anderson by ensuring that principal investigators meet FDA guidelines. He explains that this committee has enabled him to meet great scientists and develop productive collaborations. With budget cuts, he notes, the committee now meets via tele-conference, and this cost saving measure has hurt the collegial connection.

  Next Dr. Satterfield touches on his work with the Pharmaceutical Development Center Steering Committee (2003), his role as the Center’s licensed Controlled Drug Officer, and his work as the Center’s representative for the Freedom on Information Act. He took on this role in response to data mining by animal rights activists. He is responsible for reviewing all documents requested to determine what information is proprietary and can be protected by MD Anderson. He then talks briefly about his role as Deputy Director under Dr. Keeling and his role as Ad Interim Chair after Dr. Keeling’s death (2003). He notes that he was a candidate for Director, but was glad when Dr. Christian Abee took the position, as we has glad not to move fully into administration.

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  Chapter 13: Connections: Bonds with Animals and with Collaborators who Insured a Good Career

  William C. Satterfield DVM and Tacey A. Rosolowski PhD

  Dr. Satterfield begins this Chapter by looking back on the collaborators he has worked with over the years. He says he hopes that the Center will continue to support research and collaborative relationships. He also hopes that the Center will maintain a viable chimpanzee community. He says he is happy not to have any particular post-retirement plans. (He retires at the end of August 2012.) Thinking about people who have inspired him, he recalls a high school biology teacher, Mrs. Lowry, whose class was “great” and guided him to science. At the close of the interview, he speaks again about his connection to the animals he has worked with over his entire career. He returns to the shooting of the chimpanzee, Tony, and notes that the Center requested the services of an MD Anderson grief counselor to help them survive the loss –another example of the human-animal bond.

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  Chapter 01: Coming to MD Anderson for Resources to Support a Vision

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya tells the story of how was recruited by Dr. Charles LeMaistre to come to MD Anderson in 1990. He begins by explaining why the decision was made in the late eighties to turn the Section of Neurosurgery into a department and create a Brain Tumor Center. He recalls his first visit to MD Anderson. He also speaks about the possibilities the institution offered for the future –and his vision for a comprehensive neuro-surgery department-- because of resources and institutional support to build a brain center (in stark contrast to the limitations at the University of Cincinnati Medical College, where he was on the faculty until 1990). The interviewer comments that Dr. Frederick Becker [Oral History Interview], Vice President of Research, was quoted as saying that the creation of a comprehensive brain and spine center was a priority for the nineties. Dr. Sawaya also recalls that the NIH had declared the 90s to be the “decade of the brain.”

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  Chapter 02: Creating a Comprehensive Neuro Service –and the Best Service

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya states that his goal was to create a comprehensive neuro-service that was the best in all activities, a vision he (literally) illustrates by reference to an image entitled, “Neurosurgical Oncology.” (See image next page. Dr. Sawaya explains that he sketched the image and Dr. Ian Suk, a medical illustrationist, created the final design.)

  Dr. Sawaya explains the elements of a comprehensive neuro-service: high-level surgery supported by technologies, infrastructure (such as a tissue bank); a database; and education and training. (Dr. Sawaya notes that he created the first neurosurgical oncology fellowship program in 1990, accepting its first fellows in 1991.) He goes on to explain other features of a comprehensive neuro-service. Next, he notes that pain is an essential element of neuro-oncology and describes how a patient’s suffering and reliance on opiates can be surgically alleviated in some cases. The surgeon creates a tiny brain lesion that destroys the patient’s ability to sense the cancer pain. Dr. Sawaya sketches the Department’s growth (300 procedures/year in 1972 to 1,700 during 2012), and notes that the faculty works well together.

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  Chapter 03: Creating a Collaborative and Compassionate Neuro-Service

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya begins this Chapter with comments on the challenges of creating collegiality among high-intensity personalities, citing the importance of looking at interpersonal skills while hiring. Dr. Sawaya affirms that the Department has developed a culture that does not tolerate selfishness and arrogance, noting that not all departments are like that. He says he is dismayed when he hears, “You’re nice for a neurosurgeon.” He explains that a diagnosis of brain cancer is “mind boggling” for a patient, and good interactions with the care team gives the patient confidence. He then Dr. Sawaya tells the story of a young man who was given a prognosis of only six months to live before coming to MD Anderson for treatment. He is still alive, married with children.

  Dr. Sawaya describes a patient conference on brain cancers that he started at MD Anderson in the mid-nineties. It is now held every two years and designed to provide the public with information about all dimensions of brain cancer and treatment. Dr. Sawaya again talks about the “scare factor” of brain cancer, noting that it the surgeon must interact with the patient and family so the patient regains his or her confidence to begin the fight.

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  Chapter 04: Interpersonal Skills and Philosophy of Leadership

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  CLIP Included: Dr. Sawaya begins this Chapter by explaining that he learned his interpersonal skills from his father (recently deceased) who was an internist and his mentor. Dr. Sawaya credits his father with introducing him to the life and work of a physician, most importantly by taking him along on house calls.

  He next says that that he knew he would be a neurosurgeon when he took his first neuro-anatomy course in college: he was fascinated by the organization of the brain. He goes on talk about being mentored by superb neurosurgeons, then notes how proud he is of the group that he trains.

  Dr. Sawaya underscores that he has not advocated a departmental culture where everyone is the same, going on to explain some of the leadership principles he has relied on to build the department (understanding strengths, building collegiality, giving credit).

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  Chapter 05: Recruitments for the New Department of Neurosurgery

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Sawaya begins to sketch the process he went through to turn his vision for a neuro-service into a reality. He first talks about recruitments. He first hired Dr. Justi Rao, a basic scientist whose work on brain invasiveness supported his own interest in the subject. He notes that the Department’s research portfolio has diversified significantly since that time.

  Dr. Sawaya next hired neurosurgeon Ian McCutcheon, who worked on mapping the brain. Dr. Sawaya explains the problems brain surgeons face when trying to locate tumors, focusing in particular on the challenges that base-of-skull tumors present. He notes that he hired Dr. Frank Delmonte to address tumors in this region.

  Dr. Sawaya next hired neurosurgeon Sam Hassenbusch, who became the director of the pain program and the stereotactic surgery program. Dr. Sawaya explains the equipment that makes stereotactic surgery possible.

  Dr. Sawaya next hired Dr. Zia Gokaslan to develop the program in spinal oncology. He then goes on to talk about the “rough patch” with managed care in the mid-nineties, and the way he managed to hire Dr. Fred Lang in 1996 as Director of Clinical Research, despite budget limitations. Dr. Sawaya notes that by 1996, he had established the nucleus of the Department.

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  Chapter 06: The Neurosurgery Database and Tissue Bank

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  In this Chapter, Dr. Sawaya recounts how the Department established a database to record detailed information about all surgical procedures performed by clinicians. He begins by explaining why it is important to have a volumetric measurement of brain tumors. Dr. Sawaya explains how recording the size of brain tumors resected helped resolve controversy over the surgical treatment of glioblastoma. A 2001 publication of the results has been cited over 7000 times, and Dr. Sawaya explains how the database provided hard numbers about percentages of resection, replacing the vague terms surgeons previously used to determine how much tumor and normal tissue to remove.

  Dr. Sawaya next says that a “very amateurish” database was started in June of 1993, but professionalized in 1997, when the Department hired Dr. Dima Suki. He explains how Dr. Suki developed the database and data collection. He describes how data is collected from surgeons about the procedures they perform so the information can be preserved in the database.

  Dr. Sawaya explains how fundamental data and data management are in neurosurgery and explains the strict protocols that govern data collection and entering. The Neuroscience database is IRB approved, a very rare designation, he notes. It is also important that Dr. Suki oversees audits of the database and manages any mistakes to maintain database credibility.

  Dr. Sawaya next talks about the Department’s tissue bank was developed to preserve tissue samples from each patient treated. He notes the link with personalized therapy, then goes on to explain why tissue is time sensitive, requiring special handling. The Department received funding in 2001 to support handling of tissue samples.

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  Chapter 07: Developing Clinical Research Initiatives: Challenging Surgical Conventions

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya explains that Dr. Fred Lang established the infrastructure for the research program in the Department of Neurosurgery. He describes the types of questions that the Department’s research projects investigate. He next discusses the Department’s controversial study of surgery performed on patients with multiple brain metastases, a taboo intervention according to conventional surgical wisdom. The Department performed a retrospective investigation of data which then went to a randomized trial documenting the effectiveness of the procedure. Dr. Sawaya contributed to these studies and the findings that changed therapy nationally.

  Dr. Sawaya briefly speaks about his work with lasers, then explains a surgical probe that uses a GPS system to establish its location. He discusses the many challenges that tumors present and some of the technology used to determine tumor location and size. He stresses the importance of learning much more about brain anatomy.

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  Chapter 08: Strategic Educational Choices to Build a Solid Career

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya begins this Chapter with recollections of his father, who was a physician and a mentor to him. He states that he saw his father make contributions to medicine and to society alike, and that by accompanying his father on house calls, he witnessed the impact a physician could have on an entire family. Dr. Sawaya then sketches his educational path, which took him away from Syria to a French University of Medicine in Beirut, where he could receive a superior education under the French system. He note his mentor in medical school, neuroanatomist Jedeon Mohassab, and neurosurgeon Fuad Haddad who eventually established the first neurosurgery center in the Middle East, and with whom Dr. Sawaya studied during a sub-internship. Dr. Sawaya then explains his decision to come to the United States to specialize in neurosurgery and describes the (lengthy) process of securing a surgical internship at Beekman Downtown Hospital in New York. He describes the educational and cultural adjustments he had to go through. He then sketches his Surgical Residency at Upstate Medical Center in Syracuse, New York. He explains why he did not feel ready to specialize in neurosurgery at this point, but notes that Dr. Robert King “opened the door” to his eventual specialization in neurosurgery. He then traces his training in neurosurgery, finishing at Johns Hopkins, where he was Chief Resident.

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  Chapter 09: Specializing in Brain Tumors –Once an “Orphan Disease”—And Research on Fibrinolysis

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya first explains that the outbreak of the Civil War in Lebanon helped convince him to stay in the United States. He then explains his decision to specialize in brain tumors, a field that did not appeal to most physicians in the seventies, and his application to the NIH to investigate why tumors invade the brain, work that led to his eventual publication of Fibrinolysis and the Central Nervous System (1990). He explains where he developed his experience with research design; notes that he joined the faculty at the University of Cincinnati College of Medicine (advancing to full professor in 1990). Dr. Sawaya then explains the mechanisms by which tumors invade the brain, using fibrinogen as a kind of scaffold to crawl into brain tissue. During this discussion, Dr. Sawaya refers to Figure 4 from his book, Fibrinolysis and the Central Nervous System (see below).

  From: Raymond Sawaya, Fibrinolysis and the Central Nervous System (Philadelphia, PA: Hanley and Belfus, Inc., 1990), p. 15.

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  Chapter 10: Big Visions for the Tumor Program and Frustrations

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya notes that MD Anderson attracted him because resources at the University of Cincinnati were limited, and he was unable to build an adequate neuroscience team. He notes that when he arrived at MD Anderson to head the Department of Neurosurgery, he turned his research over to Dr.Justi Rao to run his RO1 grants. He was pleased with the balance of his responsibilities: 60% program building, 20% clinical, 20% educational.

  Dr. Sawaya explains that in 1997 he offered Dr. John Mendelsohn a plan for a “truly multi-disciplinary” brain tumor program. The plan was rejected, and Dr. Sawaya speculates on why that happened. He next explains that he now has plans for a whole new building to house the neurological program. He speculates on the reaction of new president, Dr. Ronald DePinho, to this proposal. (Dr. Sawaya thinks out loud during this Chapter, planning his strategy of presenting his proposal.) He also explains why physical proximity enhances the effectiveness of multi-disciplinary teams and helps prevents problems with accountability and coordination of activities. Dr. Sawaya also notes the difficulty of promoting multi-disciplinary research and other initiatives, when there is no formal system of accountability in place to hold individuals to the plan.

  Dr. Sawaya next says that Dr. Mendelsohn named him Director of the Tumor Institute in 2001, speculating that Dr. Mendelsohn felt “he owed” him the favor. Dr. Sawaya admits that he was so frustrated at the time that he almost left MD Anderson. He explains why he stayed and lists some of the concessions he received: the Directorship; the executive committee that was allowed to raise dedicated funds; permission to recruit a Director for Research (Dr. Oliver Bogler) for all labs in brain tumor programs (and that resulted in a SPORE grant). He reports that a review of the program by five outside reviewers listed MD Anderson’s tumor program as one of the top if not the top program in North America.

  Dr. Sawaya believes that more could be done for the neuro patient in a “brick and mortar” institution wher all activities related to all tumors of the nervous system were located under one roof. He describes what would be possible. He then notes that an article about him in the Texas Medical Center News states that he “dreams big.”

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  Chapter 11: Technology to Support Neurosurgery

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya begins this Chapter by noting that Dr. John Tew, chair of Neurosurgery at the University of Cincinnati Medical College in the 1980s, saw that technology was essential to a strong department. Dr. Tew secured many of the first prototypes of devices in order to test them. When Dr. Sawaya came to MD Anderson, he made sure that he secured all of the technological advances. Dr. Sawaye describes the advantages of the following: brain mapping; drills to open the skull; navigation systems for the brain and spine; the first robotic microscope and Surgi scope; Brain Suite and the Intra-Operative MRI; Vector Vision.

  Dr. Sawaya states that the next important advance will be the ability of the MRI to image microstructures in the brain, such as the speech areas. He also notes that a professor of neurosurgery in Calgary, Canada, has built a robot for use in the operating room. Dr. Sawaya explains the importance of robotics for neurosurgery, then talks about mastering the challenges of Brain Suite. He admits that he hesitated about investing in Brain Suite, but was convinced when he realized that it would allow surgeons to remove an entire tumor, leaving no pieces behind.

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  Chapter 12: Complex Training for Neurosurgeons

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya first sketches the usual educational requirements for a neurosurgical specialization: seven years after medical school, including a year of research, then a period of training for sub specialization. He then explains the one- to two-year Tumor Fellowship begun at MD Anderson in 1990/’91 with one fellow (there are now four). Very few institutions have training in tumor surgery, and MD Anderson’s program is very specialized. Dr. Sawaya describes what it offers to fellows: a large volume of patients, opportunities for constant use of technology; frequent awake craniotomies. Dr. Sawaya notes that MD Anderson fellows are very desirable hires after their training.

  Dr. Sawaya then talk about his role as head of the joint program in neurosurgery established in 2005 between MD Anderson and the Baylor College of Medicine. He tells the story of why Baylor was interested in setting up such a program and how he was approached to serve as Chair. (He tells an anecdote about going to John Mendelsohn after the five-year review of the joint program: Dr. Mendelsohn asked him at that meeting if he wanted to submit his name as a candidate for MD Anderson’s president, as Dr. Mendelsohn was leaving.) His contract to serve as Chair was renewed for another five years, and Dr. Sawaya notes that the program hired thirteen faculty in the first three years.

  Next Dr. Sawaya explains what neurosurgery residents bring to the Tumor Program and to MD Anderson. He then explains the computer matching process that links residents with institutions whose programs they might enter. He then describes the process of selecting residents and how a residency unfolds, noting that fellows have a different mindset than residents. He talks briefly about employment for neurosurgeons, which is a very small specialty. He briefly compares MD Anderson with Memorial Sloan-Kettering. Dr. Sawaya notes how the diversity of specializations and functions housed in the Department of Neurosurgical Oncology has enabled each to grow stronger.

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  Chapter 13: A History of the Brain Tumor Institute

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Here Dr. Sawaya tells the story of MD Anderson’s Brain Tumor Institute. He begins by noting that the multi-disciplinary Brain Tumor Program is one of the top three programs in the country and that it is the product of three decades of accumulated development. The story begins, he says, when Dr. Victor Levine was recruited from the University of California San Francisco to head the Department of Neuro-Oncoloy and brought with him an initial vision of a multi-disciplinary program with basic and translational research. In the mid-nineties, Dr. Levine secured the first program project grant from the NCI to study the molecular biology of gliomas. Dr. Sawaya describes the significance of that grant for MD Anderson and then goes on to talk about Dr. Peter Steck’s work on the genetics of brain tumors. This work led to the discovery (1997) of the tumor suppressor gene, PTEN –a major discovery that “crowned the project program effort.” Over the course of this time building research, Dr. Sawaya and Dr. Levine were also hiring clinical faculty, among them medical oncologists and neurooncologists. Dr. Sawaya created the largest brain tumor surgery department in the country and expanded neuropathology and neuroradiology as well.

  Dr. Sawaya then explains that Dr. Levine was asked to step down, “a significant change.” Dr. Sawaya’s next move (1998) was to propose to Dr. John Mendelsohn that all the neuro-related activities be housed in a single brick and mortar location. He explains why Dr. Mendelsohn rejected this proposal, allowing Dr. Sawaya (2001) to lead the multi-disciplinary effort of the brain tumor program, including giving him permission to raise dedicated funds. Dr. Sawaya describes the composition and activities of the Brain Tumor Institute Executive Committee, which has had monthly meetings for the last 12 years.

  Dr. Sawaya explains that the presidential permission to fundraise allows the Brain Tumor Institute to establish a premiere class tissue bank. He eplains that validation of the tissue bank came when the NCI decided to perform genetic studies of five cancers and selected the MD Anderson Tissue Bank to provide the samples of glioblastoma. Dr. Sawaya then explain how he worked with Development to identify donors. In the process he gives an overview of how Development presents possible projects to donors to secure their support.

  Dr. Sawaya next explains that funding for the Brain Tumor Institute initiatives is never funneled to individual research programs but is used to build core facilities for research, including the Animal Core, the Tissue Bank, specialized equipment, and other shared resources. He then notes that when the Mitchell Building was constructed, he was given permission to consolidate all the research laboratories in one place (2005). He explains the key role that new-hire Dr. Oliver Bogler played in organizing research in the new location and in securing the SPORE grant for brain tumors. He talks about the difficulties that neurosurgery had in getting this kind of grant and how Dr. Bogler was able to “get them back on track” so MD Anderson could be a “major player” in brain research. Dr. Sawaya then summarizes the evolution of the Brain Tumor Institute and what it required.

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  Chapter 14: Leadership Principles and Values

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  NOTE: This Chapter includes three Clips.

  Dr. Sawaya begins this Chapter with a statement about how it is key to recognize the individual when implementing complex plans, such as those he undertook to develop the Brain Tumor Institute. He explains how individual recognition a motivator is and how a leader must balance recognition of individual efforts with a larger vision. He states that the Brain Tumor Institute has reached a point of “maturity” that must now be maintained. He then acknowledges that the Brain Tumor Program trains high-level leaders and that some senior faculty are leaving to lead other departments and programs. He also notes, however, that individuals often see so many advantages at MD Anderson, that they do not feel the need.

  Dr. Sawaya next explains that he always had an “inner drive” to be a leader. He explains that he saw the difficulties arising from a lack of good leadership while he was at the University of Cincinnati. He notes that integrity is essential in leadership. He tells a story about attending a leadership course at Rice University.

  Dr. Sawaya summarizes his philosophy of integrity and honesty. He tells a story about a senior leader at MD Anderson who made a promise to Dr. Sawaya, then did not stick by his word during a public meeting. Dr. Sawaya specifies that this was not an instance of someone changing his mind and failing to communicate. Next he talks about his experiences in the Faculty Leadership Academy (2005) and in the leadership course offered at Baylor (2008-2009), a course he helped plan and then attended. He then explains that an institution must provide leadership training because physicians and researchers do not cultivate those skills during their professional training curricula, and they inevitably find themselves in situations where they must pay attention to systems and direct complex activities. He notes that his faculty have ambitions to chair departments, but lack skill. He then tells a story about a woman in one of his leadership classes who was not suited to administration.

  Dr. Sawaya then talks about the composition and function of the Executive Management Committee, which he serves on from 2005 – 2007). The committee included executive vice presidents and three other individuals “from the trenches” to ensure that the vice presidents were not too separated from the working reality of MD Anderson. Dr. Sawaya explains that the Committee gave him an inside look at the working of the institution at a very high level and changed his perspective on top leaders.

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  Chapter 15: The Neurosurgeon: Making Decisions about Course of Treatment

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya says that it is easy for a neurosurgeon to take a conservative, timid approach to a patient’s course of treatment, but that is a losing proposition. He explains how the mindset at MD Anderson is to “shift the risk from the patient to the surgeon” and go after the tumor in the most aggressive way. He emphasizes that the development of new technologies have to accompany this approach, as neurosurgeons need tools to help them preserve the function centers in the brain. He explains that the Department routinely images every patient before and after surgery and takes tissue samples for volumetric analysis of tumors.

  Dr. Sawaya explains how he works with patients to advise them of the risks and benefits of surgery. He notes how important it is to spend time to build trust. He concludes that “This is the best form of leadership I know,” where a surgeon distills and transmits knowledge to help a patient.

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  Chapter 16: MD Anderson in Periods of Change and Crisis

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya begins this Chapter by noting that the periods of major change at the institution are tied to administrative changes. He first reviews the period of change that came when Dr. John Mendelsohn [Oral History Interview] replaced Charles LeMaistre [Oral History Interview] in the aftermath of the Sharp Report and Charles LeMaistre’s successful attempts to convince the Texas Legislature to allow patients to self-refer to MD Anderson. Dr. Sawaya recalls the dramatic increase in the numbers of patients seen at the institution, with more business and money coming in. He also notes some of the programmatic expansions made under John Mendelsohn. He then notes that after Dr. Mendelsohn’s tenure, the institution was due for a change and welcomed a major scientist such as Dr. Ronald DePinho. He explains, however, that the institution is currently facing “a crisis” caused by too much controversy surrounding Dr. DePinho. He notes that the faculty feels ‘disenfranchised” and that morale is low. Though, as he says, the situation is not yet affecting patients, he has concerns for the long-term damage to the institution. Dr. Sawaya then explains that he uses the term “corporate” to describe a situation in which senior leaders are separated from faculty.

  [The recorder is paused]

  Dr. Sawaya says that an institution is greatly influenced by how a leader responds to employees’ concerns. As MD Anderson in still in the midst of crisis, it is not possible to answer questions about this administration.

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  Chapter 17: Defining What Neurosurgery Should Be and Looking Ahead to an Institute

  Raymond Sawaya MD and Tacey A. Rosolowski PhD

  Dr. Sawaya notes that he has led the development of two major programs (at MD Anderson and Baylor) and will transition out of administrative positions in each. He would ideally like to act on his vision to create a free-standing neurosurgery institute at MD Anderson that houses all laboratory and patient care activities under one roof. He suspects that MD Anderson is the only place in the country where this kind of development could happen.

  Looking back, Dr. Sawaya states that he is pleased that he has defined neurosurgery “as what it should be.” He makes reference to the tree image discussed in Session I, noting that this is a model that others would like to emulate, but cannot. He emphasizes that this multi-disciplinary approach is not theory, but can and has worked and is thriving.

  Dr. Sawaya states that each member of the Department of Neurosurgery should understand that they exist in partnership with a great department with the full backing of what MD Anderson is as an institution. MD Anderson is also stronger, he says, because of what each individual offers and creates.

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  Chapter 01: Tracking Toward a Career in Therapy Approaches

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover sketches her family background and educational pathway up to her graduate education. She talks about her areas of skill, her early interest in archeology, and how her adolescent experience of being in therapy stimulated her interest in that field. She talks about influences from her father and mother, who taught her the value of being self-directed.

  Next, she talks about selecting her college and sketches the honor’s thesis topic she worked on at Brown University (BA in psychology, 1974): selective attention in autistic children.

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  Chapter 02 : A Focus on Sex Therapy

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover explains how she shifted her focus to sex therapy, an evolving field in the seventies when she entered graduate school at UCLA (MA in psychology in 1975; PhD in clinical psychology, 1979). She explains that part of her interest arose from the fact that she was sexually harassed by her honor’s thesis advisor at Brown University, an experience that raised her awareness of gender roles and created an interest in addressing them. She also notes that more and more researchers were focusing on issues of gender and sexuality. She describes her working relationship with Ken Pope, PhD. She also talks about her own research into the reaction of psychotherapists when patients would raise issues of sexuality during sessions.

  Next, Dr. Schover talks about her postdoctoral fellowship in the department of Psychology (Clinical) Sex Therapy and Research at the State University of New York, Stony Brook (7/1979-2/1981). She describes the atmosphere in this department, which she describes as the “Camelot of sex therapy,” and where she had real mentors for the first time.

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  Chapter 03: The Decision to Bring Sex Therapy to Oncology

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  Dr. Schover begins this chapter with stories about her first job, as an instructor in the Department of Psychiatry, Sleep Disorders and Research Center at the Baylor College of Medicine in Houston (3/1981-1/1982). She describes a study she conducted, looking at erections in aging men. She discusses an ethical issue that arose during a research study at Baylor and explains how her time there taught her about physiology and disillusionment.

  Next, she explains how in 1982 she made the decision to take a position (Assistant Professor in Urology; Assistant Clinical Psychologist in Psychology, 2/1982-6/1986) at MD Anderson based on an interview with Andrew von Eschenbach, MD. She explains her strategies of transitioning to a focus on oncology, knowing little about the field. She also talks about how she presented herself and her clinical services to patients, as discussing sexuality was quite new in patients’ experience of treatment at the institution.

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  Chapter 04: Acceptance of Sex Therapy in Oncology and at MD Anderson

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover discusses the acceptance of sex therapy in oncology nationally and at MD Anderson. She begins by noting that in the 80s, sex therapy was seen as the latest thing, but it was not applied to chronic illnesses. In oncology at the time, only a few clinicians felt that addressing quality of life was a primary concern, although research showed that 60% of people with cancer end up with severe sexual problems that influence their quality of life. Dr. Schover sketches the types of problems that arise.

  Next, she explains how faculty members helped her come up to speed on oncology treatments, providing her with insight into the patients’ experience of cancer. She also talks about working with patients, her passion for educating them about choices.

  Next, Dr. Schover discusses why clinicians do not address sexuality in their work with patients and, on the other side, why patients don’t raise the issue with their oncology team.

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  Chapter 05: Issues with Multi-Disciplinary Care and Taking a Position at the Cleveland Clinic

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  Dr. Schover begins this chapter by explaining why she chose to leave MD Anderson in 1986 for a position as staff psychologist at the Cleveland Clinic. She sketches the political environment in the Department of Urology that motivated her decision.

  Next, Dr. Schover describes her work at the Cleveland Clinic, where she began to focus on fertility issues and conducted a first, pioneering study of fertility in young cancer patients. She also co-authored a textbook on sexuality and chronic illness with Tony Thomas: this book is still in print.

  Dr. Schover then explains why she left the Cleveland Clinic. Ellen Gritz, PhD, the head of Behavioral Science at MD Anderson offered her a job. Dr. Schover talks about the decision she had to make between her marriage and her career and other work/life issues.

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  Chapter 06 : Building a Program in Reproductive Health at MD Anderson

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover explains that Dr. Ellen Gritz hired her in the Department of Behavioral Science to bring in grants and create programs in reproductive health. She discusses projects she worked on: intervention studies for men undergoing prostate cancer treatment; effectiveness of online interventions for follow up; studies of women under 35 undergoing treatment who wanted to have children later.

  Dr. Schover explains the impact of her research in an evolving field and the fact that her work helped to launch the field of onco-fertility, predating even work done at the Onco-fertility Institute at Northwestern University.

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  Chapter 07: The Evolution of Onco-Fertility

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover provides an overview of the growth of the field of onco-fertility and acceptance of it within MD Anderson. She first talks about what spurred interest in the issue of fertility, citing the cancer survivorship movement as well as the adolescent/young adult movement. She sketches how the field has changed since the 1980s. She also explains how problems arose because institutions found it easy to cast onco-fertility as a “frill” rather than a service essential to cancer care; researchers were also finding it difficult to get grants to move the field ahead.

  Next, Dr. Schover talks about views of onco-fertility at MD Anderson. She explains that she made a proposal for a reproductive health center in 2010, gaining support from several departments and from then-president John Mendelsohn, MD. That plan never came to fruition, but funds were provided to hire faculty for a program.

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  Chapter 08: A Landmark Conference on Cancer Survivorship and Parenthood

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover explains that in 2004, she and others at MD Anderson wrote a conference grant to bring together basic scientists and individuals in psychological fields to discuss cancer and parenthood at a landmark conference that furthered the field of onco-fertility. She explains the issues involved in this topic and also explains that two conference participants has authored embargoed papers, attesting to the national significance of the topic. Dr. Schover explains that this conferenced spurred collaborations across disciplines and that the conference proceedings were published in 2005, the same year a follow-up conference was held. She also comments on the

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  Chapter 09: Three Small Business Grants to Advance Onco-Fertility

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover discusses three projects she developed with NCI small business grants when she returned to MD Anderson in 1999 from the Cleveland Clinic, all of which were geared to providing accurate, timely information about fertility preservation for different populations of cancer patients. The first study (1999) surveyed physicians for their attitudes and practices working with patients around the issue of sperm banking. A second part of that study involved creating interventions: guidance for both male patients and for oncology professionals to increase awareness and use of sperm banking. She talks about the challenges evaluating this study and the importance of having strong networks among clinicians to ensure a robust population for a study. Dr. Schover also discusses why MD Anderson had not invested in in-house sperm banking services.

  Next, she talks about the second study (2004) and its focus on providing an educational and counseling tool for women with regards to sexuality and fertility. The interventions included a website and a randomized trial to determine the effectiveness of in-person counseling versus 24/7 online access to information and guides to self-help in decision making. She then explains that the third grant focused on creating a similar reproductive health resource for men.

  Next, Dr. Schover notes that she used an American Cancer Society grant to develop an online intervention for couples after prostate cancer treatment.

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  Chapter 10: Will2Love: A Start-Up to Disseminate and Commercialize Work in Onco-Fertility

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Schover sketches her work with her start-up company, Will2Love. She explains that after the third business grant from the NCI came to a close, she began to explore how to create a digital health business. In 2015 the Texas medical Center was initiating the TMCx program to enhance innovation and she received special permission to take part. She talks about the process of shifting to an entrepreneurial mindset and explains why hospitals have been resistant to undertaking programs in onco-fertility and sexuality.

  Next, she sketches the services that Will2Love offers for both patients and providers. She also talks about work with a provider, Greenville Health System in South Carolina, a innovative, APN-directed fertility program. She talks about the lessons learned in developing both the patient and provider materials. She discusses a possible contract with MD Anderson.

  Next, Dr. Schover talks about what is next for Will2Love.

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  Chapter 11 : Additional Programs and Final Thoughts

  Leslie Schover PhD and Tacey A. Rosolowski PhD

  Dr. Schover begins this chapter by discussing two additional projects she has worked on to test online interventions for sexuality and fertility. Next she talks about “Bring It Up,” a marketing effort for Will2Love aimed at increasing the number of people who discuss sexuality with their oncology teams. She talks about the self-help tool provided on the site to give patients an action plan for discussing sexuality with their providers.

  Next, Dr. Schover reflects on her hopes that onco-fertility will evolve into a topic of easy discussion with patients that is fully integrated in daily care of the active cancer patient and the survivor.

  Finally, she reflects on her time at MD Anderson, noting that when she first came to the institution, the focus was on providing drugs and has shifted productively to greater focus on quality of life issues. She notes that she has contributed to strides made and is pleased to have been recognized as a pioneer in onco-fertility.

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  Chapter 01: Stimulated By Challenging Situations; Building a Career as a Woman

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 02: An Institution on the Rise Provides New Opportunities

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 03: The Division of Surgery and Anesthesiology in 1991: Advocating for the Value of a Division

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 04: The Eighties Crisis: the Push to Expand MD Anderson and Create Patient-Centered Experiences

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 05: An Encouraging and Supportive Father

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 06: Serving as the VP of Hospitals and Clinics: Budget Stresses and Impact on Employees

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 07: Confronting Managed Care

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 08: Responding to Managed Care: Moving Toward multi-disciplinary Patient-Centered Care

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 09: Turning MD Anderson Around Through the Aim For Excellence Program

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 10: Changes When John Mendelsohn Arrives

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 11: The First Woman Vice President at MD Anderson

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 12: MD Anderson Now and in the Future

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

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  Chapter 03: A Job in a New Department and Research Successes

  Margaret R. Spitz MD and Tacey A. Rosolowksi PhD

  Dr. Spitz begins by noting that she received her MPH from the University of Texas School of Public Health in 1981 and began to look at job offers. This was when Guy Newell offered her an assistant professorship in the new Department of Cancer Prevention and Control. She briefly sketches Dr. Charles LeMaistre’s vision of cancer prevention.

  Next, Dr. Spitz tells the story of discovering salivary gland cancer, which led to several publications, then her work linking parental occupations and pediatric neuroblastoma. The latter work gave her exposure. She then discusses her study of lung cancer and mutations to the p53 gene in Mexican Americans and African-Americans. She notes that this study marked the beginning of her real success.

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  Chapter 04: Epidemiology in the Eighties

  Margaret R. Spitz MD and Tacey A. Rosolowksi PhD

  In this chapter, Dr. Spitz talks about the state of the field of epidemiology in the Eighties. She notes that it was generally regarded as a “second-class science.” She quotes a colleague who made dismissive comments about the field. This situation began to change when the NCI required SPORE programs to have a population science component. At that point, Dr. Spitz explains, epidemiologists became very much in demand at MD Anderson. MD Anderson’s growing focus on prevention under Charles LeMaistre also created demand, as “epidemiology was the basic science of cancer prevention.”

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  Chapter 07: Founding Integrative Epidemiology and New Training for the New Era of Team Science

  Margaret R. Spitz MD and Tacey A. Rosolowksi PhD

  Dr. Spitz next observes that this has created the need for training programs to provide researchers with the necessary skills to work on teams. She also states that the culture of institutions needs to change to adequately recognize team science. Dr. Spitz talks about her pride in having developed the Integrative Epidemiology Workshop, an outgrowth of her innovative concept of integrative epidemiology. She explains this concept and talks about the mindset, skills, and temperament that researchers need to bring to work in this area. She explains how academic science needs to change to foster more team science. She reflects on the legacy she has left in MD Anderson’s research culture.

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  Chapter 08: Reflections on Career, Mentoring and Leadership

  Margaret R. Spitz MD and Tacey A. Rosolowksi PhD

  Dr. Spitz notes that she would like to be able to spend more time with her grandchildren, an observation that leads her to share that mentoring has been both the most challenging and rewarding dimension of her career.

  Dr. Spitz explains that she had no real mentors, which made her realize how important this is. She talks about the ways in which she has mentored others and distinguishes scientific mentors from career mentors. She also explains that she didn’t really plan her career but was in the “right place at the right time.”

  She next talks about her leadership style and explains that to be a lea

  ders, one must have reached a career pinnacle and leave competition behind. She talks about participating in leadership training and offers advice to young leaders.

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  Chapter 09: Working through Challenges for Women at MD Anderson

  Margaret R. Spitz MD and Tacey A. Rosolowksi PhD

  In this chapter, Dr. Spitz talks about challenges and changes for women faculty at MD Anderson. She recalls the salary review spearheaded by Elizabeth Travis and others and changes that came from that initiative. She notes that she herself was the first female MD to become a department chair. She also recalls the dinner for senior women at which she receive the Faculty Alumnus Award. She talks about contributing an essay to the book about senior women, Legends and Legacies and shares her views about the group photo of the contributors in eveningwear.