Interview Chapters

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  Chapter 01: How a Son's Career Can Parallel a Father's

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch talks the choices his father made while developing a career as a chemist. He observes that his own career path paralleled his father's track: entrepreneurial, research based, and academic. Dr. Balch keys on the fact that his father's entrepreneurial initiatives involved vision, a key leadership quality. Dr. Balch then talks about the leadership qualities that have been important in his own career.
  
  Next, Dr. Balch talks about R. Lee Clark's vision for MD Anderson. He describes how he met Dr. Clark.

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  Chapter 02: Creativity, Leadership, and Choosing Medicine

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch notes that he played jazz trumpet and focused on music during high school, then reflects on the importance of creativity to both leadership and research. He describes the mental process of playing jazz.
  

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  Chapter 03: Medical School and Other Training: Breaking into Opportunity

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  Dr. Balch begins this chapter on his medical training by noting that the process of applying to medical school was a "breakout moment" when he was encouraged to apply to top schools rather than setting his sights on a regional medical school. He talks about the culture shock he experienced going to New York City to attend the Columbia College of Physicians & Surgeons (MD conferred, 1967). He explains that he focused on cardiac physiology and was able to begin conducting research. Dr. Balch notes that he wanted to be in an academic medical center and explains his motivations: to focus on creating new knowledge and teaching.
  
  Next, he talks about the prominent physicians who mentored him and his ambition to become a cardiac surgeon. He mentions his internship in surgery at Duke University Medical Center (1967-1968) and his clinical residency in surgery at the University of Alabama in Birmingham (1970-1975).

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  Chapter 04: Work in the Emerging Fields of Immunology and Surgical Oncology

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch talks about how his involvement in two evolving fields, immunology and surgical oncology, influenced his career path. He notes that based on his strong record during his residency and his fellowship [1971-1973 Research Fellowship, Immunology, Scripps Clinic and Research Foundation, La Jolla, CA], Drs. Durrant and Cooper hired him into the faculty at the University of Alabama, where his work in surgical oncology evolved. Dr. Balch describes his growing experience working on clinical trials and his research on adjuvant therapies and monoclonal antibodies.
  

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  Chapter 05: Melanoma Research and Comments on Research Disappointments

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch talks about his research. He begins with comments about the balance he had to find between his surgical interests and research and administrative commitments. He notes that general surgery training enabled him to take on a project of being one of the first to insert chemo infusion pumps via abdominal surgery, and that his later research led him to focus on melanoma and breast cancer. Dr. Balch talks about his work on melanoma staging. He describes how the project came about through a desire to create a database and then evolved into new criteria for staging melanoma because of the involvement of statistician Sing Jaw Son, PhD. He talks about his sabbatical year in Australia (1983) at the Sydney Melanoma Institute, a collaborator in the melanoma project and where he wrote a book on melanoma. Next Dr. Balch talks about lessons learned from two studies that did not yield real results.

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  Chapter 06 : Surgical Oncology at MD Anderson, Part I: Changing Surgical Tradition

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  Dr. Balch begins this chapter by explaining how his research on melanoma raised his visibility and brought him to the attention of other institutions. Eventually he received a call from Bob Hickey at MD Anderson, and Dr. Balch explains that he developed a vision and plan for the evolution of surgical oncology. He describes the situation in surgery at that time (mid-eighties): excellent clinical surgery, but no academic programs, no research, no clinical trials, and a traditionalist approach that created a gap between the "MD Anderson way of surgery" and advances being adopted at other institutions. Dr. Balch explains that he presented a plan for super-specialization (to also guide recruiting), for database development, management, and biostatistics to support clinical trials, for multi-disciplinary care, and active competition for grant dollars. He also observes that he and his plan were not well-received in the Department of Surgery, explaining why. He give examples of the traditionalist approach in the department and the generalist focus.
  
  Next, Dr. Balch outlines his first steps in implementing his vision, first reorganizing the Department of Surgery as the Department of Surgical Oncology and tracking patient outcomes to set in place a system where "outcomes should be the same regardless of who did the surgery. " He talks about individuals he recruited.

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  Chapter 07: Surgical Oncology at MD Anderson, Part II: The First Multi-Disciplinary Breast Center and the Success of a Surgical Oncology Approach

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch explains his move to organize sections around organ based leadership, highlighting multi-disciplinary care as a guiding philosophy. He talks about starting the first multi-disciplinary breast center in the U.S.[1], noting that MD Anderson faculty in urology and head and neck were also using this approach. Dr. Balch explains that he used patient outcomes as evidence to advocate for the value of this system. He also explains that the multi-disciplinary approach saved the institution money. He notes that younger faculty supported the changes, as did Dr. LeMaistre. He notes that Dr. LeMaistre was a visionary and supporter of patient-centered care.

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  Chapter 08: Surgical Oncology at MD Anderson, Part III: Creating a Fellowship Program

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch talks about the academic dimension of his vision for the Department of Surgical Oncology: to create an education and research focused center to enhance patient care and train leaders for MD Anderson and other institutions. He sketches how the training program evolved, discusses the T32 training grant from the NIH, and notes that around 90% of the Department's trainees went on to positions at academic medical centers. Dr. Balch talks about how training was delivered in each content area and notes his own commitment to providing Saturday sessions on the qualities of leadership as well as good writing and presentation skills. He tells the story of Dr. Michael Henderson, an Australian surgeon and former trainee, to demonstrate the success of the program and the evolution of surgical oncology as a field.

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  Chapter 09: Transforming the Division of Surgery, an Overview

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch provides an overview of how he went about transforming the Division of Surgery when he arrived at MD Anderson in 1985. He explains the scope of his responsibility, which included the entire Division, its core resources, its clinical trials office, and the database management.
  

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  Chapter 10 : Transforming the Division of Surgery, Part of the Institution's Strategic Plan

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch explains that Dr. Charles LeMaistre allowed the Division heads to drive the institution's strategic plan and touches on the range of institutional goals that were to be addressed by transforming the Division of Surgery. (Dr. Balch was a member of the Executive Committee for the Strategic Plan from 1988 to 1996). He explains that Dr. LeMaistre's vision built on decisions made by R. Lee Clark to eliminate economic competition among specialties and reduce economic silos. He notes that the Division heads prioritized doing prospective clinical trials.
  
  Next, Dr. Balch explains why he wanted to build subspecialization in the Division of Surgery as a support for both patient care and research. He discusses how developing new training programs in surgery for fellows supported these goals.

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  Chapter 11: Subspecialization: The Key to Building a New Division of Surgery

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter Dr. Balch explains why his desire to subspecialize surgery at MD Anderson was key to his mission of developing the Division. He comments on the challenges of getting tradition oriented departments of surgery and notes that his mission to change traditional thinking was controversial. To demonstrate how he was holding traditional practice up to scrutiny for quality outcomes, he tells a story about suspending limb perfusion until consistency of the practice could be demonstrated.
  
  Next, Dr. Balch talks about how the division went about establishing practice guidelines, noting that this was precursor of the current system of linking quality and safety to evidence.
  
  Next, Dr. Balch comments on the complexity of the change process he had set in motion and its success as measured by the number of faculty and trainees who have risen tot leadership in their specialties. He makes comments on his participation at national meetings then discusses how his own laboratory became involved in sending experiments into space.

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  Chapter 12: Building the Division of Surgery: One Precursor to Disease-Site Reorganization

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter Dr. Balch provides an overview of what he accomplished after five years of service as Head of the Division of Surgery. He explain that his division focused on developing multi-disciplinary collaborations in treatment, a mindset evolving in parallel with the Divisions of Medicine and Radiation Oncology. This positioned the institution to reorganize patient care delivery around disease sites, becoming the first institution in the US so organized. He also emphasizes how R. Lee Clark's decision to pay all MD Anderson faculty on one practice plan laid the groundwork for this.

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  Chapter 13: Head of Hospitals and Clinics: Managed Care and the Origin of the National Comprehensive Cancer Network;

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch focuses on two main challenges he faced as Vice President of Hospitals and Clinics: the impending managed care crisis and the institution's initiative to develop a network of affiliates. He begins by explaining how he was asked by Dr. Charles LeMaistre to serve in this new leadership role. He discusses the context in 1993 and explains the measures taken to ensure that the institution worked more efficiently with better margins.
  
  Next, Dr. Balch tells the story of secret discussions with leaders at Memorial Sloan Kettering to join efforts in negotiating aggressively with managed care and how these conversations led to the creation of the National Comprehensive Cancer Network, a body that still establishes guidelines for standards of care in cancer treatment.
  
  Next, Dr. Balch talks about Charles LeMaistre's vision for a national and international network of institutions delivering MD Anderson care. He discusses the creation of the Tex Moncrief Cancer Center �one of the first affiliates, located in Fort Worth, Texas.

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  Chapter 14: Comments on Leadership

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  Dr. Balch begins by talking about his scope of responsibilities while he was VP of Hospitals and Clinics and then EVP of Medical Affairs. He then explains that he took on these roles out of loyalty to Charles LeMaistre and to MD Anderson, though his "core values" lie in teaching and clinical work, not in administration. He talks about the need for physicians to have leadership training and the perspective they bring to administration. He also comments that leadership training can prepare researchers to lead team scientific efforts.

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  Chapter 15: Disease-Site Reorganization;

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch focuses on the reorganization of patient care around disease sites and the creation of Rotary House, also an addition to patient care. He first sketches how Eva Singletary, MD and Gabriel Hortobagyi, MD [oral history interview] in Breast Medical Oncology asked patients to wear pedometers and discovered how far they were required to walk to circulate among the various specialists involved on their teams. He explains how this led to the decision to reorganize Breast Medical Oncology as the first multi-disciplinary breast center. He then talks about the building of Rotary House from funds from the Rotary Club and explains how it fit into Charles LeMaistre's vision of using hospital services for intensive and intermediate care.
  
  Next, he returns to the disease-site reorganization and explains how it led to specialization of the staff, cost-savings, and reduction in staff. Dr. Balch also notes that MD Anderson ran the largest pharmacy in the world, which could generate income that could be put back into clinical research for innovative therapy.

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  Chapter 16: Creating the First Prevention Program

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch talks about Dr. LeMaistre's desire to establish a Division of Cancer Prevention. He then sketches the difficulty of building a new division by taking faculty from other established divisions. He explains that conducting clinical trials to provide an evidence base to justify reimbursement for preventative therapies. He cites a study Bernard Levin, MD [oral history interview] conducted on COX-2 inhibitors and explains why no drug prevention study has been done since that time. At the end of the session, Dr. Balch previews a topic to discuss in the next session: Dr. LeMaistre's strategy of encouraging the Texas legislature to change MD Anderson's status as a not-for-profit.

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  Chapter 17: Addressing the Managed Care Crisis (mid 90s) with HR 192 and Other Legislation

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch talks about factors contributing to MD Anderson's financial instability in the mid-nineties: the impending managed care crisis, requirements that MD Anderson care for all patients even though they could not pay (when Harris County could take some of that burden), regulations governing how MD Anderson �as a state institution�could bid for services, and regulations preventing patients from self-referring. He explains that Dr. Charles LeMaistre ordered an analysis to determine how to address these challenges. He says that MD Anderson's major competitors were private institutions and needed to function more like them to create possibilities for success. He discusses Dr. LeMaistre's approach to working with the Texas legislature, and tells the story of a key reception and the day in 1995 when the self-referral legislation was speedily passed and signed by George W. Bush.
  
  Next, Dr. Balch explains how he and other administrators prepared for the impact of self-referral and the rapid increase in patients seen as a result. He talks about a new administrative layer of executive vice presidents were created to coordinate budgets and other efforts across the institution to increase revenue and reduce costs. He talks about an innovative practice of closing inpatient floors that were underutilized to save money. Dr. Balch then sketches the organization of the Executive Council in the newly formed Executive Vice Presidents' Office, specifically devoted to financial discipline and strategic planning. He notes that when the Office began, MD Anderson had no managed care contracts. The office was able to secure 90 contracts in the first twelve months. Dr. Balch next describes efforts to expand MD Anderson beyond Houston into other areas in Texas, materializing Charles LeMaistre's vision to create something new multi-disciplinary cancer care, an area where MD Anderson adds particular value for patients. Dr. Balch then explains that these measures decreased costs prepared the way for the growth generated under Dr. John Mendelsohn.

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  Chapter 18: A New Chapter as CEO at City of Hope and Other Roles

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  Dr. Balch begins this chapter by briefly touching on his candidacy for president when Charles LeMaistre stepped down and reflects on why John Mendelsohn was successful. He explains that the other candidates went on to high level positions at other institutions.
  

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  Chapter 19: A Return to MD Anderson in 2016 and Reflections on a Career

  Charles M. Balch MD and Tacey A. Rosolowski PhD

  Dr. Balch begins this chapter by explaining why he returned to Texas and then to MD Anderson in 2016, retiring from clinical practice and devoting energy to mentoring young faculty's careers. Dr. Balch next reflects on his contributions to MD Anderson then on the changes to the healthcare environment he has seen over the course of his career. He explains that he had an impact on the field through his efforts to shift the practice of surgery from a reactive intervention to surgical oncology and a treatment development mindset implemented in a collaborative team environment. Dr. Balch then talks about changes to how surgeons develop their careers as researchers and as leaders. He explains that they need special support to develop research careers and this has an impact on how fellows are trained and how surgeons manage their working environments to encompass research. In the final minutes of the interview, Dr. Balch reflects on his legacy and what his long career has done for him.

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  Chapter 02: Recollections of the Baker Estate

  Ornell H. Balzer RN and Lesley W. Brunet

  In this chapter, Balzer offers her many recollections was her time in the old Baker Estate when MD Anderson had only seven patients, her interactions with several prominent physicians, and the amount of cigarette smoking that went on in the hospital at this time.

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  Chapter 03: A Career at MD Anderson

  Ornell H. Balzer RN and Lesley W. Brunet

  Concluding her interview, Balzer talks about her elevation to charge nurse and then night supervisor, the absence of racial segregation at MD Anderson, the early work done with prosthetics, her work on the cobalt radiotherapy machines, her mandatory retirement at the age of 65, and how she was able to cope with the stress of losing patients: “When you walked out of that door in the afternoon, you left your work there, because it was just too touching. You had to tell yourself, ‘This is a research hospital. Someday they’ll find the right way to do it.’”

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  Chapter 01: Among MD Anderson's First Nurses

  Ornell H. Balzer RN and Tacey A. Rosolowski PhD

  In this chapter, Ornell H. Balzer, RN, she talks about her early career as one of the first nurses at MD Anderson in the 1950s and her work in the fledgling Radiotherapy Department

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  Chapter 01: Early Opportunities to Focus on Research

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast gives an overview of his early introduction to the researcher's life and work. He begins with brief comments about his family background and good educational opportunities, including chances to participate in medical research at the age of fifteen or sixteen. He describes the research methods he was exposed to, a precursor to translational research. He talks about his respect for data (even if it negated an initial hypothesis) and his scientific integrity.
  
  Next, Dr. Bast explains why he went to Wesleyan College (BA 1965) to major in biology with a minor in religion. He was interested in a liberal education. He also describes the research project he undertook in the pathology laboratory at Massachusetts General Hospital, where he "learned enough about reading slides to be dangerous." He talks about his undergraduate experience and his habits of lateral thinking and 3-D visual thinking.

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  Chapter 02: Integrating Research and Clinical Practice

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast explains how his desire to integrate research into his clinical practice evolved in medical school, internship and residency. He attended Harvard Medical School (MD 1971) for six years because he spent two years conducting pathology research, integrating his clinical and research practices. Dr. Bast explains how working with patients and seeing the minute-by-minute progress of disease enhanced his research. Next Dr. Bast explains his focus on cancer research, noting that he was influenced by Bill MacFarlane's early interest in immunology and cancer. He focused entirely on cancer when he took a research internship at the National Cancer Institute (1972 - 1975) and gained experience with microbacterial approaches. He explains that he studied the successful effects of Bacillus Calmette-Guerin on tumor control and metastasis in guinea pigs. He believed that there could be analogous results in humans.

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  Chapter 03: A Review of MD Anderson Research in the Early Seventies and a Discussion of Clinical Trials

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins this chapter by noting that, in the mid-seventies he wrote a review of research on BCG and cancer for the New England Journal of Medicine and included comments on the poor quality of research at MD Anderson. He gives further context, noting the controversies over randomized clinical trials and the bias at MD Anderson for conducting single arm trials. Dr. Bast next explains why today studies of targeted therapy can be productively advanced by single-arm trials, though they require final confirmation by randomized trials to win FDA approval for any drugs or procedures.

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  Chapter 04: Studies of C. Parvum and a Screening Test for Ovarian Cancer

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bast describes the research that grew from his belief that BCG could be injected into tumors to control growth and metastasis. During his residency at Brigham and Women's Hospital and then as a fellow at the Dana-Farber Cancer Institute, he looked for ways to apply intravenous tumor injection to other cancers. He talks about a study of how injected c-parvum inhibited ovarian cancer in animals by increasing macrophages. He then talks about translating the results to human treatment, describing the next step in the research involving the monoclonal antibody CA-125. An important result of this work: an ovarian cancer screening test. He explains that his laboratory developed an assay for CA-125 and in a retrospective study discovered that it could be used to track the course of ovarian cancer. The procedure is still used for monitoring. Dr. Bast then talks about uses of CA-125 for early detection.

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  Chapter 05: Developing Tools to Monitor and Screen for Ovarian Cancer

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bast notes the tools being developed for to screen for and monitor ovarian cancer. He begins by describing a study of auto-antibodies. Next he describes the SQUID detector (superconducting quantum interference device) that his laboratory is studying to fine-tune detection of presence of ovarian cancer cells. Funding comes from a SPORE grant. The project is part of the Moon Shots program.

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  Chapter 06: Increasing Patients' Sensitivity to Taxol; Understanding the Function of ARHI (DISRAS3) and Autophagy

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bast discusses two other important areas of his research. He begins with a sketch of his work on reducing patients' resistance to Taxol by manipulating the overproduction of certain kinases. Next Dr. Bast talks about his work on the gene ARHI or DIRAS3. Reexpression of this gene inhibits cell proliferation and also induces autophagy of cancer cells as well as their dormancy. Dr. Bast explains autophagy, a process that provides energy for starving cells. He also explains that after surgery and chemotherapy, some ovarian cancer cells remain. His laboratory is currently looking at drugs that can promote autophagy to rid the body of these cells. Dr. Bast goes on to explain other animal studies in progress to reveal other mechanisms of DIRAS1, DIRAS2, and DIRAS3.

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  Chapter 07: Rapidly Changing Science and the Pressure to Publish in High-Impact Journals

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins this chapter by observing that science is changing so rapidly that it's "almost always continuing medical education." He praises the wide array of specialized scientists at MD Anderson who can contribute their expertise to research. Next he observes that it is difficult to publish translational research in high-impact studies and that the mechanistic studies that are given the most respect don't necessarily take into account the variety of ways that studies effects can manifest in patients in the clinics. He notes that in today's very competitive environment, graduate students and fellows need high-impact publications to compete for a limited number of jobs. Graduate and post-graduate training programs are generating more scientists than there are positions.

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  Chapter 08: Research to Develop a Big Picture of Ovarian Cancer; Creating a Collaborative Laboratory Environment

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast describes the final area of research underway in his laboratory: collating studies of ovarian cancer to develop a big picture of the disease to identify the molecular/genetic studies required to further develop the fine details. He sketches the themes emerging from this study and their implications for targeted therapy. Dr. Bast talks about the strategies he has used to develop his laboratory. He also notes that it has been very collaborative, participating in many multi-author and multi-laboratory studies. He lists key people in the laboratory and notes the "stellar" students who have embarked on strong careers. Dr. Bast also describes how he tries to identify students who have a future in research and who will take the knowledge acquired by working in a translational setting to other institutions or back to their countries of origin. Dr. Bast then talks about different activities held in the lab to build collaboration and sharing of ideas.

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  Chapter 09: Experience at Duke and Coming to MD Anderson to Build Research

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast gives an overview of prior administrative experience then talks about his work once he arrived at MD Anderson to take over leadership of the Division of Cancer Medicine from Irwin Krakoff. He then describes the research scenario and explains that MD Anderson had always been "great clinically," but was not strong in basic science and translational research, though Dr. Krakoff built a good infrastructure for the continued growth of research. Dr. Bast talks about the opportunities he saw on arriving, noting the "anything is possible" spirit at MD Anderson, which he observes may be due to Texas culture. He notes his mission to build translational research, strengthen MD Anderson education and training.

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  Chapter 10: The Office of Translational Research: Building Collaborations

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bast talks about the roles of the Office of Translational Research: submitting applications for Core Grants that fund the shared resources critical for MD Anderson's translational research projects. He explains how the first application for comprehensive cancer center status, a status required to receive Core Grants. He describes many of the shared resources in place then and others that have evolved in the last fourteen years. Dr. Bast sketches the increases in grants awarded to MD Anderson. He lists the departments/divisions involved in translational research. He explains that his Office receives and integrates all information about the institution's translational project to help foster collaboration. Dr. Bast also explains that the Office created a system for presenting faculty CVs on a single platform.

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  Chapter 11: Training Physician-Scientists at MD Anderson

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast explains the Office's role in training and supporting physician-scientists. He talks about funding: the success in bringing the translationally focused SPORE grants to the institution and MD Anderson funding for collaborative, translational projects. Next Dr. Bast describes career development programs: the Physician-Scientist Program and a course in development teach young scientists how to approach problems translationally. Dr. Bast comments on the static number of physician scientists in all disease areas and comments on medical education. He describes a plan for an innovative patho-biology course offered at the Graduate School of Biomedical Sciences. He talks about the role that pharmaceutical companies currently serve in funding and driving research. Academic medicine has a role to play, he explains, in identifying biological processes that pharmaceutical companies can target in developing new drugs.

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  Chapter 12: The Moon Shots Program and a Model of Translational Research

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins with general observations about how translational research has evolved at MD Anderson under Dr. Ronald DePinho's leadership as president. He notes that Dr. DePinho's Moon Shots Program is the most direct application of the translational approach. As an example of how research can be optimally organized, Dr. Bast focuses on advances being made through the Moon Shots for treatments for breast cancer and ovarian cancer. He also explains that the patients involved in the Moon Shots trials are providing tissue for the study of nine different diseases. Dr. Bast notes that his own work on the mechanisms of autophagy in ovarian cancer (see Session One) connects to this Moon Shot.

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  Chapter 13: The Moon Shots Program; Genomic Medicine

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast first responds to some of the criticisms leveled at the Moon Shots Program. He explains that some individuals were skeptical that additional investment in research could bring big rewards. He then sketches advances that have been made since the National Cancer Act was passed in the seventies. He then lists some key administrators who have been working to build greater support for the Moon Shots.
  
  Next, Dr. Bast defines genomic medicine, summarizes the perspective of the Genomic Institute, and notes that this field is addressing the challenge of how much gene sequencing to conduct at MD Anderson. He concludes that the most important genes to sequence are those for which we have drugs.

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  Chapter 14: Working with Pharma; Supporting Innovation; Attracting Philanthropic Dollars

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins with a description of a pilot project designed to further research by establishing effective collaborations with pharmaceutical companies. He describes several points of difficulty in setting up these relationships: negotiating intellectual property agreements, aligning the workflow processes of MD Anderson with those of each individual pharmaceutical company, and dealing with differences in company cultures. Next Dr. Bast talks about grants the Office of Translational Research provides to support development of drugs and devices. He then talks about the private philanthropy that supports MD Anderson faculty research. Dr. Bast notes that private funds are very important in the current economic climate, where government and industry funding is very risk averse and the expectations of return on investment are very high.

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  Chapter 15: The Office of Translational Research: Growth Areas

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast discusses projects that are expanding the impact of the Office of Translational Research. He first sketches the Clinical Investigator Program, started in 2009, that allows physicians to devote 75% of their time to research. He sketches the accomplishments of some of scholars who have completed this program. Dr. Bast then talks about how the Office develops the leadership potential of the translational researchers.
  
  Next, Dr. Bast shares examples to demonstrate the importance of keeping pace with emerging technologies to support translational research. Dr. Bast notes that his Office will focus on developing its educational initiatives in coming years. He mentions courses now under development now for the Graduate School of Biomedical Sciences.

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  Chapter 16: Thoughts about Training as a Physician-Scientist; A Review of Good Colleagues

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins with a review of his own training as a physician scientist. He notes many advantages he had, but stresses he could have had more rigorous training in how basic scientists think. He also notes that he has faced some challenges in balancing the clinical, scientific, and administrative arenas of his career. He then mentions the people he has worked with at the Office of Translational Research.

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  Chapter 17: The Multi-disciplinary Research Program

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bast sketches the history, aims and successes of the Multi-disciplinary Research Program. He explains the origins of the program ten years ago and its importance as funding from other sources has diminished. He explains that MD Anderson has invested $8.7 million via the Program and seen $136 million in grant money awarded. He explains how the Office of Translational Research identifies promising research and also provides coaching services and templates that investigators can use to create successful grant applications. He comments on the idea that grantors are more conservative today and explains that what is needed now are grants specifically targeted toward discovery projects. He notes that the Office of Translational Research is contributing to a strategic plan to address this issue at the institution.

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  Chapter 18: As Head of the Division of Cancer Medicine: Building MD Anderson's Academic Programs and Research Focus

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins this chapter by reviewing his reasons for leaving his role as head of the cancer center at Duke University in 1994 to take over as Head of the Division of Cancer Medicine at MD Anderson. He sketches the restructuring of divisions at the time he arrived and explains why this helped bring good leadership to departments. Dr. Bast then talks about his work building MD Anderson's educational programs, focusing in particular on preparing physicians to get involved in research throughout their careers, even if they are in community practice. He talks about the types of research that can be conducted in community settings and explains why MDs may leave academic medicine and avoid conducting research. He lists specific indicators that show a stronger research focus among fellows.

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  Chapter 19: The Culture of Research at MD Anderson

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins by noting that the strong department leadership created when Divisions were restructured helped bolster the institution's research focus. He notes that at MD Anderson, Duke, and the Farber Cancer Center, patient care is the primary value and that research is emerging as a primary value. He notes Dr. John Mendelsohn's [Oral History Interview] influence on this process. He also notes that his work as head of the Division of Cancer Medicine led naturally to his role as Head of the Office of Translational Research. Dr. Bast notes that he was unable to centralize many activities because of the very independent leadership exerted by department heads. He also observes that he might have been more effective had he spent more time building trust with department heads. Dr. Bast observes that he was successful in raising awareness about the importance of translational research. He compares Dr. David Hone's perspective on finances with Dr. John Mendelsohn's.

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  Chapter 20: Accomplishments as Division Head and Observations about Leadership and Mentoring

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins by noting that, as Head of the Division of Cancer Medicine, he was able to build connections between people across departmental lines. He credits Dr. Waun Ki Hong [Oral History Interview] for his leadership in building appreciation for administrative personnel and staff people. He comments on how a leader can be "feared and loved." He notes that he has been inspired by the faculty and their contributions to patient care and research, but regrets the amount of time he had to spend on conflict resolution. He summarizes why he enjoyed his time as division head, specifically citing the opportunities he had to mentor people. Next Dr. Bast summarizes his approach to mentoring and sets it in the context of MD Anderson culture, where relationships with other people are a form of "currency." He also notes how inspired he has been by fellows who see patients.

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  Chapter 21: John Mendelsohn and Ronald DePinho

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast first comments on Dr. John Mendelsohn and his success at expanding MD Anderson during turbulent financial times. He also notes that Dr. Mendelsohn created connections with the Houston community, expanded the role of the Board of Visitors, and created a vision for the institution. Though he brought in strong clinicians and physician scientists, Dr. Bast says, he faced challenges recruiting basic scientists. Dr. Bast next observes that Dr. Ronald DePinho has underscored how important basic science is for a number one cancer center and he has been successful in putting together a "great team." Dr. Bast also notes that he is gratified to see that Dr. Mendelsohn and Dr. DePinho have both supported Dr. Elizabeth Travis and the Office of Women Faculty Programs.

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  Chapter 22: The Moon Shots Program and Its Impact

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast begins by commenting that Dr. DePinho's Moon Shots Program is one of the "most important projects undertaken at MD Anderson." He sketches why he believes this is so and notes some of the impact the Program is already having on patient care. He also explains that Dr. DePinho is using MD Anderson as a "pulpit" to effect national changes in how cancer prevention and detection is approached. He talks about how research is conducted under the Moon Shots model. He explains that it has been challenging to convince clinicians that they have as much ownership over the Moon Shots research as basic scientists. He explains resistance to the model and how to address these problems.

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  Chapter 23: Writing a Guidebook on Translational Research

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bast talks about a book he is writing for young researchers interested in conducting translational research. He describes the sequence of chapters. While discussing his aims for the book, Dr. Bast touches on several subjects. First he talks about MD Anderson's Apollo Program that aids in diagnosis. He explains how important it is to bring academia and Pharma together in research project. He gives examples of chasms to overcome and explains that it's important to bridge the gap because pharmaceutical companies fund so much research. Dr. Bast also notes that his book aims to increase the pool of physician scientists.

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  Chapter 24: Establishing a Habit of Translational Thinking

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  Dr. Bast explains that one aim of MD Anderson's graduate programs is to provide an environment where young scientists will develop a translational habit of thinking. He explains the input of the faculty into this process and the variety of approaches it demands.

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  Chapter 25: Photography, Basketball, and Advisor to the V Foundation for Cancer Research

  Robert C. Bast Jr., MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bast talks about his leisure activities. He is a photographer, is "addicted" to lectures by the Teaching Company and Duke University Basketball. He also talks about his work with the V Foundation for Cancer Research, an organization that funds young investigators. He serves on the advisory board.

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  Chapter 01: R. Lee Clark Chooses His Chairman of Pathology

  Frederick F. Becker MD and Lesley W. Brunet

  In this chapter, Dr. Becker discusses how he was recruited to MD Anderson to be the chair of the Department of Pathology.

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  Chapter 02: Stories: The Pathology Department in 1976 and MD Anderson as a Texas Institution

  Frederick F. Becker MD and Lesley W. Brunet

  In this chapter, Dr. Becker discusses the Department of Pathology at MD Anderson when he arrived in 1976 and his impressions of the MD Anderson President, Dr. R. Lee Clark.

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  Chapter 03: Stories: A Vision for Pathology and an Office for a New VP of Research

  Frederick F. Becker MD and Lesley W. Brunet

  In this chapter, Dr. Becker discusses his vision for the Department of Pathology; the retirement of Dr. R. Lee Clark; and his work with the new MD Anderson President, Dr. Charles LeMaistre.

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  Chapter 04: Building the Department of Pathology: Clinical Service, Research, Education

  Frederick F. Becker MD and Lesley W. Brunet

  In this chapter, Dr. Becker discusses building up the Department of Pathology and its focus on research.

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  Chapter 05: The Search for Dr. Clark’s Replacement and Charles Lemaitre’s Administrative Impact

  Frederick F. Becker MD and Lesley W. Brunet

  In this chapter, Dr. Becker discusses his insights into the administration of Dr. Charles LeMaistre.

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  Chapter 01: A Pathway to Pathology With Inspiring Mentors

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Becker talks about his early education and family background, his ties to New York City, and why he now considers himself a Texan. He notes the anti-Semitism that prevailed in many medical schools when he was applying (New York University was unusually non-restrictive) and the process that took him to New York University Medical College to work with pathologist Dr. Lewis Thomas.

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  Chapter 02: A Pathologist Discovers His "Eye"; An Introduction to Judah Folkmann

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  In this chapter Dr. Becker talk about "his eye" for cellular structure and abnormality and the environment for research at NYU during his residency-fellowship. He then goes on to talk about his experiences in the Navy, including anecdotes about meeting his good friend Dr. Judah Folkmann and the research on tumors they conducted off hours. Dr. Becker noticed that tumors didn't vascularize in their laboratory conditions: he notes that he is the "illegitimate father of angiogenesis."

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  Chapter 03: An Introduction to R. Lee Clark and MD Anderson

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Becker briefly sketches his career path when he returned to New York and joined the Department of Pathology at New York University Medical College. He describes the inbreeding that can take place at institutions and then talks about his recruitment to MD Anderson. He offers anecdotes about his interactions with Dr. R. Lee Clark, talks about his leadership style, and mentions other significant figures whom he worked with on arrival.

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  Chapter 04: Building a Modern Department of Pathology

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Becker talks about taking over as Chair of Pathology where "there was almost no research going on." He characterizes his leadership style and offers a telling anecdote about supporting a young and creative faculty member. He talks about challenges he faced as he went about modernizing research, some of which came from the institutional structure, and offers his view that all researchers evolve through experience. He goes into detail about the challenges he faced and he talks about his own requirements for upgrading his MD Anderson laboratory (detailed in a letter that came to be called "the Bill of Particulars"). There were no cold rooms, for example, some of the facilities assigned to him had inadequate electricity, and a previous faculty member had left behind radioactive materials. Dr. Becker describes how he intervened in an unusual dimension of the culture that held back researchers' careers at MD Anderson: though researchers had access to very unusual tumors, but were hesitant to publish on them. Dr. Becker encouraged them to go ahead and publish. He talks about the perception of other faculty that he was at MD Anderson to convert pathology to laboratory research rather than a complementary clinical activity.

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  Chapter 05: Memories of MD Anderson and the Texas in the Seventies

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Becker notes that when he arrived at MD Anderson, it was a large and complex institution, but still had an administrative structure designed for a very small enterprise (a "mom and pop store") and suffered from faculty inbreeding. After a pause in the interview, Dr. Becker shifts subject and tells some stories about the conservatism in Houston in the sixties, then talks about the period when Dr. R. Lee Clark stepped down and Dr. Charles A. LeMaistre took over as president of MD Anderson.

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  Chapter 06: Updating MD Anderson's Pathology Laboratories

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker first talks about the early phase of his research, beginning with a discussion of "classical pathology," the histology-based practice on which his molecular approach is grounded. He segues briefly into a description of what was required to modernize the "primitive" conditions of MD Anderson's laboratories when he joined the institution. (He was nicknamed "Cold Room Becker," because of his multiple requests for this essential facility.) He then talks about his research into cancer chemical carcinogenesis in the livers of animals. His laboratory made a significant contribution by observing alterations in cell division and identifying stochastic sequences. He notes that he also expanded research in the Pathology Department by bringing in fellows and faculty with pathology training.

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  Chapter 07: Building Research and Facilities Under Charles

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker explains some changes in MD Anderson when Dr. Charles LeMaistre took over as MD Anderson's president with R. Lee Clark's retirement. He notes that Dr. LeMaistre's qualifications and his view that the institution needed a stronger academic structure and research base. In line with this vision, Dr. LeMaistre created a Vice President for Research, asking Dr. Becker to assume this position. Dr. Becker describes how he set up his administrative practice so it would not compromise his research career, then details his efforts to increase research facilities, recruit outstanding scientists and create professorships. He recalls his insistence that he be able to recruit anyone from anywhere (even a "polka dotted hermaphroditic Venusian geneticist") in order to pursue excellence, and notes that this was unusual in MD Anderson's "deep South" mentality at the time, when the faculty was geographically and racially limited. Dr. LeMaistre supported Dr. Becker's efforts to bring diversity to the faculty.

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  Chapter 08: Creative Administration and Active Fundraising

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker talks about efforts to expand MD Anderson and try innovative administrative approaches. He recalls the effectiveness and creativity of his staff. He then touches on fundraising topics, including Dr. LeMaistre's creation of the Board of Visitors, the creation of endowed chairs, and the creation of the South Campus -Research Park. He then tells the story of how Research Park came out of the failed attempt to create a food service operation on South Campus ("the Kitchen of the Jolly Green Giant"), beginning with the R.E. Bob Smith Building for Research, which enabled recruitment of top researchers such as Dr. Isaiah J. Fidler and Dr. Margaret Kripke. He notes some pros and cons of Research Park (which is at a distance from MD Anderson's main campus). He then recalls how Dr. Andrew von Eschenbach and some other faculty came to him with a proposal for a clinical fellowship program -an instance of "bottom-up" creativity and part of the larger plan to build up to a "critical mass" of both basic and clinical laboratory research.

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  Chapter 09: Establishing Research Excellence; Expanding to South Campus

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker discusses how MD Anderson maintained excellence in research, beginning with the creation of an External Advisory Board of top research and clinical scientists who reviewed the credentials of prospective hires and who came to MD Anderson once a year to review plans that Dr. Becker made for developing research. He describes the "unhomogenous" character of research, in that not all the researchers were first class, largely due to inbreeding in early hiring practices. He notes difficulties in shifting the culture of inbreeding and praises MD Anderson's tenure system -a 7-year rollover system. Dr. Becker then describes the criteria used for determining excellence and underscores that they always attempted to be fair in evaluating faculty, particularly since they did not want to lose someone who was creative (and who might have had difficulty acquiring funding for cutting edge work). He also notes MD Anderson never lost one of the cases brought by faculty who were terminated. The support of excellence increased the institution's ability to raise fund and, therefore, recruit even more top faculty. He also addresses the past criticism that MD Anderson had never produced a National Academy of Science member, noting several faculty members who were appointed to the Academy shortly after being recruited away. He then talks about the building of South Campus and its role in expanding research.

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  Chapter 10: Four Areas of Research

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  In this chapter, begins to discuss his research contributions. He first notes that he met Dr. Judah Folkmann (while they were in the Navy) and informally began to study the growth and spread of tumor cells. Dr. Becker notes that some of his observations -made from a pathologist's perspective -contributed to Dr. Folkmann's work on tumor angiogenesis. Dr. Becker then talks about his work in epigenesis (the non-genetic modification of genes) and his work on methylation of DNA (first paper published in 1979). Dr. Becker's laboratory was the first to describe epigenetic processes in cancer. He then describes his recent work with TX-262, a compound that has promising uses in killing pancreatic tumor cells, and goes on to talk about his advances in isolating circulating tumor cells using dielectrophoresis (DEP). Dr. Becker describes how he began to work in this area, his collaboration with Dr. Peter Gascoyne (who came to work with Dr. Becker as a research fellow), and the uses of DEP.

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  Chapter 11: MD Anderson and Strategies for Weathering Financial Stress

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker shifts to administrative topics, first noting the advantages MD Anderson gains from having its faculty on salary. He describes the difficult period in the 1980s, when physicians did not want to refer patients to MD Anderson and when HMOs were restructuring medical payment -to MD Anderson's disadvantage, since its care was expensive. He explains how Dr. LeMaistre organized the Board of Visitors and others to demonstrate to the Texas Legislature that MD Anderson might go bankrupt, with the result that the Legislature created the possibility for patients to self-refer. He notes that the Board of Visitors set up special funding at that time to supplement what patients would receive from their own medical plans in order that they might receive the sophisticated treatment offered at MD Anderson. Returning to the issue of cutbacks, Dr. Becker notes that they were done by formula.

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  Chapter 12: A Search for a New President; Working with John Mendelsohn

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker begins the next section with comments on the search for the new president, John Mendelsohn, and Charles LeMaistre's retirement. He describes how the search process worked, lists Dr. Mendelsohn's credentials, and notes that he could be considered the "first outsider" to be selected as president. He notes the particular value of Dr. Mendelsohn's experience with business in creating what he calls "The New Anderson," with a corporate structure. He recalls that by 1998, two years in to Dr. Mendelsohn's presidency, he was wearing out as an administrator. He describes his role as Special Advisor to the President when he stepped down as Vice President of Research. Among other initiatives, Dr. Becker worked on developing CORE grants, sat in on the External Advisory Board, and saw through construction projects initiated while he was Vice President. Once Dr. Mendelsohn had his own support system in place, Dr. Becker stepped away, eventually giving up all administrative responsibilities and taking a faculty position without pay.

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  Chapter 13: A Named Chair and Views of Texas and Texans

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker talks about his surprise when John Mendelsohn created the Frederick F. Becker University Cancer Chair. Because it was funded by donations from many "legendary Texas families," Dr. Becker feels very accepted in Texas. He describes what he'd like to import from Texas to New York, and vice versa.

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  Chapter 14: Impressions of Dr. Ronald DePinho

  Frederick F. Becker MD and Tacey A. Rosolowski PhD

  Dr. Becker then talks about his surprise that the search committee selected Dr. Ronald DePinho to succeed John Mendelsohn. In the final moments he talks about the importance of MD Anderson being listed as a co-grantor on degrees conferred by the Graduate School of Biomedical Sciences. He notes the creation of MD Anderson's academic convocation as an important recognition of accomplishment. He ends the interview with an anecdote about attending an address by Dr. DePinho and sitting next to Dr. LeMaistre.

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  Chapter 01: An Educated Family and an Early Interest in Science

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about the influence of his parents. His father, Bernard, was a pediatrician who had his office in their home. His mother, Helen, was a PhD biochemist who eventually taught physiology at Hunter College. They instilled in him a love of learning, and listening to the babies screaming in his father's office convinced him not to be a pediatrician. His father taught him about chemistry before he took it in school and Dr. Benjamin explains what he found fascinating about the subject.

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  Chapter 02: Experiences at Williams College

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin explains his selection of Williams College for his undergraduate studies in chemistry (BA conferred in 1964). He also explains why this small and rurally located institution was not suited to him and made him realize that he is a "city person." Dr. Benjamin talks about his love of music, his first experiences with opera, and the cultural advantages that growing up in New York City offered. He notes that Williams College had few cultural opportunities and the student body was not as intellectually driven as he would have liked. He explains that he took summer school courses throughout his education and fondly recalls a language immersion program at Colby College, where he also met his wife, Nancy, whom he asked to marry him after only nine days.

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  Chapter 03: An Interest in People

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin begins this chapter by noting that he elected to go into medicine during college because laboratory work in chemistry made him realize that he is a "people person." He talks about his mother's influence on this part of his character. She taught him to "stand up for what he believes in." Dr. Benjamin also comments on his growing awareness of the Civil Rights Movement when he was in college and he describes an "incredibly moving" experience of attending a lecture by Martin Luther King on campus. He notes that he grew up in a largely black neighborhood in Brooklyn and is to this day color blind when he deals with people. Dr. Benjamin also explains his support of women, another influence from his mother. He sketches some of his wife, Nancy's, career, experiences with sexism, and her current with a Federal law court.

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  Chapter 04: A Rounded Education During Medical School

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin begins this chapter by explaining that he elected to go to New York University School of Medicine because he wanted to return to a big city (MD conferred in 1968). He also explains that he always took summer school courses to round out his education: he was interested in a liberal education. Dr. Benjamin explains that in college he took music electives and this is where his interest in music, particularly opera, developed.

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  Chapter 05: A Mentor in Medical School Teaches Important Research Lessons

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin begins this chapter by describing how well his memory serves him in recalling details of patient histories. He also notes that while working in laboratories during the summers of his medical school education he met Dr. Max Schubert, who put him to work on glycosaminoglycan. Through this research, Dr. Schubert taught him the importance of having the right controls in research and not accepting what books say about results until you have collected the data, a lesson that Dr. Benjamin says holds true in medicine. He talks about the need to exercise flexibility when interpreting research results.

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  Chapter 06: Clinical Experiences and Learning to be a Doctor

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin begins this chapter by explaining why he elected to go into internal medicine rather than surgery. He explains the differences in the mindsets of surgeons, who fix problems, versus internists, who are diagnosticians and need to know the origins of problems. He underscores that clinical rotations taught him to be a physician. Dr. Benjamin tells a story about treating "Bowery bums" at Bellevue Hospital during his internship. He describes the stress of dealing with emergency room situations and the benefits of hands-on acute medicine, which he came to like. He also notes that in the late sixties, physicians held the belief that there was nothing to be done about cancer.

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  Chapter 07: Plans to be a Cardiologist and a Key Fellowship with the NIH

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin explains that he planned to be a cardiologist when he got his medical degree in 1968. He applied for a public health fellowship with the NIH to avoid going to Vietnam and got into a program at the Baltimore Cancer Research Center treating septic shock in leukemia patients. He believed that this experience would be transferable to cardiology patients. He notes that he was selected because of his laboratory experience, but he negotiated opportunities to work with cancer patients during his laboratory year as well as his clinical year. Dr. Benjamin then describes the Cancer Center in Baltimore and how the staff knew very little about oncology (as the field was in its infancy). He says that, because of his training during his internship and residency, "I was perfect for it," though others were very stressed by working with the cancer patients.

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  Chapter 08: Stories about Work with Cancer Patients and a Switch to Oncology

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin tells stories of his work with cancer patients at the Baltimore Cancer Research Center, work that convinced him to focus on oncology. He first tells a story about a patient with stage four Hodgkin's disease who achieved a long-term complete remission with the MOPP treatment. He next tells a story of a lung cancer patient "who had more effect" on Dr. Benjamin "than anybody." After treatment with Adriamycin, this patient lived for eight months. Dr. Benjamin is very affected by telling these stories and stresses the "life and death" issues that working with cancer patients brings to the surface. He notes that the standard practice at the time was to withhold a cancer diagnosis and specifics of the prognosis from patients (and demonstrates with an anecdote). Dr. Benjamin stresses that patients are "smarter than you think" and that transparency is important. He mentions the film "Ikiru," by Akira Kurosawa, that tells the story of a man with stomach cancer and shows the "strength of the human spirit." Dr. Benjamin stresses that the dilemmas of cancer patients "are moving, people are important."

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  Chapter 09: NIH Fellowship: Researching Drugs with Amazing Effects on Patients

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about his work with anthracyclines and daunorubicin at the Baltimore Cancer Research Center. Dr. Benjamin determined the pharmacology of the recently introduced drug, Adriamycin. He describes the protocol and comments on the policies regarding consent forms at that time and now. He then talks about the results, which showed that Adriamycin was the most active drug in solid tumors up to that point. He tells a very dramatic story of the effects on a patient with metastatic sarcoma (Dr. Benjamin's first sarcoma patient). Dr. Benjamin next explains that he became involved studying the pharmacology of cancer drugs and that no one had really done that before. He stayed an extra year on this fellowship to continue his studies. He explains changes in credentialing rules that resulted in his time with the NIH to satisfy the requirements for both Internal Medicine and Oncology.

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  Chapter 10: A Lesson on Sharing Credit with Colleagues

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter Dr. Benjamin tells a story about Dr. Nick Bachur presenting the results of the studies of Adriamycin in his laboratory. Dr. Bachur stated, "All the work was done by Dr. Benjamin." This made a deep impression on Dr. Benjamin, who learned about the importance of giving credit to junior people. This is one of the "tricks" he says of an effective department chair.

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  Chapter 11: The Path to Developmental Therapeutics at MD Anderson

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin explains how he first took an assistant professorship at the University of Southern California. After an "unproductive year," Dr. Jeff Gottlieb at MD Anderson told him the institution needed a clinical pharmacologist. Dr. Benjamin came to MD Anderson in 1974 thinking he would work with Dr. Gottlieb, who also studied Adriamycin, but Dr. Gottlieb passed away. Because of his interest in sarcoma, Dr. Benjamin joined the Department of Developmental Therapeutics and he took over the area of sarcoma in 1975. Dr. Benjamin ends the interview session describing some of the working conditions in the department. He explains that he took on more patient care responsibilities and eventually eased out of clinical pharmacology.

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  Chapter 12: Family Life and Life Balance

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about his children and his family life. He begins by talking about the career choices his sons have made and why they chose not to go into medicine. He then talks about the commitment to patients that a medical career demands. Dr. Benjamin then explains how his very close family relationships have enabled him to do the very emotional work of practicing medicine with cancer patients.

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  Chapter 13: Developmental Therapeutics in the 1970s: A Place of Optimism

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin notes that the MD Anderson was intellectually challenging and exciting when he arrived in 1974. His colleagues, he says, had "incredible optimism that we were going to make a difference." He explains that since not much was known about cancer at that time, they did not feel they had to abide by accepted standards of care and were always looking to improve care. In the Department of Developmental Therapeutics (DT), in particular, each faculty member had patient care responsibilities but their primary purpose was to improve care and each patient was part of an experiment. He also notes that DT was an insular department. He sketches the history of the founding of DT and its relationship to the Department of Medicine.

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  Chapter 14: The Research Environment in Developmental Therapeutics

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin explains the climate for research that Dr. Emil J Freireich [Oral History Interview] created in the Department of Developmental Therapeutics. He begins by explaining the approval process for conducting research studies "a much simpler process than today's. He notes that all patients were provided with care, irregardless of ability to pay, and that this obligation was written into the institution's bylaws.
  

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  Chapter 15: Memories of J Freireich

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about the impact of Dr. J Freireich on researchers in Developmental Therapeutics and outside the institution. He explains that Dr. Freireich "made you think" and refers to "Freireich's Laws" first presented when Dr. Freireich gave the Karnofsky lecture in 1976. He explains Dr. Freireich's perspective on statistical models and gives his version of the Hippocratic Oath, which stressed the urgency of caring for a patient in the here and now. [Redacted]

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  Chapter 16: Research Projects at MD Anderson: A Shift from Clinical Pharmacology to Sarcoma

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin explains that he spent his first two years at MD Anderson establishing how to evaluate the function of various cancer drugs. He notes that clinical pharmacology was a nascent field at that time. He then explains that Dr. Jeff Gottlieb's clinical areas were divided and he inherited sarcoma. At the same time, the faculty's clinical responsibilities were increasing. Dr. Benjamin focused more on sarcoma and less on clinical pharmacology.

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  Chapter 17: Studies of Adriamycin and Cardiac Toxicity

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about his clinical studies aimed at reducing the cardiac toxicity of Adriamycin. He explains how his work was based on pathology studies conducted at Stanford University. He talks about how he adapted the protocols and discovered how to modify the administration of the drug. He talks about the results that were published, noting in particular those achieved when the drug was administered by continuous infusion. He notes that this protocol has been used at MD Anderson since the 1970s, though it is now being supplanted by a cardio-protective drug.

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  Chapter 18: Studies Relating to Sarcoma Treatment

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin explains that he worked in collaboration with Interventional Radiology to develop a technique for the intra-arterial delivery of Cisplatin to treat osteosarcoma: this became the standard of care at MD Anderson and at least one other institution. Dr. Benjamin explains the goals of the treatment of osteosarcoma treatments based on the fact that patients die of lung metastasis.

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  Chapter 19: Anthracyclines and Liver Function

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin describes studies he did to show that anthracyclines could be successfully used to treat cancer patients with compromised liver function.

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  Chapter 20: The Controversy over Randomized Trials

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin begins this chapter by commenting on how today's research approval processes would hinder studies of anthracylines in patients with abnormal liver function. He states the research philosophy at MD Anderson: treat everyone, regardless of how sick they are and determine why they are ill. Dr. Benjamin then talks about the belief held in the Department of Developmental Therapeutics that randomized trials were unethical.

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  Chapter 21: Drug Treatments and Multi-disciplinary Treatments for Sarcoma; A View on the Moon Shots Program

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about his research focus on sarcoma treatments, neoadjuvant therapy, and the treatment of metastatic disease.
  
  Next, he talks about collaborations resulting in multi-disciplinary treatments. He notes that as the Division of Medicine was divided into disease groups, it was easier to build collaborations. Dr. Benjamin describes results achieved by treating bone tumors with intra-arterial Cisplatin. He describes the "one of the most amazing results" that saved a patient from having a hemi-pelvectomy. With such successes, Dr. Benjamin says, it was easy to convince surgeons of the benefits of collaboration. He also notes that multi-disciplinary treatments were aided by advances in imaging. Finally, Dr. Benjamin offers some comments on the Moon Shots Program.

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  Chapter 22: Studies of Gastro-Intestinal Stromal Tumor

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about the area where the greatest advances have been made: gastro-intestinal stromal tumor (GIST). He explains that these advances built on the work of Jeffrey Gottlieb in the 1970s. He explains the successful treatments with Gleevec and notes that this is an example where the "low hanging fruit" idea associated with the Moon Shots paid off. Next Dr. Benjamin explains the value of developing good, non-toxic treatments that will inhibit the majority of pathways that become dominant in cancer. He advocates a poly-targeted approach, acknowledging that the clinician's view is that all drugs have toxicity and putting toxic drugs in combination is not as easy as it looks.

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  Chapter 23: Limb Salvage; an Informal Connection with an Italian Institute

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin gives an overview of his work with limb salvage treatments, based on the osteosarcoma model. This work was greatly facilitated by advances in prosthetics, he observes. He notes that in 1974, MD Anderson was just beginning to do limb salvage work in connection with radiation therapy. He then explains how limb salvage works with chemotherapy. He cites an important study of limb salvage conducted at the Instituto Ortopedico Rizzoli in Bologna, Italy. He explains that faculty from the Instituto learned chemotherapy from MD Anderson in the 1980. He explains some of the good results they achieved using MD Anderson techniques.
  
  Next, Dr. Benjamin talks about the national and international community of individuals who focus on sarcoma.

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  Chapter 24: Assessment of Response to Therapy

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin talks about his focus on assessing responses to therapy. He explains why this is a complex process, giving examples of confusing results that a clinician might confront. For example, GIST tumors only reduce slightly in size with treatment, but change structure. He describes a study in which patients responded well to Imatinib, but there was no way to document their improvement with the current guidelines. Dr. Benjamin says he collaborated with Dr. Choi in studying GIST tumors, work leading to the creation of the Choi Criteria for assessing therapy. These criteria, he says, have had some impact, then talks about the challenges of getting the model out and accepted. Dr. Benjamin explains what is needed for the model to be improved and expanded.

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  Chapter 25: The Section of Melanoma/Sarcoma: A History of Reorganization at MD Anderson

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin explains the administrative structure in which the Section of Melanoma/Sarcoma was situated. He talks about political issues at work in the merging of Developmental Therapeutics and Internal Medicine in the early eighties. He explains why he was a good choice to head the section of Melanoma/Sarcoma. He says that as section chief he tried to build an adequate group of people to do clinical research and care for patients. He observes that the section was always behind in staffing, as sarcoma is not considered a high priority at the institution, despite the fact that the section/department is the most productive in the country. He explains the section initially conducted many clinical trials and succeeded very well, also providing leadership to national organizations. Dr. Benjamin notes that he is one of the founding members of the Connective Tissue Oncology Society. Looking back at his administrative roles, Dr. Benjamin acknowledges that this area of service was not his top priority and he was ultimately a better clinician than administrator. Dates of Administrative Service: Section Chief, Melanoma-Sarcoma, Departments of Internal Medicine and Developmental Therapeutics 9/1981-8/1983 Section Chief, Melanoma-Sarcoma, Department of Internal Medicine 9/1983-8/1985 Section Chief, Melanoma-Sarcoma, Department of Medical Oncology 9/1985-8/1991 Section Chief, Sarcoma, Department of Medical Oncology 1/1991-1/1992

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  Chapter 26: From Section to Departments: Reorganizing Melanoma and Sarcoma

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin sketches the reorganizations that led to the division of Melanoma and Sarcoma into different departments. He explains why, for political reasons, Dr. Irwin Krakoff asked him to serve as Chair of the Department of Melanoma/Sarcoma. Next he explains that the combined department was split in 2000 and a new person recruited to head Melanoma, while Dr. Benjamin continued as Chair of Sarcoma. He explains that the only rationale for the two specialties being together was they could not be associated with a disease site. Dr. Benjamin then talks about his role as chair, stressing again that because of his personality and commitment to patients, he did not allow his administrative role to decrease his clinical work.

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  Chapter 27: The Melanoma/Sarcoma Center: An Early Multi-Disciplinary Center

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about the evolution of the Melanoma/Sarcoma Center, first established in the mid-nineties as one of the first multi-disciplinary centers at MD Anderson, predating the official institutional commitment to reorganizing care as multi-disciplinary. Dr. Benjamin explains that the cordial and collaborative relationships with surgical and orthopedic oncologists were well established and fit easily into the new model. Dr. Benjamin notes that he is very proud of the Center, which he headed from 1996 to 2006 and which he believes serves as a model of patient care. He talks about the approach that makes the Center so successful. He cites in particular MD Anderson's long-standing tradition of multi-modality treatment. He says that surgeons at other centers can be "very forceful" whereas at MD Anderson surgeons accept help easily from medical oncologists. He explains that this collaborative relationship emerged from trials he and others in Sarcoma conducted to demonstrate the value of chemotherapy. However he also notes that the tradition goes back farther, to earlier studies of amputation and then radiation as sarcoma treatments. . He tells some of the history of multi-modality treatments.
  
  Next, Dr. Benjamin notes that Winona Nelson has specific details on how the Center evolved. Dr. Benjamin explains that his role was to identify surgical, medical, and radiation people interested in collaborating. He says that the Center was originally located in Station 55 on the fifth floor of what is now called "the Main Building." Dr. Benjamin then talks about why the Center is a model of patient care. He explains that from the beginning, the Center worked from the model that a patient was "our patient," not a specific physician's, and passed easily between members of a team. He explains how teams work and that surgery can be the "last stop" in the multi-disciplinary process. He notes that medical oncologists spend the most time with patients. Dr. Benjamin then notes that it is difficult to speculate about the future of the Center as treatments will be much different in fifty years. He says he expects there will always be some kind of surgery, but that radiation treatments and cyto-toxic chemotherapy will be replaced with targeted medical treatments.

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  Chapter 28: The Clinical Research Committee

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Benjamin talks about a major contribution he made to the institution by setting up a Clinical Research Committee to administer detailed protocol review. He explains why this was necessary at the time, as there lay people on the institutional review boards were not able to fully review clinical trials. Dr. Benjamin notes that current CRC is the one he established. He sketches some changes in the roles and connections between the IRB and CRC.

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  Chapter 29: Changes at MD Anderson Under New President, Ronald DePinho

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin begins this chapter on change by noting that Dr. John Mendelsohn served as president. He explains that Dr. Mendelsohn brought an emphasis on scientific accomplishments of the faculty, in addition to clinical work and patient care.
  
  Next, Dr. Benjamin offers "the perspective of a clinician" on changes that have occurred since Dr. Ronald DePinho took over as the fourth president of the institution. He explains the revenue-generating burdens that have been shifted to physicians to pay for research and a growing administrative structure. He then talks about the deterioration of morale among clinical faculty, who feel they must meet quotas rather than focus on delivering optimal care for patients. Dr. Benjamin next talks about the institution's budget process to explain the broader arena in which the rift between the faculty and administration came from. Dr. Benjamin then gives his view of what the current situation means for MD Anderson's future. He explains that he has "always felt that MD Anderson would succeed despite its leadership," but this depends on a committed faculty. Dr. Benjamin says that he feels his time would be better spent teaching young faculty and gives examples of the training he would provide.

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  Chapter 30: Major Contributions and On Being "King Pin"

  Robert S. Benjamin PhD and Tacey A. Rosolowski PhD

  Dr. Benjamin lists his most important contributions to patient care. He then talks about his collection of pins, many of which he wears on his lab coat and which earned him the nickname, "King Pin." Dr. Benjamin then talks about his plans to retire to part time so he can select the projects he wishes to work on. He will teach and write up current projects. He notes that he likes what he does and wants to keep doing it.

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  Chapter 01: Medical Training and Education – Dual Certifications in Medical Oncology and Infectious Diseases

  Gerald P. Bodey MD and Lesley W. Brunet

  Dr. Bodey begins his interview by discussing his career path and education. Initially trained as a medical oncologist, he later transitioned to infectious diseases, earning certifications in both specialties. He completed his medical education at Johns Hopkins. After medical school, he joined the National Cancer Institute (NCI) to fulfill military obligations. Dr. Bodey found his work at the NCI with Dr. Emil J. Freireich particularly influential, especially in the areas of infectious diseases and cancer treatment.

  Following his time at the NCI, he relocated to Houston to work in the newly created Department of Developmental Therapeutics at the University of Texas MD Anderson Cancer Center. Despite initial concerns about the weather, he remained at the institution for over thirty-seven years.

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  Chapter 02: Career at MD Anderson – From Developmental Therapeutics to Medical Specialties

  Gerald P. Bodey MD and Lesley W. Brunet

  This chapter focuses on the various positions Dr. Bodey held at the institution throughout the 1970s and 1980s. Dr. Bodey began his career working with Dr. Freireich to establish a service for adult acute leukemia. The clinic’s expansion necessitated increasing the hospital’s bed count, culminating in the move to the Lutheran Pavilion in 1977. While in Developmental Therapeutics, he took over Investigational Chemotherapy, focusing on combination chemotherapy. Dr. Bodey was also the first director of Protocol Research. Before his retirement in 1995, he served as the head of the Department of Medical Specialties, focusing on infectious diseases.

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  Chapter 03: Research into Leukemia: Life Islands and Laminar Air Flow Units

  Gerald P. Bodey MD and Lesley W. Brunet

  In this chapter, Dr. Bodey speaks at length about the challenges and innovations he helped pioneer at NCI and MD Anderson. He mentions his research on infections related to neutrophil counts, which is now a standard for antibiotic studies, and a study on fungal infections in acute leukemia patients.

  Two major projects he worked on include the “Life Island” and laminar airflow units. The Life Island was a protected environment for immunocompromised patients, using a plastic tent with HEPA-filtered air. The laminar airflow units were high-efficiency particulate air filters designed to minimize infection risks. Each of these innovations faced several challenges, including building infrastructure issues and psychological challenges for isolated patients.

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  Chapter 04: Formative Experiences Random Controlled Trials at the NCI

  Gerald P. Bodey MD and Lesley W. Brunet

  Dr. Bodey discusses issues with randomized controlled trials involving infectious diseases and cancer patients. The NCI stopped funding these projects due to limited resources and questions about their usefulness. He mentions that randomized controlled trials are challenging due to the need for available units and the lack of significant improvement in solid tumor patients.

  He also talks about his multiple administrative roles at the institution and the complexities of managing overlapping responsibilities within a medical institution.