In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
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Chapter 03: Medical School with a View of How the Basic Sciences Might Address Clinical Problems
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
Dr. DuBois begins this chapter by noting that in '79-'80 he had a vision of how basic sciences observations about drugs could be used to address clinical problems. He elected to go into gastroenterology at through his medical program at UT Health Sciences at San Antonio (MD, 1985). During the summers he conducted research in Dr. Raymond Burke's laboratory, characterizing selenoproteins. He explains that he also had the opportunity to work with Thressa Stadtman, who discovered selenoproteins, through a fellowship program at the NIH (1983-1984). During that time he made advances to that work by identifying steps required in purifying the proteins.
Next, Dr. DuBois talks about his internship and residency at the Johns Hopkins Hospital (1985-88), where he worked with Dr. Victor McKusick, who was working on cloning all the genes affected when a cell is stimulated to grow. Dr. DuBois explains that he worked on an RNA binding protein, Nup475, a project he continued working on as a Research Associate to Daniel Nathans at the Howard Hughes Research Institute (July 1988-March 1991). -
Chapter 04: Research and Administration at Vanderbilt University, Focusing on Cancer
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
Dr. DuBois begins this chapter by explaining how he was led to take a faculty position at Vanderbilt University in 1991, and where he would stay for sixteen years.2 He first talks about how he continued his research, leading to the discovery that COX-2 played a role in cancer and that it could be inhibited. This work was published in Cell in 1993, and helped him make his name.
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Chapter 05: Thoughts on Healthcare, Academic Medical Centers and the Medical University of South Carolina
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
After a question about education for physician-scientists, Dr. DuBois shares some of his own experiences teaching medical students then explains how the Medical University of South Carolina (where he currently serves as Dean of the Medical College) has moved to create a flexible and integrated curriculum. He notes the institution also offers a MD/PhDs as well as combined degrees in business administration, law and other fields. He explains the "huge need" in healthcare for physicians who are good at business concepts, noting why this will be a "savior for academic medical centers."
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Chapter 06: An Offer from MD Anderson
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
Dr. DuBois begins this chapter by observing that administrators take two to three years to understand the ropes of their new roles, two to three years to set up processes, and another two to three years to reap the benefits of these processes.He next talks about stepping into the role of Director of Vanderbilt University's cancer center in 2005, because the former director was retiring and the institution wanted an internal hire. In 2006, he notes, he got a call from John Mendelsohn to talk about an opportunity to serve as Provost at MD Anderson. He explains what he learned of the situation at MD Anderson and what it might offer him. He also explains his family's reluctance to leave Nashville.
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Chapter 07: Provost and EVP at MD Anderson: an Overview
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois provides an overview of the position he assumed when coming to MD Anderson in 2012. He first shares his impressions of Dr. John Mendelsohn, then president of MD Anderson, then notes that he was involved in assisting Dr. Mendelsohn secure the $150 million gift from the Khalifa Foundation of the United Arab Emirates.
Next he explains that his mandate from Dr. Mendelsohn was to develop the institution's research to higher levels. He describes what had been set in place by the time he arrived, including Dr.Mendelsohn's idea of the "cancer care cycle." He explains that he focused on stimulating collaboration across the institution, getting teams to work well together, and on supporting study of patients who were unusual responders to treatment. Dr. DuBois talks about setting up his own lab on South Campus.
Next, he mentions that, when asked what MD Anderson could do to move to the cutting edge of research, he responded that immunotherapy would be a fruitful research path. He explains that he already knew Jim Allison and his work and began speaking with Dr. Allison about coming to MD Anderson. 3
Dr. DuBois then explains that he was hired into a role of Provost when the position had previously been titled, Chief Academic Officer, to send more of an academic message. He explains what the former CAO had set in place before he arrived. -
Chapter 08: On Growing as a Leader, First Impressions of MD Anderson, and a First Day on the Job
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
Dr. DuBois begins this chapter with a few additional comments about his decision to leave his position at Vanderbilt University and take on the role of Provost at MD Anderson.
Next he reflects on how the role of Provost allowed him to "up his game" as a leader and notes how the sheer size of the institution as well as the varied research interests of faculty presented a challenge. He also notes that his own experience with high-impact publishing allowed him gave him insight into the research environment.
Next, Dr. DuBois explains that on coming to MD Anderson he saw how dedicated employees were to their jobs and to patient-centered care. HIPAA - he also explains his personal connection with the institution through an aunt who was diagnosed with breast cancer and whose quality of life was greatly improved with MD Anderson treatment.
Dr. DuBois then explains how a family emergency interrupted his first day on the job. -
Chapter 09: Building Research from the Provost's Office
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois summarizes several of his first activities as Provost. He notes that he set up with staff then talks about how he addressed some issues in leadership of the UT Graduate School of Biomedical Sciences. He explains why he undertook to increase the amount of faculty salaries covered by grants. He then discusses how he improved reduced the time needed for IRB approval of research protocols, hiring a process engineer to evaluate the process and reduce the number of days from 250 to 80/90.
Next, he explains why he wanted to develop a mentoring plan. Next he discusses some attempts to address physician burnout and also mentions some of the Medical University of South Carolina's programs. -
Chapter 10: Strategic Planning, Budgets, Physical Space, and Industry Partnerships
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois summarizes several areas of activity with broad institutional impact. First he talks about the members of the Executive Committee who met with John Mendelsohn every week and describes the strategic plan that committee had worked out prior to his arrival.
Next he talks about the committee's relationship with the Board of Visitors in addressing the "assumptions we are making about the future of the institution." As an example he notes Dr. Thomas Burke's role managing the clinical burden and the $250 million margin that created a low margin in context of other businesses. Dr. DuBois next notes that he was surprised at the degree to which the institution's financial team wanted to ensure a return on any investment. He gives an example of the improvements that Dr. Ronald DePinho proposed to make on South Campus to foster research, and also talks about the Proton Therapy Center and the Center for Biomedical Imaging. He mentions a discussion of indoor walkways to connect the south and north campuses, which leads to a discussion of the importance of designing physical space.
Next, Dr. DuBois speaks about efforts to build partnerships with industry, also explaining how Texas laws about intellectual property hamper development of these collaborations. -
Chapter 11: Financial Processes, Challenges, and a Crisis;
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois focuses on financial matters. He notes that as Provost he was required to manage a much larger budget than he had in previous roles. He also explains that Leon Leach [oral history interview], hired by John Mendelsohn, brought a heightened awareness of finances to the institution.He next focuses on the economic downturn of 2008/2009, which required the institution to cut costs dramatically and reduce the workforce by 500. He explains how the Executive Committee worked to anticipate how to weather this challenge and talks about the parameters they used to identify employees to cut. He talks about the stresses of executive leadership.
Next, Dr. DuBois talks about building the Division of Academic Affairs. He notes that CPRIT funds were key for this growth and discusses working with CPRIT leadership to keep the MD Anderson community informed of their grant application processes. He talks about the connection between Academic Affairs and the research institutes and how key the former was in recruiting faculty for the institutes.
Next, Dr. DuBois discusses issues related to the faculty. He talks about the "Wall of Science and Medicine" he created to bring awareness to the faculty's high profile publications and to stimulate pride and competition among the faculty. He then covers work with the Faculty Senate and the themes of concern.
Next, Dr. DuBois talks about the problem of rewarding investigators for their team science efforts, then notes that the Provost's Office was able to set a good tenure process in place. -
Chapter 12: Executive Teamwork and a Long-Range Vision for the Institution
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
Dr. DuBois begins this session by observing that the evolution of his leadership at MD Anderson was tied to the close working relationship of the executive team, who may have had differences at times, but who all agreed on where the institution should be headed. As an example, Dr. DuBois talks about the economic crisis of 2008/09. He talks about the very rapid and measured response of the executive team and the success of averting a serious institutional crisis. In addition to the reduction in workforce, Dr. DuBois notes that clinicians were asked to see one additional patient per session. He explains that there was general agreement that the long-term vision of the institution focused on keeping patient care first and talks about what is involved in keeping the institution abreast of the highest standards of care, including recruiting the best faculty.
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Chapter 13: A Candidate for the Presidency of MD Anderson;
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois talks about undertaking the process of applying to be MD Anderson's fourth president. In response to the interviewer's observation that many people in the institution felt he was viewed as Dr. John Mendelsohn's heir apparent, Dr. DuBois confirms that Dr. Mendelsohn raised the issue of his retirement from the presidency during their first recruiting conversations. He felt he was "groomed for the role." He then describes the search process and the steps he underwent to apply and interview for the position of president. He notes that he had a lot of support within the institution, but that the Board of Regents makes their own, independent choice, and internal candidates have challenges. (Dr. DuBois explains that he was really focused on the administration of the institution, on making incremental changes within the reality of the institution as opposed to bringing broad visions of institutional transformation, an allusion to the perspective brought by outside candidates. Dr. DuBois sketches the areas of growth he included in the vision he presented to the Board of Regents. Dr. DuBois then talks about going through the final interview process and then getting the news that the Board had made another choice. He explains why he had wanted to job. He talks about his disappointment and initial feeling that he wanted to move on to another institution, but that people within MD Anderson asked him to stay on to help with the transition under Dr. Ronald DePinho.
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Chapter 14: An Institution Transitions Under a New President
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
Dr. DuBois begins this chapter by explaining how his role as Provost and Executive Vice President expanded his administrative experience.
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Chapter 15: Institutional Changes and the Decision to Leave MD Anderson
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois identifies the institutional changes that prompted him to leave MD Anderson. He first notes that he tried to advise Dr. DePinho about problems emerging among the faculty. He observes that he had been approached by other institutions, but had wanted for professional and personal reasons to finish his career in Texas.
Dr. DuBois lists how he and Dr. DePinho differed in their view of leadership and administration. He notes changes in the leadership structure, and how the individuals from industry that Dr. DePinho had established on South Campus reported directly to Dr. DePinho and Dr. Lynda Chin, rather than following the usual communication chain through the EVPs. He observes how unusual it is to have both a president and his wife in prominent positions in the institution.
Dr. DuBois then discusses explains the controversies around the application that Dr. Lynda Chin made for CPRIT funds, skirting the usual process. Dr. DuBois explains why the application process existed and why not following it was such a problem. He explains the impact of the Chin/DePinho actions on the CPRIT process and MD Anderson.
Next, Dr. DuBois talks about changing attitudes among long-term employees and faculty as well as the Executive Committee as the DePinho presidency evolved. He also notes that in Dr. DePinho was not entirely to blame for the worsening situation at the institution, as he came into his role with no experience running a large, clinically-focused institution. -
Chapter 16: New Roles at Arizona State University and the Medical University of South Carolina
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois talks about the roles he took on after leaving MD Anderson, first discussing his work as Executive Director of the Biodesign Institute at Arizona State University (December 2012-Feb 2016).4 He describes the change it made after MD Anderson, the scope of his work linking the physical and biomedical sciences and developing collaborations with clinicians. He explains why he enjoyed the job (and why it was, effectively, a 4-year sabbatical), as well as why he needed to leave that role.
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Chapter 17: Advances in Cancer Interruption
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois talks about the latest evolution of his research into cancer interruption. He begins by talking about the process of moving his laboratory from MD Anderson to Arizona, then his rationale of looking at targets of research opportunity in pre-malignant disease. He reviews his previous work on COX-2, then talks about his current work, which uses the approach to target processes around pre-malignant lesions, "making prevention molecular. Dr. DuBois gives some examples and discusses the implications of this approach for prevention.
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Chapter 18: Final Comments on Leadership and Retirement
Raymond N. DuBois Jr., MD, PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. DuBois shares general views of leadership. He notes that, in his view, a seven to ten year tenure is sufficient and he envisions himself working for a foundation or as a chief scientific officer after he reaches that limit. He offers his advice to individuals who aspire to executive leadership, again stressing the need for physician leaders to train for administration and in finance.
Next, Dr. DuBois underscores the need to develop a pipeline of leaders in healthcare who have emotional intelligence and can truly lead. He notes that the traditional criteria of research success is not sufficient for picking leaders for institutions today. He uses the example of the Mayo Clinic to demonstrate a very effective institution culture that builds good internal leadership. -
Chapter 01: Memories and Details about Family
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung sketches her early family experiences. She notes that she was from an “Air Force family” and lived overseas for a time, arriving eventually in San Antonio, where both her father and mother worked on planes at the Lackland Air Force Base. She shares memories of her father, who committed suicide when she was ten years old. She notes that her father named her “Wenonah” for her Shawnee grandmother and because the name means “morning star”, alluding to the fact that she was her father’s first born.
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Chapter 02 : Finding the Way to Nursing
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
Dr. Ecung begins this chapter by noting that when she began college (San Antonio College, transferring to Texas Woman’s University, BS in Nursing conferred in 1977) she believed she would focus on business. She talks about how ambitiously she approached her first jobs in high school and her success as a young employee. She then explains how a guidance counselor limited her sights for study in college to teaching and nursing because of her gender, though she notes that “he didn’t know he was doing me a favor.”
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Chapter 03: An Education that Stressed Nursing Leadership; Experiences of Bias
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
Dr. Ecung talks about her nursing education at Texas Women’s University in this chapter. She talks about the value of the Socratic method employed and shares anecdotes about racial bias she observed and experienced.
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Chapter 04: Making a Commitment to Oncology Nursing
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung explains how she decided to focus her career on oncology nursing despite her first reservations. She explains how she first took a job (after graduating in 1977) as a floor nurse at MD Anderson, caring for patients with testicular and breast cancer. She shares stories of working with patients and describes why she found it so difficult that she left after a year and a half.
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Chapter 05: Nursing in the Department of Developmental Therapeutics
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung provides a portrait of her work in the Department of Developmental Therapeutics when she returned to MD Anderson in 1978. She explains the physical organization of the clinic (Station 16). She discusses how she reorganized patients by disease type and assigned specific nurses to each disease type to deepen their knowledge so they might be more effective working with faculty and teaching patients about their diseases. She talks about the impact –notably in the retention of nurses.
Next, Dr. Ecung talks about the working relationships between research nurses and clinical nurses in Developmental Therapeutics. -
Chapter 06 : Developing Nursing Care in the New Clark Clinic
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung talks about her shift to a new position as Nurse Manager of Station 55 (in 1987), which was moved to the newly constructed Clark Clinic. She talks about the physical organization of the new clinic space and how it functioned more effectively. She outlines changes that she helped make to nursing care between 1987 and 1993, including combining the roles of research nurses and clinical nurses into the Primary Attending Nurse designation. She talks about the challenges of effecting this change and the increase in patient satisfaction it created. She notes that she “had a list of nurses waiting to get into Station 55,” and she was extremely careful to bring in new nurses who fit with the culture of the group. She also recalls that other clinics were asking for information on how Station 55 had been so well reorganized.
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Chapter 07: Reorganizing Station 65 [now the Breast Center], the Preceptorship Program, and Multi-Disciplinary Care
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung discusses the period when she was managing Station 55 and was also tapped to reorganize Station 65, now known as The Breast Center. She explains that this was the first of a number of situations in which she would serve as a “turnaround agent.” She describes some of the skills she brought to that role and then sketches the situation in Station 65 when she took over. Dr. Ecung explains that she wanted to bring a new view of nursing and nursing culture through a rapid team transformation. She explains that she was successful in establishing a core group of people who supported her vision of empowering nurses as decision makers working in concert with physicians.
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Chapter 08: A New Role as Clinical Administrative Director: Instituting Multi-Disciplinary Care
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung tells the story of taking on the role of Clinical Administrative Director (in 1996). She begins by talking about the interview process, which took place during a difficult period of her life. She then talks about her responsibility to build multi-disciplinary care teams as the institution went to a “one stop shopping” model. She also talks about the effects of this “huge change” on faculty, nurses, and on patients. She also notes that at the time other cancer centers were discussing this change, but MD Anderson took the step of instituting it and “became the way” of organizing care.
Next she notes that she has always had “great nurses” who wanted to “do more than put a patient in a room.” She talks about the interview process she used to select nurses. She also recalls her Master’s program, where she began to understand her administrative philosophy.
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Chapter 09: Period of Transition for a Leader
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung talks about a period of transition she went through in her focus on leadership. She begins talking about an MD Anderson-sponsored leadership development program she attended, then shifts gears and explains how Dr. Charles LeMaistre invited her to chair a group of classified employees tasked with interviewing candidates for the new presidency of the institution. She notes that this role gave her visibility among staff outside of medicine; she also recalls lessons learned, illustrating with an anecdote about how she had to handle an awkward moment during an interview with Dr. John Mendelsohn. She notes that these experiences prepared her for leading larger interdisciplinary teams.
Dr. Ecung then returns to her original story about her leadership training, telling a story about how she intervened as a bridge builder when Dr. Mendelsohn and Dr. Todd Pritchard got into an argument about mentoring.
This set the stage in which Dr. David Callendar asked her to interview for the role of Associate Vice President for Clinical Programs. She explains that Dr. Barbara Summers (oral history interview) was chosen for the position. She tells a story of how she demonstrated her support for Dr. Summers in her new role: Dr. Summers eventually asked her to lead the Clark Clinic Renovation project, her second major opportunity for exposure to executive leadership. [Dr. Ecung’s husband, Ramone, comes in briefly at the end of this chapter.]
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Chapter 10: Professional and Personal Values and Changes in Institution Culture
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
Dr. Ecung begins this chapter with some brief comments about mentoring: she notes that “I am a product of mentoring” and talks about her own strategies of mentoring. She tells an anecdote about mentoring staffmembers who are already fairly highly placed but looking to rise higher in the institution. She notes that by virtue of her mentoring, she began to serve as “the doorway” to the Physician in Chief’s office. She explains that honest and integrity are key concepts in her personal and professional philosophy and these values served as motives for her decision to retire.
Next Dr. Ecung offers her observations on changes that she has seen in MD Anderson’s culture over the past five years, noting that the institution does not feel “as wholesome” as it did during her years of service and that the place is “reshaping” in ways that do not match who she is. As an example, she explains that for 37 of her 39 years at the institution she never felt that she was looked at as black, but now feels invisible in meeting with the president [Dr. Ronald DePinho; oral history interview]. She also explains that she has observed Dr. DePinho’s wife, Dr. Lynda Chin, behave in ways that were damaging to moral.
She notes that in the past, she observed situations arise where the faculty might not like an institutional policy or decision, but nevertheless supported the president. Today, she explains, the faculty does not feel heard and this support is not as strongly expressed.
She also notes changes in the Physician in Chief’s office. The atmosphere was very close and trusting in the past, but now sees a kind of class system in place.
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Chapter 11: The Decision to Retire and Reflections on Working Under Two Physicians in Chief
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung explains the factors that led her to retire at the end of 2016, setting her decision in the context of her work with two physicians in chief, Thomas A. Burke, MD [oral history interview] and Robert Brigham.
She begins by noting that she was serving as Associate Vice President of Clinical Operations when Dr. Burke came in as physician in chief, and he made the conscious decision to keep her in that role. This gave her to opportunity to observe the process by which he was removed from that position and notes that she felt it was “not done with integrity.” She talks about Dr. Burke’s accomplishments in his role and explains that he had the habit of “speaking truth to power” while also being a “citizen of power.” She explains the process of removing him (2013) and why integrity is so important in executive levels of an institution.
Next, she talks about her expanded role as Vice President of Clinical Operations under Dr. Thomas Buchholz because another key individual had left the institution and Robert Brigham had come in as new Senior Vice President for Hospital and Clinics, working closely with Dr. Buchholz. She describes the new perspective that Mr. Brigham brought from his years at Mayo Clinic and the changes that he and Dr. Buchholz instituted.Dr. Ecung explains how her role changed and was ultimately diminished in this new administrative context. She talks about her decision to retire and cut off from all contact with MD Anderson for one year, explaining her reasoning. She also talks about how people who remained in the office of the Executive Vice President felt they had lost an advocate when she left.
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Chapter 12: Associate Vice President of Clinical Operations, an Evolving Role
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung talks about her role as Associate Vice President of Clinical Operations (2003 – 2014). She explains how she was selected for this position then talks about the steep learning curve she had during her first two years: it was a few years before a task crossed her desk that she had performed previously. She gives examples of the tasks she took on during Hurricane Katrina and during the Joint Commission Survey to accredit the institution.
She observes that after five years, she was familiar with the role. She gives examples of how she instituted processes that could be repeated: evaluating faculty salaries; the holiday letter program; advisory board contracts. She compares her view of the role to Dr. Barbara Summers, who had held it previously.
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Chapter 13: Key Projects
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
Dr. Ecung begins this chapter by identifying her role as Chair of the Clark Clinic Renovations Project Team as one of her most significant (2005 – 2008). She ran the first interdisciplinary committee comprised of forty-three individuals from all over the institution to have input. She notes that it was extremely successful. She talks about the impact of her decision to have committee members present to the Dr. Buchholz, rather than presenting their conclusions herself.
Next she talks about addressing long wait times (sometimes twelve hours) in the Emergency Center (though the recommendations were not implemented). She speaks on more detail about the survey conducted to gather information for the American College of Surgeons’ accreditation process, noting that MD Anderson most often received a “commendation” level evaluation.
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Chapter 14: Vice President of Clinical Operations, and a New Working Environment
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
Dr. Ecung begins this chapter by narrating the story of how she was promoted in 2014 to Vice President of Clinical Operations (along with others in the Office of the Executive Vice President). She notes that her official role didn’t change, as its scope was already “huge” and she was required to have a great deal of agility to take on new projects.
The role did shift, however, along with circumstances over the next two years, she explains, because Dr. Buchholz had taken over as Physician in Chief in 2013. Once Robert Brigham came in as Vice President of Hospital and Clinic, she explains that she was expected to do more, but also serve a more restricted and diminished role.
She notes that projects effectively stopped when Dr. Buchholz came in as he adjusted to the new role.
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Chapter 15: Instituting Multi-disciplinary Care and Electronic Medical Records
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung sketches some of the major changes she saw during her years working for the Physician in Chief.
First she talks about the process of adopting electronic medical records. She explains that under David Callender, the institution looked at a variety of vendors and determined that the MD Anderson-developed system, ClinicStation, exceeded what was on the market. In 2014, she explains, leadership decided to adopt the EPIC EMR system. She talks about the pros and cons of ClinicStation and notes that the administration planned on a $250 million loss when instituting EPIC.
Next, she talks about the process of supporting the evolution of multidisciplinary care at MD Anderson, a process that involved helping faculty and staff understand what it was about and then managing the transition of practice to a team approach. She talks about the difference between physically bringing the different specialties together versus creating a culture of collaboration. She talks about some of the strategies used to foster collaboration, including the importance of cross-training nurses and holding planning conferences with faculty across specialities. She talks about the importance of spatial support in design of clinics, developing teams, holding formal conferences, and including multidisciplinary teams in patient visits, the latter resulting in a “show of force for a patient.”Dr. Ecung talks about working on the Clinical Effectiveness Committee that formalized multidisciplinary approaches in the MD Anderson algorithms of care. She points out that the Sarcoma center did a costing of each algorithm.
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Chapter 16: A PhD and Teaching Leadership Theory and Policy after Retirement
Wenonah B. Ecung PhD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ecung first explains her decision (in 2010) to get a PhD and then talks about teaching Leadership Theory after her retirement in 2016.
First she explains how she came to earn a PhD at Our Lady of the Lake University at San Antonio after that institution established a cohort in Houston in 2010. She talks about her husband, Ramone’s support of her work and the challenges of doing a PhD (conferred 2013) while involved in a demanding position. She recalls her graduation.
Dr. Ecung then discusses the impact of her program of study as she served as Associate VP and VP of Clinical Operations.
Next, she explains how she was invited to teach leadership theory and policy after her retirement. She explains that she wants to give back to the University and this is her contribution of community service.Finally, she notes that her heroine is her mother.
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Chapter 01: An Early Interest in Writing Serves a Career in Science
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting briefly talks about her parents then sketches her early educational experiences. She explains that though she took science and math courses, she loved to write and planned on focusing on writing and literature when she attended Lindenwood University in Saint Charles, Missouri. She explains how her skill in writing has served her career in the sciences. Dr. Elting talks about the learning environment and then explains why she returned to Houston to attend the University of Houston.
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Chapter 02 : Inspired by J Freireich and Doing Support Work for MD Anderson Researchers
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting explains that after a friend suggested she work at MD Anderson to make money for college, she got a job as a clerk-typist in the Tumor Registry, where she learned about diagnoses, anatomy, and treatment. She tells an anecdote about how she came to attend rounds one day in Developmental Therapeutics. The outcomes for patients that day were particularly bad, she recalls, and Dr. Emil J Freireich [Oral History Interview] talked the faculty to remind that that a cure could be discovered at any moment. She says, “I was a goner,” she was so inspired.
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Chapter 03: Finding a Way to Have a Research Career at MD Anderson
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting explains why she rethought her career path so she could come to MD Anderson and conduct research. She was interested in her work in the Coding Department, where she was recognized, and rewarded. She decided to switch her studies to medicine and thought of applying to medical school, however, ultimately attended Houston Baptist University for a degree in Nursing (BS conferred in 1974). In 1976 she began working at MD Anderson working for Dr. Gerald Bodey [Oral History Interview]. She explains the pharmacological studies she worked on and notes the status of research nurses.
Dr. Elting describes the unstructured environment in Developmental Therapeutics, where it was possible to be innovative. Dr. Elting tells a story of taking such an opportunity to aggregate data on one study when Dr. Bodey was away. She observes that some people thought it was presumptuous to take over a task usually performed by a physician, a fact that led to a divide between floor nurses and research nurses, but that didn’t stop many people from simply taking over a task. Dr. Elting notes that in an unstructured environment, mentoring is unstructured as well.
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Chapter 04: Earning a Master’s in Public Health and a Landmark Study of Infections
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting explains the work she did under Dr. Gerald Bodey while also attending the UT School of Public Health to work on her Master’s and supplement the information she knew she lacked. She talks about the open environment that provided her with a good learning experience. She notes that she was interested in infections caused by multiple organisms. Dr. Elting explains that she did a large study of polymicrobial septicemia, which still may be the largest study ever conducted.
Next Dr. Elting explains the main lessons she learned during her Master’s program: that she could offer clinicians a view of entire populations (rather than a focus on individual patients); that she could strengthen studies by insisting that the basic research question be articulated. She also explains that she learned to communicate effectively with clinicians and non-biostatisticians by using graphic charts and pictures, rather than tables of numbers.
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Chapter 05: A Doctorate in Public Health and Appointment to the Faculty
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting begins this chapter by explaining that her Master’s program gave her confidence in the quality of her own research questions and helped spur her to pursue doctoral work.
Dr. Elting explains why she never considered leaving MD Anderson.
Next she sketches the skills her doctoral program helped build, particularly computer skills. She observes that computers were not much in use in research at MD Anderson during the eighties.
Next Dr. Elting explains MD Anderson rules that made it difficult for her to be promoted to the faculty. She also notes that it was difficult to get some physicians to see her as a colleague when they had known her for years as a nurse/technician. She describes her duties once she was promoted to the faculty.
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Chapter 06 : Early Research Studies
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting talks about research studies she conducted just after receiving her DrPH. She worked on two emerging types of infections (alpha streptococcal infection and pseudomonas maltophilia) and explains how here research was constructed to enable her to draw solid conclusions about infection risk factors.
Dr. Elting notes that she conducted this research with Dr. Gerald Bodey’s research money, then explains that she was able to get an independent grant to study how to effectively present data from clinical trials so clinicians would understand and use it. She designed a study using comparing the use of numbers versus pictures in communicating information about drug toxicities and patient responses. It was clear that pictures worked best, and Dr. Elting’s conclusions were adopted at many other institutions. Dr. Elting notes that MD Anderson has always been “behind the curve” in adopting medical records systems.
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Chapter 07: Research Focus Expands to Risks and Outcomes of Care
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting begins this chapter by explaining that the threat of infections was decreasing and so she expanded her research focus to supportive care. She transferred to the Department of General Internal Medicine (GIM) and worked with the Ambulatory Treatment Center.
Dr. Elting notes that she was advised to begin working independently of Dr. Gerald Bodey, as many professionals attributed her research to him because of their long working relationship.
Dr. Elting explains that in GIM she conducted research on nausea and vomiting. She also developed an interest in effectiveness, efficiency, and cost and conducted time/motion studies and studies to demonstrate the effectiveness of expensive drugs that insurance companies were unwilling to cover. She began to study economics.
She then makes observations about her own learning and mentoring styles.
Dr. Elting discusses the first study she conducted independently of Dr. Gerald Bodey: a study of the frequency and outcomes of thrombocytopenia (low platelet count) and the cost/benefits of transfusion versus drugs to treat the condition. This study brought her recognition and established her as the primary researcher in the field of risk and the outcome of care.
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Chapter 08: A Study of Thrombosis Opens New Research Niche in Side Effects
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting explains how her study of thrombosis in cancer patients enabled her to establish a new research niche.
She explains how her study of thrombocytopenia led to her interest in thrombosis and helped shape her approach: looking at individual patients at MD Anderson and carefully describing symptoms in this large population in a way that had relevance to current practice. This was the beginning of her focus on side effects, she notes.
Next, Dr. Elting compares her approach to the typical retrospective study often conducted by fellows. She notes that the most frequent question she received from reviewers was, Are these symptoms as bad outside of MD Anderson, in ordinary practice? She explains why MD Anderson has a different patient population, but notes that it was possible to generalize this information to the general population and she began to look at expanding studies accordingly. -
Chapter 09: Departing from Epidemiology and Conducting Cost-Effectiveness Studies
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting talks about how her interest in value of care evolved.
She sets context by noting that in the 2000s many states began requiring that hospitals report the quality of results, making available data about procedures and surgical outcomes. Dr. Elting was able to look at toxicities that caused death and fees for procedures. She explains that expensive and effective new drugs were available to treat toxicities, but insurance companies were unwilling to cover the cost. She says that she initiated cost effectiveness studies to demonstrate that the more expensive drugs ultimately saved money. Her studies were very successful at convincing payers to change their policies. She then talks about the reactions of her colleagues to her change in research direction.
Dr. Elting explains that this research took her away from traditional epidemiology and allowed her to differentiate herself, a fact that was critical to her success.
Dr. Elting tells a story about a period when General Internal Medicine didn’t have enough beds because they were filled with patients made too sleepy to function by their anti-toxicity medications.
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Chapter 10: Research on Health Effects of Policy Decisions and a Study of Childhood ALL
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter Dr. Elting talks about her current research focus on the health effects of policy decisions made by state and local governments.
She begins by noting that there is no federal health policy in the United States, so policy decisions made at a “semi-macro level” have an effect locally on subpopulations. Dr. Elting gives an example from Texas health care.
Dr. Elting explains that to study these effects, she began to study outcomes by volume of cancer procedures. She then gives an example of a study she conducted on the availability of mammogram machines across Texas, showing that in areas with no machine, patients suffered more late-stage breast cancer. She notes she is currently working with a pediatric surgeon looking at pediatric cancer in Texas.
Dr. Elting notes that few families can afford care for childhood cancer. She explains the funding of the study and its impact. She gives an example of partnering with the University of Texas Medical Branch to produce video talks and other educational materials for communities and primary caregivers. She mentions some other efforts to disseminate information beyond academia.
Dr. Elting talks about why Texas is an interesting state to study and why it allows conclusions about how barriers to care operate and affect outcomes. She talks about interventions her office has helped to create.
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Chapter 11: Providing Data to Inform Policy Makers
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting begins this chapter by talking about how the Affordable Care Act has had an impact on the study of health outcomes. She also notes that the ACA has provided an opportunity for her to provide information to the state legislature in Austin and influence the conversation about healthcare. As an example of the issues she might take on, she explains her work on Medicaid has shown that people who have gaps in insurance coverage have worse outcomes than those with continuous coverage. The latter is ultimately more cost effective.
Next Dr. Elting talks about the mechanisms her office uses to deliver information to Austin. She explains that, as a public institution, MD Anderson can only educate, not lobby. A report goes to every legislator. Individuals specifically interested in public health receive an email and those who interact with legislators on behalf of health issues also receive information.
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Chapter 12: Training Laboratory and Clinical Researchers in a Populations Perspective
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting talks about Project 4, a training initiative run by Dr. Carlos Barcenos to inform junior faculty about health policy issues and encourage them to integrate a population-focus into their thinking and research. She gives examples of how they encourage this integration and how the training changes the faculty’s thinking about resource allocation, the cost of care, and what insurance can and cannot accomplish. Dr. Elting explains that the participants will become leaders in their fields and educators of the next generation of oncologists, so this training is key to shift their practice and contributions to how the healthcare system works.
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Chapter 13: Developing the Ambulatory and Supportive Care Oncology Research Program
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting talks about her roles as Director of Clinical Epidemiology and Informatics within the evolving Ambulatory and Supportive Care Oncology Research Program (1992 – 1998), housed in the Department of General Internal Medicine.
She explains the vision and goals of this new research program, designed to provide data to guide initiatives to de-hospitalize chemotherapy patients to outpatient status and she brought quantitative methods to this clinical department.
Dr. Elting talks about research conducted when a new group of antibiotics became available, making it easier to treat infections and fevers in chemo patients. She explains that the research conducted in the new program shifted the standard of care from inpatient to outpatient treatment. She notes that this was considered “a wild and crazy thing to do,” very risky and dangerous.
Dr. Elting talks about how the study offered a leadership opportunity. She reflects on the success of the program.
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Chapter 14: Training Clinicians to Think Analytically about Research Problems
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting talks about how expanding General Internal Medicine’s research program allowed her to train clinicians in analytical thinking. She explains how physician’s generally think about clinical problems, defines what analytical and quantitative thinking are, and the effect that training in these methods has on clinicians.
Dr. Elting ends this chapter by explaining what she learned from working with clinicians in this way. She notes that her role as Director of Research (1998-1999) in the Section of General Internal Medicine was simply an expansion of her role as Director of Clinical Epidemiology and Informatics.
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Chapter 15: Developing Health Services Research in the Division of Cancer Prevention
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting talks about her role as Chief of the Section of Health Services Research (2001 – 2013) and explains the department affiliation.
She sketches the research focus on the outcomes (including economic and business outcomes) of treatments, not the treatments themselves.
Dr. Elting explains why she was selected to take on this role and how she was asked to head the section and “go find a department to be in and make us famous.” She explains why she identified the Department of Biostatistics and Applied Mathematics as the most likely home.
Dr. Elting then sketches this administrative history of the Departments of Biostatistics and Applied Mathematics. She describes the challenges of finding a way to work with other department members whose perspectives were different and notes a landmark moment of finding common ground for collaboration.
Dr. Elting notes that her appointment to the role of Vice Chair of the Institutional Review Board raised the profile of Health Services Research and further credentialed her and her Section.
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Chapter 16 : Institutional Review Boards at MD Anderson
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting sketching her role in MD Anderson’s Institutional Review Boards, including establishing a new IRB when the board overseeing clinical research didn’t serve the needs of non-clinical researchers. She talks about the role of the research review committee (PBHSRC) that also looks at protocols.
Next, she sketches a history of IRBs at MD Anderson, first established in 1966, before the federal requirement to establish such review processes. She explains how attempts were made to create effective processes that would not slow research.
Next, Dr. Elting explains the value of IRBs and traces how their role has changed as more resources have been provided to support monitoring.Dr. Elting explains that the computer system that enables efficient entry and management of data has lagged behind the development of IRB processes and causes problems with the system. She also notes that when HIPPA requirements
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Chapter 17: A Brief History of Office Space Occupied
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting begins this funny chapter by announcing that she has “done some homework.” She goes on to explain that she has had twenty-four different offices at MD Anderson, two of them in buildings that were ultimately imploded. She notes that the fact that she was asked to relocate before the implosion, and jokingly adds that she sees this as proof that the institution values her work.
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Chapter 18: A Brief History of Institutional Review Boards at MD Anderson
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting begins this chapter by reviewing the proliferation of IRBs at MD Anderson. She discusses the reasons why they were necessary and how they have emerged as pressures on researchers were changing. She explains why the mid-nineties were a key time for rising resources to fund IRB oversight. She explains that when HIPPA went into effect, MD Anderson’s Compliance office became more concerned about adherence to proper policy.
Next Dr. Elting talks about the need for IRB oversight given ethical issues that have arisen with the increase in genetic/genomic research and increases in projects involving ‘big data’ requiring that personal health information moves from institution to institution.
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Chapter 19: Researchers in Relationship to Institutional Review Boards: A Perspective from an IRB Chair
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting responds to the observation that many researchers have an adversarial view of IRBs. She underscores the importance of training in IRB issues and then explains that she was responsible for formalizing MD Anderson’s IRB training program for new faculty members and research nurses.
She explains her strategy of addressing IBR mistakes while she served as Chair (Institutional Review Board IV, 2003-2005). She gives examples of the kinds of issues that would arise and explains why they appear, particularly in the social sciences departments.
Dr. Elting notes that the IRB she chaired was formed to handle issues arising from research projects, such as hers, conducted in the community with non-MD Anderson patients. She explains the issues that would arise and gives examples of creative solutions to these unexpected situations.
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Chapter 20: Adding Biostatistician to Research Protocols Raises the Bar of MD Anderson Research
Linda E. Elting DPh and Tacey A. Rosolowski PhD
In this chapter, Dr. Elting explains how it became a requirement to include a biostatistician to all MD Anderson research protocols. When Dr. Don Berry was recruited to head the Department of Biostatistics, this new requirement was a condition for accepting the position.
Dr. Elting agreed with his requirement and talks about its significance. She explains how important a biostatistician’s view can be in designing and protocol as well as interpreting data. (She comments on the design of research conducted by pharmaceutical companies.) She talks about the positive effect on MD Anderson research.
Dr. Elting observes that PIs were at first skeptical, because they didn’t know how they would pay for biostatistics services, but Don Berry secured substantial funds from MD Anderson to provide this support free of charge and most people were happy to have the help.
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Chapter 21: A View of Women’s Careers at MD Anderson
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting offers observations and personal experiences to illustrate changes in the climate for women at MD Anderson.
She talks about challenges when she was not accorded respect or opportunities. She notes that she was the fortieth woman at MD Anderson to be promoted to full-professor.
Dr. Elting observes that the executive leadership at MD Anderson expresses concern about women’s representation, but this was not repeated at the mid-level of management until Dr. Elizabeth Travis [Oral History Interview] began working on advancement for women. Dr. Elting explains why she was reluctant to align herself with the Women Faculty Organization and Women Faculty Programs. She observes that women have an equal chance at becoming a department chair, but not at rising any higher. She explains why this is the case.
Dr. Elting points out some differences in the ways that men and women look at their subject matter, particularly the way men are quicker think in entrepreneurial ways about their work. She explains how she developed this perspective.
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Chapter 22: Cultivating Talented People Willing to Dedicate Themselves to a Research Life
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting talks about her mentoring strategy of identifying talented people who can dedicate themselves to the demanding life of a researcher and principle investigator. She talks about the role of senior faculty in weeding out junior faculty who will not be worth a department’s investment.
Next, she explains that leadership involves a wide range of skills, including presentation and fund-raising skills and the ability to sell their ideas to for-profit companies.Dr. Elting observes that too many women accept roles that involve a lot of work, but that do not showcase their skills. She talks about her style of mentoring women for leadership.
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Chapter 23: Projects Remaining Before Retirement
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting first talks about the writing and research she will focus on in her remaining time at MD Anderson. She notes that she is very proud of her work on the Institutional Review Boards (she was the first woman chair of an IRB) and her early work on treatment outcomes. (Health Issue raised, no HIPPA authorization needed.) She says she never realized how much her work on controlling infection effectiveness mattered until her mother was treated for cancer.
Dr. Elting recalls that when she came to MD Anderson nearly everyone died from infection. She notes that it could be a depressing place, but the researchers and support people who stayed helped each other through that time and achieved great things.
Dr. Elting also observes that she was one of the first people at MD Anderson to look at health issues from a population perspective. She is pleased at how far the institution has come in supporting that research.
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Chapter 24 : Overview of MD Anderson Presidents and the Effects of Rapid Growth
Linda E. Elting DPh and Tacey A. Rosolowski PhD
Dr. Elting begins this chapter by sketching the approaches of MD Anderson’s presidents. (She worked under all of them.) She observes that R. Lee Clark was primarily focused on patient care. Dr. LeMaistre [Oral History Interview] was an “ambassador president” who worked well with the University of Texas System. Dr. Mendelsohn [Oral History Interview], she says, brought a research perspective and now Dr. Ronald DePinho [Oral History Interview] is moving MD Anderson into new areas of science.
Dr. Elting states that MD Anderson’s next challenge is to determine how to function as a research institution and deliver care at the same time. She explains how MD Anderson has “seesawed” between these two poles over time. She observes that the negative press the institution is receiving is a function of the institution growing big very rapidly in an environment of financial complexity. She asks, How big is big enough? She observes that the institution has lost its cohesive feel. She compares MD Anderson with the Dana Farber Institute, which has remained small and focused.
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Chapter 01: A Sketch of a Family
Carmen Escalante MD and Tacey A. Rosolowski PhD
In this segment, Dr. Escalante names her family members and sketches their ethnic and economic background (Mexican/Cajun).
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Chapter 02: Encouraged to Get an Education and Leave a Small Town
Carmen Escalante MD and Tacey A. Rosolowski PhD
p>Dr. Escalante talks the value of education in her family and the encouragement she received from her parents to a good education. She tells a story about her mother opening savings accounts for her children, to be used specifically for a college education.
Dr. Escalante next talks about two woman who mentored her in high school, confirming that she had the ability to excel and encouraging her to become a doctor. She explains what she found exciting about a medical career. She finishes this segment with memories of her two mentors and their responses when she sent them each a copy of Legends and Legacies: Personal journeys of women physicians and scientists at MD Anderson Cancer Center, a collection of essays by women physicians and scientists at MD Anderson.
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Chapter 03: Deciding to Practice General Internal Medicine
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante explains how she chose to attend Nicholls State University in Thibodaux, Louisiana (BS, Chemistry 1981). She notes the lack of direction she had in making choices because of her own inexperience and the lack of informed support in her family and the small town where she was raised and educated. She also talks about the concern with money at the time. She worked throughout college and asked her family physician about jobs. She eventually worked as a ward clerk in a local hospital and Dr. Escalante explains how this experience added to her understanding of what medical practice involved. She also explains that she majored in chemistry, as opposed to biology, because she was attracted to the “rigor and challenge” of chemistry. She notes that she always had to work hard to excel, but wanted to distinguish herself.
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Chapter 04: Selecting a Medical School
Carmen Escalante MD and Tacey A. Rosolowski PhD
In this segment, Dr. Escalante explains why she chose to go to Louisiana State University for medical school (MD 1985) and how she was suddenly competing with other top students and had to adjust to not always being the best in the class. Next she describes how her rotations at Charity Hospital led her to focus on Internal Medicine. She speaks at length about the negative impression she had of surgery because of her rotation. She found Internal Medicine the most stimulating because it was intellectually challenging and involved looking at the whole patient.
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Chapter 05: Uncertain about a Career at MD Anderson
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante explains her career moves as she was nearing the end of her residency and describes the process that brought her to MD Anderson in 1988, to be part of the new Section of General Internal Medicine headed by Edward Rubenstein. She recalls that she had done a rotation at MD Anderson when she was an intern and found it very difficult to adjust to a context in which patients were doing poorly. When a position opening in 1988, she wasn’t certain it would be a good fit, but decided to take the job for a year to think things out.
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Chapter 06: The New Section of General Internal Medicine in the Late Eighties
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante talks about MD Anderson’s section of General Internal Medicine (GIM), the first to open in the country. She explains the roles that GIM physicians serve in treating oncology patients and the supporters of GIM at MD Anderson, though it was novel for internists to be on staff at a cancer center. Dr. Escalante explains her daily routine and notes the increasing for services. She talks about the role of GIM in Station 19 (the Emergency Service). She traces changes in how internists’ services were tracked and charged for.
She notes that her appointment at that time was 100% clinical, with no protected time and no discussion with her superiors of how to move to promotion. (She notes that GIM faculty were considered “help.”)
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Chapter 07: Choosing to Stay at MD Anderson
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante describes why she decided to stay at MD Anderson despite her original misgivings. A primary consideration: she like the people and the patients. Dr. Escalante explains how oncology patients have taught her a lot and helped her “reset her life priorities.” She also explains that she would never have predicted a career for herself that included academic medicine. She also notes that it was of benefit that she didn’t fully visualize her future, as this kept her open to opportunities.
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Chapter 08: Learning to Build a Research Career
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante next describes how she expanded her career vision to include a research program, noting a few mentors, but the general lack of attention to career development within her department. She explains that Dr. Robert Bast [Oral History Interview] came in as Head of the Division of Medicine and changed the requirements for promotion, raising the standards for publications. She describes the process she went through to learn how to write reviews and research papers without formal mentoring.
Dr. Escalante then explains that Dr. Andrew von Eschenbach helped further her career by arranging for her first administrative appointment on the Disaster Committee (which she eventually chaired). She observes that committee work provides valuable opportunities to network and learn about the institution.
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Chapter 09: Research into Dyspnea
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante explains that her first research focused on symptoms that patients presented in the emergency service, Station 19. She first looked at dyspnea, combing through records to discover what kinds of patients presented symptoms of shortness of breath, eventually developing a derivation model that predicted who would die from dyspnea, a signal that “the end is coming.” She explains the significance that this information could have for physicians, patients, and families making end of life treatment decisions. Dr. Escalante explains that she conducted this research with very little money (none at the beginning) and learned research methods from the bottom up. She describes the impact her findings might have had, but observes that in practice this information is not used enough to have long term impact.
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Chapter 10: Research into Cancer-Fatigue
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante describes cancer-fatigue then tells how MD Anderson established the first cancer-related fatigue clinic in 1998. She describes services that patients received and notes that the MD Anderson clinic served as a model for others all over the world. She explains what was offered for patients: treatment for depression, anxiety, sleep deprivation, “cheerleading”, and advice about exercise. She notes that she enjoyed the level of interaction with patients and the confirmation that “we can make a clinical difference”. Dr. Escalante explains that, at first, she served as medical director and both managed and staffed it on her own. She and others are now working on national guidelines for treating cancer fatigue and she has given lots of interviews and lectures for other providers and patients. She describes how the clinic really functioned as a “virtual multi-disciplinary clinic” with connections in services all over MD Anderson.
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Chapter 11: Research into Venous Thrombosis
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante explains that she is the Site Principle Investigator for a national study investigating how to treat blood clots in cancer patients. She explains why cancer patients develop clots and describes the results: the superiority of low molecular weight Heparin over Coumarin (Warfarin). Heparin is now standard of care and covered by insurance.
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Chapter 12: Research on Hypertension, A Side Effect of Inhibitors
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante describes her studies of hypertension control, work begun when inhibitors were prescribed to cancer patients. She talks about the severity of the hypertension and the research questions that she posed. Dr. Escalante explains that her team began to do data-mining to design prospective studies and also collaborated with clinical trials to study side effects. She describes the process of acquiring data from data pools and patient charts. She also compares the electronic medical records systems, EPIC and ClinicStation. Dr. Escalante notes that she will be presenting this work at a conference this June. She also explains that this information will help community physicians treating patients and survivors as well as providing opportunities to inform the public and health professionals about drug toxicities.
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Chapter 13: General Internal Medicine: From a Section to A Division and Department
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante notes evidence that it has taken a relatively long time for internists to be accepted as part of oncology teams. She lists the individuals she recruited to the Department of General Internal Medicine once funding began. She says she is pleased with the progress this young Department has made in the past nine years.
Dr. Escalante sketches the history of the Division and the Department of General Internal Medicine, noting increasing acceptance of generalists. She explains that “we need a team approach to take care of these patients.” She discusses ways in which MD Anderson is far ahead of other institutions in allotting resources to General Internal Medicine and notes the creations of support care teams that provide patients with services not available at other cancer centers.
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Chapter 14: Section Chief and Department Head: Learning to Lead
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante begins this segment with a description of how she replaced section chief Ed Rubenstein in 1997 because of complaints about his leadership. She explains that morale was very low in the section during this difficult time for her and for the section. A central problem: when she replaced Dr. Rubenstein, she was also promoted above him. Dr. Escalante next talks about the challenges she faced during this period when she had to cope with a great deal of conflict within the section. After a year, she explains, she went to her supervisor, and Dr. Rubenstein was moved to another section. Dr. Escalante talks about her leadership style: she stresses consensus, but she is also a decision-maker. She has learned a great deal about organizing administrative structure effectively and also cultivates leadership talent within the department.
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Chapter 15: A New Department is Created: Growing the Department
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante explains how she came to be Department Chair once the Section of General Internal Medicine was reorganized as a Department within the Division of Internal Medicine. She applied internally during the search process, which lasted until 2005, a difficult period in which she was a leader, but without any resources to build the Department. In 2005 she received a package and was able to develop both research and clinical activities. She gives an overview of what has been accomplished in the last nine years. Next she notes that Dr. Robert Gagel instructed her to build a research program. She reports that he also told her that he never thought she would be able to do it and speculates that this was a gender-motivated comment and might also have been influenced by the fact that she does not have an Ivy League degree.
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Chapter 16: The Hospitalist Program
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante talks about the Hospitalist Program, beginning with the need that this program addresses. She talks about controversy over integrating hospitalist support to care teams. She lists supporters of the Hospitalist Program and those who are interested in establishing a connection with the service. She talks about the three existing service teams and explains the difficulties that an internist can face working as part of an oncology team. She explains how a focus on general internal medical conditions has resulted in a different process for admitting patients. She notes that the Hospitalist Program is one of the most important in the Division and how its services will be important to bundled care structures as it decreases the number of consults.
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Chapter 17: Developing Educational Initiatives in the Department of Internal Medicine
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante explains her educational mission as Department head. She talks about programs to develop educational initiatives to the same level as research and clinical programs. She notes that, in collaboration with Sai-Ching [Jim] Yeung and Robert F. Gagel she wrote the textbook, Medical Care for the Cancer Patient. She actively attends conferences on cancer patients and survivors. She notes that Dr. Jeong Oh received an Educator of the Year award. She explains that everyone in the Department has exceeded her expectations and her success is due to her good faculty.
Next, Dr. Escalante explains what remains to be done to develop the Department: build up the Hospitalist Program, invest in research, and develop the Suspicion of Cancer Program, which enables patients to obtain a diagnosis and get care at MD Anderson.
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Chapter 18: Developing Station 19 and the Emergency Medical Center
Carmen Escalante MD and Tacey A. Rosolowski PhD
She explains the administrative re-structuring of Station 19 as well as changes in physical location. She explains the staffing of the Emergency Center and the challenges of hiring faculty for these positions. She recalls Station 19 when she first worked there and notes the growth and improvement in treatment of patients since that time. She explains that, in 2010, Dr. Robert F. Gagel decided that the Division of General Internal Medicine was too big and split Emergency Medicine into a separate department, with positive results. She notes that Chairman Dr. Todd is developing a research program and filling clinical positions. She also notes that the economic crisis has created a lot of stress in the emergency service.
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Chapter 19: A Chemotherapy Clinic to Serve the World’s Largest Ambulatory Clinic Center
Carmen Escalante MD and Tacey A. Rosolowski PhD
In this segment, Dr. Escalante explains her role as Medical Director of the Chemotherapy Clinic. She notes that services have grown immensely and that the Clinic serves the largest ambulatory clinic in the world.
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Chapter 20: Work on Significant Committees: Disaster Committee; Transfusion Committee; Medical Practice Committee
Carmen Escalante MD and Tacey A. Rosolowski PhD
In this segment, Dr. Escalante explains that the committees she worked on helped her grow as a leader, with each being a step up in importance. She mentions the Disaster Committee and Transfusion, then goes into detail about some of the issues examined when she served on the Medical Practice Committee. She also explains how this committee worked with the JCHO in the credentialing process and notes her role on the Credentialing Committee, indicating the types of issues addressed. Dr. Escalante explains the lessons she learned from this process and explains that this kind of close review of processes have led to evaluation of quality of care, formalized with hiring of Quality Officers. Dr. Escalante then sketches the leadership skills she acquired through her committee work.
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Chapter 21: Changes for Women at MD Anderson
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante provides an overview of the status of women at MD Anderson.
She begins by talking about what Margaret Kripke, Ph.D. (Oral History Interview) contributed to the institution after her arrival in 1984. She also points out what needs to be done, particularly in seeing women represented in executive leadership, and notes the contributions of Elizabeth Travis, Ph.D. who administers the Office of Women Faculty Programs designed to promote women. Dr. Escalante explains what she believes women bring to leadership.
Next Dr. Escalante notes generational differences in attitudes about family and work/life balance. She talks about her own difficulties in arranging time to address family issues in a Department that was inflexible about scheduling meetings. She cites changes to tenure clock policies as an indication of positive progress and notes that younger women have started a faculty moms’ group.
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Chapter 22: Changes at MD Anderson Under a New President: for the Institution and General Internal Medicine
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante offers observations about changes that Dr. Ronald DePinho has brought to the institution after assuming the role of president in 2011.
She first discusses Dr. John Mendelsohn’s contributions to the institution, recalling times of uncertainty. Today, she explains, there are shifts in leadership at the senior level and a lack of information from senior administration about budgets and institutional directions has made it difficult for her, as a Division Head, to communicate effectively with her faculty and staff.
Next, Dr. Escalante talks about the uncertain future of the Division and Department of General Internal Medicine, given that “we’re not the group that’s going to cure cancer.” She also notes that the balance between clinical and basic research is shifting, with clinical functions pressured to become much more efficient and funds for research shrinking. She explains that these shifts raise questions about faculty responsibilities, requirements for promotion.
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Chapter 23: Refining Policies While Serving on Executive Committee of the Medical Staff
Carmen Escalante MD and Tacey A. Rosolowski PhD
Dr. Escalante reviews her decade of service on the Executive Committee of the Medical Staff and notes the networking opportunities it offered. She explains how the Committee works and lists some of the issues addressed.
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Chapter 24: A Girl Scout Leader Pursues Her Passion for Women’s Advancement
Carmen Escalante MD and Tacey A. Rosolowski PhD
In this segment, Dr. Escalante explains that she is a very private person, then notes that she is very passionate about women’s rights and providing opportunities for women even in her life outside work. Because of this, she took became a leader of her daughter’s Girl Scout troop. She describes some of the activities organized for the girls and expresses how much enjoyment she derives from this role and from “teaching them to be leaders.”
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Chapter 01: Education with a Strong Humanities Thread
Michael S. Ewer MD and Tacey A. Rosolowski PhD
Dr. Ewer begins this chapter by sketching his family background: German parents who met in England, a father who was a lawyer and a communist agitator in Nazi German, and a physician uncle who had a great influence on him.
Next, Dr. Ewer begins to recount his educational path, noting that he originally intended to be a violinist and attended the High School of Music and Art in New York. He explains his continued participation in music despite his decision not to continue with training in this area once he went to Hunter College [Bronx, New York; BA, 1964]. There he majored in chemistry and credits his father with solidifying his decision to go to medical school at the University of Basel in Basel, Switzerland [MD, 1969]. Dr. Ewer explains his choice to minor in theology to take a philosophical approach to human nature. He talks about features of Swiss medical education, which stressed the clinician’s ability to take care of people. He comments on living overseas.
Next, Dr. Ewer explains the evolution of his interest in anatomy and the opportunity he had to work with the famous surgeon, Rudolph Nissen, then at the University
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Chapter 02 : Residency Training and Trials
Michael S. Ewer MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ewer covers his post medical school experiences, beginning with his Rotating Clinical Internship at Norwalk Hospital in Norwalk, Connecticut (1970-1971). He talks about his work in internal medicine and pediatrics and tells anecdotes about medical education at that time.
Next, he notes that he undertook his Junior Residency at Norfolk General Hospital in Norfolk, Virginia (1972-1973). He then explains how he came to be fired from that position.
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Chapter 03: Two Years on the “Love Boat” and Reflections on a Dissertation
Michael S. Ewer MD and Tacey A. Rosolowski PhD
Dr. Ewer begins this chapter by noting that he needed a job in a hurry after being let go and found a position as a staff physician (1972 – 1974) on a Princess Cruises ship (which served as a model for the ship in the television series, the Love Boat).
He tells several stories from his work on the ship and also comments on how this position expanded his medical practice: he set up a water potability testing lab and an ICU on board the ship. He talks about the success of these ventures and notes that the water potability studies were his first bona fide academic pursuit. He explains that he technically received both and MD and a PhD in medical school, he does not count his brief dissertation as true research, even though he made a discovery considered significant.
He also notes that the ICU was established primarily to treat older patients and explains that he had worked in a nursing home earlier in his career to pay for flying lessons.
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Chapter 04: A New Residency Program and Thoughts on Challenging the Status Quo
Michael S. Ewer MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ewer explains why he left his job with Princess Cruises returning to his medical education with a Senior Residency at Pawtucket Memorial Hospital at Pawtucket, Rhode Island, where he also served as chief resident (1974-1975). To demonstrate his belief in questioning the status quo and conventional ways of operating, he tells an anecdote about a choosing a controversial and unorthodox stress test he applied to assess cyanosis in his own son. He goes on to talk about the importance of assessing how much of medical treatment actually benefits the patient.
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Chapter 05: A Fellowship in Cardiology at Baylor University Medical Center, Dallas
Michael S. Ewer MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ewer discusses his fellowship in Cardiology at the Baylor University Medical Center (Dallas, Texas, 1975-1977).
He notes that he was very intrigued by the new cardiac ultrasound capabilities being developed (and set up the first echocardiogram progam? At MD Anderson). He explains that during his fellowship period, he was very focused on assessing the value of cardiac interventions, given that there was no data about how various interventions effected outcomes.
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Chapter 06 : Building Intensive Care at MD Anderson
Michael S. Ewer MD and Tacey A. Rosolowski PhD
Dr. Ewer begins this chapter by explaining how he found out about an opening at MD Anderson and the interview and selection process. He joined the institution in 1978 and notes that he only expected to be at MD Anderson for six months to work on the cardiotoxicity of chemotherapeutic agents.
He then talks about how he assumed the de facto leadership of the intensive care unit, a role he served until the early 1990s. He talks about a prevailing attitude that had an impact on the perceived value of intensive care: that cancer is more interesting in the early stages, when medicine could have more impact than at the end of life. He talks about the growing acceptance of critical care at the institution and also recounts advice he received from Robert Benjamin, MD [oral history interview], who told him never to get tunnel vision about medicine. He talks about working with Dr. Benjamin on a heart biopsy program and conducting two thousand procedures with no deaths.
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Chapter 07: A Shift in Philosophy and the Growth of Medical Ethics at MD Anderson
Michael S. Ewer MD and Tacey A. Rosolowski PhD
Dr. Ewer begins this chapter by explaining that in the early eighties, as a result of his work in intensive and critical care, he began to develop the philosophy that clinicians shouldn’t assume that anyone wants to be in intensive care on a ventilator to die. He speculates that intensive care at MD Anderson may have been the first setting to develop a process of “terminal weaning.” He notes how controversial the practice was, but that his group prevailed in gaining acceptance for it. He next talks about two important figures in ethical care at the institution: the head of the chaplaincy program, Sister Alice Potts, and Jan Van Eys, MD, a former head of the Ethics Committee.
Next he talks about his own role on the Ethics Committee (formed in the early 80s prior to the national mandate for academic institutions to have such a body). CLIPS He gives examples to demonstrate the conventional approach to ethical issues at the time and his new approach that considered ethical cases as an appeals court. One of these cases highlights MD Anderson’s relationship with drug companies and how these contextual factors can influence ethical decisions.
Next, Dr. Ewer explains his view of why the Ethics Committee was disbanded and how this indicates the relationship between the practice of ethics and the administration of healthcare in the institution.
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Chapter 08: The Ethics Committee at MD Anderson, Part I: an overview
Michael S. Ewer MD and Tacey A. Rosolowski PhD
Dr. Ewer begins this chapter by stressing that MD Anderson has always been interested in ‘doing the right thing for patients.’ He goes on to sketch how that desire was first formalized when the Ethics Committee was formed under President Charles. A. LeMaistre [oral history interview]. Dr. Ewer sketches the membership of the committee. He then talks about the main types of policy issues the Committee worked on during the period when he was a member and chair (1985-1993; 1988-1993). First he discusses the committee’s development of a “decision triangle” to determine the weight that patient/family input should have in medical decision making. Next he talks about how MD Anderson stopped the current (in the 80s) “go slow” code in use at many institutions. Next he explains why the Ethics Committee decided not to become involved in the IRBs and examine issues in research protocols, but focused on clinical situations.
Dr. Ewer notes that the Committee made many controversial decisions, which eventually led to its disbanding (as sketched in the last session). He discusses two cases of controversy.
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Chapter 09: The Ethics Committee at MD Anderson, Part II: Practicing Ethics in a Context of Innovation
Michael S. Ewer MD and Tacey A. Rosolowski PhD
Dr. Ewer begins this chapter by discussing some political infighting in the Ethics Committee. He then goes on to describe how much of the committee’s work was conflict resolution. He gives an example to demonstrate.
Next, Dr. Ewer explains how pushback against Ethics Committee recommendations was often philosophical and rooted in the prevailing mindset that “a patient who doesn’t survive is a failure.” He explains that that mindset cannot serve the institution as cancer care and healthcare environment has evolved over the last 40 years. CLIP He also talks about the challenges of balancing ethical concerns with the creative impulse to push the research envelop that is also so important to the institution.
At the end of this chapter, he expresses concerns for the institution, its financial health, and how MD Anderson might be positioned for a takeover, which would destroy its research identity.
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Chapter 10: Ethics after the Ethics Committee
Michael S. Ewer MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ewer sketches how ethics evolved at the institution after the Ethics Committee was disbanded in 1993. He explains that Rebecca Pentz, PhD, was appointed head of ethics (though was uncertain if it had been formalized as a department at that time) and recounts a story to demonstrate how her perspective on handling ethical situations differed from his own. He notes that some of the original members of the disbanded ethics committee joined Dr. Pentz’s group.
Next he talks about Colleen Gallagher, PhD, who came to MD Anderson in XXX to head the Department of Integrated Ethics. He describes the leadership she has built and notes similarities in their perspectives. He talks about their collaboration on a book.
Next, Dr. Ewer explains his terms, “macro ethics and micro ethics.”
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Chapter 11: Bringing a Legal Perspective into Ethics Work
Michael S. Ewer MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ewer explains why he earned a legal degree (JD 2001, Advanced degree in Health Law) and the impact it has had on his thinking about ethics. He begins by how he first thought of law school when he worked for Princess Cruises because of a chance encounter with Earl Warren, former Chief Justice of the Supreme Court. He sketches the process of getting into law school at the University of Houston then gives examples to demonstrate how this perspective has shaped his thought.
Next, Dr. Ewer talks about his roles as Special Assistant to the David Callendar (1994-1997), the VP of Patient Care.
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Chapter 12: Views on Changes at MD Anderson
Michael S. Ewer MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ewer offers his perspective on how the institution has changed since 2011. He offers his view of Dr. Ronald DePinho’s vision for developing MD Anderson’s research capacity and the struggles the institution had implementing this during a period of financial change in healthcare. He then talks about offering his services to Dr. Peter Pisters, the new president of MD Anderson.
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Chapter 13: Research on Cardiology
Michael S. Ewer MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Ewer sketches his research on the cardio-toxic effects of chemotherapy. He tells the story of one set of trials focused on Herceptin. He talks about formulating a controversial theory of Type 1 and Type 2 cardiotoxicity. At the end of the chapter, he sketches his formal retirement in 2013 and changes to his partial appointment thereafter.
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Chapter 14: Final Comments
Michael S. Ewer MD and Tacey A. Rosolowski PhD
Dr. Ewer begins this chapter by looking back at the impact he feels he has had on the institution. He notes that he wishes he could have had more of an impact on young faculty in cardiology, helping them to think outside of the box in the ways that are essential to address cardiac issues in cancer patients. He notes that he is currently working on a case study of basal cell carcinoma. At the end of the session, he comments on the profession of oncology.
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Chapter 01: From Veterinary Medicine to Cancer Research
Isaiah J. Fidler DVM, PhD and Tacey A. Rosolowski PhD
In this Segment, Dr. Fidler talks about his youth in Israel, the decision to study veterinary medicine that brought him to the United States in 1958, and the later events that inspired his shift from veterinary medicine to the study of cancer in humans. In 1961 he received his B.S. in Veterinary Medicine at Oklahoma State University, Stillwater, Oklahoma. Dr. Fidler was awarded his Doctorate in Veterinary Medicine from the same institution in ’63. He describes the difficulties of setting up a veterinary practice upon returning to Israel, where pet owners chose to terminate the lives of even beloved pets much more quickly than they do today. “I didn’t work so hard to become an executioner,” he recalls, explaining decisions that took him from private practice, to pharmaceutical research, and eventually back to the U.S. for a fellowship at the University of Pennsylvania Veterinary School, where his work on animals with cancer sparked his passion for problems of metastasis. After receiving a fellowship that enabled him to conduct basic research at the U. Penn. Medical School, he was advised to apply to the Department of Pathology, where many scientists were conducting research on metastasis. He received his Ph.D. in (human) Pathology from the University of Pennsylvania Medical School (Philadelphia) in ’70. There he framed the basic question that would govern his career: how cancer moves from the primary tumor via the circulatory system to create secondary tumors and ultimately the metastases that are still the primary killers of cancer patients. After receiving his Ph.D., he went to work in the Department of Pathology in the U. Pennsylvania Dental School with a Luther Terry Fellowship(late ’70).
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Chapter 02: A New World of Research at University of Pennsylvania: Focusing a Research Career
Isaiah J. Fidler DVM, PhD and Tacey A. Rosolowski PhD
Dr. Fidler details how he began to look more deeply into the question of cancer cell differentiation, a groundbreaking discovery that was ultimately published in Nature. (Dr. Fidler shows the interviewer a Plexiglas containing a unit he invented to facilitate injection of cells into the tail veins of up to 100 mice per hour, underscoring the resourcefulness that a researcher had to have to move ahead quickly with a study.) Through this success, he was recruited to join the National Cancer Institute at Frederick, Maryland. His wife-to-be, Margaret Kripke, known for her pioneering work in photoimmunology, was also hired in a concurrent recruitment, and he describes how Dr. Kripke challenged him with the question that inspired a new line of research: “How do you know whether the cells you are culturing from a line are a selection or an adaptation?” His discovery that the differentiation of metastasis cells is a priori “revolutionized the world,” he states, noting that “you cannot treat a heterogeneous disease with homogeneous therapy” –the origin of individualized therapy. Dr. Fidler then explains connections between Paget’s “seed and soil” theory and his next experiments with transplanting metastatic cells between the organs of mice.
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Chapter 03: Metastasis: A Regulated Process
Isaiah J. Fidler DVM, PhD and Tacey A. Rosolowski PhD
Dr. Fidler begins this segment by explaining that, in contrast with the prevailing belief (in the 70s) that cancer is the “ultimate expression of cellular anarchy” and that metastasis is random, his work has shown that cancer is a regulated process along every step of the way; similarly, metastasis is predictable. In response to a question about why scientists held (and still hold to) these conventional assumptions about cancer, Dr. Fidler notes how difficult it can be for a scientific community to accept innovative ideas. He then talks about significance of training clinicians in research and the basic sciences.
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Chapter 04: Reflections on Research; Becoming a Citizen; Influences: Words of Wisdom
Isaiah J. Fidler DVM, PhD and Tacey A. Rosolowski PhD
In this character-revealing segment, Dr. Fidler talks about his ability to think outside the box. He recalls becoming a citizen and some of the cross-cultural challenges he faced. He recalls family members who influenced his independent thinking. He reflects on the contributions he has made to his field and the influence of Dr. Judah Folkmann on his thinking.
He ends this session by talking about the implications of his discoveries for research, its links to the current push for individualized care. He also questions how quickly they have been translated into therapies that will benefit patients.
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Chapter 05: Recent Research: A Focus on Brain Metastasis
Isaiah J. Fidler DVM, PhD and Tacey A. Rosolowski PhD
Dr. Fidler discusses his research focus for the last four years: brain metastasis. He emphasizes that very few researchers focus on brain metastasis, largely due to the complexities presented by the blood-brain barrier. Dr. Fidler explains that the blood-brain barrier is already compromised in metastasis, a fact that has implications for treating as well as studying the condition. He discusses his work on astrocytes, which protect tumor cells from chemotherapy, until he and his group discovered a drug (now patented) that interrupts the astrocyte’s protective activity.
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Chapter 06: Brain Metastasis: Activating the Body’s Capacity to Heal Itself
Isaiah J. Fidler DVM, PhD and Tacey A. Rosolowski PhD
Dr. Fidler begins this segment by noting his roles as the president of the International Differentiation Society and as the youngest president of the American Association for Cancer Research. He talks about how leadership of professional societies. He then returns to a discussion of the mechanisms of brain metastasis. He notes that the death of his friend, Judah Folkman, led him to re-evaluate his life and step down from his administrative responsibilities, a move that left him with more time to think about his research and investigate the role of astrocytes. He believes that intervening in the role of astrocytes in interacting with the genetics of metastatic cells has implications for treatment of many different diseases as well as other forms of cancer. He then turns back to a discussion of his work on activating macrophages to attack metastasis, quoting from “The Doctor’s Dilemma,” a play by George Bernard Shaw (1911), to dramatize that the body has all it needs to cure itself: “Nature has provided in the white corpuscle… a natural means of devouring and destroying all disease and germs…. Drugs are a delusion.”