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 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.”
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Chapter 07: Translational Research at MD Anderson
Isaiah J. Fidler DVM, PhD and Tacey A. Rosolowski PhD
Dr. Fidler explains that changes at NCI had threatened to limit his research freedom and motivated his move in 1983 to MD Anderson, where collaboration with clinicians was fostered: his main goal at that time was to understand metastasis at a clinical level. He speaks about his work training clinicians, many of whom now work at MD Anderson. In the final fifteen minutes of the session, Dr. Fidler tells an amusing anecdote about how he came to occupy the R.E. “Bob” Smith Distinguished Chair in Cell Biology (as his wife, Margaret Kripke was simultaneously offered the Vivian Smith Distinguished Chair in Cell Biology). He describes his relationships training Japanese and Korean clinicians, and notes that the work at MD Anderson he is most proud of is training the next generation. He closes with an anecdote about his most significant award, though he also quotes words attributed to King Solomon: “Don’t do things for the sake of an award.”
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Chapter 01: An Interest in Sports Shapes a Fascination with the Body
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch begins the interview by sketching his family background and then talking in detail about his lifelong interest in sports. He explains that he “understands the world through sports and sports metaphors.” He explains the process of visualizing how to execute a series of plays and links this to mindfulness skills he would become interested in as a medical professional. He cites his mentor, Dr. Waun Ki Hong [Oral History Interview] who told him (ironically) that his job is “easy,” since meeting healthy goals is a step-by-step process. He observes that his interest in sports probably led to his fascination with the physical body.
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Chapter 02: An Early Desire to Become a Doctor and a Range of Interests and Gifts
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch recalls that he decided to become a physician at the age of eleven, inspired by physicians on TV shows. He notes that his grandmother took his interest very seriously and bought him Gray’s Anatomy. He also observes that he was “drawn to complexity” very early and that this interest became a theme in his career.
Dr. Fisch talks about his high school experience, recalling that he was a motivated, hard worker with many extracurricular activities. He also explains why he considers himself a creative person, noting that his style creativity lends itself to working in groups, a characteristic important for conducting team science. Dr. Fisch explains that he loves team science for the way it brings together people from different disciplines. He makes observations about his inspirational style of leadership, noting that his love of leadership roles began in high school. He also notes that he is at his best when he is in the state referred to as “flow.”
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Chapter 03: Challenges in College and Medical School; Seeking a Specialty
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch talks about selecting his college (University of Virginia at Charlottesville, BA conferred 1986) for financial reasons and explains the value of a state education. He notes that he was not a top student and had to work very hard as an undergraduate. He notes that he discovered his lack of visual/spatial ability, which made certain courses very difficult and caused him to consider a career in nursing.
Next, Dr. Fisch talks about his medical education at the University of Virginia Medical School (MD conferred in 1990), noting how he loved surgery, but his lack of visual/spatial ability made this specialty impossible for him. By working with surgeons, however, he learned to love clinical medicine and post-operative patients in particular because they were “endlessly complicated.”
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Chapter 04: Early Research Experiences Leads from Infectious Diseases to Hematology/Oncology
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch describes the evolution of his interests leading to his focus on oncology.
He discusses a college research projects and tells an anecdote about an ethical mistake he made while interacting with participants.
Next, Dr. Fisch explains that he discovered hematology/oncology during his rotations and he was attracted to the field because it afforded the opportunity to build long-term relationships with patients and their families. He also notes that he was inspired by experiences of an uncle and his grandfather with cancer.
Dr. Fisch explains why he tracked into hematology/oncology and was always focused on academic medicine and a career in research. He describes his studies in medical school reflects on his residency (Internal Medicine, University of Virginia, 1990-1993).
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Chapter 05: Bringing Focus to Patients’ Emotions
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch describes the process of entering a fellowship program in Hematology/Oncology and General Internal Medicine at Indiana University at Bloomington. He then explains that it was during this time that he became interested in “things that were happening to cancer patients that we weren’t talking about.” He gives examples, first discussing the problem of depression in cancer patients. He then explains that on the transplant service, patients were uniformed about treatments and he did a project on the effect of informed consent on emotions.
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Chapter 06: Entering the New Field of Symptom Experience
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch explains how his career path evolved once he decided, during the second year of his fellowship, to focus on symptom experience. He was involved in a research project on cisplatin adducts when he decided to focus on quality of life research and realized he needed additional training to work in this new field. He took another fellowship in general internal medicine and worked with Dr. Robert Diddis, who advised him to do a Masters in Public Health (Indiana University, Bloomington, Indiana; MPH conferred in 1997). He explains how this training benefited his approach to quality of life problems.
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Chapter 07: Coming to MD Anderson to Learn Palliative Care on the Job
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch explains how he moved to MD Anderson from a position as Assistant Professor at the University of Virginia Health Science Center in Charlottesville. He recalls management issues in Charlottesville that helped convince him to take another position. He talks about presenting a paper on cancer and depression at a conference held by the American Society of Clinical Oncology. There he met Dr. Eduardo Bruera, who had been recruited to set up a palliative care program at MD Anderson. Dr. Fisch describes the advantages of the offer he was made to join MD Anderson to help establish that program, working from the Department of Critical Care and Anesthesiology.
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Chapter 08: Building a Palliative Care Program at MD Anderson
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch talks about the challenges faced as he and others set up palliative care program at MD Anderson from scratch. He defines palliative care, which he stresses is much broader than pain management. He also explains how the culture of MD Anderson worked against acceptance of palliative care. Dr. Fisch notes that the palliative care program stressed quality of life and that a decision was made to change the name to the Supportive Care Center to help overcome resistance . He gives examples of how he and other palliative care providers would figure out how to “create an interface” with treating oncologists, so they would integrate a palliative care provider into the team.
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Chapter 09: A Precarious Time for the Palliative Care Program
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch talks about a period when the Palliative Care Program seemed less valued than anesthesiology and the administration was splitting off groups from the department of Anesthesiology and Critical Care. He recalls that Dr. Bruera interviewed for a new job and he himself began calling about positions in Virginia. He tells an anecdote about where he was on 11 September 2001. He explains why he remained at MD Anderson and how, after a meeting with leaders, the situation for the department and program seemed to improve.
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Chapter 10: Building the Reputation of Palliative Care
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch sketches how the talented team in palliative care was successful in securing regular referrals from a few oncologists, building the program’s reputation. He tells anecdotes about the surprising and positive results they would get from integrating palliative approaches into treatment protocols.
At the end of this chapter, Dr. Fisch shares lessons he learned about how to interact successfully with oncologists to ensure they would call on him as a palliative care providers.
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Chapter 11: Defining the Scope of General Medical Oncology
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch begins with an explanation of why he felt like a disciplinary “refugee” when he arrived at MD Anderson and joined the Department of Critical Care and Anesthesiology.
He then defines the purpose and scope of General Medical Oncology as a practice: the long-term care of patients with cancer when overall care is the focus, including delivery of pharmaceuticals and injections and after care following surgery, radiation or chemotherapy. The GMO clinician work with a patient over a lifetime. He notes some controversy in the field over when the GMO clinician “lets go” of a patient who is transitioning to survivorship.
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Chapter 12: Reimbursement for General Medical Oncology; the Value of Generalists in a Field of Subspecialties
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch begins this segment by explaining the challenges of arranging insurance reimbursement for services and value that general medical oncologists deliver. He also notes that losing connection with the GMO clinician can be very setting for a patient, and he gives examples of problems that can arise.
Dr. Fisch also explains that “people’s health stories are not completely oncology.” They often have co-morbidities and challenges can arise in bringing together specialists to fully treat a patient. In a fragmented system organized by subspecializations, often the patient must serve as “project manager” of his or her own care.
Next Dr. Fisch talks about the value of having a generalist perspective in this situation. He then talks about LBJ Hospital. He comments that eventually generalists will define the pathways into a patients care and then specialists will take over.
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Chapter 13: The Community Clinical Oncology Program (CCOP)
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this segment, Dr. Fisch talks about the history of the Community Clinical Oncology Program (CCOP). (He has served as Medical Director since 2004.) He notes NCI involvement providing funds for community based initiatives and explains the purpose: to develop clinical trials linked to the community contexts where eighty percent of patients are treated. He characterizes MD Anderson’s reputation as a “solution shop” driving treatment, with the CCOP’s different approach to treatment and research, including that community practice has something to teach about treatment.
He then notes that, as Medical Director, he served as a facilitator and broker for trials. He talks about how CCOP trials and research worked at MD Anderson, including how biases against randomized trials worked into the planning process, with efficacy trials conducted with MD Anderson patients and Phase 3 trials conducted in the community. He gives an example.
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Chapter 14: The Community Clinical Oncology Program (CCOP); Transitioning to Research in Cancer Control and Prevention
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this segment, Dr. Fisch explains how research conducted via the CCOP transitioned from a focus on treatments to a focus on prevention, cancer control, and symptom management.
He first talks about his role as a facilitator setting structures for research collaborations. He notes that community settings offered a comprehensive view of patients, driving his own interest in symptom management. He talks about the overlap of different specialties whose borders are all debated. He illustrates with the example of pain management.
Next he sketches the factors that led to his decision to “sunset” the treatment focused trials. He was partnering with Dr. Blyer, who shared his vision. The NCI was also requiring that more research focus in these areas. Many regional research groups were putting together trials focused on prevention and control.
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Chapter 15: The Community Clinical Oncology Program (CCOP); Finances, Organization of Research, Some Examples
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch begins this segment by noting that he began looking for experts to begin developing the new focus of the CCOP. He explains why MD Anderson physicians need community based patients.
He explains finances: the program pays for the infrastructure, not the drugs and other related costs. He discusses strategies researchers use to address this challenge. He gives an example of a trial run by Dr. Lorenzo Cohen comparing the impact of meditation versus relaxing music on patients’ inflammation cascade. He discusses how to convince community physicians of the value of such studies.
Dr. Fisch notes his role as facilitator and stresses the importance of being respectful of the research issues that behavioral scientists confront. He gives some examples.
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Chapter 16: A New Department of General Medical Oncology
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch notes that the Community Clinical Oncology Program (CCOP) offered a platform to create a new Department of General Medical Oncology. He tells the history of how the department was formed. He explains how the program at LBJ Hospital was involved as well as Dr. James Cox’s [Oral History Interview] mandate to expand radiation oncology services beyond MD Anderson proper.
Given this complexity, Dr. Fisch notes, it made sense to put all generalists together in a new department. He lists the functions included and talks about the challenges of creating cohesion in the diverse department.
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Chapter 17: Concern about the MD Anderson Brand as the Satellite System Grows
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch responds to a question about the growing acceptance of General Medical Oncology at the institution.
He first explains the concerns about brand and quality of care that faculty have had as the satellite system grows. Dr. Fisch explains decisions that had to be made about protocols offered in satellite centers. He talks about his own view of the controversy and notes that it takes skill to work with community people and subspecialists alike.
He notes that “the MD Anderson story has been about subspecialization” and “becoming like our competitors is difficult.” He explains that MD Anderson’s general medical oncologists have raised the bar of care in the community and at the satellite centers. He also stresses the importance of building shared research programs and harmonizing budgets to stress that satellite centers create a shared win for MD Anderson rather than competition.
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Chapter 18: Accomplishments at MD Anderson and a New Career Opportunity
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch then talks about his plans to leave MD Anderson for a position as Medical Director of Medical Oncology Solutions at Ames Specialty Health in Chicago, Illinois. He notes that, with changes at the institution, general oncology and cancer control are not top priorities, and he wanted a new opportunity to rise to the next level.
Dr. Fisch talks about the skill set he will bring to Ames, where he will be assessing value-driven quality care. It is also an opportunity for him to learn a great deal, saying “It will be like doing a fellowship in managed care” and give him an opportunity to have an impact on care.
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Chapter 19: International Travel and Providing Team Care to VIP Patients
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch notes that global oncology has become an increasingly important dimension of MD Anderson’s business. He explains that, as MD Anderson set up links with international partners, he helped them set up team-based treatment plans, multi-disciplinary care, and research. He gives examples of the types of research projects that might be set up.
Dr. Fisch talks in depth about his participation in international clinical care teams making “global house calls.” He explains that his role was to offer palliative care, manage anxiety, sleeplessness, and rehabilitation, sometimes spending weeks abroad. He notes that these special trips helped clarify the services he could offer as a general medical oncologist and demonstrate their value to the patients and the institution. He also describes how people would receive MD Anderson faculty overseas, which helped increase his own feeling for the institution.
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Chapter 20: The PREDICT Trial: A Unique Study of Biomarkers for Cardiotoxicity
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this segment, Dr. Fisch talks about the PREDICT trial, a landmark study he conducted in the late 2000s on predictors for cardiotoxicity in patients treated with anthracyclines. He explains the effects that anthracyclines can have on the heart and notes that this is a survivorship treatment issue. The study asked Can you use point-of-care biomarker testing to assess cardiac toxicity of chemo regimens. Dr. Fisch notes that when this project began around 2007, cardiac studies were very new. He describes some challenges enrolling patients (eventually enrolling over five hundred) and reports the outcomes. He says that it was a good descriptive study, unique in the realm of oncology. His role, he explains, was facilitating set up and implementation of the project and executing the trial as part of a team effort.
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Chapter 21: A Landmark Study on Chemotherapy and Depression
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch begins this chapter by explaining that as Chair of the Eastern Cooperative Oncology Group’s Symptom Management Committee, he wanted to study how to manage patient symptoms, but there was a lack of basic data about symptom experience. This led to a landmark study of more than three thousand patients that surveyed a broad range of symptoms and practice patterns for lung, breast, colorectal and prostate cancers. (He observes that such long-term studies sometimes fail, discouraging some researchers in the process.)
Dr. Fisch notes that the SOAPP study continues to make a unique contribution. An unusual feature is that the study has a website (http://www.ecogsoapp.com/) to facilitate dissemination of information. Data also is available through twelve published papers, with more coming. Dr. Fisch talks about the difficulties of maintaining the website when money runs out.
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Chapter 22: An Emerging Field of Cardio-Oncology
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
In this chapter, Dr. Fisch notes that field of cardio-oncology emerged over the last seven or eight years, concurrent with the PREDICT trial. He observes that the field is becoming important because new classes of drugs are cardio-toxic and many of the molecular and genetic pathways involved in cancer are also important to cardiologists. He notes that his own contributions to this field have become increasingly important.
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Chapter 23: Compassionate Care
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch begins this chapter by defining compassionate care along with the division of labor required between symptom management, communication and inter-disciplinary team work. He stresses that “words matter, how you talk about things matters,” and notes the importance of learning how to ask patients questions to encourage them to tell their story, though current time pressures make this challenging. He stresses, however, that there are skills a physician can learn to make patients feel they are receiving compassionate care.
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Chapter 24: The Schwarz Rounds at MD Anderson and Mindful Medical Practice
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch talks about the Schwarz Rounds implemented at MD Anderson in 2007. He describes the focus on the experiences of the care providers and the emotions that come up for them while offering care to patients. He explains that the need for the Schwarz Rounds arose because the Medical Oncology fellows were experiencing fatigue and burnout. Dr. Fisch explains why the program stopped.
Next, Dr. Fisch talks about mindful medical practice, which helps reduce burnout and fatigue among. He gives examples of the stresses of an oncologist’s job. He notes that the value of awareness is increasingly recognized in medicine. He has worked to bring visibility to the issue at MD Anderson by drawing attention to research that shows how mindfulness can ensure delivery of high-quality care.
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Chapter 25: Exploring Uses of Social Media
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch talks about his fascination with social media and his attempts to introduce its creative use at MD Anderson to communicate more effectively with patients and the public.
Dr. Fisch talks about his introduction to Twitter and his efforts to use it in healthcare, beginning with the Community Clinical Oncology Program. He explains why ASCO now has a Social Media Working Group. (Dr. Fisch serves on that committee.) Dr. Fisch explains the impact that social media can have on individuals and institutions and stresses the importance of making education about social media part of medical curricula. He states that MD Anderson has made some headway in this area, and he lists the consequences of not keeping up.
Dr. Fisch next talks about his involvement in a clinical trial that proposed to use social media to increase patient enrollment. He contributed to the grant, which the South Western Oncology Group has funded.
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Chapter 26: MD Anderson’s Focus on Patient Experience
Michael J. Fisch MD, MPH and Tacey A. Rosolowski PhD
Dr. Fisch talks about two initiatives to involve patients as partners in planning processes: the Patient Experience Steering Committee and the Patient and Family Advisory Council. Dr. Fisch notes that though he received invitations to serve on both committees, he was given no charge or mission and there is no natural momentum on patient experience at the institution. He talks about the advantages to the institution of addressing patient experience and notes that MD Anderson’s attention to this matter is a response to an Institute of Medicine report that other institutions are moving ahead.
Dr. Fisch then observes that if an institution is not patient-centered, shifting focus is difficult. He suggests ways in which MD Anderson communicates that it is not patient centered. He then talks about Leadership Rounds, which help leaders see the institution from a patient’s perspective. He acknowledges that the institution is listening to patients more and coming up with creative ways of reorganizing care.
At the end of the session, he makes some final comments about working at MD Anderson.
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Chapter 01: Growing Up in a Small Town; Medical Education
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall gives a brief overview of his family life then notes his first interests in science. He touches on his experiences at the Baylor College of Medicine and explains that his interest in primary clinical care and in health populations began at this time, particularly when he spent time in his home town working with family physicians and saw a wide range of health problems. He also cites the influence of school integration –the seventies were a time when the nation was changing and there were opportunities to learn and grow.
Dr. Foxhall notes that his interest in cancer and cancer prevention grew during his residency and the first years of his private practice at Houston Northwest Medical Center where he was able to follow patients over many years and recognized the missed opportunities to intervene with patient and avert cancer risk.
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Chapter 02: A Growing Interest in Cancer, Cancer Prevention, and First Connections with MD Anderson
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall notes that his interest in cancer (and tobacco) began during his private practice; he mentions other professionals in Houston who were also focusing on tobacco. He lists the projects he implemented during this time and notes his involvement in the Texas Academy of Family Physicians and its subgroups focused on prevention.
Dr. Foxhall then explains that he met and worked with Dr. Joseph Painter of MD Anderson was also interested in community outreach at the time. He describes the projects the worked on to educate physicians (part of a national movement). Dr. Foxhall also explains that it was key to demonstrate to physicians the value of collaborating with a large cancer center. He explains the previous mindset physicians held about their relationship to cancer centers.
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Chapter 03: An Opportunity to Leave Private Practice for MD Anderson
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall first describes the ways in which he and Dr. Joseph Painter worked together in the late 80s. He then explains why he decided to leave private practice at that time: Dr. Foxhall first took a faculty position with UT Health Science in Family Medicine in 1991. In 1993 Dr. Foxhall was hired to help Dr. Painter with outreach and educating primary care physicians.
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Chapter 04: MD Anderson’s Outreach Programs—the Physician Relations Programs
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Here, Dr. Foxhall describes what was involved in the Outreach Programs, which resulted in the Physicians Relations Programs. He notes the ill will created immediately after the Texas Legislature’s 1995 decision to allow patients to self-refer. He talks about the scope of the programs set up to preserve patients’ connection to the primary care physician during and after cancer treatment; he also outlines the significance of the primary care physician’s role in this process.
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Chapter 05: The Charity Care Program
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall describes MD Anderson’s work with indigent patients and the Charity Care Program.
He notes that MD Anderson was founded as a charity care institution and sketches the later history of this obligation. He explains the financial stresses this caused the institution. He explains that he worked with the Charity Care Program to reduce costs while paying for care, helping to stablilize the financial situation. He notes the partnership with the Lyndon Baines Johnson Community Hospital to serve charity cases.
Dr. Foxhall observes that patients at MD Anderson in general represent the cancer levels in the general population, though MD Anderson sees insured patients and the rates of the uninsured in Houston are very high (1/3 of population). He explains why the level of uninsured is so high.
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Chapter 06: The Office of Health Policy: Focusing on Outreach
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall lays out the history of the Office of Health Policy. He explains that it originated in the need to reach out to community physicians and develop their relationships with MD Anderson. He explains how a team was created to conduct surveys and also to work with programs internal to MD Anderson. Dr. Foxhall explains the issues that community physicians had in sending their patients to MD Anderson, largely in the area of need for more communication with the institution after their patients went into treatment at the institution.
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Chapter 07: The Office of Health Policy: Focusing on Survivorship
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall goes into detail about the Office’s focus on survivorship, including connections with community physicians and mechanisms for survivorship information to community physicians so they can partner in a cancer patient’s after care.
He explains the origins of the Survivorship Initiative and discusses his role on the Survivorship Committee and other programs designed to create an integrated approach to care.
He lists health policy challenges that have an impact on survivors. He describes results of studies that have confirmed the benefits of survivorship programs for patients.
Dr. Foxhall sketches the history of thinking about survivorship. He lists key people at MD Anderson involved in the survivorship program. He also lists some of the places he has been globally (through the GAP program--Global Academic Programs—MD Anderson’s network of sister institutions) to speak about survivorship, stressing that the focus on survivorship is a world issue.
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Chapter 08: Work that Takes Eternal Optimism
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall responds to a question about those particular gifts that suit him and others to policy work. He explains that a focus on outreach beyond the institution is key, as well as a comfort with collaboration. He also talks about the commitment to the institution and to its mission to cure cancer and a commitment to a sense of equity in reaching out to all patients. It’s a challenge financially to do that in an environment of limited funding and requires a high level of patience, persistence, and optimism to move issues forward.
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Chapter 09: Associate Vice President of the Office of Health Policy
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall talks about his role as Associate VP for Health Policy.
He defines the scope of “health policy” and gives examples of policy issues addressed in collaboration with other health organizations. He stresses MD Anderson’s role as a resource and support for public officials who lobby for health policy in the legislature.
Dr. Foxhall next explains the relationship between the Office of Referral Relations the Office of Health Policy.
Dr. Foxhall next talks about the big projects he undertook as Associate Vice President: creating the network of physician referrals; a program to educate physicians about cancer screening; creating an internet based educational outreach program.
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Chapter 10: The Texas Cancer Data Center
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
He explains the funding and mission to collect information from the state cancer registry and convert it to a searchable system that includes statistics on patients and other information. He explains how the system evolved, shifts in its management, and the programs it includes. He notes that a related education program has reached about 500 nurses and 1000 social workers with information about programs for patients. He notes that this was one of the first data centers of this type in the country.
Dr. Foxhall notes partnerships with the American Cancer Society and with other public health agencies to educate patients about cancer risk. He also notes the work with the Harris County Healthcare Alliance to support prevention programs in community clinics and improve access to healthcare for low income patients. (Additional information on the Texas Cancer Data Center is presented in Segment 09.)
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Chapter 11: Grant-Funded Projects in the Office of Health Policy: The Texas Cancer Data Center
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Here Dr. Foxhall talks about a number of key projects run by the Office of Health Policy. He first follows up on a discussion of the Texas Cancer Data Center (discussed in Segment 10), explaining difficulties in collecting information in the early days of the project and then sketching how services have evolved an been updated since the late eighties. He lists the kinds of information that the Center provides, its heavy use (around one million hits per year) and its impact. Dr. Foxhall notes that it is used as a platform for educational programs supported via CPRIT money. He also describes how the Center provides information for individuals with no insurance and education for nurses and social worker to help people get access to care. This need has been intensified since Texas made the decision not to participate in the Medicaid portion of the Affordable Care Act.
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Chapter 12: Grant-Funded Projects in the Office of Health Policy: Services for the Uninsured
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Here, Dr. Foxhall describes initiatives supported by the institution and by federal money that are designed to reduce cancer risk among low-income individuals. He first talks about the tobacco program, mentioning the ASPIRE program designed to reach maximize tobacco avoidance/cessation in adolescents. Dr. Foxhall explained how the Office of Health Policy helped support this project. Next he talks about the project, Ask, Advise, Connect, a quit line service that services HIV patients. Dr. Foxhall notes that this is a good example of how the Office of Health Policy identifies a government program that can provide funding for initiatives relevant to the needs of at-risk individuals. He describes the individuals involved in organizing the funding mechanisms and notes where difficulties arise in the process. Dr. Foxhall explains that this is a slow and often frustrating process, but the benefits come when “you see that you help someone” and can track progress with use rates.
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Chapter 13: Grant-Funded Projects in the Office of Health Policy: Screening for Colorectal Cancer and Breast Cancer
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall talks about projects that support screening for colorectal cancer and for breast cancer (via a mobile unit). The Office of Health Policy “provides the infrastructure,” identifying an opportunity and partners who can help accomplish goals that fit with MD Anderson’s mission. He provides additional information about both of these screening programs.
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Chapter 14: Grant-Funded Projects in the Office of Health Policy: Cancer Survivor Management
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall talks about a grant that the Office is now preparing for Cancer Survivor Management –a training program that will be instituted in clinical around the state. Dr. Foxhall explains that his “love in life is education,” and that such projects are very significant for him. He explains the elements of the training program: identify survivors; create care plans to maximize the effectiveness of aftercare following MD Anderson guidelines; follow up with providers to help them adhere to best practices; monitor patients receiving services. He discusses a tele-mentoring system that will be used to provide support for health care personnel. He talks about collaborating on the Cancer Survivorship Manual that will be published this summer.
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Chapter 15: Educational Projects with Physicians and Medical Students
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall talks about the importance of educational outreach to the mission of the institution.
He lists the impact that educational initiatives have in the community.
Next he describes the Preceptorship Program initiated in the eighties at the UT Medical School in Houston. The challenge, he explains, was (and is) that “we need more primary care physicians” and medical students need to know that family medicine can be a viable career path. Dr. Foxhall explains that the Preceptorship enables medical students to spend a month with a family physician. He talks about the importance of targeting students early. He notes that in a national ranking of states and the availability of primary care physicians, Texas ranks #42. The grant supporting the Preceptorship was renewed several times and the program has been successful at convincing medical students to enter family medicine. Recently funding was cut and then transferred to the Texas Council of Family Physicians.
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Chapter 16: Projects in Cancer Prevention; the Lung Cancer Moonshot; CYCORE
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall talks a cancer prevention programs and the place of the lung cancer screening trial in the Lung Cancer Moon Shot. He then talks about CYCORE, a program that uses electronic devices to address patient needs and treatments. This project was funded by stimulus money and uses a tele-monitoring device created by Time Warner. He describes some of the benefits and also mentions the video conferencing systems that can support patients. Dr. Foxhall notes that the Office tries to keep up with the latest electronic advances that can help patients.
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Chapter 17: A Major Challenge: Serving the Uninsured as Health Care Changes
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall talks about the challenge of expanding access to care, his role as a governor-appointed member of the Texas State Health Services Advisory Council (2009 – present), and the challenge of transitioning from a fee for service system to a value-based care system.
He notes that Texas ranks number one in numbers of uninsured individuals, but there are early signals that the Affordable Care Act is reducing those numbers, though the issue is complicated by the decision Texas made not to participate in the Act.
Dr. Foxhall describes services provided by the Texas State Health Services Advisory Council and gives examples.
He defines value-based care, founded on careful documentation of care provided and outcomes. He explains the related concept of “the triple aim”: to improve quality of care, to reduce cost, to increase levels of patient satisfaction, noting that some policy makers include a fourth aim, insuring equal access to care. He explains why the status quo cannot continue.
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Chapter 18: Impact of Institutional Growth on the Office of Health Policy
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall comments on how the MD Anderson’s growth since the nineties has had an impact on the activities of the Office of Health Policy.
He notes the huge expansion of external connections with network affiliates and also with international connections, with MD Anderson adopting the CDC’s Comprehensive Cancer Control Program to organize information provided to the external connections. He sketches the history of that program. He notes that the Lung Cancer Moon Shot is part of the Prevention and Control Platform.
Next, Dr. Foxhall talks about how the institution’s financial structure has changed: healthcare delivery has changed and it is increasingly difficult to secure funding for research and also raise income from patient care. He notes that the institution’s ability to provide personalized and compassionate care for patients has not changed, because it is imbedded in the culture and tradition of MD Anderson.
He ends this segment with comments on how MD Anderson is seen by the community.
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Chapter 19: The MD Anderson Presidents; No Plans for Retirement
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
Dr. Foxhall begins this segment with comments on MD Anderson presidents, Dr. Charles LeMaistre, Dr. John Mendelsohn, and Dr. Ronald DePinho. He then notes that he has no immediate plans for retirement (he is “having too much fun”), and explains that intends to further the tobacco agenda and to develop survivorship management, positioning the institution to work within more effective shared care models for survivorship.
Dr. Foxhall comments on the legacy he will leave: a network of collaborative connections designed for cancer control and management. He comments briefly on his love of travel, the enjoyable time he spends with his children, and his hobby, landscape photography.
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Chapter 20: Texas and the Affordable Care Act
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall discusses the Affordable Care Act (ACA) passed on 23 March 2010 and its impact on Texas Health and the activities of MD Anderson. He begins by noting that Texas has the highest rate of uninsured individuals in the nation and that only a limited number of categories of individuals are eligible for Medicaid, with the result that a percentage of individuals who are diagnosed with cancer are uninsured. He explains the hopes that the ACA would provide coverage to the uninsured, to cancer survivors unable to get affordable insurance, and to low income individuals in need of cancer prevention services. He then goes into more detail about the Texas limitations on Medicaid as well as some alternatives under discussion in the Texas Legislature to provide coverage to ineligible individuals.
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Chapter 21: MD Anderson’s Response to the Affordable Care Act; ACA Requirements; Value-Based Purchasing
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall continues discussion of the Affordable Care Act.
He sketches MD Anderson’s programs to help with financial assistance.
He then talks about the requirement that institutions report on the quality of care. He gives examples to explain what is involved in this process, noting that historically, medical practices have not had enough transparency in care and outcomes. Reporting enables consumers to have a better idea of how well providers are doing. In addition, this information will be used as a basis for determining payment. Next Dr. Foxhall explains that the ACA requires that institutions participate in an Accountable Care Organization. He explains the reasoning for this, and notes that it is not clear how a specialized hospital will engage with them.
Next Dr. Foxhall talks about the ACA’s requirement for Value-Based Purchasing, giving examples of how examining processes has revealed unnecessary costs in deliver of care.
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Chapter 22: The Future Under the Affordable Care Act: the Value of Prevention Services
Lewis E. Foxhall MD and Tacey A. Rosolowski PhD
In this segment, Dr. Foxhall sketches what the future looks like under the Affordable Care Act, noting that a change in leadership in Texas might change any predictive scenario and the state will continue to have poor and undocumented individuals to cover.
Dr. Foxhall explains that the focus on preventive services is a very positive feature of the ACA. He explains the requirements and notes the benefits that can come from screening services and tobacco cessation programs. He cites statistics for the increase cancer risk that comes with smoking and obesity. He explains why institutions tend not to invest in prevention, noting that the ACA is unusual in adding this to its requirements.
In conclusion, Dr. Foxhall notes that the ACA is “still a political football” and that politics has an impact on each decision connected with it.
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Chapter 01: Growing Up in Chicago with Unusual Opportunities
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about growing up in Chicago during the Great Depression, his early education, his difficult home life, the early influence of a family physician on his life, attending medical school at the University of Illinois at Urbana-Champaign, and being disqualified for service in World War II.
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Chapter 02: Medical School and Residency in Chicago and a Growing Interest in the Science of Medicine
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks further about attending medical school at the University of Illinois at Urbana-Champaign, interning at Cook County Hospital, and why he got fired from Cook County Hospital.
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Chapter 03: On to a Fellowship in Boston and to Hematology
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about moving to Boston and studying and practicing hematology, shares his observations on grant funding, talks about how success is defined in science and medicine, and talks about his wife.
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Chapter 04: Oncology Research at a New Hospital at the National Institutes of Health
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about being drafted into the Army, why he thinks that World War II was won by the defeat of malaria, going to work at the National Institutes of Health, and dedicating himself to curing leukemia. “You could either go to Bethesda and take care of leukemia patients,” he was told, “or you could serve in the military and go get blown up in Korea. So what the heck? Cure leukemia—that’s what I’ll do.”
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Chapter 05: Treating Leukemia at the NIH
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about researching and treating leukemia at the National Institutes of Health and how everything he is famous for was done during his 10 years there. He also talks about why academics hated him and starting the first formal clinical trials.
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Chapter 06: The First Systematic Studies of Chemotherapy for Leukemia
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the first study of chemotherapy for treating leukemia, developing new treatments for childhood leukemia, and combination chemotherapy.
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Chapter 07: Treating Hemorrhage in Pediatric Leukemia Patients
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about treating hemorrhaging in pediatric leukemia patients.
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Chapter 08: A Research Controversy: Treating Hemorrhage in Childhood Leukemia
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the controversies surrounding treating hemorrhaging in pediatric leukemia patients.
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Chapter 09: At the NIH: Studying Infection in Leukemic Patients [early 60s]
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about his studies of infection in childhood leukemia, conducted at the National Institutes of Health in the early 1960s.
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Chapter 10: At the NIH: Vincristine, a Cure for Childhood Leukemia, and VAMP
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the development of a drug called vincristine and the work for which he is famous: curing childhood leukemia.
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Chapter 11: Leaving the NIH for a Turbulent Research Environment at MD Anderson
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich says that “We’re now in ’64, and things are going along famously. I had the biggest and best pediatric leukemia service in the world. We were internationally famous. Everybody was following our lead. People came to learn how to do platelets, how to do white cells, how to do antibiotics, and how to do combination chemotherapy. We were really rolling.” He then talks about why he left the National Institutes of Health and joined MD Anderson Cancer Center, his relationship with Dr. R. Lee Clark, and why his family’s transition to Houston was “painful.”
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Chapter 12: The Lay of the Land: Developmental Therapeutics and MD Anderson in 1965
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the Department of Developmental Therapeutics at MD Anderson, the prominent physicians he worked with at MD Anderson in the mid-1960s, more about Dr. R. Lee Clark, and the use of radiotherapy for treating cancer.
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Chapter 13: Getting to Work, Diving into Controversy, and Studies of POMP
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the difficulties of treating children, getting fired as head of Pediatrics, and being put in charge of Leukemia.
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Chapter 14: Developmental Therapeutics in the Midst of Opposition to Systemic Treatment of Cancer
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talk about the Department of Developmental Therapeutics amid opposition to systemic treatment of cancer, the development of the immunotherapy program, and animosity among different departments and personalities at MD Anderson.
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Chapter 15: Developmental Therapeutics, the Division of Medicine, and Dr. Clark’s Final Years as President
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich continues talking about the Department of Developmental Therapeutics at MD Anderson, the Division of Medicine, the medical school in Houston, and Dr. R. Lee Cark’s final years.
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Chapter 16: Charles LeMaistre, the New President, Initiates Reorganization, with Impact on Developmental Therapeutics
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the new president of MD Anderson, Dr. Charles LeMaistre; reorganization initiatives of the new president; and how Dr. LeMasitre’s changes affected the Department of Developmental Therapeutics.
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Chapter 17: The Beginning of the Division System, Closing Developmental Therapeutics (1983), and the Legacy of the Department
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the beginning of the division system, the closing of the Department of Developmental Therapeutics in 1983, and the department’s legacy.
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Chapter 18: Departments Undergoing Change under Charles LeMaistre
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the many changes that occurred at MD Anderson under the leadership of Dr. Charles LeMaistre.
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Chapter 19: Head of the Adult Leukemia Program and a “Project Reassignment” Year at the NIH
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about his role as head of the Adult Leukemia Program and a “Project Reassignment” year at the NIH.
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Chapter 20: A “Flexner Report for Cancer” and Commitment to Education
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about developing and writing a “Flexner Report” for cancer and touring medical centers nationwide.
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Chapter 21: Views of Charles A. LeMaistre and MD and R. Lee Clark, MD
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about Dr. LeMaistre; how, in his view, Dr. LeMaistre abused his power as president; and why he thinks MD Anderson was hated by other state institutions.
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Chapter 22: An NCI Audit and Problems with a Protocol and Leadership
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about being audited by the NCI and suffering a heart attack.
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Chapter 23: Charles A. LeMaistre’s Administrative Success
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about some of Dr. Charles LeMaistre’s administrative successes.
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Chapter 24: Controversies over Use of Drugs in Clinical Trials (1980s)
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about controversies over the use of drugs in clinical trials in the 1980s.
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Chapter 25: Multi-Disciplinary Clinics in a Politicized Environment and a Review of Key MD Anderson People [Restricted]
Emil J. Freireich MD and Lesley W. Brunet
This interview chapter is restricted. Please contact archivist for details.
In this chapter, Dr. Freireich talks about the operation of multi-disciplinary clinics in a highly politicized environment and discusses his thoughts about key personnel and leaders at MD Anderson.
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Chapter 26: Reflections on Leadership Style, Intellectual Freedom, and MD Anderson
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich reflects on leadership style, intellectual freedom, the legacy of Dr. Charles LeMaistre, Dr. John Mendelsohn, and MD Anderson in general.
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Chapter 27: The Development of the ALZA Infusion Pump
Emil J. Freireich MD and Lesley W. Brunet
In this chapter, Dr. Freireich talks about the development of the ALZA infusion pump.