Interview Chapters

Follow

• 

  Chapter 03: Specializing in Radiation Oncology

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  Dr. Buchholz begins this chapter by talking about the scholarship he received through the Air Force to support his medical studies [Tufts University School of Medicine, Boston, Massachusetts; MD received in 1988]. He discusses the dimensions of radiation oncology that convinced him to specialize in that field and talks about the research project on lung cancer he participated in during medical school. He notes that today it is very competitive to find fellowships in the field and talks about finding his opportunities at the University of Washington. He explains why he preferred a clinical focus to research in a laboratory.He then alludes to his first teaching position as an Adjunct Associate Professor in Radiology (non-tenure) at the University of Texas Health Science Center at San Antonio, San Antonio, TX, [1/1994-6/1997]. He notes that the Radiology Department in San Antonio started the first stereotactic radiology program in the Department of Defense.

• 

  Chapter 04: Coming to MD Anderson

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  Dr. Buchholz begins by observing that he came to MD Anderson [in 1997] as a seasoned clinician, then explains that he was hired at the institution because he approached Dr. Kian Ang at a conference to ask for advice. He mentioned several people who were important in his early years at the institution, including James Cox, MD [oral history interview], who was instrumental in connecting him with the group involved in breast cancer research.

• 

  Chapter 05: Creating Research Collaborations Focusing on Breast Cancer

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz explains how he found his research niche with the breast cancer group because the radiation oncology dimension of breast cancer treatment at MD Anderson and in the field had not yet been established. He began to use his skills to establish research collaborations that resulted in over one hundred publications that influenced treatment and the field of radiation oncology. Dr. Buchholz describes several of his research collaborations and the projects he worked on.

• 

  Chapter 06: Chair of Radiation Oncology and Views on Leadership

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  Dr. Buchholz begins this chapter by noting that it took only ten years for him to become Chair of the Department of Radiology. He explains that he earned the role by being a well-liked and respected leader. Next he discusses how he based his strategy for developing the department on the what he had already accomplished for the residency program.
  
  
  
  Next, Dr. Buchholz talks about his views of leadership. CLIP He shares an anecdote about how he interacted with colleagues from Harvard and Yale to defuse competition and form meaningful relationships.

• 

  Chapter 07: The Radiation Oncology Fellowship Program

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz discusses his strategies and philosophy as he assumed directorship of the department's fellowship program (1998 - 2001). He explains that he and the Division head, James Cox, MD [oral history interview] were in agreement about the importance of education for the department and Division of Radiology as a whole. He notes that he wanted to establish a new culture for education.His first task was to involve the department in writing a mission statement, a step that was met with skepticism based the medical community's distrust of ""leadership sciences."" He describes this process as an ""elucidating moment"" where he saw how a group could be transformed. He explains that the mission statement raised productive questions about the program.
  
  
  
  Next, Dr. Buchholz talks about the process of changing culture in the department.

• 

  Chapter 08: A Changed Perspective as a Chair of the Department of Radiation Oncology

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz discusses the ways that his perspective changed when he was promoted to department chair (2007 - 2014). He talks about how he saw the institutional politics at work for the first time and notes how his social relationships changed with his new status and the importance of not creating perceptions of favoritism.
  
  
  
  Next, Dr. Buchholz tells a story to document how he learned that sometimes ""elegant solutions wouldn't work"" when solving department problems because ""people can reject self-evident truths."" He also talks about the consequences of trying to force people to change and how leaders must do a cost/benefit analysis before embarking on that path. He describes why change can be hard and how important it is for leaders not to be rigid. He also concludes that the art of human relationships is particularly important when dealing with senior faculty.

• 

  Chapter 09: A Decision-making Process Includes Lessons about Leadership

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz continues his discussion (in Chapter 08:

• 

  Chapter 10: Looking Back on Years as Department Chair

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz takes a retrospective look at what he accomplished as chair of Radiation Oncology and summarizes some of what he learned as a leader. He notes that he saw a lot of change in the department. He hired 35 new faculty members and comment on how important it is for a chair to recognize that faculty entrust their professional careers to the chair's leadership. He also notes that this role offered him an opportunity to set expectations about professionalism, workplace behavior and fairness. He explains how he would talk to a new hire about expectations to reinforce the culture of civility. Finally, he explains what he means by saying that being a chair was "fun."

• 

  Chapter 11: On Changes Under Ronald DePinho, MD

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz lays out the context in which the new president, Dr. Ronald DePinho [oral history interview] asked him to take on the role of Provost and Executive Vice President ad interim (2012-2013). He explains why the previous Provost, Raymond Dubois, left the institution. He gives first impressions of Dr. DePinho's gifts and leadership style. He also comment on the issues of equity began to surface, changing faculty perceptions of Dr. DePinho and leading to several years of turbulence at MD Anderson.He then explains how he was offered the Provost and EVP position. He describes why it was challenging. He also provides perspective on why the Executive Committee was dysfunctional and the effect that active circulation of rumors had on the institution. He also comments on how MD Anderson culture changed under Ronald DePinho. He explains that Dr. DePinho took MD Anderson "from incrementalism to boldness" with his view of the Moon Shots and his process for making that shift led to the perception that clinicians are less valued than researchers.

• 

  Chapter 12: An Offer to Serve as Provost and Executive Vice President

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz explains how he was offered the Provost and EVP position. He describes why it was challenging. He also provides perspective on why the Executive Committee was dysfunctional and the effect that active circulation of rumors had on the institution. He also comments on how MD Anderson culture changed under Ronald DePinho. He explains that Dr. DePinho took MD Anderson "from incrementalism to boldness" with his view of the Moon Shots and his process for making that shift led to the perception that clinicians are less valued than researchers.

• 

  Chapter 13: From Provost to Physician in Chief

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  Dr. Buchholz begins this chapter by observing that the role of provost gave him an entirely new perspective on the institution. He talks about role of the provost and why he considered staying in the position long-term, though the Division wanted to see him return as leader. He talks about the selection of Ethan Dmitrovsky, MD for the Provost's role, then being offered to position of Physician in Chief, a better fit for his background, in his view. Dr. Buchholz then talks about stepping into the Physician in Chief role, which he had considered not taking (2014 � 2017). He notes that he ""jumped back in to the firestorm"" of controversy surrounding Dr. DePinho and the Executive Committee. He also notes that he ""underappreciated the job,"" noting that the Physician in Chief has responsibility for 80% of a 4 billion dollar budget. Taking the role, however, Dr. Buchholz said he felt empowered to make changes in the clinical environment and he lists what problems needed to be addressed. He concludes that he is very proud of what was accomplished and notes that MD Anderson offered a ""most unique place"" to effect management over a system of clinical care.

• 

  Chapter 14: A Physician in Chief's View on Strategic Planning: Successes and ""Stumbles""

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz offers his views on the institution's strategic planning process he participated in once he assumed the role of Physician in Chief [in 2014] and joined the Executive Committee. One priority, he explains, was to shift MD Anderson into a more patient-centered perspective in recognition that several dimensions of patient experience directly affect treatment outcomes. In response to a question posed from a ""cynical perspective,"" that treating patients like customers is really about making money, Dr. Buchholz talks about how gratified he feels helping patients. He notes that the institution has made headway in addressing the aspects of patient experience the Executive Committee identified as priorities.For contrast, Dr. Buchholz discusses the lessons learned from a transition that did not go as smoothly as planned: centralizing the process of securing healthcare authorization for treatments.

• 

  Chapter 15: Shifting to Epic: Taking Stock of a Major Change

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz gives his view of MD Anderson's shift to the Epic electronic health records system, calling it "the most significant transformative moment in the institution's seventy-five year history." He first outlines how costly Epic was to implement and lists the administrative and financial advantages of the system, noting that "it taught us as an institution to work on multi-disciplinary project management."
  
  Next, he talks about resistance to Epic from physicians, explaining that electronic health records have an impact on physician identity. Acknowledging what is lost in shifting away from "poetic," physician-crafted medical notes, Dr. Buchholz explains that templated notes allow the institution to collect of structured clinical data.
  
  
  
  Next, Dr. Buchholz discusses the impact of Epic on the institution's financial crisis of 2015-2016. He explains some of the systemic issues that compounded problems with the EHR system and offers his perceptions of how money is dispersed.

• 

  Chapter 16: MD Anderson in Transition after Ronald DePinho's Resignation: Context

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz begins to address the transition MD Anderson has been experiencing around Ronald DePinho's resignation only five and a half years after becoming the institution's fourth president. He first addresses the low faculty morale under Dr. DePinho and offers a critical perspective of how the situation was addressed, based on a White Paper prepared by the executive committee of the Faculty Senate at the request of Chancellor McCraven and published in July 2015.
  
  Next, Dr. Buchholz characterizes Dr. DePinho as a boss and talks about the lack of cohesion within the executive leadership team.

• 

  Chapter 17: MD Anderson in Turmoil Under Ronald DePinho: A Critical View of the UT System Response

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz offers a critical perspective on the measures that leadership at UT System took to address the turbulence at MD Anderson under Dr. Ronald DePinho. Specifically, he cites the fact that no one from UT System personally came to MD Anderson to speak with those on the executive leadership committee about the situation or to conduct their own assessment of Dr. DePinho. Dr. Buchholz talks about the UT System solution of appointing Dr. Stephen Hahn [02/03/2017] to be deputy president and chief operating officer. He feels this was done in recognition of the strength of Dr. DePinho's ""outward facing skills,"" but lesser strength as an institution administrator. In support of his view that UT System didn't not communicate adequately with MD Anderson's executive leadership, he explains that the committee was not informed of Dr. DePinho's resignation [8 March 2017] and given no opportunity to discuss preparations for that event or the transition period. Dr. Buchholz talks about a phone call in which Stephen Greenberg tested his interest in serving as interim president.

• 

  Chapter 18: MD Anderson in Transition after Ronald DePinho

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz talks about the administrative confusion that took hold after Dr. DePinho's resignation when the institution was dealing with a complete administrative restructuring, not merely a process of replacing the president. He talks about why Dr. Marshall Hicks was selected as interim president and how the eventual selection of Peter Pisters, MD to head the institution made sense. He comments on his own experience of being asked to leave his position as physician in chief and return his department without any administrative responsibilities.

• 

  Chapter 19: A New Opportunity in California

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this final chapter of the interview, Dr. Buchholz explains his decision to retire from MD Anderson (effective 02/28/2018) to assume the role of Medical Director at the Scripps MD Anderson Cancer Center in San Diego (effective 04/16/2018). He talks with great feeling about his time at MD Anderson and describes the sendoff he is getting from colleagues as "awesome."

• 

  Chapter 01: Taking Opportunities and Integrating Talents Drawn From Many People

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke sketches his family background and early influences that left him open to taking new opportunities. He explains that he knew he wanted to be a physician when he was five years old. He notes that he still has a photo that appeared in the newspaper in which a little neighbor girl has brought him a “sick” doll and he is listening to the doll’s heart.

  Dr. Burke explains his interest in the sciences, particularly the “interactive” parts of science: anatomy, dissection and comparative biology. He mentions his mother’s love of animals as an influence and notes that his mentors in surgery were enormously important.

• 

  Chapter 02: Developing A Surgical Perspective and Style, Passing it on Through Mentoring

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke begins by describing the unique qualities of the operating room environment where, he notes, a surgeon’s interactive style may be more important than his technical skills He explains his philosophy of “de-stressing” the surgery environment to in order that a patient is not put at risk.

  Dr. Burke talks about his surgery training. He observes that the environment that a surgeon created in the operating rooms influences how they were able to attract people to their specialties, a fact he has integrated into his own surgical practice and environment.

  Dr. Burke tells a story of acquiring a cadaver during his clinical fellowship to redo anatomy from the perspective of surgeons. Dr. Burke explains what he learned from this and how the experience has helped him in his work at MD Anderson.

• 

  Chapter 03: College at a Tumultuous Time and the Benefits of an Army-Subsidized Medical Education

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke talks about his experiences at Tulane University in the 1970s (BS Biology, 1974; MD ’78). He explains his concern about the draft (and his plans to avoid being drafted) and his decision to join the ROTC (1975) so the Army would pay for his medical education.

• 

  Chapter 04:On the Importance of Relationships in Medicine and Medical Care

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke explains why he specialized in Gynecologic Surgery, which he saw as bringing together his love of surgery with birth, a happy time where a physician develops and sustains a relationship with a patient over time. He goes on to explain how an oncologist and a patient are partners in risk, care and outcome, and how this is for him a very rewarding personal experience. He talks about his ability to deal with life and death situations without being weighed down by them. Since MD Anderson people can do this, they do not abandon people who will not survive their treatment

  Dr. Burke next talks about the challenge of attracting cancer nurses to oncology specialties and recalls a program he established (early in his administrative career) to bring nursing students to MD Anderson. He notes that this program was successful in introducing students to careers in oncology nursing

• 

  Chapter 05: Coming to MD Anderson to For Surgical Innovation

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke explains how he came to join MD Anderson. He first explains that a surgeon’s style develops as an amalgamation of those who have trained him/her, but the question is, how does a great surgeon move beyond this training? Next, he explains how he came to MD Anderson from Fort Leavenworth (and sketches his positions prior to that). He explains that he had done all the routine procedures, but he wanted to become more innovative and be in a place where he could “attempt what was not possible.” Dr. Burke recalls that he was the first person in Gynecologic Oncology who had not been trained at MD Anderson. He describes the atmosphere and his recruitment process.

• 

  Chapter 06: The Late Eighties: Clinical Services in Gynecologic Oncology and Reproductive Medicine and Serving as “The Last Resort Guy”

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke describes the clinical situation when he arrived: patients came to the place, rather than to a particular surgeon, and so assigning cases was an issue.

  He describes how a clinician develops a practice at MD Anderson and explains that he decided to take cases that no one else wanted, offering “a unique service to patients, families, and to the referring MDs.”

  Dr. Burke talks about how experiences in the military prepared him for this kind of situation. He also notes that critical situations in the military were great preparation for critical care in oncology. He gives an example of creative problem solving from an ob/gyn service in Kansas. He uses the example of two- and three-team surgeries to illustrate how MD Anderson provides innovative care to patients.

  Dr. Burke notes that multi-team surgery was very limited when he arrived but increased quickly, with patient recovery improved as a result.

• 

  Chapter 07: An Overview of the Gynecologic Oncology Clinic: Offering Multi-Disciplinary Care Before It Was an MD Anderson Norm

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke explains how he came to his first administrative position as Medical Director of the Gynecologic Oncology Clinic, or Station 82, when the institution was transitioning its organization from one focused on specialization to multi-disciplinary clinics based on disease site. He notes that Gynecologic Oncology always operated that way, beginning with the founders of gynecologic practice at MD Anderson and their early recruitments.

  He talks about the rudimentary situation of the clinics in the early nineties, the early record keeping practices (see example from a PowerPoint presentation, available from the Archivist, Research Medical Library). He developed on the history of the Clinic, which includes information about these practices).

• 

  Chapter 08: Developing Multi-Disciplinary Care Within the Department and in the Institution

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke talks about his work in the early nineties on a planning group to develop multi-disciplinary care and more patient-centered care throughout the institution. (They had patients wear pedometers to see how far they had to walk for appointments.) He notes the speed at which the transition was made and the shock it could create.

  Dr. Burke explains how the move to multi-disciplinary among faculty also created a situation in which all support services were also disease linked with resulting in increases in their specialization and expertise. He notes that this has been a “recipe for MD Anderson success.”

  Dr. Burke notes that Gynecologic Oncology operated in a multi-disciplinary fashion from the start. He notes that MD Anderson was the first cancer center to restructure care around disease sites.

• 

  Chapter 09: Bringing Experience with Surgery and National Trials to MD Anderson; Research on Endometrial Cancer

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke sketches the evolution of his research career and the specific perspective that made him attractive to MD Anderson. He explains that he started this career while he was a Fellow at the Walter Reed Hospital in the late seventies. He notes the strange situation in which the Army was at the forefront of research in ob/gyn cancers. He then notes that, when he came to MD Anderson, there were many unanswered questions and he brought the institution his experience with national trials and his strong surgical background, and broad network of connections. He briefly explains his leadership philosophy with regards to junior faculty and research: allow them to choose different disease area interests so they don’t get in each other’s way.

• 

  Chapter 10: Research on Gynecologic Cancers; the Impact of Research on How a SPORE is Administered

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke sketches his study of endometrial cancer that involved a decade-long project of looking at techniques to reduce the radical surgery needed. His model has radically changed the management of the disease. Dr. Burke describes a uterine SPORE he worked on with Dr. George Stancel [oral history interview] and two junior faculty members, resulting in many new discoveries and new investigators attracted to the field.

  He also explains an important outgrowth of this project: inclusion of patient advocates on the research team.

• 

  Chapter 11: Maintaining MD Anderson Culture Despite Growth and Financial Challenges in Healthcare

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke begins this Chapter by describing how the culture of MD Anderson has changed since 1988 when faculty easily had face-to-face relationships. He notes that many institutional values have been formalized as the institution shifted to multi-disciplinary care models and translational research.

  He talks about the advantage of the MD Anderson system in which physicians are not compensated per procedure: this has been maintained a “clean way of providing care.”

  He next talks about the “financial clarity” that Dr. Leon Leach [Oral History Interview] brought to the institution under Dr. John Mendelsohn.

  He next talks about what makes MD Anderson unique: keeping the mission areas in balance has been part of institutional strategy.

• 

  Chapter 12: Medical Director of the Gynecologic Oncology Center: Developing Processes and Faculty Talent

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke begins by describing how he resolved inefficiencies in the Gynecologic Oncology Center when he took over. He describes a quality control program he set in place and sketches increases in the Clinic’s patient traffic and faculty numbers.

  Dr. Burke next comments on positions that can serve as training ground for mid-career physicians who will rise in the administration. He explains how his leadership skills grew and talks about his roles on the Credentials Committee and the Medical Staff Committee. Dr. Burke notes how important it is that a hospital’s leadership has this broad perspective: he looks for young faculty who will be open to these opportunities and to future leadership. Dr. Burke talks about how he looks for faculty with potential and gives them chances to develop themselves.

• 

  Chapter 13: Serving as MD Anderson’s Chief Medical Officer and Physician in Chief A: The Administrator;

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke first explains how he came to serve 50% of his time as Chief Medical Officer in 1998. He notes the scope of this role and how it affected his clinical practice. He next notes that when John Mendelsohn became president, he was asked to come full time into administration. He explains his decision to shift into administrative work.

  Next, he explains the scope of his responsibilities as Physician in Chief and stresses that clinical operations should be led by a physician. He talks about the complexity of MD Anderson search processes.

• 

  Chapter 14: As Physician in Chief: Addressing Needs in Pharmacy, Nursing, and Quality and Safety

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke explains the major clinical needs of MD Anderson in 2007.

  He talks about pharmaceutical needs. He next explains how he built his support team by seeking out people.

  He describes the Quality and Safety program focused on patient safety, explaining the related Clinical Safety and Effectiveness Program first developed for industry, duly adapted for MD Anderson and other health care institutions. He talks about the influence of this Quality and Safety program. P

  Dr. Burke explains how changes innovated by the Clinical Safety and Effectiveness Programmed were first received when introduced. He notes resistance and that the Program encouraged individuals to innovate their own improvements to process and gave prizes for the best solutions to process problems. He gives examples of innovations.

• 

  Chapter 15: Building a Highly Skilled Nursing Service

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke describes how he addressed the need for an increasingly skilled staff of oncology nurses.

  He talks about partnering with Dr. Barbara Summers [Oral History Interview], Head of Nursing, to create a program to attract young nurses to the field. He explains that oncology nursing is not a “happy area” and has had difficulty attracting students. They also created programs to help nurses develop their skills and expertise with additional training and degree programs.

  Dr. Burke gives an overview of changes in nursing that broadened the scope of nursing to management, administration, and advanced practice nursing. He notes that Advanced Practice Nurses have expertise and serve as preceptors to their teams and those under them, increasing the quality of care.

• 

  Chapter 16: As Physician in Chief: Building the Survivorship Program and Pharmacy Support

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke first explains that he hired Alma Rodriquez to head the Survivorship Program and gave her a mandate to build that program. One of the first projects undertaken was information gathering to discover what issues and needs patients had as they entered survivorship and long-term survivorship. Dr. Burke describes the feedback from patients and how the Program went about addressing those needs. He notes that today the Survivorship Clinics see thousands of patients. He explains his hope that a freestanding survivorship clinic will be built someday (the institution was closed twice).

  Next, Dr. Burke explains the complexity of pharmacy needs at MD Anderson, how these have been addressed, and how his office is currently building a training program in cancer related pharmacy.

• 

  Chapter 17: Comprehensive Approaches to Faculty Burnout in a Complex, Growing Institution

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke talks about the reality and sources of faculty burnout and the support for those who experience it. He explains that faculty who are deeply connected to the institution’s mission create their own mechanisms to cope with stress and burnout and those who cannot, leave MD Anderson.

  Next, Dr. Burke talks about the mechanisms in place to help faculty with stress. He explains that mentoring can help young faculty find balance and a research niche, which will help with their career stress, and gives examples from his department. He mentions MD Anderson’s counseling services.

  Dr. Burke talks about his personal experience with burnout.

  Dr. Burke says that burnout is an ongoing issue that will not go away. He advocates that faculty work in teams and that these teams care for one another. He also mentions efforts in 2010 and after to rid the institution of dysfunctional behavior. The mentoring program and safety and quality programs arose from this effort.

• 

  Chapter 18: The Institute for Cancer Care and the Challenge of Value-Based Care

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke talks about the creation of the Institute for Cancer Care Excellence in 2008 and its role in defining value-based care. He sets this in the context of the current focus on the financial side of healthcare and the huge effort underway to map processes of care, attach cost to those processes, and determine ultimate value. He first gives context, explaining that MD Anderson wanted to be in the forefront of thinking about value-based care and he and others began to make connections with the “quality movement” (e.g. Brent James). One of the first aims was to publish papers on “value propositions in health care.” Dr. Burke gives some context, explaining that quality, safety and cost lead to a notion of value.

  Dr. Burke explains the viewpoint that MD Anderson took on quality --different from the prevailing viewpoint in the nation. The Institute served as the focal point to bring together all information about this ongoing conversation.

  Dr. Burke explains the challenges in assembling data that support the view of quality advocated by MD Anderson.

• 

  Chapter 19: Financial Realities in Healthcare: The Need for Investment in Healthy Behavior; Treatments Near the End of Life; the Affordable Care Act

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke talks about the fiscal realities that MD Anderson is confronting now and in the immediate future. He first observes that there has been no effort at the national level to make an investment in healthy behaviors, though he sees some change in that recently. He mentions where the resistance has been to such investment and observes that MD Anderson has advocated for these changes, but that no single institution can influence national priorities.

  Dr. Burke next talks about the difficult financial decisions tied up with establishing care protocols at the end of a patient’s life. He talks about studies in progress to determine which efforts near the end of life have value (in that they improve a patient’s survival). He then discusses the realities of the conversations that physicians must have with patients, the decisions that patients and families must make.

• 

  Chapter 20: Financial Realities in Healthcare: The Affordable Care Act

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke talks about the Affordable Care Act. Though creating access to care is a critical benefit, Dr. Burke explains via examples that the Act has created challenges because the payment system it relies on will not survive the Value-Based Care movement. He also gives examples of how the current system pays an institution for “doing things wrong.”

• 

  Chapter 21: The MD Anderson Network: Origins, Mission, and Lessons of MD Anderson Orlando

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke talks about becoming Vice President of the MD Anderson Cancer Network, established early in 2014.

  He gives background on how the Network began.

  Next, he explains why he was appointed to the position and his personal reasons for taking the position.

  Dr. Burke sketches why the MD Anderson Cancer Network offers “a huge delivery” on the institution’s mission.

  He comments on the dissolution of MD Anderson’s partnership with Orlando Health and the lessons.

• 

  Chapter 22: The MD Anderson Network: Building Partnerships Based on Shared Mission

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke explains that his current assignment as Vice President of the MD Anderson Network is to establish partnerships with institutions whose missions link with MD Anderson’s.

  He talks about Network goals of increasing MD Anderson trained physicians and researchers. He gives examples of an innovative program to accomplish this. Dr. Burke notes the importance of this program given that the nation is confronting a shortage of oncology professionals.

  Next he mentions the Network’s role in expanding access to MD Anderson’s clinical trials, lists the features of a good partner institution, and talks about how he is going about bringing MD Anderson’s outside connections under one umbrella. He notes that these partnerships represent revenue streams for MD Anderson.

• 

  Chapter 23: Building the MD Anderson Cancer Network

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  Dr. Burke begins this chapter on his strategies for building the MD Anderson Cancer Network with a discussion of the major challenges that this initiative must face.

  He talks about the importance of “profiling” the patient populations at each partner institution in order to select the right clinical trials for their involvement and gives an example.

  He discusses the financial projections for the Network’s operation (in the 60 – 80 million range) and how that revenue will be used.

  Dr. Burke explains his philosophy and goals. By bringing all partner institutions under a single umbrella, the Network can to touch as large a percentage of the United States population as possible.

• 

  Chapter 24: Significant Research Initiatives

  Thomas W. Burke MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Burke talks about the significant research he conducted prior to devoting most of his time to administration. He was involved in early projects defining the respective roles of radiation and chemotherapy. He talks about the challenges of large-scale clinical trials, particularly with rare cancers. He sketches his work defining the surgical staging for uterine cancer in the eighties and nineties and his work training individuals in robotic and laproscopic techniques.

  Dr. Burke next explains why vulvar cancers were “a great niche” for him to take on in the sixties and seventies and describes an additional study.

  At the end of this chapter –and the interview—Dr. Burke talks about how satisfied he has been to work at an institution that enabled him to reinvent himself. He is content to know that he has trained many people and put together many teams that have launched all kinds of services.

• 

  Chapter 01: A Family Tradition in Medicine; Attracted to the Medical Mentality

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar begins this chapter by explaining that his father, who was in banking, wanted all his children to become physicians (and they did enter medicine). He explains that the educational system in Pakistan was based on the British system, and he entered the science track in eighth grade. He recounts inspiring scenes from science classes. He also explains that his college and medical school experiences were unique, as he attended the 200 year old Nishtar Medical College, Multan, Pakistan [MB,BS, 1967], where he received a high quality education. Dr. Buzdar notes his own qualities of curiosity, his intellectual interest in medicine, and his interest in "looking for things for tomorrow."

• 

  Chapter 02: The Advantages of Moving to Texas and to MD Anderson

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar begins by talking about how he came to leave New England (where his wife, Barbara, was very happy) and come to Houston. He explains that there was an unexpected opening at MD Anderson, and called Dr. Schullenberger to follow up. Dr. Buzdar then sketches his evolving research focus within the Breast Cancer Section. He explains that, at the time, there was little that could be done for breast cancer patients as oncology was in its infancy. He talks about the dramatic results achieved when he and Dr. Gabriel Hortobagyi [oral history interview] developed the 3-drug combination of 5-flourouracil, Adriamycin and cyclophosphamide for use in patients with metastatic breast cancer, resulting in cancers shrinking in 75% of patients. The combination was then used for adjuvant therapy. Dr. Buzdar talks about controversy over using aggressive chemo therapy with severe side effects, noting that the study was blocked by other disciplines when it came up for review in the IRB.

• 

  Chapter 03: Undertaking Breast Cancer Research When the Field was Young

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buzdar sketches his evolving research focus within the Breast Cancer Section. He explains that, at the time, there was little that could be done for breast cancer patients as oncology was in its infancy. He talks about the dramatic results achieved when he and Dr. Gabriel Hortobagyi [oral history interview] developed the 3-drug combination of 5-flourouracil, Adriamycin and cyclophosphamide for use in patients with metastatic breast cancer, resulting in cancers shrinking in 75% of patients. The combination was then used for adjuvant therapy. Dr. Buzdar talks about controversy over using aggressive chemo therapy with severe side effects, noting that the study was blocked by other disciplines when it came up for review in the IRB.

• 

  Chapter 04: A Philosophy of Clinical Research (and Its Early Controversies)

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar first sets his philosophy of clinical research in the context of his early work on aggressive chemotherapies. He says that a principle investigator should always be honest with the patient. [The recorder is paused.] The "gold standard," he says, is full information. [The recorder is paused.] Dr. Buzdar notes that there was almost a "cult" attitude at the time that the best procedure was to push more drugs at higher doses, without evidence that this had an impact on outcomes. He notes that he was chair of the institutional review board at the time. He then notes that MD Anderson was the first institution to add taxanes to the FAC regimen, a combination that is still standard of care.

• 

  Chapter 05: IRBs and a Few Words about the Growth of Multi-disciplinary Care

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar begins this chapter with an explanation of why ethical review boards (the first IRBs) were established after the Second World War. MD Anderson was in the forefront of the movement, and established the first ethics committee in 1966. Dr. Buzdar served on the IRB for a decade. Dr. Buzdar then talks about the power of the IRB, which operates as an independent and final authority in determining whether a protocol can proceed. He gives an example of immunotherapy trials using CAR T cells [chimeric antigen receptor T cells], a treatment that has very serious side effects, leading in some cases to death. Dr. Buzdar describes the unique (in the nation) initiative that MD Anderson has undertaken to monitor and treat these patients for side effects. He notes the value of immunotherapy for patients who are resistant to every other known treatment. Dr. Buzdar also explains that the immunotherapy protocols represent efforts in multidisciplinary care and research. This, he says, is MD Anderson's unique system. He describes how multidisciplinary care works and how it gives rise to research. This has also necessitated a move away from the traditional axiom, "do no harm," he states.

• 

  Chapter 06: Research on Hormone-Dependent Breast Cancers

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buzdar talks about his work on the effectiveness of anti-estrogens in shrinking cancers. He led the research, he explains, on aromatase inhibitors that block estrogen production. After skepticism, this work led to new therapies that became standard of care. Dr. Buzdar talks about his collaboration with Dr. Gabriel Hortobagyi. He notes that accepting the challenge of collaboration is an important first step in doing multidisciplinary research.

• 

  Chapter 07: VP of Clinical Research

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buzdar talks about his role as Vice President of Clinical Research, an office that oversees five IRBs. He notes that in the mid-eighties, there was one IRB with a tiny office and one secretary; now he has three hundred people working under him. [The recorder is paused.] He explains that the office has a dual role, to oversee clinical research and ensure compliance with federal regulations, and to educate faculty and personnel about regulations. [The recorder is paused.] Dr. Buzdar stresses that patients come to MD Anderson because of the innovative research conducted and to have access to clinical trials, and research remains a primary part of the institution's mission. He then offers examples of his Office's role in preserving transparency in the process protocol approval process. He notes that investigators are impatient to get their protocols underway, and the Office is involved in educating them about the complex processes that have to unfold in order for this to happen prior to and after approval (which involves many legal documents).

• 

  Chapter 08: The Clinical Effectiveness Committee and the MD Anderson Algorithms of Care

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar chaired the Clinical Effectiveness Committee from 2007 to 2014, and in this chapter he talks about the committee's role in "spelling out patient care." [The recorder is paused.] The purpose of the Committee's activities was and is to develop the MD Anderson approach for disease management from start to finish, for every disease site, based on evidence. A primary downstream use of this information is to define the rationale behind care to insurance companies. Dr. Buzdar explains that the algorithms were developed by disease center experts, who present their findings to the committee. They are then approved as the institutional standard of care. Dr. Buzdar notes that Medicare has used the MD Anderson model as a national standard. There is also a series of publications based on the algorithms. He explains that the Committee is still in existence and continues to develop and refine the algorithms in real time. There are yearly reviews of all algorithms and there may be immediate reviews in response to a new study or treatment innovation.

• 

  Chapter 09: Early Research: Changing the Natural History of Breast Cancer

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buzdar talks about his first studies of combination chemotherapy that he conducted with Dr. Gabriel Hortobagyi and that successfully "changed the natural history of breast cancer." He discusses a first study of patients with recurring breast cancer in one or two places, noting that 25%-30% of the patients treated in the seventies are still alive today. He explains that the success of the treatment meant that the research team never conducted a randomized trial. He discusses the next study of combination chemotherapy given to patients with inflammatory carcinoma of the breast. He explains how skeptical individuals were of the success of the trail, both within and outside the institution. He talks about the controversy surrounding aggressive chemotherapeutic treatments.

• 

  Chapter 10: Research in Breast Medical Oncology: Pushing Against Medical Conservatism

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar begins this chapter by describing the overall culture of medical conservatism he and others faced as they conducted studies with chemotherapy. He talks about the innovations led by J Freireich and Emil Frei in the Department of Developmental Therapeutics, and that it took a while to convince others in the institution about the value of combination treatments and aggressive treatments.
  
  Next, Dr. Buzdar sketches a picture of how small Breast Medical Oncology was when it began, occupying only a hallway with pull-down desks to write on. Despite such small beginnings, he points out, MD Anderson research had great impact on the natural history of breast cancer; he cites the publication of a recent book on MD Anderson treatments for the disease. Dr. Buzdar also cites the influence of R. Lee Clark on this research, noting that he instituted the policy of keeping comprehensive data on patients (following a patient to the end of his/her life, if possible). He describes Dr. Clark as "down to earth" and tells a story about sleeping in Dr. Clark's office.

• 

  Chapter 11: Endocrine Treatments for Breast Cancer

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buzdar talks about research that developed in the aftermath of the discovery of Tamoxifen and hormone dependent cancers. He was the principle investigator on a national blinded study of the effectiveness of the aromatase inhibitor, anastrozole, which was eventually approved by the FDA and approved globally based on his work.
  
  Next, Dr. Buzdar talks about the origin of research into the link between hormones and cancer. He notes his collaboration with endocrinologist Dr. Najib Saaman. He explains the impact that advancing technology has had on the study of tissues.

• 

  Chapter 12: The Evolution of Tumor Registries at MD Anderson

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buzdar explains how tumor registries have evolved at the institution. Originally there were many registries associated with departments, but now there are two. Dr. Buzdar participated in a group to advocate for an institutional bank which was activated on 31 January 2017. He explains that all patients are now asked if they will donate tissue to the bank. He talks about the "clear environment" conditions maintained at the registry and why this is important. Another bank, in existence for two or three years, preserves samples of metastatic disease collected sequentially from a patient as the disease evolves. Dr. Buzdar sketches the controversy around creating these institutional banks. He also talks about the evolution of the methods for analyzing tissues and how they are subject to government regulations when used in research studies. He also stresses that the primary purpose of the banks is patient care: to preserve tissue for use in treating the patient who donated the sample. Dr. Buzdar gives some examples to illustrate how the tissue resources are used. He also talks about the size of tumors and the size of samples preserved.

• 

  Chapter 13: Additional Research Studies: HER2/neu Breast Cancer; Taxanes

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar begins this chapter by talking about MD Anderson's contributions in the 1990s to therapy for HER2/neu breast cancer. He describes a trial with women with intact breast cancer, half of whom were given the best standard chemotherapy before surgery and half who were given the new anti-HER2/neu therapy. He describes the dramatic result when surgeons discovered that the tumors had disappeared, even microscopic tumors, resulting in this drug's approval as standard of care. Dr. Buzdar notes that the MD Anderson breast group has been on the forefront of research. He gives the example of Dr. David Hohn, who conducted the first studies of taxames in humans. He describes the randomized trial that resulted in Taxol becoming standard of care. He notes that now the challenge is to determine which patients will respond to which treatments.

• 

  Chapter 14: Research Nurses at MD Anderson

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar begins this chapter by noting how important transparency is when asking a patient to participate in clinical trials. He then discusses a new, four-month training program for research nurses that was launched eight months previously (the first structured program for training research nurses). He explains the special features of training for research nurses and their role in educating patients about clinical trials. He sketches the history of research nurses at MD Anderson and notes that the new training program was created on the recommendation of a group of investigators.

• 

  Chapter 15: Electronic Medical Records at MD Anderson, Yesterday and Today

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  Dr. Buzdar begins this chapter by noting that, though MD Anderson was slow to update its electronic medical records system, it was an early adopter of the technology, developing a home-grown system, ClinicStation. He sketches come of the issues involved with the new system, Epic, that was adopted to integrate all patient records and provide some additional features. Dr. Buzdar gives the example of patient consent forms to participate in clinical trials: this is now fully electronic and to date fifty thousand patient consents for trials have been processed electronically. He also explains that key elements of all the protocols in which a patient is involved is accessible through Epic. Dr. Buzdar also explains that, at MD Anderson, each patient has always only had one medical record, not a separate set of records for ambulatory and inpatient care, as is the norm elsewhere.

• 

  Chapter 16: The New Committee on Drug Side Effects

  Aman U. Buzdar MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buzdar explains the function of the Committee on Drug Side Effect, created six months previously, as a response to the serious [rapid and life-threatening] side effects possible with immunotherapy such as CAR T-cell therapy. He explains the special procedures used to deliver care to these patients and the training that the teams receive to watch appropriately for signs of side effects. He also explains that he and others are working with Informational Technology and Epic to put a red banner on these patients' electronic medical records to alert all teams that they require special monitoring. Dr. Buzdar notes that all unexpected events are reported to his Office [Clinical Research]. The first immunotherapy side effect was "alarming" and he met with division heads to talk about how to manage and prevent these side effects. They responded quickly to set up a system to manage these patients. In the final minutes of the interview, Dr. Buzdar talks about retirement and the contributions he is pleased to have made to the institution.

• 

  Chapter 01: A Family Experience Rich in Influences

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Cohen talks about the rich array of influences his family life offered. He talks about his multicultural upbringing by an American father and Florentine mother. He recalls his summers spent in Italy, notes that he speaks fluent Italian, and observes that Italy feels like home to him. He begins to talk about the maternal line of his family and particularly his grandmother, Vanda Scaravelli, whom the family would visit each summer and who became one of his most important mentors. He recalls early influences that raised his awareness of the pleasures and health benefits of food: in the early 1980s, his parents did research for their first cookbook (he was their "number one taster") and that his uncle, Alberto, was a vegetarian and macrobiotic gardener. He recalls their garden in Italy and the "gourmet vegetarian" foods that would be prepared.

• 

  Chapter 02: A Path to the Emerging Field of Health Psychology

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Cohen talks about his educational path and the evolution of his interests. Because of his interest in marine biology, he attended Reed College (Portland, Oregon, BA conferred, 1987), but was uncomfortable with the institution's policy about early specialization. He explains how he gravitated toward courses in psychology, pharmacology, and physiology, eventually becoming a psychology major. He talks about the professors he worked with and animal experiments he helped conduct on drugs and behavior. He notes that his thesis on the role of alcohol in disrupting complex behavior was published in APA.

• 

  Chapter 03: Professional Goals Coalesce During a Post-Graduation Gap

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Cohen tells the story of his experiences during a two-year gap period after his graduation from Reed College. He begins with the influence of mentor, Arthur Patton, whom he had met at the age of fifteen and who encouraged him to take time off after graduation to spend time with his grandmother, Vanda Scaravelli, and take music and yoga lessons from her. Dr. Cohen describes the impact of this time, particularly on his sense of discipline, noting that his grandmother was his "main mentor." Dr. Cohen then talks about his uncle Alberto, who had a dream of going to India and inspired him to go to India for three months.

• 

  Chapter 04: Identifying a Purpose and a Graduate Focus in Health Psychology

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen begins this chapter with an anecdote about an experience he had while traveling in India that convinced him he needed to find a purpose. This motivated him to think about graduate study, and he again gravitated toward the field of health psychology, selecting a program in Medical Psychology at the Uniformed Services University of the Health Sciences, Bethesda, Maryland (MS conferred, 1993; PHD, 1994). Dr. Cohen stresses that his aim was to go into research. He describes research he conducted during his fellowship years [1/1994-11/1995 National Cancer Institute of Canada and The Toronto Hospital, Toronto, Canada, Paul Ritvo; 1/1995-12/1997 Postdoctoral Research Fellowship, National Cancer Institute of Canada, Division of Behavioral Medicine and Oncology, University of Pittsburgh, Pittsburgh, PA, Andrew Baum]. He goes into detail about his work with mentor, Andrew Baum and the value of medical school courses he took in Bethesda. He then narrates how he came to focus his research on cancer. He observes that the field of health psychology was just forming and framing research questions to explore how psychological processes have an impact on health. He recalls his excitement when reading an influential study published in 1990 that showed that HIV patients who took part in stress management had improved immune markers. He was also influenced by John Kabat-Zinn's work applying eastern based philosophy to medical problems. He talks briefly about his dissertation research on the effects of surgical stress on the immune system. He recalls that the research pathways available when he left graduate school were "HIV or cancer." He discusses why cancer was a good choice for him. He mentions meeting his wife, Alison Jeffries, in graduate school. He explains how he ended up working with Andrew Baum at the University of Pittsburgh, noting that he learned to collaborate with a surgeon and run a small clinical trial.

• 

  Chapter 05 A Graduate Focus in Health Psychology

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

• 

  Chapter 06: Early Research and the Art of Grantsmanship

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen begins this chapter by explaining that he transferred his fellowship work to the University of Pittsburgh because he was unable to do the research he wanted at Toronto Hospital: he was approved to transfer his grant money from NCI Canada to do this work. Dr. Cohen explains that his study originally focused on how group support post-surgery influenced outcomes for men with prostate cancer. This next turned into a study of pre-surgical stress management. He then talks about the art of writing grants to "market" research to a "reluctant buyer." He talks about how he adjusted to the medical center environment at the University of Pittsburg and discusses the importance of the support of surgeons for his work.

• 

  Chapter 07: Building Psycho-Oncology at MD Anderson; Setting Up Research

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen first tells the story of applying for a position at MD Anderson, noting that he wanted to leave the University of Pittsburg in order to become more of a leader in his field. He notes that no one was focusing on psycho-oncology at MD Anderson when he came in 1997; he explains why he was hired, noting that it was rare for a new faculty member to "walk in with an RO1." He then talks about the first studies he set up in collaboration with other faculty members. He also talks about learning to work with temperamental researchers and explains that the environment at MD Anderson was very drug focused with little focus on patient experience.

• 

  Chapter 08: Opening the Place of Wellness [The Evolution of Integrative Medicine, Part 1]

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Cohen talks about how the development of integrative medicine services at MD Anderson began with a survivorship conference in 1997, where patients became enthusiastic about yoga, massage and other complementary offerings and asked, Why don't we have this at MD Anderson? Dr. Cohen then describes how the Place of Wellness began as a very small, very patient-driven initiative with very little budget, but nonetheless the first integrative medicine center in a free standing cancer hospital. He notes studies indicating that the majority of cancer patients favored using complementary medicine to supplement standard of care treatments. Then around 2000, Dr. Cohen explains, the Physician in Chief and John Mendelsohn directed more support to formalize Integrative Medicine as an initiative to improve patient quality of life and conduct research. Dr. Cohen was approached to design the program and sketch a 5-year budget for a center and a department. The program was approved, and the Place of Wellness became a center incorporative research.

• 

  Chapter 09: A Vision for the Integrative Medicine Center; Building Support among Faculty [The Evolution of Integrative Medicine, Part 2]

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen begins by explaining that he had the vision of turning the Integrative Medicine Center into a Department, but this would take time. He talks about the administrative homes the IMC had over time. Next he talks about the process of promoting the new array of treatments and services and building support for prescribing these treatments in the medical consultation process. He notes that the Center originally offered more than 200 programs but eventually streamlined in order to offer what could impact cancer outcomes based on evidence. Dr. Cohen talks about the aggressive promotions he and others did to build awareness of the Center's offerings and tells several anecdotes to illustrate the process, including how physicians often need to directly experience benefits of complementary techniques in order to support them.

• 

  Chapter 10: Integrative Medicine at MD Anderson: Challenges and the Future

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen talks about the impact that executive leadership had on Integrative Medicine at the institution by insisting that the program "start small," but nonetheless has supported recruitments. Dr. Cohen talks about how John Mendelsohn has served as a mentor for him. He also talks about his shift in perspective, accepting that serving patients is more of a goal for him than transforming the Center into a department. He offers observations about the hierarchical organization at MD Anderson and how this influences getting things done. Next he talks about obstacles to building integrative medicine into the standard of care.

• 

  Chapter 11: Research Projects at MD Anderson, the First Focus on Integrative Methods

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen notes that the first phase of his research conducted when he arrived at MD Anderson in 1997, focused on "conventional psychodynamic studies" such as his study of management of presurgical stress in breast and prostate cancer patients. He notes that a turning point came when he met Alejandro Chaoul, a graduate student at Rice University who was volunteering at MD Anderson, and initiated a study of the effects of yoga on post-surgical lymphoma patients (published in Cancer). He explains the focus of the study, the results, and how it evolved.
  
  Next, Dr. Cohen talks about the life quality issues of primary concern to cancer patients, including fatigue, pain, peripheral neuropathy, and sleep disturbances.

• 

  Chapter 12: Consolidating the Focus on Mind/Body Research

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen explains how his focus on mind/body research intensified once he met Dr. Raghuram Nagaranthna from the VYASSA Institute. He talks about the mission of the institute and explains the organization of the pilot study they ran studying the impact of yoga on the quality of life of breast cancer patients undergoing radiation therapy. He talks about the publicity that this study attracted then tells an anecdote to illustrate how a radiologist became convinced of the value of yoga and became a supporter of the study. Next he talks about a study of the treatment of "chemo-brain" with Tibetan sound meditation. He then describes new work on the use of hypnosis in combination with local (as opposed to general) anesthesia for breast cancer procedures. He explains the risks of general anaesthesia.

• 

  Chapter 13: Research with Chinese Partners at Fudan University Shanghai Cancer Center

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Cohen talks about the turn his research took when he began to build a research partnership with Fudan University Shanghai Cancer Center [now a Global Academic Partners sister institution]. He first explains that he was interested in partnering with institutions that offered a combination of western and traditional treatments and details why Fudan was a good choice.
  
  Next, Dr. Cohen talks about three clinical trials set up at Fudan, looking at natural products, acupuncture and chi quong. He talks about the results of the studies and the impact on Fudan University.

• 

  Chapter 14: A New Holistic Focus on Quality of Life and Transformation

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Cohen talks about his shift in focus away from "reductionist research" to a whole-life view of health and transformation. He explains that perspective goes back to experiences he had as a child and young adult in Italy, when he learned the benefits of being mindful about everything in his life. Next he tells the story of a turning point in 2009, when John Mendelsohn was interested in bringing author David Servan-Schreiber to MD Anderson to talk about his book, Anti-Cancer Way of Life. [NOTE: health info discussed, but Servan Schrieber is on record about it.] He tells the story of how Dr. Servan-Schrieber was able to inspire philanthropists to contribute several millions for a pilot Comprehensive Life Study in Stage 2 and 3 breast cancer patients. Dr. Cohen talks about how the design of the study and its transformational effect on patients.

• 

  Chapter 15: A New Book on the How-To of Quality of Life

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Cohen explains his approach to a new book that is intended to be a practical follow up to Dr. Servan-Schrieber's more theoretical, Anti-Cancer Living, with Dr. Cohen's wife, Alison Jeffries serving as the "how to" voice. He explains the approach taken in the book and how he and Ms. Jeffries approached Penguin/Random House to secure a contract. He also talks about working with agent Doug Abrams. Dr. Cohen also explains the complexities of basing the book on the in-progess comprehensive life study at MD Anderson. He talks about anticipated criticisms from colleagues.

• 

  Chapter 16: The Future of Integrative Medicine

  Lorenzo Cohen PhD and Tacey A. Rosolowski PhD

  Dr. Cohen shares observations about where he is in his career and the support that MD Anderson is currently providing to Integrative Medicine now that John Mendelsohn is no longer president. He also observes that the timing might be right for a change, as growing evidence about the value of IM approaches may support insurance reimbursement. He talks about the health trends in China and India, both of which are now in the "Reagan Era Good Life" period, with threats to quality of life and health. He expresses his hope that colleagues at Fudan University will become involved in quality of life studies.

• 

  Chapter 01: The Path to Radiation Oncology

  James D. Cox MD and Lesley W. Brunet

  In this chapter, Dr. Cox talks about his educational background, his training in radiation oncology, and his interest in cancer. He also discusses his further training in several European hospitals and the development of the field that used to be called “radiotherapy.”

• 

  Chapter 02: Appreciation for Surgeons and Surgery in Collaboration with Radiology

  James D. Cox MD and Lesley W. Brunet

  Dr. Cox talks about the people who were major influences on him, his reflections on leading physicians at MD Anderson, and how surgeons often interacted with radiation oncologists.

• 

  Chapter 03: Military Experience

  James D. Cox MD and Lesley W. Brunet

  In this chapter, Dr. Cox talks about his military service during the Vietnam War, his work being stationed stateside at Walter Reed Army Medical Center, and his treatment of patients with cancer. “We saw very large numbers of young men with Hodgkin’s disease and testicular cancer,” he said, “and women who were dependents of active-duty army personnel, with cancer of the cervix, breast, and so on.”

• 

  Chapter 04: Responsibilities at MD Anderson, the Limits of Leadership Roles, and Working with Other Leaders at MD Anderson

  James D. Cox MD and Lesley W. Brunet

  Dr. Cox talks about his decision to come to MD Anderson, his position as Vice President for Patient Care and Physician-in-Chief, and why that “title was a great title and it was a bad job, for me.” He also discusses being glad to return to being a practicing radiation oncologist, is reflections on MD Anderson President Dr. Charles LeMaistre, and the main differences between being a physician and being an administrator.

• 

  Chapter 05: Inside Institutional Structures: Personalities and Remaking the Division System

  James D. Cox MD and Lesley W. Brunet

  In this chapter, Dr. Cox talks about various personalities at MD Anderson and difficulties regarding its organizational structure, specifically related to its departments and divisions. He also shares what he considers his biggest mistake: his efforts to restructure the institution.

• 

  Chapter 06: On Executive Leadership Styles within the Division System

  James D. Cox MD and Lesley W. Brunet

  Dr. Cox talks about the varied leadership styles of people in the MD Anderson division system. Many, he said, “were considered kind of wild and crazy and off in their own world, and although they were enormously creative … they were always a little suspect.”

• 

  Chapter 01: Early Memories and a Visual Mind

  James D. Cox MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Cox talks about childhood memories of West Virginia and Dayton, Ohio, where he recalls blackouts during WWII and his parent’s Victory Garden. He recalls his early inclination for the sciences and talks about the strongly visual field he ultimately selected as well as some of the visual qualities of his own thinking. In addition to appreciating Early Renaissance art and Gothic architecture, he admits that he loves women’s fashion, particularly enjoying features of design and proportion. His visual sensibilities focus on structure, he notes.

• 

  Chapter 02: Clinical Research in MD Anderson Culture; The Radiation Therapy Oncology Group; and Specific Clinical Trials

  James D. Cox MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Cox talks about his focus on clinical research. He begins by explaining why clinical research has been less appreciated at MD Anderson than laboratory or translational research. (As an instance of how clinical research can transform a field, he cites studies comparing the effectiveness radiation therapy vs. chemotherapy plus radiation.) Most clinical studies of radiation therapies were started by the Radiation Therapy Oncology Group (RTOG), and MD Anderson faculty was an important participant in these studies. Dr. Cox sketches the history of the RTOG, explaining its central role in organizing studies and gathering research statistics for twenty institutions. Dr. Cox explains that he viewed the RTOG as his laboratory, during his years of administrative service, and he served as senior investigator, though others were more hands-on participants.

  Dr. Cox reflects on his skills in research design, offering as an example these skills, ideas he summarized in “Design and Implementation of Ion Beam Therapy,” a chapter in the book, Ion Beam Therapy: Fundamental Technology, Clinical Applications (Springer, 2011). He explains what is meant by good research design and lists several factors that contribute to a successful clinical trial.

  Dr. Cox then compares laboratory to clinical studies and notes that, in general, laboratory researchers are more directive in trials, while clinical researchers tend to be more cooperative. He says that there is a give and take in clinical research that would not be comfortable for most senior laboratory investigators

• 

  Chapter 03: An Education Leading to Clinical Study

  James D. Cox MD and Tacey A. Rosolowski PhD

  Here Dr. Cox explains the path that led him to clinical work in radiology. Dr. Cox became interested in cancer during his second year in medical school, while taking pathology, and he describes his first autopsy of an individual who had died from stomach cancer. He was fascinated by the cellular destruction and compares it to being “fascinated with a fire.”

  Dr. Cox next talks about the curriculum he followed at the University of Rochester School of Medicine and Dentistry (Rochester, NY) and his year at the Penrose Cancer Hospital in Colorado Springs, where he saw how helpful radiation therapy could be in combination with surgery. This convinced him to return to U of R to train with Dr. Juan del Regato in radiation oncology. He talks about his shift to the residency program at Penrose, where he became involved in a B-04 trial on breast cancer run by Dr. Bernie Fisher.

• 

  Chapter 04: Challenges of Clinical Trials: Informed Consent

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox explains that, while in his residency at Penrose, he became interested in the issues involved when obtaining the collaboration of patients in a study. He then discusses informed consent at length, describing the issues involved and making reference to the Tuskegee syphilis case as a summary of the ethical issues at play. To demonstrate his ideas about informed consent, Dr. Cox describes a trial on cancer of the esophagus. While patients treated with radiation or surgery had some results, pairing chemotherapy with radiation therapy has such profound results that they “couldn’t ethically continue the trial.”

  Dr. Cox explains that the Data Safety Monitoring Committee makes recommendations to stop any trial that is not ethically sound. Dr. Cox talks about several cases in which trials were conducted without any informed consent, and talks about the ethical and philosophical issues involved. He notes that informed consent was not a prominent issue until the 1970s, though now Institutional Review Boards are “out of hand.”

• 

  Chapter 05: The Radiation Therapy Oncology Group

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox begins this segment with a brief history of the ROTG, founded in the late sixties, after several individuals running clinical trials created centers to gather statistics and manage trial operations. In the late sixties, the NCI gave instructions and funds to draws the disparate centers together. Dr. Cox became involved in 1978 or ’79 and soon became vice chair for research strategy. He lists the areas of research the ROTG followed: hypoxic desensitizers and hypothermia; chemotherapy; and fractionization. He explains that he evaluated the results of studies. He speaks about an MD Anderson study treating cancer of the cervix with a combination of radiation and chemo.

  Dr. Cox describes how technologies of radiation therapy have evolved and how this evolution has been influenced by the NCI’s interest. (Dr. Cox feels the NCI has a prejudice in favor of chemotherapy, thus making less money available for radiation and surgery, even today.)

• 

  Chapter 06: Radiation Oncology at MD Anderson

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox briefly describes how radiation is used to kill cancer cells and mentions a few of the first studies to investigate its effects.

  Dr. Cox then talks about the Dr. Gilbert Fletcher’s role in developing radiation therapy and its use at MD Anderson. He discusses the challenges Dr. Fletcher faced during this time when surgeons believed that the best treatment was to surgically remove cancer. Dr. Fletcher eventually convinced the MD Anderson community that radiation therapy could be successfully combined with surgery for positive patient outcomes. Dr. Cox talks about the attitudes of several surgeons: Dr. William MacComb, Dr. Richard Jesse, and Dr. J. Ballantyne.

  Dr. Cox describes Dr. Fletcher’s strong will, his unique form of genius, and his honesty even about toxicities of radiation levels. He notes that MD Anderson people “had great affection for him.”

• 

  Chapter 07: Leadership Experience

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox reviews the experiences that led to the many leadership roles he has held during his career. He begins by noting that when he entered the military under the Berry Plan, there was a shortage of career people in radiation oncology and, at the age of thirty two, he became Head of the Radiation Oncology Service at Walter Reed Hospital, though he had served in administrative roles in smaller arenas.

  Dr. Cox offers comments on the qualities of MD Anderson and why he has stayed at the institution so many years, noting that it offers “the best cancer care anybody can get.”

• 

  Chapter 08: Early Clinical Studies

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox begins the discussion of his research career with his residency. He explains that hypotheses in clinical research derive from the care of patients. Survival is the “immutable endpoint” that determines whether a treatment is successful, but survival does not tell you why a treatment is successful. Early in his career, Dr. Cox developed an approach to determine why treatments succeed, though he observes that many of the questions he asks about patterns of failure are irrelevant from other perspectives (e.g. medical oncology).

  Dr. Cox describes studies done in the 70s with lung cancer to determine why treatments failed. When he became involved in the Radiation Therapy Oncology Group (RTOG) his style of designing studies influenced the group. All of the ROTG studies during his ten years with the group used survival as the endpoint. Returning to his residency years, Dr. Cox talks about his studies of cancer of the breast and cervix. Dr. Cox notes that his view of clinical trials was strongly influenced by his mentor, Dr. Juan del Regato.

• 

  Chapter 09: Research Focused on a Range of Body Areas

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox summarizes the range of research he administered on fractionation while involved with the RTOG: lung cancer, head and neck cancers, cervix and brain. He also discusses the key importance of adding chemotherapy to patients’ treatment regimens to get the best results.

  Dr. Cox next explains that while he was Chair of the RTOG he was able to move combined treatments forward in the NCI and other organizations. He explains why the NCI is biased toward chemotherapy. He also comments on NCI politics is influencing how gynecologic cancers will be investigated.

  Dr. Cox next comments on other cancer studies he oversaw during the period when he was Vice President for Patient Care under Dr. Charles LeMaistre [Oral History Interview].

• 

  Chapter 10: Lung Cancer and Uncommon Lymphomas

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox describes the research he undertook when left the position of Vice President for Patient Care and returned to his full-time faculty position, beginning with his new role as “the lymphoma person.” He explains the lymphoma trials that combined radiation and chemotherapy and that resulted in a successful response as well as a genetic translocation that will give rise to a genetic marker. He notes studies of radiation and chemotherapy in uncommon lymphomas.

  Dr. Cox next explains how he was involved in teasing out the natural history of unusual lymphomas to understand them as distinct cancers. He uses testicular lymphoma as an example, describing how this cancer is treated with both radiation and chemotherapy. Patients with this cancer were rarely cured before this approach was developed: with this treatment, the cancer is eliminated in 50% of cases. Dr. Cox conducted this work between 1992 and 2000.

  Dr. Cox then explains that he always saw cancer as more than one disease: he explains what it means to understand this at the molecular and cytogenetic level, eventually resulting in diagnoses being rendered by biochemical, molecular or genetic findings. He notes that his work at MD Anderson was tightly linked to his work with the RTOG. He continues, explaining that he returned to work with lung cancer in the late nineties. He mentions that lung cancer still has the highest death rate among all cancers, though mortality from lymphoma is increasing and Dr. Cox explains this is largely attributed to environmental chemicals. He explains the “modest progress” that he and the lung group at MD Anderson have made combining drugs, radiation, and surgery. Dr. Cox explains his work using prophylactic cranial irradiation to decrease the risk of brain metastasis from small cell carcinoma and notes that studies were also done to determine if this irradiation increased the risk for neuropsychological complications.

• 

  Chapter 11: Documenting the Benefits of Proton Therapy

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox explains a difficulty with proton therapy: the advantages can be seen on paper and modeled by computer, but “we don’t yet have the evidence that people want.” He describes the kinds of treatment advantages that proton therapy provides, particularly the reduction of toxicity.

  Dr. Cox explains a study showing that proton therapy avoided toxicity in treatment of 15 patients with cancer of the tongue, then describes the next step of this research: to demonstrate the differences between two dimensional and three dimensional, conformational therapy. He explains that proton therapy offers these advantages because the beam can be targeted to hit very isolated structures.

• 

  Chapter 12: Multidisciplinary Conferences at MD Anderson Lead to More Effective Treatment Plans

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox notes that proton therapy treatment focuses heavily on lung cancer and lists other cancers being studied, explaining that the study of esophageal cancer puts all the modalities together. This leads Dr. Cox to talk about the Tumor Board and Thoracic Conference –weekly multi-disciplinary meetings where specialists from different disciplines discuss cases and treatment options for patients. He explains that surgical techniques have improved so much that surgery is now also being integrated into the treatment modalities. He then describes the history of the conferences, which go back to the earliest years of MD Anderson and have proliferated through the entire institution. Dr. Cox describes how these meetings educated everyone, e.g. by having specialists from a wide range of fields talk to a radiologist, a pathologist, or someone conducting research on molecular markers. (He acknowledges that attendees are self-selected).

  Dr. Cox affirms that the multi-disciplinary meetings have affected the culture of MD Anderson: Multi-disciplinary care is a hallmark of MD Anderson care. He explains that that the salary pool on which compensation is based at the institution insures that there is no economic incentive behind treatment decisions. “We function as a team” for all patients.

  Dr. Cox explains that not everyone embraces multi-disciplinarity and that, in the past, MD Anderson faculty who worked on the disease sites tended to talk only to one another. When he brought in the RTOG, the multi-disciplinary focus has a definite impact on the institution. Dr. Cox closes this section by noting some other multi-disciplinary organizations and by explaining that MD Anderson may not be helped by some of the NCI’s recent decisions on how to restructure cooperative groups.

• 

  Chapter 13: The Regional Care Centers and Sister Institutions

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox gives an overview of issues involved in setting up regional care centers and sister institutions. He begins by noting that Radiation Oncology backed away from involvement in MD Anderson-Banner because of concerns that MD Anderson would have no hand in quality control for patient care. He next talks about setting up the first regional care center in Bellaire (1998/99): the regional care centers were originally established to provide radiation therapy.

  Dr. Cox explains that for thirty years the treatment plans for all MD Anderson patients are created by way of a peer-review process that insures high quality care and results.

  Dr. Cox next lists some other satellite centers and describes the lessons learned about recruitment and competition from within the communities. He concludes that, in general, the quality of the care centers has stood the test of time and paved the way for medical oncology and laboratory services to be offered at the sites as well. He summarizes the convenience that the care centers offer to patients. Next he describes the financial and administrative relationships between the care centers and MD Anderson. Dr. Cox then comments on the sister institutions in Orlando, Florida and Madrid, Spain, noting the importance of quality control and oversight of faculty for the success of such initiatives.

• 

  Chapter 14: Head of the Department and Division of Radiation Oncology

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox explains his dual role as Head of the Department and Division of Radiation Oncology, first discussion his Departmental goals of expanding the faculty and creating a strong and highly specialized department. He also notes that the department was technologically out of date when he took over, and he explains the upgrades he introduced: a modern system for treatment planning, a CT simulator, and the transition from 2-D to 3-D treatments. The department next combined 3-D treatment planning with computer assisted treatment planning to refine patient protocols. Dr. Cox explains how the Department established a dosimetry school as the program grew. The Department next developed intensity modulated radiation therapy.

• 

  Chapter 15: The Division of Radiation Oncology

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox describes challenges that he faced in developing the Division of Radiation Oncology. a change in attitude toward buying new equipment greatly helped move the Division forward. He describes a communication gap that existed with Ken Hogstrum, Chair of the Department of Radiation Physics (who focused on education over patient care and research), a problem resolved when Dr. Cox removed him. Dr. Cox describes some of the changes that took place as Dr. Hogstrum and a number of his supporters left, emphasizing that the individuals recruited to replace them shared his goals of developing the technological base of the Division as well as the ‘research portfolio,’ which went from effectively no research to over a million dollars of research funding. Dr. Cox ends this segment with comments on his administrative approach.

• 

  Chapter 16: The Division of Radiation Oncology"”Strategic Planning and Growth

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox summarizes the growth of the division between ’97 and 2007, when he retired: from seventeen to fifty full-time faculty and from 240 to 600 patients seen per day. He notes that the Division made a lot of money for the institution and achieved a high level of credibility from good planning. He sketches the yearly strategic planning meetings the Division held each year, noting that the main goal of all planning was to ensure that the Division was the best in all areas. He explains that a second goal was to create a supportive environment for everyone, and believes that they were successful in achieving that. At the end of this segment, Dr. Cox offers reasons for the separation of Departments within the Division of Radiation Oncology.

• 

  Chapter 17: The Proton Therapy Center

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox notes that the use of intensity-modulated radiation therapy was a starting point for thinking about how advanced technology could be used to concentrate radiation beams on a tumor. The idea to construct a Proton Therapy Center began in 1998, when Dr. Cox spoke to John Mendelsohn about the possibility, and Dr. Mendelsohn then went to the UT System. Though the University of Texas System would not fund it, Leon Leach [Oral History Interview, Dan Fontaine and others were enthusiastic and looked for other funding sources. Dr. Cox explains what created the enthusiasm for proton therapy, given the absence of any studies to confirm its benefits or advantages over other types of therapy. Dr. Cox believes that his credibility in the institution spurred the administration to embrace the idea.

  Dr. Cox next sketches the partnership between public and private sources created to fund the initiative, with Hitachi as the vendor. He notes that his wife, Dr. Ritsuko Komaki, served as a mediator to help MD Anderson people deal with cross-cultural issues that arose during negotiations with Hitachi. He then explains what they requested in the design of the proton source and the challenges that arose as Hitachi dealt with their specifications, noting in particular how difficult it was to get three computer systems to work together.

• 

  Chapter 18: Research at the Proton Therapy Center; the Future

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox notes that the Proton Therapy Center project was started in May 2003. Since 2006, when the first patient was treated, 4400 patients have been seen, with virtually all patients involved in research studies. Dr. Cox explains that there is a master protocol for studying increasing dosages and the degree to which normal tissue is spared. Specific protocols have been created to compare proton therapy and intensity-modulated radiation therapy on non-small cell lung cancer and for cancer of the esophagus. Next Dr. Cos explains the reasons why individuals question the value of proton therapy. Some are anti-technology. Some admit that it looks valuable on paper, but question whether the effects are real; some say that, in principle, there is value, but there are too many technical uncertainties to warrant going ahead with it. Others accurately state that no randomized trials have been conducted to definitely prove that proton therapy is superior to x-rays. These studies are underway now. Dr. Cox says that the main benefits are fewer side effects for the patient. In some cases physicians are able to deliver higher doses of radiation, which may result in better tumor control. Dr. Cox says that all of these objections make it difficult to get papers accepted in journals so good results can be demonstrated.

  Dr. Cox affirms that the Proton Therapy Center has been very successful. The Center is also in the process of expanding uses for patients, so proton therapy will be part of treatment for many diseases and stages of disease. He anticipates that eventually 20% of MD Anderson patients will be treated with proton therapy. He explains how patients are identified for proton therapy (curative uses, rather than palliative). The Proton Therapy Center will be upgrading certain functions, taking advantages of developments Hitachi has recently made.

  Dr. Cox observes that the regional care centers have not referred as many patients for proton therapy as he would have expected and that they would like to treat even more patients. As the segment closes, explains that the original investors pulled out of the project and MD Anderson owns 51% of the interest in the Center.

• 

  Chapter 19: The MD Anderson Presidents

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox begins with observations about Charles LeMaistre, who recruited him to serve as Vice President of Patient Care, “a good title, bad job,” as he says. Cr. Cox explains that he and Dr. LeMaistre had very different orientations toward MD Anderson administration. Dr. LeMaistre was interested in issues related to the UT System, Dr. Cox says, then explains why he believes that Dr. LeMaistre didn’t fully understand what was going on at the institution. Dr. Cox says that during Dr. LeMaistre’s tenure, the institution was on the verge of greatness, but couldn’t take the next step because many faculty were “living in silos.”

  Dr. Cox next talks about John Mendelsohn, who was very aware of what was going on in the institution (at least during the first years). He then turns to Ronald DePinho, whom he admires for his grand aims and desire to change the institution in a major way. He offers his view of the Moon Shots Program, which he sees advancing team science, though he has no expectation that is will eliminate the cancers at which the various sub-programs are aimed.

• 

  Chapter 20: Contributions to MD Anderson

  James D. Cox MD and Tacey A. Rosolowski PhD

  Dr. Cox talks about his contributions to MD Anderson: he spurred clinical research and therefore contributed to the care of patients. Administratively he believes he helped foster collegiality across departments and division, making faculty comfortable with multi-disciplinary work styles. Dr. Cox recalls that Gilbert Fletcher set a very high standard for radiation oncology at MD Anderson. Dr. Cox says that he has contributed to maintaining that stature, one that differs from any other cancer center in the world.

• 

  Chapter 01: Always a Builder

  William Daigneau and Tacey A. Rosolowski PhD

  Mr. Daigneau begins this segment with a brief view of his family experience growing up in Cleveland. He explains his interest early in life in the sciences and engineering. He notes his fascination with "how things went together: he built a layout of trains in the basement and worked with old gas model airplanes. He notes that we has a Boy Scout and received an Eagle Scout award.