Interview Chapters

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Chapter 28: The Physician-Scientist Training Program and Other Activities and Some Thoughts on Retirement

Emil J. Freireich MD and Lesley W. Brunet

In this chapter, Dr. Freireich talks about the Physician-Scientist Training Program at MD Anderson and shares his thoughts about retirement.
Chapter 01: A New Idea and A Controversy: Transfusing Platelets in Leukemia Patients

Emil J. Freireich MD and Tacey A. Rosolowski PhD

Dr. Freireich begins this chapter by explaining the origin of his first name, "J".

Next, he describes how he worked with pediatric patients in the fifties, noting that he would see blood sprays on the walls of childrens' hospital rooms from their hemorrhages. This led to his decision to treat the patients with massive doses of platelets. Dr. Freireich gives detailed accounts of the patients' physiology, the technical challenges to overcome when giving patients blood from donors (as opposed to a bank blood), as well as the clinical trails he ran to determine the treatment's efficacy. Dr. Freireich explains in very dramatic terms, how treating leukemia patients was influenced by confrontations between those who advocated for laboratory over clinical research, as well as by intra-institutional political conflicts. What results is a full and realistic portrait of how scientific and clinical paradigms shift in complex social/political contexts
Chapter 02: Building the Continuous-Flow Blood Separator

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Freireich describes treating infections by transfusing white blood cells. He goes over the technical difficulties of separating white cells from platelets. (He describes his lab at NCI, festooned with 50 feet of tubing.) Here he also specifies why a continuous flow of blood was needed: using the analogy of an artificial kidney, he explains that leukemia patients required a huge number of either platelets or white blood cells, so the aim was to process a donor's entire blood supply, while mobilizing the donor's body to replace the elements removed for the transfusion. The next phase of the blood separator story begins when an IBM engineer, Al Judson, appears and asks if there's something he might do to help cure leukemia. (His son was afflicted by the disease.) Dr. Freireich describes the materials and technical challenges of creating an instrument that would channel blood from a donor into a centrifuge, collect the proper layer of separated elements for the patient, and deliver plasma back to the donor.
Chapter 03: Perfecting the Blood Separator in the Department of Developmental Therapeutics: Shifting MD Anderson Culture to Innovative Research

Emil J. Freireich MD and Tacey A. Rosolowski PhD

Dr. Freireich explains why the slow evolution of the blood separator made it necessary for him to leave the NCI and join MD Anderson in 1965. He speaks at length about R. Lee Clark, "a giant of a person" (who visited Dr. Freireich's family at home in order to convince him to come to Houston). He compares leukemia treatment services at NCI and the "primitive" situation for clinical research at MD Anderson. The faculty, he notes, saw his treatment/research approaches as potentially disruptive. He illustrates Dr. Clark's political skill in the face of this enmity: Dr. Clark rented a mobile home and set it up in a parking lot, where Dr. Freireich and Dr Frei (his close colleague from NCI who also joined MD Anderson in the sixties) established the new Department of Developmental Therapeutics. Dr. Freireich describes the process of establishing a fully functioning program in two years. He also describes tensions in the institutin as Developmental Therapeutics presented a new model of innovative research on treatments other than surgery. He explains how they finalized the design of the continuous blood separator (Model 2997), and he describes how the device and innovations it stimulated led to a revolution in stem cells transfusion.
Chapter 04: MD Anderson Changes Under Charles LeMaistre: Expansions in Leukemia Research

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Freireich covers several topics, among them changes in MD Anderson's administration when Charles LeMaistre became president, departmental reorganizations, and clinical experiments with "life islands" and granulocyte transfusions.
Chapter 05: New Chemotherapy Treatments for Breast and Cultural Challenges to Research Innovation

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Freireich discusses his work on breast cancer chemotherapy, simultaneously reflecting on cultural trends in the United States that work against the spirit of innovation.
Chapter 06: A Commitment to Training and Education: A Failed Battle For an MD Anderson Medical School

Emil J. Freireich MD and Tacey A. Rosolowski PhD

this chapter begins with Dr. Freireich's reflections on the circuitous path that took him to hematology. He describes the unique clinical oncology program he helped set up at MD Anderson, and the "best and brightest" fellows who came to train. He traces the creation of graduate education at MD Anderson. He weaves in discussion of how growth at MD Anderson was tied to debates over bringing a medical school to Houston.
Chapter 07: Building the "Best Graduate Medical Education Program in the Country"

Emil J. Freireich MD and Tacey A. Rosolowski PhD

Dr. Freiriech next traces the growth of education at MD Anderson when Dr. Charles A. [Mickey] LeMaistre took over as president from Dr. R. Lee Clark. He describes his close collaboration with Dr. Emil Frei, III. He explains how the Department of Developmental Therapeutics evolved because of initial connections with Japanese and Mexican Fellowship students. He explains his role in taking medical oncology to Japan and to Mexico. Dr. Freireich also sheds light on the development of the administrative structure governing clinical and basic research and explains how he established the Institutional Grand Rounds, a contributor to what he calls "the best graduate medical education program in the country."
Chapter 08: A History of Institutional Grand Rounds, The Core Curriculum, and the Physician's Assistant Training Program

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Freireich explains the Institutional Grand Rounds in greater detail, focusing on how it offers a multi-disciplinary perspective on a topic to appeal to a broad audience within MD Anderson. He discusses how he established the Core Curriculum, a program that all graduates students at MD Anderson are required to take and which he describes as the "best program in the country" because of the comprehensive view of cancer it provides. He also discusses how he believed that the new idea of a "physician's assistant" was worth pursuing, leading to the Physician's Assistant Training Program.
Chapter 09: Creating Patient-Oriented Research in a Complex Scientific and Institutional Context

Emil J. Freireich MD and Tacey A. Rosolowski PhD

Dr. Freirech begins this chapter by discussing the importance of research funding and the creation of the Association for Patient-Oriented Research. He sketches the "structural problem" that research funding through the NIH channels funds to basic scientists when "100% of our ability to manage diseases in man began at the bedside with a doctor." He speaks at length about the bias he perceives against physicians and clinically based research and the limitations of basic research to reveal the intricacies of disease in patients, despite the "ethos" in medicine and in the country to view clinical research as secondary because it merely applies discoveries revealed by basic research. Dr. Freireich talks about the origin of the K-series NIH grants for physicians. He then gives examples of how the bias against clinicians has influenced funding and administrative organization at MD Anderson. He speaks about the Physician Scientist Program (funded by a K-30 grant) and the Patient-Based Research Program. He talks about the challenges arising from the fact that MD Anderson does not administer its own Graduate School.
Chapter 10: Advocating for Patient-Oriented Research and Patients

Emil J. Freireich MD and Tacey A. Rosolowski PhD

Dr. Freireich begins this chapter by sketching the educational opportunities that MD Anderson offers. He then talks about his continued commitment to education and his pride in one of his trainees, Dr. Hagop Kantarjian, who now heads the Department of Leukemia. Dr. Freireich then further discusses the bias he perceives operating when it comes to awarding grants and awards to physician-scientists. He sketches the history of science in medicine, beginning with the founding of the Association of American Physicians and leading to his role in founding the Society of Patient-Oriented Research in 1998. He sketches the challenges the struggling organization is facing. He stresses that MD Anderson is set up to allow physicians to focus on their specialty, which means their minds are always immersed in their research area as well.
Chapter 11: A Critical Need to Fund Patient-Oriented Research

Emil J. Freireich MD and Tacey A. Rosolowski PhD

Dr. Freireich begins this chapter by reflecting on the role that national and international organizations have served in furthering research in his field (the fifties to the present), circling back to the main theme of Session Two by pointing out that the character of these organizations again demonstrates that basic research is valued more highly than clinical research. He also presents his belief that funding research on cures for cancer will be more effective than funding preventative measures.
Chapter 12: The FDA as a Barrier to Research Innovation

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this chapter Dr. Freireich stresses that cancer will only be cured by funding clinical research into cures for cancer and offers his personal belief that the population at large understands this. (He uses the example of AIDS activists, who were successfully organized and lobbied for effective treatments.) He talks about the role of the FDA, which he sees curtailing physicians' ability to make progress by restricting the use of experimental drugs in dying patients. He sums up the affect of what he sees as bureaucratic conservatism: "If there's no drug, there's no danger, and there's no progress."
Chapter 13: Leukemia as a Key to Understanding

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Freireich presents his theory that the ability to control cancer (determining which cancers will metastasize and kill) will come from research in leukemia because leukemia is a systemic cancer and everything discovered about it is immediately transferable to solid tumors. He talks about molecular and genetic advances in understanding cancer. He notes that we don't need to understand the source of cancer, since will never be eradicate it, we need to understand how cancer operates so it can be controlled. At the end of this chapter, Dr. Freireich observes that individuals understand that tobacco and alcohol have an impact on cancer and health but it is a slow process to regulate against their use.
Chapter 14: The Partnership Between Basic Science and Clinical Research

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Freireich further clarifies his view of the relationship between clinical and basic research. "I want to spend double the money on basic research. The problem is the translation. If you don't have the clinical arm, it's like trying to play the piano with one hand. We need basic sciences to do the rhythm and the clinical scientists to do the melody and then we get music." He talks about some of his collaborations with basic sciences, but also gives examples of how, contrary to popular opinion, patient-oriented research is basic research. He explains why global oncology should be a lower priority than other missions: e.g. funding clinical research, targeted therapy.
Chapter 15: A Legacy of Strong Faculty and Advances in Blood Cancers; Awards; as a Disease and MD Anderson Presidents

Emil J. Freireich MD and Tacey A. Rosolowski PhD

Dr. Freireich begins this chapter by listing some of the key faculty he has brought to MD Anderson. He then reviews advances in blood cancers that have been made during his time at the institution. He next compares the three presidents of MD Anderson and speculates that incoming president Dr. DePinho has "the same genes" as R. Lee Clark, and may prove a visionary leader.
Chapter 16: A Life of Work with the Support of a Strong Wife and Family

Emil J. Freireich MD and Tacey A. Rosolowski PhD

In this very personal chapter, Dr. Freireich reflects on his lifelong focus on work. He speaks at length about his relationship with his wife and beloved partner, Haroldine Freireich (Cunningham), whom he married on a Saturday morning when there were no samples to count. He talks about the importance of his family and notes that his children and grandchildren in providing distraction from intense focus on his research life.
Chapter 05: The Leadership Styles of Dr. Frei and Dr. Freireich and Working with the Southwest Oncology Group (SWOG)

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

In this chapter, Dr. Gehan contrasts Dr’s Frei III and J. Freireich’s administrative styles and capabilities. He mentions the adult and pediatric divisions in the Southwest Oncology Group (SWOG) and MD Anderson pediatric researchers Dr. Margaret Patricia Sullivan and Dr. Wataru "Walter" Sutow. Dr. Gehan then discusses the politics, group composition of the Southwest Oncology Group (SWOG), and MD Anderson’s participation in it. Specifically, he talks about the election of the successor to Dr. Tom Frei III as Chairman of the Southwest Oncology Group and mentions successors Dr. Barth Hoogstrate and Dr. Charles A. Coltman Jr.
Chapter 06: Dr. Gehan's Research and Publishing Impact

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

In this chapter, Dr. Gehan assesses his research output. He talks about: the number of patients required in Phase II clinical trial, comparison of two survival distributions with no average survival time, the extension of the Wilcoxin (Frank) Test with two-sample tests with censoring (loss) when working with Professor Sir David Roxbee Cox in London, the Gehan-Breslow (Norman Edward)-Wilcoxon generalization of the Wilcoxon statistic test to the two-sample problem with censored data, and hazard functions. Dr. Gehan then discusses the impact of computers on statistical research publications. He talks about the necessity for, and research perspectives and publications regarding, non-randomized controls in cancer clinical trials. He mentions the influence of Dr. Franz Joseph Ingelfinger, Editor of the New England Journal of Medicine, in promoting a constructive Gehan/Freireich publication approach where there was a conflicting research theory (Thomas C. Chalmers, known for randomized clinical trials). He also discusses the development of cancer research cooperative groups, epidemiologist Eleanor Macdonald and many of his co-authored biostatics articles.
Chapter 07: The Relationship Between the Department of Developmental Therapeutics and Department of Medicine at MD Anderson

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Gehan talks about patient referral practices and perspectives between the Department of Medicine, headed by Dr. Clifton “Cliff” Howe, and the Department of Developmental Therapeutics headed by Dr. Emil Frei III. He discusses direct referrals to Dr. Frei III and Freireich, Dr. C. C. Shullenberger (chronic leukemias), and Dr. Raymond “Ray” Alexanian (multiple myeloma).
Chapter 13: Transitions at the Department of Developmental Therapeutics

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Gehan concludes the interview by discussing changes at the institution including the closure of the Department of Developmental Therapeutics. He talks about the importance of having passion in cancer research, a trait he greatly admired in Drs. Frei and Freireich. He talks about the role of pharmaceutical companies and Rituxan, the first monoclonal antibody to be approved by the Food and Drug Administration (FDA).
Chapter 01: Early Life and Education in Brooklyn, New York

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Edmund “Ed” Gehan summarizes his tenure at MD Anderson, how he came to MD Anderson, prior work in the Biostatistics area of the National Cancer Institute (NCI)/National Institute of Health (NIH), and graduate education. He briefly talks about his pre-collegiate life and career influences in Brooklyn, New York - including his attendance at St. Augustine’s Catholic High School. Dr. Gehan then details his range of performance on career aptitude tests (e.g. Wiggly Block Test) at the Johnson O’Connor Research Foundation and how his enjoyment of Reader’s Digest Word Power influenced his decision to attend Manhattan College.
Chapter 02: Choosing An Educational Background Focusing on Statistics

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Gehan reflects on his curriculum, performance, and choice of major at Manhattan College, and factors that influenced his selection of the University of North Carolina, Chapel Hill for graduate study in statistics. He talks about the “giants” at UNC Chapel Hill in the Department of Theoretical Statistics: Harold Hotelling, Herbert Robbins in probability, R. C. Bose, and S. N. Roy while he spent a year in that program. Dr. Gehan switched to the Department of Applied Statistics at North Carolina State in Raleigh, North Carolina under Gertrude M. Cox. While he graduated from NC State, Dr. Gehan spent most of his in Chapel Hill and reminisced about his time there. His last years at Chapel Hill were spent as a doctoral candidate and faculty member under the leadership of Bernard “Bernie” G. Greenberg, Dean of UNC School of Public Health.
Chapter 08: Working as Adjunct Faculty at Rice University and The University of Texas School of Public Health and Consulting Work with the Southwest Oncology Group

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

In this chapter, Dr. Gehan talks about his adjunct faculty work at Rice University when Dr. James “Jim” R. Thompson was the head of the Department of Statistics, and at The University of Texas School of Public Health’s Department of Biometry. While at the latter, he supervised Lina Asmar’s master's thesis and participated on her Ph.D. committee, which she completed in 1992. Then, he gives an overview of Terry L. Smith’s and his consulting work in the Department of Biostatistics supporting several people/entities, like Dr. Raymond “Ray” Alexanian (Department of Medicine), the Department of Developmental Therapeutics, and while serving as the head statistician of the Southwest Oncology Group (SWOG), he mentions work with Dr. Micheal Keating, Dr. Kenneth “Ken” B. McCredie, Dr. Wataru “Wat” Walter Sutoh (pediatrics), Dr. Margaret Patricia “Pat” Sullivan (Intergroup Hodgkin's disease). He talks in detail about Dr. Grant Taylor (Chair of the SWOG), his relationship with President R. Lee Clark, his authoring of the book “Pioneers in Pediatric Oncology” (of which Mr. Gehan’s autobiography is included), and his involvement in the MD Anderson’s purchase of the Prudential building.
Chapter 09: Luminaries in the Department of Pediatrics and Evolution in the Field of Cancer Research

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Gehan fondly recalls Dr. Wataru Walter Sutow, recollects his participation with Dr’s Grant Taylor and Margaret Patricia Sullivan in a group studying the effects of atomic radiation, and speculates on how they came to MD Anderson’s Department of Pediatrics. He discusses pediatric cancer researchers’ perspectives on cancer research, how they differed from cancer research in adults, and changing involvement over time in various research groups (e.g. Southwest Oncology Group). Lastly, he notes Dr. Archie Bleyer would know more information regarding the pediatric cancer research activity.
Chapter 10: Dr. Jan VanEys and the Development of MD Anderson’s Code of Ethics; Working with Pharmaceutical Industry

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

In this chapter, Dr. Gehan talks about Dr. Jan VanEys’ work in pediatrics and as an ethicist at MD Anderson. He mentions Dr. VanEys’ work with Dr. James M. Bowen in the creation of a code of ethics at MD Anderson. He then talks about the role of statistics in cancer research, cancer research ethics, and the ethical use of randomized trials. He goes on to reference Donald “Don” Arthur Berry, head of the Department of Biostatistics at MD Anderson, talks about clinical equipoise, contrasts Bayesian and Frequentist reasoning, sequential analysis, randomized trials, etc. Dr. Gehan talks about the statistics department’s working relationship with other areas at the institution including working with Dr. Charles Blach who was the Head of the Department of Surgery at the time. Before 1980, the National Institute of Health (NIH) funded most research. Changes in the industry saw a bulk of funds coming from drug companies, which required new logistical concerns regarding data management and patient participation numbers to justify expenses. He provides examples of Dr. Bodey's research in protective environments for cancer patients.
Chapter 11: The Differing Leadership Styles of Drs. Clark and LeMaistre

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Gehan provides a brief comparison of Dr. R. Lee Clark and Dr. Charles A. LeMasitre, who were the first two MD Anderson Presidents. According to Dr. Gehan, Dr. Clark was personable compared to Dr. LeMaistre's more organizational management style.
Chapter 12: The Contributions of Colleagues to MD Anderson's Legacy

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

The interviewers ask Dr. Gehan to talk about his MD Anderson colleagues. A statistician by nature he offers to evaluate his colleagues on a 1-10 rating scale while identifying the strengths and weaknesses of each individual.
Chapter 03: Work at NCI/NIH, the Role of Statistics in Medical Research, and its Application in Sequential and Combination Cancer Treatment Evaluation

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Gehan talks about working for, and remembrances of, Nathan Mantel (known for survival rate analysis) at the NCI/NIH. Also at that time, he received direction from Jerome “Jerry” Cornfield, senior statistician (best known for the causal relation between cigarette smoking and lung cancer). He talks about the importance of statistics in medical research and publication, gives an example of a “6-Mercaptopurine (6MP) and Methotrexate (MTX)” treatment response rate study, and how he provided “analytical support” for Drs. Emil “Tom” Frei III and Emil J. Freireich’s sequential and combination treatment “ideas” for Leukemia treatment.

At an MD Anderson dinner event the prior evening, Mr. Gehan mentions several prominent researchers (Dr’s Emil J Freireich, Emil “Tom” Frei III, Michael Keating, Jeffrey Gotlieb, Levy[?], and 6th Annual Emil J. Freireich Award for outstanding achievement of a young researcher in clinical cancer therapeutic award recipient Eric K. Rowinsky), their passion for research work, and being “turned on” serving as the statistical “member of the team.” The beginning of work with Drs. Frei and Freireich in January 1958, Dr. Gehan lists his roles over time as the replacement for Marvin A. Schneiderman, his career advancement to Acting Head, then Head of the Biometrics Section, Cancer Chemotherapy National Service Center and NCI Southwest and Eastern Clinical Trials Cooperative Groups. As a member of the Acute (now Cancer) Leukemia Group B, he reminisces about the face-to-face meeting style where Dr’s Frei III, Freireich, and James “Jim” F. Holland developed ideas for clinical studies. Additionally, he mentions his marriage to wife Brenda (nee McKeon) before his time working for Sir David Roxbee Cox (known for Regression Models and Life Tables) from 1962-1964 as a special Fellow at Birkbeck College of London, England.
Chapter 04: Strengthening Medical Oncology at MD Anderson with the Aid of NCI Researchers in the Department of Biostatistics

Edmund A. Gehan PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Gehan recollects Dr. R. Lee Clark’s approach to funding, recruitment, and management and the attraction of MD Anderson/Houston to Dr. “Tom” Frei III, his wife Elizabeth “Liz” (nee Smith), as well as himself. Dr. Olson mentions from Kenneth Endicott (NCI Director) to Dr. R. Lee Clark (President, MD Anderson) lamenting the move of Dr’s Frei III and Freireich to MD Anderson. When Dr. Gehan started at MD Anderson in 1967, Dr. Lee D. Cady Jr. was the Head of the Department of Biomathematics. Dr. Gehan talks about the impact of the arrival of Dr’s Frei III and Freireich on MD Anderson Research. Dr. Gehan cites the cooperative group collaboration model of NCI/NIH Clinical Chairman Dr. C. Gordon Zubrod and biostatistician Marvin A. Schneiderman on the first randomized trials in acute leukemia and solid tumors. He recalls the members of the administration and the research team at MD Anderson before the arrival of Dr’s Frei III and Freireich: Dr. H. Grant Taylor, Chairman of the Southwest Oncology Group (Southwest Oncology Group), epidemiologist Eleanor Josephine McDonald (known for creating the National Cancer Registry) statistician Kenneth M. Griffith, Dr. Roy C. Heflebower, Joe E. Boyd and Dr. Stuart O. Zimmerman, Chairman of the Biomathematics Department. He also mentions other MD Anderson administrators and researchers: Terry L. Smith, Dr. Peter F. Thall, Dr. J. Jack Lee, President Dr. Charles A. LeMaistre, Dr. Frederick F. Becker and President Dr. John Mendelsohn. Finally, he talks about the Department of Biostatistics, how it differs from Biomathematics, and the effort to strengthen medical oncology at MD Anderson.
Chapter 01: Recruitment to MD Anderson

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 02: Meeting Mary Lasker

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 03: The Early History of Interferon Research

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 04: Making Connections and Issues with Acquiring Interferon

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 05: Funding Interferon Treatment and Looking towards Future Developments

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 06: Funding Interferon Research through Connections and Industry

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 07: Challenges in Funding and Acquiring Interferon

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 08: Promoting and Publicizing Interferon Research

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 09 : The Ideal Patient

Jordan U. Gutterman MD and Lesley W. Brunet
Chapter 01: Early MD Anderson Pioneers

Jordan U. Gutterman MD, Lesley W. Brunet, and James S. Olson PhD
Chapter 02: Dr. Emil J Freireich and the Early Years in Departmental Therapeutics

Jordan U. Gutterman MD, Lesley W. Brunet, and James S. Olson PhD
Chapter 03: On Writing about the History of Medicine

Jordan U. Gutterman MD, Lesley W. Brunet, and James S. Olson PhD
Chapter 01: Lessons from Family and the Liberal Arts

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Gutterman talks about growing up in a small South Dakota town, and the "amazing training" he received by accompanying his mother on her habitual visits to shut ins and ill neighbors. He also reflects on his own character and the faceted approach he brings to medicine and science, given his broad interests in religion and philosophy (both of which he studied in college).
Chapter 02: Mary Lasker: Personal and Financial Support for Research

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

Dr. Gutterman discusses his close relationship with Mary Lasker (treated in depth in the 2006 sessions with Lesley Brunet), a philanthropist who was immediately interested in his interferon work in the seventies and who eventually gifted one million dollars toward his research. Mrs. Lasker schooled him in dealing with people and in strategizing to get a job done in the face of obstacles. Dr. Gutterman also talks about his gifts for visual thinking, his colorist paintings, and his habits of self-reflections which come from an interest in holistic systems.
Chapter 04: Research Challenges: Ethical Questions and Celebrity

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

Dr. Gutterman talks about how he dealt with two problems that the interferon studies raised. First he discusses the ethics of selecting patients for treatment and of treating patients because they can afford to pay for an experimental drug (while others cannot pay). He gives specific examples of patients he has treated. Second, Dr. Gutterman talks about how he coped with the public attention and even notoriety that arose from his work. He digresses and talks about how the Mary Lasker came to fund the Lasker Award to raise awareness of medical research.
Chapter 05: Interferon and the Control of Hairy Cell Leukemia

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

Dr. Gutterman recounts one his great success stories with interferon "the control of hairy-cell leukemia". He talks about the dramatic and unexpected results seen in patients with this heretofore incurable disease.
Chapter 06: The Department of Developmental Therapeutics; Personal Stories and Reflections

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Gutterman talks about MD Anderson and the Department of Developmental Therapeutics, which he joined as a Senior Fellow in 1971. He first explains that his participation in the Berry Plan brought him to MD Anderson. He talks about immediately sensing the spirit of freedom and possibility, the availability of money to support research, and the presence of many accomplished people, such as Dr. Emil J Freireich, who influenced him with his passion and intellect. Dr. Gutterman speaks about his brother and father as inspirations as well as his own artwork, his paintings. The session comes to a close with two personal stories that demonstrate that angiogenesis can both kill and heal.
Chapter 07: Testing Interferon against Many Cancers

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Gutterman picks up the story of his interferon work during the early Eighties. He explains that, after repeating his first experiments with the newly-manufactured recombinant interferon, he was eager to try the drug on other cancers, such as renal cell carcinoma and chronic myeloid leukemia. This was a bold move in some eyes, but the unique intellectual environment in the Department of Developmental Therapeutics in the Seventies supported this kind of creative experimentation. He speaks briefly about finding funding for this work, then focuses on his work with chronic myeloid leukemia (for which there was no treatment at the time).
Chapter 08: Furthering Research through Partnerships with Drug Companies

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Gutterman offers several examples of how he learned to work with drug companies to further his own research. He was approached, for example, to test GM-CSF [granulocyte macrophage colony-stimulating factor] to restore platelet counts in chemotherapy patients. He also learned to protect his intellectual property. He attended meetings at the emerging drug companies and describes the impact of "seeing the power of venture money." He also observed how the biotech companies set up creative environments, sensing a kinship with the imaginative work they were doing.
Chapter 09: Research Money: The Economics of Drug Companies; Philanthropy

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Gutterman talks about working with "big pharma" and operating largely independently of MD Anderson. He discusses the economics of pharmaceuticals, noting a lesson he learned from philanthropist Mary Lasker, who said "money is frozen energy." He talkss about his own entrepreneurial spirit, linking it to his father's business ventures and critiques "conservative approaches" to drug experimentation. Dr. Gutterman ends this section with a passionate description of Houston philanthropy at that time. He then responds to a question about the downside of working with drug companies, concluding, "Don't count on the drug companies," because he discovered interferon's hairy cell leukemia at MD Anderson, with private money.
Chapter 10: R. Lee Clark, Charles LeMaistre, and Philanthropic Houston Oilmen

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Gutterman shares memories and observations about Dr. R. Lee Clark and Dr. Charles LeMaistre. This includes a narrative of how Dr. Clark worked with Mary Lasker to support Dr. Gutterman's work on chronic myeloid leukemia, resulting in the use of interferon to suppress malignant clones while normal cells return. Dr. Gutterman provides many examples of challenges that arose within the institution to hold back his work. At the close of the session, Dr. Gutterman sketches the formation of the Interferon Foundation by several Houston oilmen, several of whom visited Charles LeMaistre to insist he remove obstacles to Dr. Gutterman's work.
Chapter 11: Funding Innovative Clinical Research: Some Institutional Obstacles

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter Dr. Gutterman comments on the reaction of MD Anderson "and then president Dr. Charles LeMaistre-- to the private funding of his interferon research." He also underscores how unique MD Anderson is, with all of its many resources, intellectual, creative, financial, etc. He also comments on his role as Chair of the Department of Clinical Immunology and Biological Therapy, noting candidly that he was not passionate about administration and unable to manage the Department adequately.
Chapter 12: Department Chair and Section Chief: Leadership Issues

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Gutterman comments on his role as Chair of the Department of Clinical Immunology and Biological Therapy, noting candidly that he was not passionate about administration and unable to manage the Department adequately.
Chapter 13: Going on Record with New Research: Avicins and Nutrition

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

For the first time, Dr. Gutterman goes on record with a discussion of his current research on avicins and nutrition, work that required him to "change fields" and study botany. He explains that in the mid-Eighties he found inspiration in an early article on the isoflavone Genistein, then speaks about the deaths of his mother and father, sources of the values that are personal foundations to that work. He notes that the epidemiology of cancer itself suggests that its cure lies in the understanding the interaction of genes with the environment. Near the end of this section, he notes that in 1994, financial difficulties at MD Anderson made it necessary for clinical departments to generate more revenue "another impetus for him to leave administration and find a new research arena."
Chapter 14: Establishing a New Research Focus: Experiments, Money, Organization

Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

Dr. Gutterman then speaks at length about the intricacies of setting up his new research program. He describes his new collaboration with botanist Dr. Charles Arntzen at (the Biodesign Institute at the University of Arizona?) and the Clayton Foundation's role in financing his research. During the next half hour he details how he was invited to study desert plants in Tuscon. He believed that these plants must contain substances that protect them from UV light and dehydration, and that might be helpful in combating cancer. He describes the long process of making extracts from the plants and the studies that revealed that one extract, from the acacia victoria, would kill ovarian cancer cells (and not kill normal cells). He talks about the process of finding a lab to make a pure extract (needed in the late nineties), a goal achieved in October of 1998: "Now I have to learn chemistry," Dr. Gutterman recalls saying. He and colleagues successfully mapped the chemical structure of the active terpinioid and then embarked on discovering the mechanism of its action. Near the end of this section he talks about how they named avicin and applied for the patent, awarded in 2002. (This session ends abruptly, due to Dr. Gutterman's throat irritation from allergies.)
Chapter 01: Resolving to Become a Volunteer

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison begins this segment by noting that she and her husband, Bedford Harrison, moved to Houston in 1947. She began as a floor hostess in about 1968, working with both adult and pediatric patients. When the new building was constructed, she chose to work with adults and explains that she eventually worked in the protective environment floor: she explains some of the requests that family members made, as she could interact with their loved ones in ways they could not.
Chapter 02: The Children’s Christmas Card Project

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison begins by talking about Page Lawson, “the most innovative person in the world” (who served as Director of Volunteer Services at MD Anderson from 1973 – 1991). As an example, she says that Ms. Lawson arranged for the volunteers to have t’ai chi classes as a relaxation technique. She also speculates that the Children’s Christmas Card Project was really Ms. Lawson’s idea, though Ms. Lawson circulated the story that the idea came from an unnamed volunteer who taught art classes for children at MD Anderson and discovered a particular piece of artwork she thought would make a wonderful Christmas card. Mrs. Harrison then explains how Ms. Lawson offered her a job as manager of the Children’s Christmas Card Project; her first main task was to develop a five-year plan to expand the project. She was fortunate, she notes, because MD Anderson was connected to the UT System: she actively promoted the project at all the UT Divisions. She also explains that an important expansion occurred when Randall’s Supermarket agreed to sell the cards at no profit (and continues to sell them today).

Next, Mrs. Harrison talks about how funds from the Project were used: MD Anderson employees submitted requests for funds to a board of volunteers who decided how money should be spent. She notes that the aquariums one can still see around MD Anderson were one of the first projects funded. At the end of this segment, Mrs. Harrison talks about the importance of spirituality in her life.
Chapter 03: Details about the Children’s Christmas Card Project

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison begins this segment talking about several volunteers who worked on the Children’s Christmas Card Project. She then describes how the cards were selected: artwork up for consideration was presented at an event where volunteers could vote for the designs to be turned into cards. She describes one of her favorite cards and then notes that the five-year plan included an initiative to offer cards for the Jewish community. She goes on to explain that the Art Department turned selected designs into production-ready images and the Project then took bids for producing the cards. All this work first took place in a single room on the first floor of Volunteer Services, she explains, then moved to a larger room as the Project grew. She notes that there is a Karen Harrison Award given to a volunteer each year at the Volunteer Appreciation Luncheon.
Chapter 04: Expanding the Children’s Christmas Card Project

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison begins this section talking about “some political things that influenced the Project,” citing as an example the invitation extended to Barbara Bush to attend the Project kickoff party. Mrs. Bush’s presence had a very positive effect. She then goes on to explain that after Randall’s Supermarket began selling the cards, she hired a consultant to help the Project break into grocery stores nationwide. The describes attending a supermarket trade fair and the resulting success of selling MD Anderson holiday cards in markets around the country. She also explains that the Project eventually separated from Volunteer Services (coming under the management of Steve Stuyck in Public Affairs) because there was too much to do. She speaks briefly about the art classes offered to children and notes that Page Lawson offered an award to each child who entered a piece to be considered for a card. The children whose designs were selected participated in the holiday parade that circulated through MD Anderson.
Chapter 05: Creating an MD Anderson Annex to House Patients

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison explains that she purchased a very large home after her husband died and patients coming in from out of town stay with her. One woman gave her two robes to keep in the guest room, embroidered with “MD Harrison.” This is “another step in her love of Anderson.” Mrs. Harrison then describes the accommodating nature of people who work and volunteer at MD Anderson.
Chapter 06: On the Children’s Christmas Card Project, Volunteers, and Faith

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison tells of a holiday card that was sent into outer space and talks about the generosity of volunteers that kept the Children’s Christmas Card Project moving forward. She then clarifies the progressive expansion of her role as she worked with the Card Project. Mrs. Harrison next talks about Page Lawson, who was known nationally as an expert in volunteer affairs and sought after as a speaker. Mrs. Harrison shows a picture of Ms. Lawson and goes on to describe her character. She recalls support that Ms. Lawson gave cancer patients. Mrs. Harrison recalls some volunteers she worked with and talks about her plans to continue volunteering with the institution. She talks about qualities that a person needs to volunteer.

Mrs. Harrison says that many people shudder when she mentions volunteering at MD Anderson, but explains that she always leaves feeling better than she did when she arrived because she has helped people.

Mrs. Harrison talks about the importance of her faith in her work as a volunteer: “God gave me the job.”
Chapter 07: Memorable Volunteers and Caring for Patients

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison explains that when she began to volunteer at MD Anderson, she worked with young men with testicular cancer. She describes them as very determined to fight their disease and believes that she was able to give them confidence. Next Mrs. Harrison talks about working with patients on the protected environment floor. She describes the physical setting, in which patients were separated from their families by a glass window. Mrs. Harrison entered the protected environment (she put on scrubs), and she explains her role with patients. Often patients asked her to take personal items, such as a bible, to be sterilized so they might have it in the room with them. She tells a story of one woman who asked her to massage her daughter’s shoulder. Mrs. Harrison also explains that she served as an informal recruiter of other volunteers: she brought in her husband and a former classmate of her husband, Rock Rabinowitz, who worked volunteered many, many hours. Mrs. Harrison notes that people would often react very negatively to the idea of working in a cancer center, and explains how she countered their qualms. She explains that she established strong connections with patients and their families. She invited many of them for the holidays.

In this touching story, Mrs. Harrison describes how she cared for a little girl who came from Hawaii with her family for treatment. After the child’s death, her mother asked Mrs. Harrison to help her choose the dress her daughter would be buried in.

Mrs. Harrison says that she believes that her ability to connect with people is “God given.” She describes her relationship with a patient who now has an externship with MD Anderson. She then recalls Sister Alice, an energetic volunteer who was a “cheerleader” at one of the Children’s Art Project kick off parades. Finally she talks about Tom Jean Moore, the volunteer who took care of the rose garden and brought roses to be delivered to any patient who did not have flowers that day.
Chapter 08: Recalling Volunteer Events and Volunteers

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison first recalls the Children’s Christmas Card Project kick off parade, which took place in early fall. She describes the parade, recalling the young men pushing their IV poles, the St. Thomas bagpipers, and the fire truck that drove patients along the route. She describes the route and notes that the barbecue restaurant, Goode Company, served sandwiches for lunch. Next Mrs. Harrison recalls valued volunteers. She notes that when she was promoted from Manager of the Children’s to Assistant Director of Volunteer Services, her role did not change, though her income increased. Next Mrs. Harrison talks about Page Lawson, “volunteer extraordinaire,” who had good business sense, enthusiasm, and a gift for matching people to the right job. She recalls that Ms. Lawson told her she’d been watching her in the cafeteria and decided that she “had what we needed.”
Chapter 09: Memorable Volunteers and the “MD Anderson Annex”

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison explains that her husband, a chemical engineer, volunteered in the radiology department and could be comforting to patients, in part, because of his technical understanding of radiology. Mrs. Harrison then recalls a woman who became a volunteer after undergoing an hemi-hipectomy and who continued to volunteer, even after her husband died.
Chapter 10: The “MD Anderson Annex”

Karen K. Harrison and Tacey A. Rosolowski PhD

In this segment, Mrs. Harrison describes the “annex” she has been running for the past 8 years. She explains that she purchased a very large home after her husband died, acting on her son’s comment that she could turn it into an annex for MD Anderson. She explains how she invited her first MD Anderson patient to stay with her, then recalls some of the other patients and families who have stayed with her over the years when they came into town for treatment.
Chapter 11: Family Background

Karen K. Harrison and Tacey A. Rosolowski PhD

When asked whether she came from a large family (which might explain her gregariousness), Mrs. Harrison says that she had many, many cousins. She also explains that she was married before she graduated from college, though eventually she finished her degree, earning a degree in Political Science from the University of Houston in 1951. He notes that her husband did not want her to work, but she did, teaching third grade. She explains some of the challenges of teaching and recalls an autistic child in her class. She speaks briefly about the television and radio appearances that she made while working with the Children’s Christmas Card Project. She tells an anecdote to demonstrate that she inherited her public speaking skills from her “daddy.”
Chapter 12: At Eight-Three, Still Providing Service to Patients

Karen K. Harrison and Tacey A. Rosolowski PhD

Mrs. Harrison tells of her plan to accrue another 2,000 hours of volunteer time so she will be “neck in neck” with her late husband’s 10,000 hours. She notes that she has introduced people to MD Anderson. She ends by talking about what she has received from her years of service to the institution.
Chapter 01: A Career in Medicine

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks sketches his family background and talk about how his older brother influenced his decision to go into medicine. He also talks about his visual thinking skills, noting that he started out in surgery but switched when he became excited about the new imaging technologies that were introduced when he was a young professional.
Chapter 02: College and Medical School

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks talks about the economic realities behind his decision to go to college and to medical school at the University of Kentucky (MD, 1982). He tells stories about doing one of his rotations in Appalachia and the dedication and compassion of the physicians there. He shares stories of his mentor in medical school, Ward Griffin, MD, as well as his skills in visual thinking.
Chapter 03: Specializing in Diagnostic Imaging [Part 1]

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks begins by noting that he realized that “the diagnostic dilemma would be solved by imaging” while he was interning in general surgery at Memorial University Medical Center in Savannah, Georgia (1982 – 1983). This prompted him to undertake his clinical residency in radiology at the Indiana University Medical Center (Indianapolis, 1983-1986). He describes how imaging was used to enhance the surgical perspective and also comments on how the entire practice of medicine was changing at that time.
Chapter 04: A Child with Cancer

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks talks about the turbulent period that ensued after his son, Graham was diagnosed with kidney cancer at 8 months of age. He describes his experience as a parent, the lessons learned, and the impact that experience has had on his own work with patients.
Chapter 05: Specializing in Diagnostic Imaging [Part 2]

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks talks more about his experiences in his clinical residency in radiology at the Indiana University Medical Center (1983-1986) where he went on to serve as an instructor in vascular radiology (1986-1987). He talks about what it is like to practice medicine in an evolving field/specialty.||The recording cuts off mid-sentence at 36:30.||
Chapter 06: A Sketch of Research in an Evolving Field

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks sketches the research he did in his early career, prior to switching his focus to administration. He notes that he “loved anatomy” and focused on research to perfect early interventional radiology devices and quantify their value for patient outcomes. He gives an example of his work with IVC filters. He explains how this experience with research served him when he came to MD Anderson to become Section Chief of Interventional Radiology.
Chapter 07: Challenges for the Section of Interventional Radiology in 1998

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks explains how his experiences at the University of Washington in research served him when he came to MD Anderson to become Section Chief of Interventional Radiology. He notes that his mandate when he came to MD Anderson in 1998 as a section chief was to rebuild the Section of Interventional Radiology. He explains why the section had fallen into a period of dormancy with a very small faculty/staff and few resources. The section required new leadership and he describes his first steps. He also talks about the challenges of leadership during this period and how he set an example by pitching in.
Chapter 08: A Turning Point in Building Interventional Radiology in 1998

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks explains how the Section of Interventional Radiology emerged from its period of lassitude in the late 90s with the support of David Callendar, the Physician in Chief, who send Dr. Barbara Summers to help him devise an organized process for the section’s transformation into a strong program that attracted innovative, quality recruits.
Chapter 09: Choosing to Focus on Administration

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks reflects on what attracted him to administration and institution building. He explains how he relied on his supportive family. He talks about how the commitment of faculty and leaders at MD Anderson to patients helped him overcome any periods of frustration.||He notes that the patients at MD Anderson are inspiring and shares stories of meaningful patient interactions.
Chapter 10: A Discussion of Leadership Challenges

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks begins this chapter with a few comments on growth in the Section of Interventional Radiology. He then takes the rest of the section to comment on leadership issues. He explains that he was part of the Faculty Leadership Academy, found it extremely valuable, and notes the long-term coaching relationship he established with Fred Schmidt. He talks about working with Dr. Schmidt to develop team alignments in the Division of Diagnostic Imaging.||Next he talks the importance of “in-the-moment coaching” and notes that the Faculty Leadership Academy began his “journey” to develop his own leadership. He talks about the importance of finding support via networks. He explains that he has contacted emerging leaders to support them. He explains his view that there are untapped resources for coaching among volunteers and gives an example of a former patient and volunteer, a highly placed individual at Dell, who was able to speak to MD Anderson faculty about leadership issues.||Session Three: 3 July 2018
Chapter 11: Chair of the Department of Diagnostic Radiology

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks discusses how he stepped into the role of Chair of the Department of Diagnostic Radiology and developed a vision for developing the department. He explains that there had never been a dedicated chair of the department, that the head of the division had always served that role. He explains that to date there had been difficulty getting the section heads to work together. Dr. Hicks talks about his goal of creating a true department identity with a clear governance structure. He reflects on the value of this process as a kind of leadership training for the young section heads in the department and talks about the identity that emerged.
Chapter 12: Leadership Lessons Learned with Growing the Department

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks summarizes what he learned from serving in this first major leadership role as department chair of Diagnostic Radiology. He begins by saying that his role required him to become “reacquainted with the broad field of radiology” in order to be able to properly understand issues in each of the sections. He also talks about gaining the confidence to elicit information and the challenge of creating an environment that fosters sharing of information.||Reflecting on his leadership style, Dr. Hicks explains that he allows others to air their views fully, often not sharing his own perspective in order to allow free flow of discussion. He notes that some colleagues have criticized him for being too slow to voice his own views and make decisions, but feels his slower style has served him well.||Dr. Hicks also comments on the importance of admitting when something didn’t go right, giving an example of the department’s inefficient first attempt to address effort allocation.
Chapter 13: Landmark Moments in the Growth of Diagnostic Radiology

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks summarizes key moments of change during his leadership of the Department of Diagnostic Radiology. He first notes the governance structure he helped organize and his role working within the Division of Diagnostic Imaging so the department could function as a full partner with other departments. He also notes the strategic recruiting that build the research and clinical capacity of the department, as well as the strengthening of infrastructure and administrative support for the new activities.||Dr. Hicks also explains that the Department began looking beyond the confines of the Houston campus to the region. He talks about the “groundbreaking moment” of developing very patient-centric radiology services at West Houston Imaging in the Bellaire area of Houston. On this theme he also notes that the department shifted from a faculty-centric to patient-centric focus, with Dr. Joey Steele leading the patient experience initiative. Dr. Steele worked with the Dean of the hospitality institution, the Conrad Hilton School at University of Houston, to improve customer service. Dr. Hicks shares a summary of the positive feedback to a study on patient satisfaction.
Chapter 14: Head of the Division of Diagnostic Imaging

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks talks about assuming the role of Head of the Division of Diagnostic Imaging in 2010 while also serving as Chair of the Department of Diagnostic Radiology –a doubling of roles he took on to encourage MD Anderson to appoint a permanent department chair. He explains that as division head, he was particularly concerned about “how do we develop leaders” and he lists the individuals in leadership positions at that time. He explains that the Department of Experimental Diagnostic Imaging was poised to make key changes regarding the evolution of research into areas of translational research and cancer systems imaging. He talks about the creation of CABIR [Center for Advanced Biomedical Imaging Research] and QAAC [Qualitative Imaging Analysis Core] as part of this growth. He discusses how challenging it is to develop new technological and research infrastructure in a complex institutional environment.
Chapter 15: The Division of Diagnostic Imaging Creates a Leadership Development Program

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks begins this chapter by talking about the vision he created for the Division in 2010, even before he took over as head, with a particular focus on developing internal leadership. Dr. Hicks explains that the division created a program of “Ten Things You Need to Know in a Year” to counteract the fact that the Faculty Leadership Academy did not address some practical skills that division leaders needed. These fell into three categories: knowing and managing self; managing others; systems management. He describes the pilot program the division ran and the positive results: the Leadership Academy began to absorb some of the division practices. He confirms that in the next fiscal year, the division will be working with HR and Faculty and Academic Development to continue the program. He also stresses that leaders need a support network for coaching and problem solving when challenges arise.||Session Four: 24 July 2018
Chapter 16: Transitions under Ronald DePinho: Epic and Financial Struggles

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks begins to sketch the period of institutional turbulence during Ronald DePinho’s [oral history interview] presidency. He begins by sharing his personal view of Dr. DePinho and his vision for developing MD Anderson’s commitment to translational research. Dr. Hicks notes that many people saw Dr. DePinho’s Moon Shots program as a divisive force in the institution, but he saw its potential for bringing people together.||

Next, Dr. Hicks touches on factors leading to negative views of Dr. DePinho’s leadership: poor communication, top-down decision-making, and a growing feeling among clinicians that their perspectives were not heard.||Next he focuses on the financial crisis in the institution. He explains that MD Anderson came out of the recession to face a new financial environment in healthcare and that the decision to implement Epic (in spring 2016) greatly compromised the institution’s financial comeback, despite the fact that a $250 million loss was anticipated. The comeback took longer. He explains that the immediate fix –to see more patients—was not adequate to the situation. The measures needed to remedy the situation were complicated and difficult to implement. He explains that solutions were proposed from many sources, but the siloing in the institution as well as lack of responsiveness from executive leadership delayed the recovery and intensified the growing sense of mistrust in the institution. Dr. Hicks also observes that payroll expenses were out of control in 2017.l
Chapter 17: Transitions under Ronald DePinho and the Seeds of Shared Governance

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks shapes his response to a question about shifts in MD Anderson culture under Ronald DePinho by discussing the Committee of Division Heads that he chaired in 2012. He explains that the committee meetings first functioned as gripe sessions, but by 2012, the committee decided to be solution oriented. They addressed the lack of trust between these levels of leadership by sending an invitation to the executive committee and Dr. DePinho to come and talk to the division heads. He sketches the topics discussed and noted that Dr. DePinho and the Executive Committee attended the meetings when they could.||

Next, he sketches landmark moments in the disintegration of leadership relationships which reached a low point in 2015, when Chancellor William H. McCraven took action. Dr. Hicks talks about the causes of the morale problems among faculty and notes his personal view of how frustrating the situation was at that time.||

Next, Dr. Hicks explains that the Division of Diagnostic Imaging began to look seriously at the issue of leadership, shifting perspective and viewing leadership within the Division as an institution-wide role. He notes that there was a growing desire to help the division heads make a difference with leadership as well as growing frustration that the executive leadership was not listening to genuine concerns, a situation that resulted in an increased lack of trust, disempowerment. Dr. Hicks discusses many aspects of leadership style and how this factored into growing problems at the institution. He explains that it is important for a leaders to let go of the desire to micromanage, to trust lower levels of the organization to do what is best. He also notes that leaders can give in to the temptation to not show they don’t have expertise in an area.||Dr. Hicks then discusses the problem of siloing in at MD Anderson and gives an example of how silos prevented solutions from being implemented to resolve financial difficulties stemming from the transition to Epic.||He ends this chapter by noting that Hurricane Harvey (2017) was a “stress test for shared governance.”
Chapter 18: Transitions under Ronald DePinho: Creating Shared Governance

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks describes events of Spring and Summer of 2015 that marked the turning point in the institutional response to the institutional turbulence under Dr. DePinho. The Faculty Senate and the Division heads had been advocating for more of role in decision making, and the situation had become serious enough that UT System Chancellor McCraven visited in the spring. The Faculty Senate issued a White Paper (https://cancerletter.com/articles/20150713_1/) outlining issues underlying low faculty morale. Chancellor McCraven issued an invitation for a group of three members of the Executive Committee and three division heads to come to Austin to discuss the White Paper. This meeting led directly to the formation of the shared governance model. Dr. Hicks describes the mood of the meeting and the impact of the chancellor stepping in.||

Next, Dr. Hick talks about the first actions taken by the newly formed Shared Governance Committee: addressing issues of confidentiality of meetings, defining committee identity and principles, and creating a strategic plan from the Faculty Senate White Paper. He notes that the committee divided into two (informal) groups: one was committed to looking at issues of culture and communication and the other more focused on the scientific and clinical activities at the institution. The concerns of the first group were eventually dropped by the SGC, however Dr. Hicks, who was part of the group, says they continued meeting to discuss how the climate of the institution could be changed to stress how people come together and work together to save the institution.||

Next, Dr. Hicks talks about the impact of McChrystal Group in 2016. Dr. Hicks explains how he became aware of the book, Team of Teams, by General Stanley McChrystal, who was then invited to MD Anderson to speak when the SCG was still new. The Committee encouraged the institution to invite McChrystal associates to evaluate MD Anderson. Dr. Hicks explains that their four page assessment of the institution was on target and spurred concerned work [document in Supplementary Materials]. At this point, he says, people really began to come together. He also notes that at this point, the people working on institutional change began to realize the stakes of what they were doing.
Chapter 19: The Shared Governance Committee: the McChrystal Group’s Recommendations for Change

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks reviews the assessment that the McChrystal Group performed (2016) to support the Shared Governance Committee as it restructured MD Anderson [document in Supplementary]. He reviews their key points: a lack of trust and transparency; siloing and lack of alignment; problems with accountability; and problems with communication. He also sketches how the McChrystal Group worked with the SGC beginning in February of 2017 to the end of that year to align groups and determine a new governance structure to facilitate transparency.
Chapter 20: A New Administrative Structure and Lessons Learned from Working with the McChrystal Group

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks reflects on leadership lessons he learned by working with the McChrystal Group. CLIP: He explains that he learned to see decision-making as a disciplined process and details what he means by that, giving an example of a failure of process that led to poor decision making. He then discusses the importance of using a rational process to create alignments between teams and working group.||

Next, Dr. Hicks talks explains the rationale the Shared Governance Committee used to transform MD Anderson’s administrative structure, creating a more functionally driven structure aligned with new operational priorities.
Chapter 21: An Interim President and His Team Address Institutional Challenges

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks begins this session by explaining how he was offered to opportunity to become interim president of MD Anderson after Dr. Ronald DePinho [oral history interview] resigned. He explains his reasoning for accepting this role and clarifies how he saw his mandate for this short-term position. He notes that UT System did not intervene in MD Anderson’s change process. He describes the steps taken to use a team approach to turn around the financial crisis and return the focus of the institution to core values, multi-disciplinary care, and patient care.||Dr. Hicks discusses his working relationship with COO, Stephen Hahn, MD and the other members of the team he worked most closely with. He explains how Ben Nelson was selected to become CFO.||Next he discusses how a new administrative structure emerged from the joint work of the President’s Leadership Team, the McChrystal Group, and the Shared Governance Committee. He also describes the process of requesting input on the proposed structure from the UT System Chancellor and the Board of Visitors. Dr. Hicks talks about some challenges that emerged from this implementing this reorganization, which eliminated the need for certain formerly key leaders within the organization.||[The recorder is paused and the session is not resumed]
Chapter 22: Changing the Institutional Governance Model: Challenges

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks begins this chapter by reviewing how the shared governance committee was formed (Summer 2016). He notes that a good deal of the transformation process was set in motion when Dan Fontaine, Senior Vice President for Business Affairs, decided to retire. A reorganization was needed to ensure that the function areas and his people would have homes, and this was an opportunity to determine what would be the best structure for the organization. The Shared Governance Committee determined that a flattened structure would address the deep silos and communication issues and offer stability and flexibility.||Dr. Hicks then explains how the SGC worked out the reporting structure. He says that the Chancellor of the UT System liked the proposed structure and also put in place the Chief Operating Officer role to pull the silos together; however this new structure also changed the reporting structure and created stresses for people who previously reported directly to the president. He further clarifies the rationale for the new structure. He then begins to explain that it was very difficult for the VPs and others to take a reduced role.
Chapter 23: Implementing Change, the Influence of the Board of Visitors

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks describes an obstacle to implementing the shared governance system. He explains that the majority of the higher level individuals accepted the reality that their own roles had to shift and also recognized the institutional problems the new structure was designed to address. However, it became clear that neither the physician in chief, Dr. Thomas Buccholz [oral history interview] nor provost Dr. Ethan Dmitrovsky shared a view of the need for change. Dr. Hicks explains that it became clear they needed to be removed from their roles. As discussion evolved, he says, the process became contentious and members of the Board of Visitors “kitchen cabinet” became involved, meeting with him and attempting to guide the process (which is beyond the official scope of the Board of Visitors). Dr. Hicks says that he decided to focus on advice provided by MD Anderson about MD Anderson processes.||Dr. Hicks reflects briefly on his handling of this difficult situation. He observes that leaders must not allow personalities and emotions get in the way of doing what is best for the organization.||

Next, Dr. Hicks reflects on Dr. DePinho’s leadership, noting that “he did not fail alone, he had a team.” He explains that the removal of Drs. Dmitrovsky and Buccholz was the last task before the institution could move out of the DePinho years and into a new transition. He also summarizes the Board of Visitors concerns and motivations for becoming involved in this process. He notes that removing these two key people and making the governance change had a positive effect on the new president’s administration [Peter Pisters, MD].
Chapter 24: Thoughts about Serving as President

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks traces the shift in his thinking about possibly serving as permanent president of the institution. He reports on conversations he had with Dr. Raymond S. Greenberg, University of Texas System’s Executive Vice Chancellor for Health Affairs: both he and Dr. Greenberg were concerned that looking ahead to permanent presidency would raise questions about decisions Dr. Hicks made as interim president. On the other hand, he says, he was energized by the thought of taking on the challenge of the permanent presidency and building a team-based culture for the institution. He notes that he received a lot of encouragement to apply and reflects on the challenges that a high profile, public role presents to an introvert, such as himself. He notes that he put in an application, which only went as far as the first round of interviews. At the end of the session, Dr. Hick talks about the challenges a leader can face that make you “lose a part of yourself.”
Chapter 25: A Follow Up on Being Recruited for President and Views on Harvey

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks begins this chapter with a brief follow up to last session’s discussion of his thoughts about applying for the position of permanent president. Despite his reservations, he explains, he was approached by a recruiter and after eliciting various opinions, decided to apply.||

Next, Dr. Hicks talks about how Hurricane Harvey, which made landfall in Houston during 2017 and which was “a coming-together moment” and a test of all the structures and skills that the Shared Governance Team was putting in place. He describes how the institution was at first caught off guard because of meteorological reports that underestimated the amount of rainfall and the rapidly shifting nature of the storm of increasing magnitude. He describes how the institution quickly put the skills and resiliency to use to manage institutional operations and successfully rebound. Dr. Hicks talks about the impact on employees and The Caring Fund of about one million dollars that was established via donations to help.||Dr. Hicks shares his “most precious memory” of his time as interim president: the post Harvey celebration at The Park that acknowledged the way that the institution came together during the storm.||

Next, he shares the lessons learned: specifically how the crisis revealed certain local areas of operation with less developed communication networks, resiliency, confidence in local decision-making, and abilities to ask for help. He explains that the McChrystal Group was still involved in mentoring the institution and helped them undertake an “After Action Review” to examine how Harvey was handled and identify areas that needed additional analysis and intervention.||

Next, Dr. Hicks talks about the financial impact of the institution, explaining that at the cusp of the 2017/’18 and 2018/’19 fiscal years, MD Anderson was on track to achieve a $25 million margin. The storm's impact was around $30 million. Dr. Hicks explains that he decided to make various institutional awards, despite the fact that those would increase the shortfall.
Chapter 26: Defining Operational Priorities and Preparing for Dr. Pisters to Step into the Presidency

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks discusses the identification of the operational priorities [ROPR] during October and November of 2018 to manage the institution’s change process before Dr. Peter Pisters arrived to become institution president.||[The recorder is paused]||Dr. Hicks lists the Operational Priorities: patient experience; enhanced information systems; geographic expansion; discovery; education; recruitment and development; financial sustainability. He explains how this type of planning was different from what occurred prior to Dr. Ronald DePinho’s arrival and how it was managed to provide structure and also flexibility once Dr. Peter Pisters arrived.||Dr. Hicks provides a summary of what Peter Pisters brings to the institution (having worked at MD Anderson before) as well as his lack of immediate familiarity with the recent turbulence.||He comments on the selection of Dr. Pisters and how it reflected concerns that the new president have adequate familiarity with MD Anderson culture.
Chapter 27: Views of MD Anderson Presidents; Peter Pisters and the “Care and Feeding” of MD Anderson Culture

Marshall Hicks MD and Tacey A. Rosolowski PhD

Dr. Hicks begins this chapter by commenting that the state legislature in Austin monitors MD Anderson because the financial health of the institution has an impact on the entire University of Texas system. He notes that MD Anderson has returned to a solid financial footing.||Dr. Hicks comments on Dr. Peter Pisters’ style, noting that he is a “student of leadership.” He also observes that leadership used to take culture for granted, but now there is a concerted effort to cultivate the culture of the institution.||

Next, Dr. Hicks sketches the leadership approaches of the MD Anderson presidents. He explains that Dr. Pisters is particularly attuned to the fact that healthcare is changing and brings skills in preparing the institution to navigate changes as the stakes and risks rise.||Dr. Hicks then explains that presidents need to resist the temptation to operate solely within their comfort zones. He comments on his own comfort zone and notes that he was tested by a financial crisis during his period as interim president.
Chapter 28: Experiences at the Mallinckrodt Institute of Radiology and Their Impact on Later Leadership (1988-1998)

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks talks about the ten years he spent in the newly established interventional radiology group at the Mallinckrodt Institute of Radiology at the Washington University school of Medicine, St. Louis, Missouri. He talks about the opportunities this afforded him immediately after his fellowship period to build a clinical and educational training programs and makes connections between these early-career experiences and his later leadership at MD Anderson, e.g. immersion in a positive culture at the Institute; the opportunity to build a clinical practice and develop excellent patient care. He also describes his experience observing issues that arose at University of Washington, the academic and healthcare delivery arms of the institution were divided into different financial areas.||

Next, Dr. Hicks confirms that these experiences helped give him the skills to rebuild Interventional Radiology at MD Anderson and to recruit well. He also learned how to treat patients. He tells a story that illustrates how faculty in an emerging field can be tempted to push boundaries when the treat patients and how collaborative discussions can ensure responsible action is taken. He notes as well that he brought this team based approach to MD Anderson.
Chapter 29: Transitioning out of the Interim President Role

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks focuses on his role as Head of the Division of Diagnostic Imaging after serving as MD Anderson’s interim president. He discusses issues the division was facing, including the discussion of how to move services out into the region as well as staffing needs occasioned by the implementation of the Epic electronic medical records.||Dr. Hicks also discusses challenges he experienced as he returned to a divisional role after serving at the highest executive level: after a few years looking at institutional issues from a very broad perspective has changed how he interprets issues that seem pressing when seen only from the departmental and divisional level. He explains that he is questioning whether he is best able to serve the institution as a division head and has been considering other options. Dr. Hicks notes he has enjoyed working on the In-Patient Planning Committee, and he reflects on the difficulty of making late-career moves.
Chapter 30: On Ongoing Strategic Planning and the Future of MD Anderson (2019)

Marshall Hicks MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Hicks talks about the strategic planning model Play to Win (Lafley Martin) that Dr. Peter Pisters brought to MD Anderson in the early days of his presidency. He outlines several positive features of the model and notes the importance of defining MD Anderson’s “aspirational win” (a key concept in the method), given the need to avoid “turning into a corporation.” He talks about how important it is not to “lose the people” of MD Anderson, as patients constantly mention the caring people the encounter during treatment and this gives the institution its edge.||Dr. Hicks then sketches what lies ahead for the institution: the need to succeed in a changing healthcare environment linked to politics; the need to fund research more independently of clinical revenue; and to develop a wide range of clinical service to be flexible. He also notes that MD Anderson needs to position itself advantageously in the region to manage risk and also work collaboratively with institutions across Texas.
Chapter 01: A Nursing Student Discovers MD Anderson and Oncology Nursing

Deborah A. Houston and Tacey A. Rosolowski PhD

In this segment, Ms. Houston talks about her family background and the path that led her to oncology nursing. Born into a military family, she moved a great deal as a youngster. As her mother and aunts were nurses, she followed in their path, attended Texas Woman’s University in Denton, Texas. She began to work at MD Anderson while still in nursing school (in ’68 or ’69), choosing Anderson over Methodist Hospital, because of the higher wage ($18/8 hour shift). She describes her responsibilities at this time (dressing changes, for example). When she did her clinical rotation at MD Anderson, she was so impressed with the culture of work and care for the patients that she decided to become an oncology nurse.
Chapter 02: Why Oncology Nursing is Unique

Deborah A. Houston and Tacey A. Rosolowski PhD

Ms. Houston describes how important a nurse is during the frequent “life ending” situations of cancer. She explains how a nurse gets to know patients and helps them confront all dimensions of their disease, though she also describes how uplifting it is to see patients beat cancer, as she was able to see when working with many lung cancer patients. She gives an example of a life-ending situation with a patient she particularly admired, and who spoke with her about how he could help his family during the rapid progression of his small-cell cancer.
Chapter 03: Nursing and Nursing Management at MD Anderson in the Seventies

Deborah A. Houston and Tacey A. Rosolowski PhD

In this segment, Ms. Houston talks about the progression of her nursing career. She first summarizes her experiences as Staff Nurse (“72 – ’76), when she worked with a number of units: Surgical, Thoracic, General, and Head and Neck. The separation of these units causes her to observe that although multi-disciplinary treatment was a goal from MD Anderson’s inception, it became a reality in the 90s with centralization of patient services. She also comments on the role of nurses in the team of care providers, noting that before the hiring of physicians assistants, nurses helped physicians manage their patients. Next she talks about her role as a teacher and mentor once she became a Nurse Manager (Head Nurse) in 1976, and she helped nurses under her to learn how to care for lung and esophageal patients. At the time, there were only three people in nursing staff development (now there are over thirty).

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