In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
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Chapter 24: Transitional Moments in MD Anderson History
Alma Rodriguez MD and Tacey A. Rosolowski PhD
Dr. Rodriguez sketches key moments of change in MD Anderson history since her arrival. She first talks about the eighties and the “growing consciousness that MD Anderson is an economic entity,” moving on to the nineties and the complexities that evolved with more billing forms, rules, and concern for downstream revenue generated from patient care. She gives an example of chemo therapy orders and talks about pros and cons. Dr. Rodriquez then talks about the MD Anderson’s physical expansion to the point where she “can’t embrace” the institution. She notes that the physicians and nursing staff have preserved their dedication and pride.
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Chapter 25: Change Under Ronald DePinho: The Balance Between Research and Clinical Care
Alma Rodriguez MD and Tacey A. Rosolowski PhD
Dr. Rodriguez states that MD Anderson has shifted away from its mission as a care facility since Ronald DePinho assume the institution’s presidency in 2011, moving toward a research-generating facility. She sets context by discussing the growth of research under Dr. John Mendelsohn, noting that research still served patient care despite accelerated industry-sponsored research. She next talks about MD Anderson’s focus on new drug development and the implications, specifically in the demand for financial and intellectual resources this requires.
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Chapter 26: Turbulence During Dr. DePinho’s Early Presidency; MD Anderson’s Future
Alma Rodriguez MD and Tacey A. Rosolowski PhD
Dr. Rodriguez comments on the changes created at MD Anderson under Dr. DePinho’s early presidency then talks about the future of MD Anderson under the Affordable Care Act. Dr. Rodriguez first comments on the magnitude of institutional change that Dr. DePinho’s administration has brought to MD Anderson. Making reference to literature from the field of organization transformation, she notes that change on such a scale requires a “message of urgency” that was not verbalized by the administration. Change has felt imposed from outside, creating tensions in the institution, she observes. She notes that the Board of Regents was slow to recognize problems.
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Chapter 27: Creating a Future Under the Affordable Care Act
Alma Rodriguez MD and Tacey A. Rosolowski PhD
Dr. Rodriguez explains that MD Anderson’s future will be determined by changes to healthcare under the Affordable Care Act. She first talks about the loss in revenue anticipated, then describes initiatives that the Office of Medical Affairs is setting in place to help address anticipated problems. She talks about the need to document all care processes in the spirit of moving toward more evidence-based care and shifting the mindset of providers away from an expert mentality to a spirit of self-reflection and improvement. She also talks about the importance of examining and optimizing all of MD Anderson’s resources.
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Chapter 28: Women and Leadership at MD Anderson
Alma Rodriguez MD and Tacey A. Rosolowski PhD
Dr. Rodriguez provides her views of women and leadership at MD Anderson. She cites statistics in support of her view that “the workforce in medicine is about women.” She stresses that women have to know systems in order to succeed in leadership positions. She offers her view of coming up through the ranks when there were many fewer women and notes that MD Anderson does not have clear processes for filling leadership positions or establishing a pipeline of leaders. She talks about her own strategy for cultivating leadership.
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Chapter 29: Accomplishments, Retirement, and a Love of Cosmology
Alma Rodriguez MD and Tacey A. Rosolowski PhD
Dr. Rodriguez begins by listing her most significant accomplishments: launching the concept of survivorship; imbedding into MD Anderson culture the role of quality officers; integrating Advanced Care Planning into treatment planning; serving as champion for the Physician Assistants Program; helping everyone who has reached out to her as a role model. Next she talks about the interests she plans to pursue in retirement: psychology, art, reading, and cosmology. She notes that she minored in philosophy as an undergraduate and her thinking has been very influenced by process philosophers who believe that reality self-creates. She believes that the Universal Mind is also self-creating and explains that this spiritual component of her belief system helps her cope with change.
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Chapter 01: Multidisciplinary Care at MD Anderson
Alma Rodriguez MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Rodriguez provides an overview of MD Anderson’s multidisciplinary approach to patient care. She defines the approach and notes that it began with R. Lee Clark’s vision for cancer care. She gives examples of the specialties that collaborate to provide comprehensive management of a patient’s disease throughout treatment. She also offers observations on how the tradition of multidisciplinary care has had an influence on the culture of the institution.
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Chapter 02: The Important of Clinical Leadership at MD Anderson
Alma Rodriguez MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Rodriguez about the important role that clinical leadership has played in developing the institution and that it continues to play in the current healthcare environment. She sketches the qualities that leaders must have to steward institutions in the current climate and connects that to the culture of the institution.
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Chapter 03: Leadership in a Period of Change
Alma Rodriguez MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Rodriguez comments on the period of change the institution is experiencing, stemming from changes in the healthcare system, financial stressors, and internal turbulence stemming from Dr. Ronald DePinho’s resignation as president in March 2017.
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Chapter 04: Multidisciplinary Care and the MD Anderson Algorithms
Alma Rodriguez MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Rodriguez defines the MD Anderson algorithms of care and explains how they were created and are continually evolving, based on current research. She explains how they are connected to multidisciplinary care, and how important they are for standardizing care at MD Anderson’s partner institutions.
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Chapter 05: Envisioning the Next Period of Leadership
Alma Rodriguez MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Rodriguez talks about the qualities that the next president of MD Anderson will need to confront successfully the institution’s fiscal and other challenges. She comments on the stability that MD Anderson’s tradition of physician leadership has provided.
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Chapter 01: 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 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 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 11: The First Woman Vice President at MD Anderson
Donna K. Sollenberger and Tacey A. Rosolowski PhD
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Chapter 01: An Early Start on a Research Path and Critical Thinking
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel sketches the experiences that inspired him to pursue science and shaped his attitudes about education. After tracing his own educational track through chemistry, to biochemistry, to physiology, and to a first faculty appt in pharmacology he concludes: “If you get good training as a doctor of philosophy you are trained to think critically and that skill in experimental work transfers to a lot of different fields.” He reflects on how key critical thinking skills are to the contemporary researcher –a recurring theme in these sessions and a keystone in his philosophy of education.
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Chapter 02: Building a Department of Pharmacology in the New UT Medical School
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel notes that his research path in endocrinology evolved at the time when the link between estrogen and cancer was first demonstrated. (He will speak in detail about his research in Session II.) Here, he focuses on his recruitment (in 1972) to help build a Department of Pharmacology in the brand new UT Medical School. He gives a vivid picture of this unique enterprise: building every dimension of a new school and new academic venture. He talks about the teamwork and trust required as the new faculty met an array of challenges, noting also that he immediately struck up connections with MD Anderson Cancer Center. Talking about this “remarkable time,” he brings alive the social life of the medical professionals (and their families) as they devoted themselves to building the new school.
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Chapter 03: A Brief History of the Texas Medical Center and MD Anderson
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel sketches the history of the Texas Medical Center and MD Anderson (and how they came to be located in Houston) and clarifies the administrative relationships between the UT System, the UT Health Science Center, the Texas Medical Center, the Graduate School of Biomedical Sciences, and MD Anderson.
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Chapter 04: The Graduate School of Biomedical Science: Creating A Unique Approach to Biomedical Education
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment Dr. Stancel talks about the environment of young institutions in place when he came to Texas in the Seventies. He talks about the founding of the Graduate School and recalls R. Lee Clark’s vision of researchers in basic sciences working alongside clinical researchers and those delivering patient care (an early version of translational research). He observes that to bring this environment into being in the GSBS, the faculty faced dual challenges: building careers and defining the identity of an institution made unique by its relationship to a cancer center and a mission to promote interdisciplinary communication among cancer scientists from many areas. Dr. Stancel describes how the GSBS preserves interdisciplinary breadth of education while developing programs with focal points defined by faculty interests. He sketches the major tasks of the GSBS during each decade of its existence, focusing in particular on the challenge of lobbying the Texas legislature to allow the MD Anderson to award graduate degrees jointly with the Health Science Center --the first instance, Dr. Stancel, notes, of a dedicated cancer center becoming a degree-granting institution.
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Chapter 05: Developing an Administrative Track and Dealing with Multiple Institutional Connections
George M. Stancel PhD and Tacey A. Rosolowski PhD
Dr. Stancel discusses his administrative track during the last forty minutes. He traces his various roles in the Medical School, culminating in his GSBS Deanship (’99), an appointment that made him “the Dean for everybody,” both Dr. John Mendelsohn, president of MD Anderson, and Dr. David Low, president of the Health Science Center. He talks about the process of winning degree-granting status for MD Anderson. He tells a story to illustrate the kinds of dilemmas he works with as a Dean who must collaborate with multiple institutions. Dr. Stancel gives an overview of his responsibilities: reviewing of programs, building enrollments, improving academic planning processes, and integrating young faculty more effectively into their roles.
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Chapter 06: Building Curricula and Leveraging Institutional Connections to Create Educational Opportunities
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel first talks about leveraging regional resources for biomedical education with training grants that draw build on the Gulf Coast Consortium (formed to broaden the educational/research resources available to students at six regional institutions). He then talks about the unique features of the education offered at the Graduate School.
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Chapter 07: Current Challenges in Biomedical Education: Duration of Degree Programs and Mentoring
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel first explains why the time to get a PhD in the biomedical sciences has increased and then talks about how the Graduate School is addressing the (national) challenge of reducing the length of time required to earn this degree. He then moves to the related issue of changes in mentoring of graduate students.
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Chapter 08: Issues in Graduate Education: Attracting and Retaining Women in the Graduate School; The Future of Biomedical Education
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel first observes that women had difficulty finding mentors in the early years of the GSBS (and recounts how the newly-created UT Medical School wanted to compete for the best students with more established schools and so actively recruited women and tailored courses to what were perceived to be women’s learning/working style). He explains discussing why the GSBS must have “a much deeper conversation with itself” about preparing students for careers outside of academia and how to foster innovation and creativity. At the end of this segment he mentions various books dealing with innovation and medical education.
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Chapter 09: Evolution of Research on Estrogen and Sweeping Changes in Biomedical Science
George M. Stancel PhD and Tacey A. Rosolowski PhD
Dr. Stancel next turns to his own research linking estrogen and uterine cancer. During his postdoctoral fellowship at the University of Illinois at Urbana he worked in the “hot contemporary area” of hormone mechanisms. He summarizes the shift in thinking about hormones at the time and the innovations that enabled detailed investigation of these substances and their relationship to cancer. Dr. Stancel was recruited for his work on steroid hormone action. He gives a vivid description of how technical innovations completely transformed his laboratory between 1972 and 2000. He describes several of the projects undertaken in his lab, including attempts to distinguish estrogenicity and carcinogenicity, successful demonstrations that hormones such as insulin and thyroid hormone would effect how a female animal would respond to estrogen, and work on mechanisms to predict susceptibility to uterine cancers. Dr. Stancel offers a lively anecdote of how the lab relied on-cutting edge equipment, such as the RT-PCR --a first reverse transcription polymerase chain reaction processor, the first at the UT Medical Center (and one of the first in the nation –their processor had serial #8), which they shared with others. At the end of this segment he describes the process of closing down his laboratory.
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Chapter 10: The First Uterine SPORE Grant
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel talks his role (partnered with two junior faculty members at MD Anderson) on the first uterine SPORE grant (Specialized Programs of Research Excellence) in the country.
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Chapter 11: The First Course in Ethics
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel talks about his role on the Research Ethics Task Force. He stresses that as far as he knows the Graduate School of Biomedical Science is the first institution to offer a course in ethics and to require it. He explains why teaching ethics has been controversial, then talks about the plans to formally track the effect of this program and possible ethical dilemmas medical professionals will face. He vividly describes some of the teaching methods.
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Chapter 12: Executive Vice President of Academic and Research Affairs
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stancel talks about his role as Executive Vice President of Academic and Research Affairs for the Texas Health Science Center (appointed in 2011). He observes that this high-level administrative work is much like “building a structure or a framework to help people” do their work more effectively and effortlessly. He foresees that future collaborations between UT Health Sciences and MD Anderson (and other institutions) will become more important as these institutions deal creatively with budgetary constraints and share resources and expensive equipment.
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Chapter 13: Proud of Teaching; A Goal of Maximizing Intellectual Cooperation Between UT Institutions
George M. Stancel PhD and Tacey A. Rosolowski PhD
In this segment, Dr. Stances shares some of his private life and perspectives. He talks about his long-time participation in the Ride for Multiple Sclerosis, a bike ride between Houston and Austin that hundred of people participate in, including many teams of Houston medical professionals. Among his professional achievements, he is most proud of developing new educational programs from scratch or significantly modifying them. He is also proud of having taught every single medical student who has come through the Texas Medical School, as well as teaching students in every school in the health science center, including graduate students at MD Anderson. He concludes the interview with a snapshot of what he would like to achieve in his remaining time in administration: a maximization of intellectual cooperation between all the University of Texas components and other institutions in Houston. He hopes that institutions might find ways of overcoming unhealthy rivalry and “build a better family” of biomedical intellectuals and institutions that might serve as “better stewards of public trust.”
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Chapter 01: Inspired By Work at a Medical Institution
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck explains that he came to work for MD Anderson's Department of Public Information and Education in 1975. (Prior to that he worked in a University of Texas Medical School Information Office that served both the Medical School and MD Anderson.) He then offers some background information, including how he came to spend his "formative years" in Houston. He notes that he spent his undergraduate years at University of Texas at Austin majoring in advertising and journalism. He secured a job in public information at the University of Texas Medical Branch in Galveston after graduation. Seeing the caring dimension of medicine inspired him to continue to work with the medical field, however he was drafted in 1969, going to Vietnam in 1970 as a public information specialist who wrote for the Army until his discharge in 1971. Though he returned to the University of Texas at Austin for graduate work, he left because for a job in the Public Affairs office at the University of Texas Houston.
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Chapter 02: Public Affairs: Working Closely with MD Anderson Presidents
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck describes the work he did promoting awareness of the new medical school (University of Texas Medical School) until 1975, when he was made Director of MD Anderson's Department of Public Information. He explains why the rapidly growing institution needed such a Department at that time and why Dr. R. Lee Clark offered him the job [the letter mentioned is reproduced in Steve Stuyck: The MD Anderson Years]. He talks about Dr. Glen Knots, to whom Mr. Stuyck reported, and the lessons he learned from him about management and leadership. He then explains why, in 1981, Dr. Charles LeMaistre arranged for Mr. Stuyck to report directly to him. He tells a story about a speech he volunteered to write for Dr. LeMaistre when he had to testify in Washington D.C. about the deaths of several patients, and how pleased Dr. LeMaistre was with his work.
Mr. Stuyck explains the particular abilities he was able to bring to MD Anderson and to the institution's presidents. In addition to being a good editor of others' work, Mr. Stuyck describes himself as a strong writer about MD Anderson and about cancer, with a skill to commit issues to paper. He had a special sense of Dr. Charles LeMaistre's way of expressing himself and could capture it. (Mr. Stuyck says that "I could hear him saying the words from the podium.) He notes that the archives have about 700 speeches that he wrote over the course of his career.
Mr. Stuyck describes the exhausting schedule of working with Dr. LeMaistre's speech trips and notes that, when Dr. John Mendelsohn arrived, it was agreed that Mr. Stuyck would not write his speeches.
Mr. Stuyck then tells several anecdotes to demonstrate what he learned about leadership from Dr. Charles LeMaistre. In particular, he mentions Dr. LeMaistre's habit of encouraging people who worked for him.
Mr. Stuyck recalls that Governor Bill Clemmons shouted at him during a visit, and Dr. LeMaistre phoned him later in the evening to tell him not to worry about it. Next he speaks briefly about Dr. John Mendelsohn, noting that he was just what the institution needed at the time. Dr. Mendelsohn promoted Mr. Stuyck to Vice President of Public Affairs.
Mr. Stuyck notes that he had thirty years of working with great bosses and great leaders.
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Chapter 03: Early Developments in the Department of Public Information and Education
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
This chapter opens with the interviewer providing an overview of the three story threads told in Mr. Stuyck's interview: the story of his career, of the Public Affairs at MD Anderson, and a story of what public affairs encompasses.
Mr. Stuyck asserts that he had a direct effect on the broad scope of Public Affairs, citing the gradual absorption of Volunteer Services into the Department.
Mr. Stuyck next explains that he was able to secure a contract to set up the Cancer Information Service in 1974. This was the first NCI-funded initiative to create a public information call-in line, and it was controversial, as most professionals did not believe that laypersons could be sufficiently trained to provide medical information.
Mr. Stuyck explains how he became principle investigator, and what was involved in setting up the service on this grant, which has run for 30 years for a total of twenty-six million dollars. Mr. Stuyck then provides historical context. He notes that the CIS was part of a larger national effort to open up communication about cancer, to develop advocacy for many groups, and to increase the role patients could play in their health decisions. He also notes that the President Nixon signed the National Cancer Act in 1971 and that knowledge in the sciences was growing at a tremendous pace during this time. He also cites the culture of excellence that existed at MD Anderson in the seventies.
Mr. Stuyck gives several examples to demonstrate how far cancer treatment has come since the seventies: the first BCG (Bacillus Calmette-Guerin) trials that required patients to be scarified; "gruesome" chemotherapy treatments; and treatments that required extreme surgical damage to a patient. He also recalls the first outpatient clinic at MD Anderson, which was very primitive by today's standards.
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Chapter 04: The Faculty: The Intellectual Engine of MD Anderson
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck expresses his appreciation for the MD Anderson faculty who are the "intellectual engine" of the institution even though they represent only twenty percent of employees. He says he has always tried to understand faculty issues and "speak their lingo." He traces his support for faculty back to his experiences at University of Texas Medical Branch, where he loved attending Grand Rounds. He sketches how issues have changed for faculty and lists the pressures upon them. He also characterizes MD Anderson faculty as possessing great intellectual curiosity.
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Chapter 05: Expanding the Scope of Public Affairs: Increasing Services for Faculty, Patients, and the Public
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
In this chapter, Mr. Stuyck talks about the expansion of the idea of public affairs at MD Anderson.
Mr. Stuyck explains that after he secured the NCI contract for the Cancer Information Service, "Public Education" was added to the name of the Department of Public Information, going on to detail what education can do for an institution.
Next, Patient Education came under the scope of Public Information, and he explains what sorts of educational materials the department produced. Volunteer Services was next folded into Public Affairs, and Mr. Stuyck explains that he wanted to bring together in one unified division all the functions that would reach out into the public. Next he explains why Public Affairs was sequentially identified as a Department, then an Office, and finally a Division. He comments on the perception of Public Affairs within the institution then goes on to explain some of the many services provided to MD Anderson. He begins by explaining Creative Services then talks about the role Public Affairs played when Dr. Jordan Gutterman [Oral History Interview] and his work on Interferon attracted tremendous media attention. He explains that Dr. Gutterman received 7,000 to 8,000 letters from people begging to participate in his trials. Public Affairs set up a service to answer all of these letters.Mr. Stuyck talks about preparing faculty to deal with media appearances. Then he identifies the sections within Public Affairs and notes that he and his management team produced both monthly and annual reports to document the contributions they made to the institution. At the end of this chapter, Mr. Stuyck notes that MD Anderson has generally received very good press. Most of the negative press has come during the last year.
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Chapter 06: Public Affairs: External Communications
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck explains the changing role of Public Affairs since the seventies. At that time, physicians were not concerned about public relations. He then points to Dr. John Mendelsohn's arrival as a turning point in the institution's dealings with the public: Mr. Stuyck explains how he and others worked with Dr. Mendelsohn to draw greater attention from national and international media, eventually hiring a New York public relations firm, The GabbeGroup (which still works for MD Anderson). He also explains that the single greatest factor to change the institution's media needs was the passing of the self-referral legislation in 1994.
Mr. Stuyck describes the challenges created when the bill went into effect in 1995 and forty percent of patients could suddenly request their own appointments. He explains that the information service, Ask MD Anderson, was created to help patients navigate the complex institution: it takes 100,000 calls per year.
Mr. Stuyck next describes several strategies used to raise the institution's profile. He describes the trips that Public Affairs planned for Dr. Mendelsohn, designing them to create more exposure for cancer and the institution. The GabbeGroup suggested that Public Affairs submit profiles on cancer issues to the US News and World Report website. Public Affairs also published surveys on attitudes about cancer and attitudes about breast cancer in Prevention Magazine.
Mr. Stuyck explains that departments that heavily use Public Affairs services fund positions within the Department. This insures that Public Affairs serves their needs.
Mr. Stuyck points to the important and productive link between Development and Public Affairs. He then identifies some key moments in the institution's relationship to the public: achieving status as a cancer center; the change in the institution's name in the 1980s; the impact of the Internet.
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Chapter 07: Public Affairs: Internal Communications
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
In this chapter, Mr. Stuyck gives an overview of internal communications in the institution. He notes that, in 2001, MD Anderson was at a crisis point in communications and Public Affairs hired the management group, Deloitte &Touche, to analyze the issues. At this time he proposed to the Management Committee of Public Affairs to establish a section for internal communication. As an example of communication difficulties, he talks about the mistrust created by layoffs in the early to mid-nineties, describing the publications created to address the issue. He compares the paper communications of past decades with the online communications of today. He then talks about new technologies that communications specialists must master today, noting that "it's fun to be around" the new media specialists and to strategize how to use new technologies. He notes that Communications has "reinvented itself" six or seven times in the past decades.
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Chapter 08: Public Affairs: Writing the MD Anderson Mission Statement and the Code of Ethics
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
In this chapter, Mr. Stuyck next talks about his work on two key documents: the Vision and Mission Statement and the MD Anderson Core Values. He explains why there was controversy over the core values.
Mr. Stuyck gives an example of why the word "hope" was controversial in the Core Values, saying that he was "never a fan of hope," but other committee members convinced him it was key to MD Anderson. He then talks about the impact of the two documents, citing a survey of employees that revealed almost 100% satisfaction with the institution values. Next Mr. Stuyck briefly compares Public Affairs at MD Anderson to analogous departments at other institutions. He comments on the role of the Management Group within Public Affairs and its strategic work in guiding the departments activities and evolution. He briefly comments on how Public Affairs is working with the current controversies surrounding Dr. Ronald DePinho.
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Chapter 15: A Key Publication: Making Cancer History
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
In this chapter, Mr. Stuyck tells the story of how Making Cancer History, a history of MD Anderson came to be written. Dr. James Olsen, a historian at Sam Houston State University, originally approached Dr. James Bowen with the idea, however the Management Board under Dr. Charles LeMaistre had no enthusiasm for the project.
Mr. Stuyck speculates on why this was the case, then goes on to trace how the Historical Resources Committee was created under Dr. Stephen Tomasovic, with a first goal of producing a history of the institution. He explains the lengthy process of looking for a writer and the eventual hiring of Dr. Olsen, as well as securing Johns Hopkins University Press to publish it.
Mr. Stuyck recalls that he and Stephen Tomasovic [Oral History Interview] both read the manuscript.
Mr. Stuyck says that Making Cancer History is a great book that tells history in a human way. He also talks about his favorite chapter. Next he next talks about what it meant for the institution to have a book that celebrates the culture. He speaks about the number of documents James Olsen reviewed as part of his research, the committee members who worked on it, and what was done to promote it.
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Chapter 16: Changes at MD Anderson
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck gives an overview of the changes he has seen at the institution over the course of his career. He notes that people in the past worked just as hard as they do now, but worked differently. He talks about the dramatic expansions to ambulatory care and patient care in general and the improvement of quality of life issues for patients. He makes some observations on cultural changes and the increasing interest in work/life balance. He then talks about the plan to merge the University of Texas Health Science Center with MD Anderson, a move that was resisted to preserve the institutions mission and resources.
Mr. Stuyck also talks about changes that Dr. John Mendelsohn brought to the institution, particularly the dramatic growth, for which the institution is now paying the price, he says.
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Chapter 17: The Murder of Dr. Fred: A Challenge for Public Affairs and the Institution
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck talks about the day that Dr. Fred G. Conrad, Vice President for Patient Care, was fatally shot (17 December 1982). He recalls Elmer Gilley calling him early Friday morning, and he went to MD Anderson to wait for the police and the coroner and to handle the reporters.
Mr. Stuyck recalls how calmly Dr. LeMaistre handled the situation and helped calm the tension. He then talks about how Public Affairs handled the media, noting that the crisis brought out the best in people at the institution. He describes Dr. Conrad and explains why his murder was a "seminal moment" in the institution. He ends with a story about a woman who had flown into town to be interviewed for a job, arriving at MD Anderson to discover "bedlam" so she returned to New York.
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Chapter 18: Departments Within Public Affairs
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
In this chapter, Mr. Stuyck talks about four departments within Public Affairs: Volunteer Services, the Children's Art Project, Public Education, and Patient Education. He begins with Volunteer Services, a service within MD Anderson that goes back to the 1950s. He then talks about Page Lawson, a director who greatly expanded Volunteer Services in the 1970s. He explains how he came to oversee the Department and tells a story about Tommie Stewart, a volunteer known as "the Hug Lady." He notes that MD ANdserson has 1200 volunteers who contribute the equivalent of 100 full time employees. He mentions the series of directors leading up to Page Lawson, whom he calls "a dynamo." Mr. Stuyck explains the lesson he learned from Page Lawson about remembering the names of volunteers.
Mr. Stuyck next talks about the Department of Patient Education, created by Dr. Charles LeMaistre. He explains how it came from the first patient satisfaction survey conducted in the 1980s. Dr. LeMaistre used the results of the survey to add valet parking, patient advocates, and patient education functions.
Mr. Stuyck explains changes in the reporting structure that came about with these changes, as well as the database that evolved to support patient education activities. He sketches the types of materials produced and who works on them. Next Mr. Stuyck talks about the Children's Art Project, beginning with an anecdote: Page Lawson showed him children's drawings arranged on an ironing board and asked him which ones would make a good card. He talks about his decision to separate the Art Project from Volunteer Services.
Mr. Stuyck describes what the Children's Art Project contributes to MD Anderson. He explains that it gives the institution a chance to talk about its successes. He notes how the Children's Art Project has come to be part of the MD Anderson brand.
Mr. Stuyck then tells the story of how the Public Education Department started. He comments on his colleagues in the Division of Public Affairs. Finally, Mr. Stuyck talks about what the Department of Public Education does for ME Anderson.
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Chapter 19: A Fun Job at an Institution that Inspires Commitment
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck speaks briefly about some constraints he felt for his activities at MD Anderson. He notes the commitment employees at MD Anderson feel for what they do and how much job satisfaction employees have.
Mr. Stuyck speaks briefly about receiving the Anderson Network Award. He also notes that the Division of Public Affairs is one of only three institutions that have twice received recognition as an Outstanding Public Affairs Program. He briefly talks about the book that he received on his retirement, Steve Stuyck, the MD Anderson Years, and clarifies two mysterious references in that book. He then notes that his is most proud to have started the Cancer Information and Public Information services, both of which were groundbreaking at the time. He is also very proud that he engaged the institution's first public relations group. Next Mr. Stuyck talks about what MD Anderson has given him over the years: a rewarding and fun job. At the end of the interview he notes that he gave his job "his all" and hopes that MD Anderson will continue to lift the "huge burden" that cancer represents.
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Chapter 09: Public Affairs at MD Anderson: Supporting Cancer Prevention and Education
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck begins this chapter talking about a joint project between Public Affairs and the Division of Cancer Prevention. He provides context, explaining that Dr. Bernard Levin (Vice President of Cancer Prevention, [Oral History Interview]) was approached by Channel 13 to do a promotion of the new fecal test for colon cancer screening. He explains how the project turned into a research project supported by SmithKline as well as a public service initiative. Nine thousand people participated in a study to compare fecal testing methods. Laboratory Medicine helped, but Public Affairs organized volunteers to read the cards. This study was eventually published.
Mr. Stuyck explains his axiom that "good public education is the best public relations. He then describes how he used that axiom to make decisions about public affairs is
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Chapter 10: R. Lee Clark and Charles LeMaistre
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck notes that MD Anderson has been strong because of the continuity of its CEOs. He notes that the institution's first full-time president, Dr. R. Lee Clark, had a solid public relations staff; he also focused on international activities.
Mr. Stuyck tells an anecdote about accompanying Dr. Clark to a television interview prior to his retirement.
Mr. Stuyck then talks about Dr. Charles LeMaistre [Oral History Interview], noting that he was erudite and chose his words carefully. Dr. LeMaistre also improved the look of MD Anderson and enhanced the clinical environment.
Mr. Stuyck notes that paying patients would go to other institutions, but Dr. LeMaistre's initiatives made MD Anderson more attractive, and turned that around. He says that Dr. LeMaistre was very effective at representing the institution to the public. He also contributed to the institution in many ways. One was by making the controversial move of starting the Division of Cancer Prevention. Dr. LeMaistre also led the initiative to change legislation to patients could self-refer. He explains why attitudes of physicians outside of MD Anderson made self-referral controversial at the time.
Mr. Stuyck notes that the transition to self-referral was very smooth.
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Chapter 11: John Mendelsohn: MD Anderson's Secret Weapon
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck begins this chapter on John Mendelsohn [Oral History Interview] by noting that he was a "dark-horse candidate" for president. He describes the interview process and how administrators were invited to participate. During an interview session, Mr. Stuyck found Dr. Mendelsohn to be very "energetic and wiry." Mr. Stuyck notes that MD Anderson had been ranked second to Memorial Sloan Kettering, but that changed under John Mendelsohn. He says the Dr. Mendelsohn arrived at just the right time in the institution's history: he describes Dr. Mendelsohn as "MD Anderson's secret weapon." He tells an anecdote about giving Dr. Mendelsohn advice"which he ignored.
Mr. Stuyck then talks about Dr. Mendelsohn's difficulties with the media during two conflict of interest cases involving his involvement with Imclone and Enron.
Mr. Stuyck explains how he prepared Dr. Mendelson for interviews with the media. He then describes how Dr. Mendelsohn handled his interview with a reporter from KTRK-TV, Channel 13, Wayne Dolcefino, about expenditures for furniture and art: Dr. Mendelsohn was very forthright and convincing, and the reporter let the story slide without publishing it. He then tells a story about a trip to Washington, D.C. for interviews at the Washington Post and PBS.
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Chapter 13: The Changing Organization of Public Affairs
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
A conversation about Cancer Bulletin, published through Scientific Publications, leads to a discussion of how and why Public Affairs has been reorganized over the years.
Mr. Stuyck says there are rumors that it will be reorganized again, under Dr. DePinho. As an example of reorganization, Mr. Stuyck talks about the Place of Wellness, which he originally managed until he decided he was not in a position to make the necessary medical decisions, so it became the Integrated Medicine Program directed by Dr. Lorenzo Cohen.
Mr. Stuyck also talks about the unique roles of JoAnn Ward and Louise Villejo [Oral History Interview].
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Chapter 14: Public Affairs and Communication Tools
Steve C. Stuyck MPH and Tacey A. Rosolowski PhD
Mr. Stuyck first talks about The Messenger, the first employee communication tool, which has been published for forty years. Next he discusses Conquest, a publication designed to generate awareness of MD Anderson among opinion leaders, donors, and corporate executives.
Mr. Stuyck talks about how Conquest was started and how it tells the MD Anderson story. He tells an anecdote about putting a donor envelope inside of Conquest with no accompanying solicitation for funds: the envelope alone has generated three million dollars (never less than $25,000 per issue). Next Mr. Stuyck talks about Cancer NewsLine, a series of video news releases launched in 1986 to provide media with news about cancer research and treatment. He describes the impact of these on the institution's reputation. He then talks about the Network Newsletter, launched in 1988 and mailed to all former patients ("a lifeline to the institution"), then moves on to the CancerWise Community Speaker's Bureau and MD Anderson Ambassadors programs, through which MD Anderson employees go into the community to talk about cancer issues. He notes that many within higher levels of the institution were at first suspicious of employees going out into the community.
Mr. Stuyck then talks about the "Too Cool to Smoke" program for kindergarten through fourth graders. Lastly he talks about Contributions to Making Cancer History (first published in 2007), launched because Dr. John Mendelsohn wanted to address the frequent question What are specific advances that MD Anderson has made against cancer? Mr. Stuyck explains how the approximately 100 advances were compiled and selected, and how Scientific Publications helped edit it to ensure its credibility.
Mr. Stuyck notes that this is a unique document among academic institutions: the content is now on the website, with about 150 advances included. At the end of this session, Mr. Stuyck tells a story to demonstrate Dr. John Mendelsohn's communication skills.
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Chapter 01: A Child with a Different Perspective
Pamela Sat Siri Sumler and Tacey A. Rosolowski PhD
In this chapter, Ms. Sumler talks about her early realization that she had a different perspective on life than other children her age. She talks about her early affinity for nature when was a child in Connecticut, her fascination with questions about the universe and intuitive grasp of non-duality. She tells an anecdote about how her father would joke with her, inadvertently supporting her growing perspective. She then talks about discovering the Daoist koans, yoga and pranayamic breathing.
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Chapter 02: Scoliosis Changes Life and Perspective
Pamela Sat Siri Sumler and Tacey A. Rosolowski PhD
Ms. Sumler begins this chapter by noting that she initially aspired to be a dancer. She then narrates the progression of her scoliosis through the seventies and after her spine fusion surgery in 1976 and shares several stories of significant physical and psychological events. She talks about the grieving she had to do because of the blow scoliosis dealt to her identity as a dancer and describes her process of coming to accept her new physical state and identity.
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Chapter 03: Exploring Massage and Raja Yoga; Cancer is a New Health Challenge
Pamela Sat Siri Sumler and Tacey A. Rosolowski PhD
Ms. Sumler begins this chapter by explaining that she became interested in massage during the year she spent in bed after her spinal surgery for scoliosis and was learning about alternative treatments. She also talks about joining a raja yoga community because of her desire to live a spiritual life; her yogi was the source of her name, Sat Siri, and her yoga teaching practice at Yoga Central. She then talks about her diagnosis with melanoma and describes undertaking yogic death practices to confront this challenge.
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Chapter 04: Massage and Cancer Patients: A Contemplative Practice
Pamela Sat Siri Sumler and Tacey A. Rosolowski PhD
Ms. Sumler begins this chapter describing how she began to practice massage in 1986 and tells stories to illustrate how "massage is artistic expression." She also notes some myths in the massage community at that time, e.g. that massaging cancer patients would spread their disease through their bodies. Ms. Sumler questioned this belief and decided to know more about massage and cancer. At the same time, family and friends were referring clients with cancer to her for massage. She explains technical aspects of her work with cancer patients.
Next, Ms. Sumler explains how she came in contact with Integrative Medicine at MD Anderson. She describes how she felt a "sense of calling" when she was at the institution. She was first invited to come and teach yoga, but that opportunity didn't work out.
