Interview Chapters

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Chapter 01: Inspired to Practice Medicine and Lured to MD Anderson with an Electron Microscope

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

At the chapter, the interviewer and interview subject discuss a milestone for the School of Health Profession.

Next, Dr. Ahearn outlines his professional path leading from the small-town environment of Jackson, Texas, to the University of Texas, Austin, where an inspiring professor and mentor at who guided him toward graduate work in cytology. Dr. Ahearn received his B.A. in Zoology in 1958, his M.A. in Zoology and Biochemistry. His Ph.D. in Cytology was conferred in 1965. Specializing in ultrastructural pathology, Dr. Ahearn was brought to MD Anderson by Dr. Russell, Chair of the Department of Clinical Pathology, to serve as Director of the Diagnostic Ultrastructure Hematology Laboratory and work with the newly acquired electron microscope.
Chapter 02: Memories of a Small MD Anderson and R. Lee Clark

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn shares memories of a much smaller-scale MD Anderson on his arrival. He also shares recollections of the "visionary" Dr. R. Lee Clark.
Chapter 03: Research Innovation Leads to a New Ultrastructure Diagnostic Laboratory and Discovery of a Cytogenetic Marker

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn sketches his main contributions to pathology and the institution. First he describes his development of a rapid histo-chemical technique for differentiating forms of leukemia. His technique required only 24 hours rather than the standard five days "“a "revolutionary" advantage, as he notes, for diagnosis and treatment. He describes the challenges of diagnosis at that time at MD Anderson and some of the institutional reorganization that took place as a result of MD Anderson's growth and commitment to new technologies. He also explains his view that work at MD Anderson was at the leading edge of innovation in the years when he first arrived.
Chapter 04: Creating a New School of Allied Health Professions

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn speaks about the creation of the degree-granting School of Health Professions from the loosely structured, certificate-based training programs then in existence. The School was formed in reaction to the (national) shortages of allied health professionals at that time and it continues to address that problem. He explains problems that arose from the fact that MD Anderson was not a degree granting institution despite the fact that it offered many training programs. He describes the advantages that degree-granting status would offer MD Anderson.
Chapter 05: Establishing the School of Allied Health Professions: Challenges and A Commitment to Excellence and Critical Thinking

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn goes into more detail about creating the School of Allied Health Professions in an institution already very pressed for space. He paints a striking picture of the School's first class of 35 students maneuvering their way into tiny ad hoc classrooms. He outlines the School's educational philosophy and commitment to critical thinking.
Chapter 06: A Virtual Radiation Therapy Machine: Innovative Education in the School of Allied Health Professions

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn gives a vivid description of a virtual radiation therapy interactive simulator and its benefits for education. He also explains how the school relies on the faculty to be aware of technological advances that might enhance training.
Chapter 07: Feeding the Pipeline of Health Professionals: The Outreach Programs

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn talks about his work creating summer programs for high school students, medical students and educators (e.g. Carl B. and Florence E. King Foundation Summer Program in Biomedical Sciences for Graduating High School Students). The aim of these program: to build awareness of the allied health professions and technological advances. He talks about his interest in working with young students who need educational guidance.
Chapter 08: The Rosalie B. Hite Fellowship for Graduate Students in Cancer Research

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn continues his discussion of the summer programs he has founded. He first explains the founding and mission of the Rosalie B. Hite Fellowship Committee (that supports graduate students in cancer research), stressing the importance of philanthropy in supporting the educational programs. He then fleshes out more details about the summer programs described in the last session.
Chapter 09: Creating Project SAFETY [Sun Awareness For Educating Today's Youth]

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn turns to the pro-bono projects he has instigated in cancer prevention, projects inspired by the blistering burns he saw on young people who attended his summer programs. He describes these programs in detail and offers touching anecdotes on their influence. He talks about the dangers of tanning booths for young people. He talks about a state-sponsored action plan to address skin cancer.
Chapter 10: Charles LeMaistre, John Mendelsohn, and Other Leaders

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn offers his perspective on the three presidents he has served under, noting that MD Anderson was a different institution under each leader, though each has "shared the vision" of MD Anderson as a caring institution. That feeling, he says, also filters into a sense of pride and mission in the faculty.
Chapter 11: Awards and Pride in the School of Health Professions and MD Anderson's "Pipeline of Caring"

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn talks about awards he has received. In response to a final question about what he does to relax, Dr. Ahearn recounts an anecdote about caring for Tobias, a miniature horse.
Chapter 12: The Future of The School of Health Professions and the Summer Programs

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

Dr. Ahearn begins this chapter by talking about the School of Health Professions at a moment when the School is poised for growth, and as Dr. Shirley Richmond succeeds him as Dean. He offers his views on Dr. Ronald DePinho, who on September 1st succeeded John Mendelsohn as president of MD Anderson. He speaks about his hopes for Project SAFETY, the skin cancer awareness project that is attracting national attention, as well as the King Foundation project. (He shares amusing stories about dealing with high school students who are away from home from the first time.)
Chapter 13: Time for Travel; A New Business

Michael J. Ahearn PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Ahearn talks about his plans for retirement. He is looking forward to a trip to County Cork in Ireland, where he will immerse himself in the Irish heritage important to his family. He is also assisting his wife in her custom tile business. (Dr. Ahearn joking says that his wife offered him the positions of CEO, COO, or CFO, but never discussed salary or benefits.) He reflects on the fact that his career has allowed him to make contributions in all four of MD Anderson's mission areas: research, clinical service, patient service, and education. He reflects on how his spiritual life has influenced his work: "everything we do is for the glory of God," and hence "I have always tried to do my very best."

Working with colleagues at MD Anderson also inspired him throughout his long career. Finally, reflecting on the interview process, Dr. Ahearn notes that everything he has said reflects his perspective alone but nevertheless one thread will run through all the interviews included in this collection: the concern with patients and patient care.
Chapter 01: An Early Interest in Medicine: Seeking a Well-Rounded Liberal Education

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian begins this chapter with some comments about his family background, and the family's focus on education. Dr. Alexanian explains that he wanted to be a physician form the time he was a child, motivated by his illness and exposure to doctors, and by his mother's stories of his great uncle, who was a famous dental surgeon.

Next, Dr. Alexanian talks about his undergraduate experience at Dartmouth College. Dr. Alexanian explains that he wanted a broad, liberal arts program during college because he believed that the well-educated physician is a well-educated human being, sensitive to society and able to contribute to society beyond his medical sphere.
Chapter 02: Medical School and a Brief History of Medical Education in the U.S.

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian briefly talks about his classes and then explains the accelerated program at the Dartmouth Medical School (MD '53). Dr. Alexanian also sketches the history of medical education and explains the impact of the Flexner Report in closing down a number of programs. He then compares the medical training at Dartmouth and at Harvard University and briefly discusses his internship at the University of Washington.
Chapter 03: Committed to Academic Medicine

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian begins this chapter with a discussion of his military service (U S Army, Captain, 1956 - 1958). He discusses his reason for specializing in anesthesia. He comments on serving as part of the occupying force in Japan.

Next, Dr. Alexanian sketches his path from a research fellowship (1960-1962) in Hematology at the University of Washington School of Medicine in Seattle, Washington to a second fellowship (1962âˆ’1963) in Radiobiology at the Christie Hospital and Holt Radium Institute in Manchester, England. He explains that his interest in cancer research emerged as he sought opportunities for positions in academic institutions. At the end of this chapter, Dr. Alexanian talks about his comic book collection.
Chapter 04: Early Research on Stem Cells and Erythropoietin

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian explains how he came to MD Anderson in 1964, then then talks about the evolution of his research, beginning with his experiences working on stem-cell kinetics while working with Dr. Laszlo Lajtha when he was on fellowship in Manchester, England. This focus enabled him to make the move to his second research fellowship in Seattle, where he worked with Dr. Clement Finch, a specialist in red cells, who taught him to focus on disease from a clinical perspective. Dr. Alexanian explains the skills he learned from these two mentors. He also notes that his experience enabled him to apply for grants for his own projects, and initiated work on erythropoietin. He describes his research and notes that he was the first person to measure normal levels of this hormone in human urine.
Chapter 05: MD Anderson In The mid-Sixties

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian provides a snapshot of MD Anderson when he arrived in 1964. He explains that Dr. Bergsagel wanted to combine clinical and basic research and the institution president, R. Lee Clark, MD, wanted to shorten the time between laboratory discoveries and delivery of treatment to patients. Dr. Alexanian lists the programs he inherited on arrival. He tells some history of the Department of Developmental Therapeutics and explains why he joined the Department of Leukemia.
Chapter 06: Focusing on Myeloma and Perspectives on Myeloma Research and Treatment

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian discusses his work with erythropoeinin and its impact. He then talks about how myeloma emerged as a research focus. He explains the mindset he uses when he approaches patients as subjects of research. He then explains how competition for patients with blood diseases was controversial at MD Anderson: administrative decisions eventually distributed between departments and eased some of the tension (though this took about ten years). Dr. Alexanian then traces the evolution of his research on myeloma, noting that clinical trials were conducted through the Southwest Oncology Group. In 1969, he was the first to combine melphalan and prednisone, which became the worldwide standard of care for many years. He describes how he worked with others to devise drug combinations.
Chapter 07: Myeloma: Breakthroughs with Transplant Supported Chemotherapy

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian discusses the transplant supported program in myeloma. He sketches the history of the program and the rationale of the treatment: administering extremely high doses of melphalan and then "rescuing" the patient from toxicity with stem cell transplants, a procedure resulting in 25 - 30% complete remission lasting four years. He explains how willing patients were to participate in these studies and he describes his interactions with patients as he explained procedures. Dr. Alexanian next talks about the challenges of obtaining insurance coverage for experimental therapies. He then goes on to note that this chemo-transplant procedure is still the standard of treatment for some patients. Dr. Alexanian then explains how Dr. Barlogie left MD Anderson.
Chapter 08: A Breakthrough Myeloma Treatment with Thalidomide

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian talks about the treatments he innovated using thalidomide. He explains that thalidomide can inhibit angiogenesis, and Dr. Barlogie used it on dying patients with good results. Dr. Alexanian explains that he was looking at the next step: to use thalidomide in combination with Velcade and dexamethasone, supported by stem cell transplantation. He notes that over forty years of working with drug combinations, the treatment of myeloma at MD Anderson has gone from no remissions to remissions that last an average of six years. He also notes that he has been following patient for twenty years and there are some who have not relapsed in twelve years.
Chapter 09: The Challenge of Defining "Cure" in Oncology; Views of Research Approval Processes

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian talks about the difficulty in defining "cure" when discussing cancer, and notes his own publication on the topic: Alexanian R, Delasalle K, Wang M, Thomas S, Weber D. Curability of multiple myeloma. Bone Marrow Res 2012:916479, 2012. e-Pub 5/2012. PMCID: PMC3366198. [The recorder is paused for about 3 minutes.] Dr. Alexanian talks about how MD Anderson's research approval processes get in the way of research and addressing patient needs. He admits, "I'm a bit of a rebel." He tells an anecdote about providing drugs to patients.
Chapter 10: Threats to MD Anderson's Status: Losing Focus on Innovative Research and Problems with Regulatory Procedures

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this section, Dr. Alexanian comments on the uneven focus on innovative research among the faculty during his years at MD Anderson. He explains innovative clinical researchers in many sections were not promoted or recognized for their work and often left the institution. He cites several areas that are making innovative contributions and acknowledges that factors outside the institution create fluctuations in national standing and research contributions. Dr. Alexanian next sets some context for the research activities at MD Anderson, beginning with Dr. R. Lee Clark's desire to build a research mission into every department at the institution. He lists factors that accelerated research progress in the 60s, though he notes that many faculty were hired to be clinical experts in their field and had no desire or capacity to do research, leading to conflicts between clinical and research faculty. He uses the treatment of Hodgkin's disease as an example of a conflict.
Chapter 11: Regulatory Procedures: A Critical View

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian offers his views on the "regulatory climate" at MD Anderson, another source of difficulties for the institution. He explains the reasons why MD Anderson has created an increasingly cumbersome set of regulations for clinical research. He notes that early regulatory mechanisms facilitated research, but the current system exists for future government review processes. As an example of how current review processes may hinder research, Dr. Alexanian offers the example of Dr. Bart Barlogie's use of thalidomide (most likely without regulatory approval, he notes) to successfully treat patients dying of myeloma. He contrasts two attitudes toward clinical research: "Do no harm" versus "Try only after exhaustive review and delay." Dr. Alexanian also explains that because of complex internal regulatory procedures, MD Anderson is often the last institution to enter patients into multi-center clinical trials.
Chapter 12: Chief of the Myeloma Section, 1998 - 2004: Leveraging Resources and Mentoring Young Faculty

Raymond Alexanian MD and Tacey A. Rosolowski PhD

At the beginning of the chapter, Dr. Alexanian and the interviewer review CV entries for relevance to the discussion.

Next, Dr. Alexanian explains the evolution of the focus on the Myeloma Section. He explains that he was the only person working with myeloma between 1964, when he arrived at MD Anderson, and 1984, when Bart Barlogie joined the institution. They next formed an association with the Transplant Department, and Dr. Alexanian notes the "easy melding" of departments at MD Anderson where credit and projects were shared. He next sketches his activities as section chief -largely leveraging resources already in existence. Dr. Alexanian talks about the advantages that MD Anderson offers the researcher.
Chapter 13: Mentoring Young Faculty in Research Flexibility and Writing Skills

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian explains how he would advise young faculty to be flexible in their research and pace their careers, taking advantage of existing resources whenever possible. He notes the importance of mentoring to careers. He also stresses the importance of writing skills to a research career.
Chapter 14: The Research Committee; The Surveillance Committee

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian explains the roles of the Research and Surveillance Committees in this chapter. He begins with the Research Committee and notes that it was most likely established by Dr. Clark to advise faculty on their research projects and make sure that projects did not overlap. He describes how the process worked and gives some examples of issues discussed. Dr. Alexanian explains that the Surveillance Committee was created when the NIH required that institutions evaluate their patient protection procedures and contracted with institution individually to formalize these procedures.
Chapter 15: "The Research Report": an Innovative Communication Device for MD Anderson

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian talks about activities of the Research Committee, particularly its publication of MD Anderson's yearly Research Report, which helped build cooperation between departments and also documented faculty activities even if they were not publishing. He recalls learning at a conference that "other centers did not have the process as well-oiled" and their faculty were amazed at the activities and contributions of the Research Committee. He also tells a story of reporting this to R. Lee Clark, who "beamed." Dr. Alexanian briefly sketches Dr. Clark's vision and notes that MD Anderson was founded because of un-met cancer care needs in Texas, particularly in the area of women's cancers.
Chapter 16: The Faculty Classification Committee and Related Issues with Tenure and Promotion

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian discusses the Faculty Classification Committee and its activities standardizing the guidelines for promotion and tenure across departments. He notes that MD Anderson's guidelines were less stringent than at Harvard or Yale Universities.
Chapter 17: The Patent Committee

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian talks about the Patent Committee, designed to provide early documentation of innovations which would late be patented. He gives an example of a device invented by the nursing service to administer chemotherapy.
Chapter 18: The Transfusion Task Force and National Transfusion Standards

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian talks about his work on the Transfusion Task Force (1997 - 2004). He explains that it was set up to establish criteria for giving transfusion and he set about simplifying the guidelines. He also notes that the Task Force set up blood rallies and organized the first employee blood drive. He also gives background on the waiver that all patients sign on intake to MD Anderson which allows transfusions.
Chapter 19: The Summer Students Program; Changes in MD Anderson Culture

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian talks about the Summer Students Program that brings high school students into MD Anderson to conduct their own research programs.
Chapter 20: The Value of Committee Work; Changes in MD Anderson Culture and the Need for Mentoring

Raymond Alexanian MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Alexanian explains that committee work is not "a waste of time" as so many faculty believe. He notes that committee discussions with conflict can be very helpful in bringing important issue to the foregrounds for resolution. In the final minutes of this chapter, Dr. Alexanian notes changes in MD Anderson culture: Department heads no longer mentor as actively nor do they foster as much exchange among faculty. He explains what is needed in a good mentoring relationship.
Chapter 21: Retirement and Contributions

Raymond Alexanian MD and Tacey A. Rosolowski PhD

Dr. Alexanian begins this chapter with an explanation of why he cut back his work schedule to two days a week for seven to eight years, taking full retirement in 2013. He lists the activities he participates in now, noting that he plays tournament bridge and holds the rank of Silver Life Master.
Chapter 01: Radiation Therapy: A Brief History and Basic Principles

Peter Almond PhD, Lesley W. Brunet, and James S. Olson PhD

In this chapter, Dr. Almond discusses the physical principles that govern radiation therapy. He begins by describing x-ray tubes and how skin damage limited the dose of x-rays that a patient could receive. The chapter ends as Dr. Almond explains how this limitation led to the search for a higher energy alternative that would not share the same limitations.
Chapter 02: Cobalt-60 and the Evolution of Radiation Therapy at MD Anderson

Peter Almond PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Almond explains how the use of cobalt-60 could overcome several of the issues presented by x-rays in this chapter. He then discusses the progression of radiation machinery that used cobalt-60. From Betatrons to linear accelerators, Dr. Almond describes the evolution, advantages, and disadvantages of the different early radiation machinery used to treat tumors.
Chapter 03: The Race to Build a Cobalt-60 System and Why it Was Key to MD Anderson’s Reputation

Peter Almond PhD, Lesley W. Brunet, and James S. Olson PhD

Here, Dr. Anderson describes the race to build the first Betatron between Leonard Grimmett and researchers at MD Anderson and Harold Jones, a Canadian researcher. Grimmett designed the first device and provided its proof of concept at MD Anderson but was not able to get cobalt 60 to build the first machine, which was eventually built by Atomic Energy of Canada, Limited.
Chapter 04: Gilbert Fletcher’s Impact on Radiation Therapy

Peter Almond PhD, Lesley W. Brunet, and James S. Olson PhD

In this chapter, Dr. Almond discusses the advent of cobalt unit F. Hundreds of these units were built around the world, which made radiation oncology much more accessible. Dr. Almond then explains the impact that Gilbert H. Fletcher, an MD Anderson physician, had on developing a unique and aggressive—although controversial—treatment regimen.
Chapter 05: Developing Radiation to Address the ”Oxygen Effect” in Tumors

Peter Almond PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Almond describes the “oxygen effect” –the idea that anoxic cells are more resistant to radiation than those that are supplied oxygen—and discusses how researchers attempted to overcome it in this chapter. He describes MD Anderson’s collaboration with Texas A&M in the 1960s to build a Cyclotron that could use deuterons instead of cobalt-60 to provide radiation therapy and the eventual end of this treatment due to high complications.
Chapter 06: Assessing Aggressive Radiation Treatment, Cost Effectiveness and Proton Therapy

Peter Almond PhD, Lesley W. Brunet, and James S. Olson PhD

Dr. Almond discusses the debate among oncologists between using aggressive treatment, which may cure cancer but also give the patient complications, and moderating adverse effects, which may lead to cancer reappearing later. He also describes modern advancements in radiation oncology such as proton therapy, which is a new and precise treatment, and its advantages and disadvantages in this chapter.
Chapter 07: Surgery vs. Radiation Therapy; Long-Term Complications with Radiation Therapy

Peter Almond PhD, Lesley W. Brunet, and James S. Olson PhD

In this chapter, Dr. Almond explains the debate between treating tumors surgically or with radiation. Physicians like Fletcher preferred treating tumors with radiation therapy first to try to preserve a patient’s quality of life and resorted to surgery if radiation therapy failed while surgeons preferred to do the surgery immediately. Dr. Almond describes how this led to complicated discussions among surgeons.
Chapter 01: An Early Commitment to a Career in Nursing

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

Ms. Alt begins this chapter by sketching her upbringing in a very small town in Iowa where there was a strong sense of community that taught her “a lot about life.” She talks about the limited education when she was growing up, but appreciated her teachers who attempted to make opportunities for their students. She notes that she received a college scholarship from her church (Lutheran). Ms. Alt explains that her town “lived in the shadow of the Mayo Clinic,” and she was always impressed with its history, which inspired her from an early age to go into nursing. She also talks about her experience at Luther College in Decorah, Iowa.
Chapter 02: Nursing Education and Early Professional Life

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

Ms. Alt begins by talking about how she came to attend the Allen Memorial Hospital Lutheran School of Nursing in Waterloo, Iowa, then sketches her first job as a charge nurse on the medical surgical unite at Allen Memorial Hospital, and then as Head Nurse for the Medical Surgical Unit at Methodist Hospital in Houston.
Chapter 03: Nursing at MD Anderson in the Mid-Sixties

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

Ms. Alt begins this chapter by explaining how she became aware of a job opening at MD Anderson for a Head Nurse in the Perioperative Care Unit. She sketches the work environment for nurses in the 60s, where the MD was the boss in a unit, the head nurse ruled next and nurses followed the chain of command; nurses has no real opportunity for advancement unless they went into management. She observes that nurses may have had good ideas for how to improve workflow or patient care, but there was no culture to support local innovations by individuals not in leadership positions.
Chapter 04: Observations about Renilda Hilkemeyer and Nursing at MD Anderson

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

In this chapter, Ms. Alt first notes that her own three years as supervisor corresponded to a difficult time for Renilda Hilkemeyer. Ms. Alt discusses Dr. Hilkemeyer’s contributions and the thoughts about her length of service in the role head of nursing. She then talks about how difficult it was to find trained oncology nursing, as the specialty was not treated in depth in nursing schools. She comments on the process by which Dr. Hilkemeyer was removed from her position.
Chapter 05: Director of Nursing and Addressing the Serious Turnover Problem

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

Ms. Alt begins this chapter by explaining the “Mason-Dixon line” that separated inpatient from outpatient care at MD Anderson at that time. She then recounts how she stepped into the role of Director of Nursing after the selection committee had interviewed several other external candidates, noting her initial ambivalence about the role. She then explains how she addressed her primary concern at that tim the 90% turnover rate among nurses. She explains why turnover was so high. She also notes that she was working on a Masters degree at that time, at Texas Woman’s University (MS in Mental Health conferred in 1977), and elected to do her thesis on the turnover problem.[The recorder is paused]

Next, Ms. Alt discusses her findings and how she put them to work at MD Anderson, noting that institutional directors were very favorably inclined to evidence based action. Lack of promotion opportunities were a key issue for nurses, and Ms. Alt explains the three-option system instituted in clinical, management/education, and research. She notes that this was a large and very costly program to build and maintain, but it was well supported by Dr. LeMaistre and Mr. Gilley. She observes that they also understood that they had to address problems in the payroll system. She worked with IT to develop a computerized payroll system for nursing. Ms. Alt then reports that at the end of the first year of her service as Director, they institution had reduced turnover to 17%. She notes that Nursing had hired an employee advocate and a mental health counselor. She created a program, “Build Your Own Package,” based on a model she learned from a fire department, that helped with recruitment and retention.
Chapter 06: An Invention and Advancing Nursing Research

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

Ms. Alt begins this chapter by talking about what she enjoyed about her role as Director of Nursing.
Chapter 07: The First AIDS Unit at MD Anderson

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

In this chapter, Ms. Alt recalls the period in the 1980s when MD Anderson established its first AIDS clinic, staffed by volunteers. She describes this period as “a nightmare” firstly because of how ill the patients were and secondly because of the prejudiced attitudes were revealed among the faculty and staff. She notes that she was surprised that older faculty were more understanding than younger faculty. She talks about the work of a Dr. Rios, who left MD Anderson to establish a private AIDS clinic.
Chapter 08: Building the Foundation for the Shared Governance System

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

Ms. Alt begins this chapter on nursing’s shared governance system by recapping the research she conducted for her Master’s these MD Anderson’s serious retention problems with nurses. (She discussed this in session one as well.) Next she explains that when she stepped in as Head of the Division of Nursing, she began to build an environment where clinical staff saw their units as a community in which everyone had a voice. She discusses how the key was to address and build skills in good interpersonal relationships. She talks about the problems of staffing and explains why some physicians did not support her efforts to change the values of the nursing environment.
Chapter 09: Successes in Strengthening Nursing Community and Practice

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

Ms. Alt begins this chapter by commenting on the reputation of MD Anderson and how this bolstered the successful evolution of the Division of Nursing. She notes that other departments/divisions were jealous of the fact that she was able to secure so much support for nursing staff. She also notes that the turnover rate went down to fifteen percent, where it stayed.

Next, Ms. Alt explains the Medical Technician Program and the context in which the need evolved for special staff to provide drugs safely and comments on the sharp divide between in-patient and out-patient services.

Next, she talks about the “build your own package” program. She notes that all nursing were “graded” according to a transparent system. She talks about vising a fire department to see how they addressed staffing issues and explains why human resources didn’t grasp the specifics of nursing’s work scenarios.
Chapter 10: Leaving MD Anderson

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

In this chapter, Ms. Alt talks about coming to the understanding in the mid-nineties that her position in the institution had shifted and it was time to leave. She notes that she was the first female division head at MD Anderson. She explains that the emphasis of the institution had shifted, with new financial administrators coming in and reorganizing finances to exert an influence on how patient care was practiced. She notes that Dr. Charles LeMaistre was able to support her with an advantageous severance package.

Next, Ms. Alt lists the areas in which she feels she left a lasting mark on the institutio in strengthening the role of the clinical nurse and promoting the idea that self-governance is not a privilege but a responsibility of all. She notes that she is being interviewed for a film produced by the Texas Nursing Association, then talks about how she began to settle into retirement after her departure from MD Anderson in 1995/96.
Chapter 11: The Enterstomal Ostomy Team, Infusion Therapy, and the Oncology Nurse Certification Program

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

In this chapter, Ms. Alt talks about additional projects she took on that made a lasting mark in nursing and the institution. In response to an interviewer comment about fragmentation in nursing currently, Ms. Alt notes that during her tenure, there was no particular fragmentation. She also comments on the growing use and acceptance of physician assistants during that period.

Next, Ms. Alt discusses the evolution of the Enterstomal Ostomy Team, created under Renilda Hilkemeyer [oral history interview]. She explains the context in which the need for this team evolved to provide support and education for patients who needed to manage these appliances. Her goal was to also add an educational component for students learning this dimension of oncology nursing. She notes the close relationships that evolved between the team and patients.

Next, she talks briefly about the Infusion Therapy Team and the IV Teams. She then turns to the development of the credit-bearing Oncology Nurse Certification Program, which was a precursor to the master’s degree in cancer nursing. She notes that the Division of Nursing was the first to have such a program in Houston. She explains that the curriculum focused on nursing care around chemotherapy treatments, side effects, and care of the catheter. Ms. Alt explains that small hospitals across the country could call on her for advice as they set up oncology services.
Chapter 12: The Enterstomal Ostomy Team, Infusion Therapy, and the Oncology Nurse Certification Program

Joyce Alt RN, MS and Tacey A. Rosolowski PhD

In this chapter, Ms. Alt talks about her participation in an informal group of nursing leaders from the Texas Medical Center; she notes that they all observed that healthcare organizations were shifting nursing leadership from nurses to administrators. She touches on several initiatives undertaken under her leadershi the offsite rehab center that she staffed with nurses; nursing conferences that helped instill pride in MD Anderson nurses; and the development of the discharge planning team. She talks about the strong culture of communication and leadership that was evolving among nurses. She ends the interview with final comments about her time at MD Anderson.
Chapter 01: Attracted to the Challenges of Pharmacy at MD Anderson

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 02: Expanding Pharmacy Services, Part I: Creating Connections

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 03: Expanding Pharmacy Services, Part II: Complex Needs and Advancement in Treatment

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 04: Managing Drug Purchases and Inventory

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 05: Working With Research Protocols and Drugs for Research

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 06: Building Pharmacy Administration, Recruitment and a Supportive Care Mindset

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 07: Building the Division of Pharmacy: Shifting Perceptions of What Pharmacy Does, Addressing Costs, Measuring Outcomes

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 08: Preparing to Leave Anderson and A View of What’s Been Accomplished

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 09: A Degree in Public Health

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 10: A Great Hire for Pharmacy and Support for Patients

Roger W. Anderson PhD and Lesley W. Brunet
Chapter 01: About Monroe Dunaway Anderson

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 02: Memories of Monroe Dunaway Anderson

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 03: Connections with MD Anderson and Memories of R. Lee Clark, MD

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 04: The Origin of the Texas Medical Center and MD Anderson Cancer Center

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 05: The Early Growth of MD Anderson Cancer Center

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 06: The Board of Visitors and Views of Dr. Charles LeMaistre

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 07: Physician Referrals and Other Changes at a Growing Institution

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 08: More on the “Primitive Beginnings” of MD Anderson and the Texas Medical Center

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 09: Family Connections with MD Anderson and the Texas Medical Center

Thomas Dunaway Anderson and Louis J. Marchiafava PhD

The interview begins with Thomas Dunaway Anderson’s recollections of his uncle, Monroe Dunaway Anderson, the founder of the M.D. Anderson foundation and namesake of the University of Texas M.D. Anderson Cancer Center. The interview continues with a description of the establishment and purpose of the M.D. Anderson Foundation and the growth and development of several recipients of M.D. Anderson’s philanthropy, including the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center. Thomas Anderson’s memories and interactions regarding Dr. Randolph Lee Clark, the first full-time president of what is known today as the University of Texas M.D. Anderson Cancer Center, are recounted as well. A discussion concerning Thomas Anderson’s family contributions associated with the University of Texas M.D. Anderson Cancer Center and the Texas Medical Center ends the interview.
Chapter 01: Key Research on ABL Kinases

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus first talks about a study he will soon initiate on the role of JANUS Kinase 2 on chronic lymphocytic leukemia. He next quickly defines the field of molecular pathology and techniques that molecular pathologists use to break open cells and analyze their functions. He gives the example of the drug, Gleevec, and his contributions to work that unraveled how Gleevec successfully deactivates a key cell function that maintains leukemia. Next he talks about his work on the ABL kinase protein and chronic myeloid leukemia). He explains how this protein is involved in cell abnormalities and signaling functions that support the production of leukemia cells. He then goes into detail about how the BCR-ABL onco-proteins lead to leukemia. He notes some of the early studies that advanced knowledge, but did not immediately lead to treatment because the drugs under study (a precursor of Gleevec) were too toxic.
Chapter 02: A Death Inspires a Career Change and a Commitment to Leukemia Research

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus explains his reasons for focusing on leukemia research and the process of coming to MD Anderson. He begins the story in 1967, when he was working at the Plum Island Animal Disease Laboratory (Greenport, NY, 1965 - 1969). This is when his first wife died of chronic myeloid leukemia. They had three children. Dr. Arlinghaus decided to stop working on the virus and processes that lead to foot and mouth disease and shift "all of my scientific brain power to work on that disease." He explains how he was invited to come and present a talk in the Department of Biology. He notes that, usually, a new faculty member brings something to the institution, but at the time, he was unproven in cancer (though he had significant publications in other areas), and Dr. Haas "took a chance" on him. Dr. Arlinghaus describes the expertise in proteins he brought to MD Anderson.
Chapter 03: Initial Research with Viruses and Proteins: Slow Progress on the Gag Paul Gene

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus confirms that when he arrived at MD Anderson he "had no idea how to attack CML." He describes how he began working on viruses that cause leukemia in mice using widely studied technologies, including the Rauscher leukemia virus.

Dr. Arlinghaus explains the details related to discoveries about the genomic RNA of the Rauscher leukemia virus and three key proteins associated with it.

Dr. Arlinghaus explains his advances in understating the roles of genes and proteins (GAG-Paul, PR 65 GAG) in creating a leukemia particle that has a unique identity and integrity within cell systems.He also explains his discovery of the protein sequence and "stop code" of the viral protein.Next he talks about the implications of his discovery and sets it in context of other discoveries. Dr. Arlinghaus explains that he eventually received a warning after a year passed with no grants being awarded.He then explains that the NIH's Virus Cancer Program initiated in the late seventies "saved him." He talks about the acceptance of some of his discoveries.
Chapter 04: Leaving MD Anderson for Industry: Research into Hybrid Proteins with Tyrosine Kinase Activity

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus explains that in 1983 he resigned from MD Anderson and took a job as Vaccine Development Director, Johnson and Johnson Biotechnology Center, in San Diego, California (1/1983-1/1986).They agreed to give him money to develop his CML research.He was able to secure his own laboratory space as a Visiting Investigator (Member) at the Scripps Clinic & Research Foundation in La Jolla (1/1983-1/1986).

Dr. Arlinghaus describes his roles and notes that he arrived at Johnson and Johnson with an NCA grant awarded shortly before his departure from MD Anderson.

Dr. Arlinghaus next describes the work he performed for Johnson and Johnson developing synthetic peptide vaccines.He describes the molecular chemistry that makes peptide vaccines impossible.He then outlines his next steps in studying the structure of the abnormal ABL protein in leukemia viruses.He describes the discovery of the "ABL-fused" gene in CML, adding a new dimension to his research and resulting in a 1995 paper.
Chapter 05: Leaving Johnson and Johnson to Return to MD Anderson

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Arlinghaus explains why he left Johnson and Johnson in 1986 and returned to MD Anderson.He first provides some background regarding conflicts with Dr. Demakowsky, head of Virology, that had contributed to his departure from the institution.

Next, Dr. Arlinghaus explains why Johnson and Johnson was no longer a good fit for his interests.

Dr. Arlinghaus explains that MD Anderson hired him back in 1986 to form the new Department of Molecular Pathology.

Dr. Arlinghaus asserts his intention at that time to recruit "the best people on the planet" and he talks about the qualities of the colleagues he admired at Johnson and Johnson and Scripps Laboratory.

Dr. Arlinghaus explains that he returned as a Department Chair, with the support of then-president Dr. Charles LeMaistre, who by-passed any decision-making by the Vice President for Research, Dr. Frederick Becker, who had significant differences with Dr. Arlinghaus.
Chapter 06: The New Department of Molecular Pathology

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus explains the package he received when he returned to MD Anderson in 1986 to set up the new Department of Molecular Pathology.He sums up his vision for the Department and lists the individuals he recruited to build out research.He explains that he looked for researchers with "vision and creativity" who could develop a unique set of independently funded research projects.Administratively, he did not want to create pyramids of grant support, a situation that would weaken the department.

Dr. Arlinghaus notes that, two years ago, he was asked to step down as chair, and he felt relieved to do so.He next reviews his accomplishments as department chair.He lists the faculty members and notes that his department may be one of the best funded basic science departments in the institution.[The recorder is paused for about 5 minutes.]Dr. Arlinghaus makes brief comments on why a change in leadership was needed at the time.
Chapter 07: Translational Research in the Department of Molecular Pathology (Now the Department of Translational Molecular Pathology)

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus talks about the new Department chair, Ignacio Vestula, who took over when he was asked to step down in 2012.He also discusses the Departments change of name to Translational Molecular Pathology.

Dr. Arlinghaus observes that the Department had a translational focus prior to the name change, and he explains how his own work fits the definition of translational research: to conduct research with the goal of having a direct impact on the cancer patient.

Dr. Arlinghaus then sketches his model of how a translational study takes shape.The interviewer talks about a model described by Dr. Mien-Chie Hung, and Dr. Arlinghaus comments on that.He notes that he does not work directly with clinicians and that his strategy has always been to focus on CML, learning from journals what he needs to know.
Chapter 08: Discovering a Talent for Laboratory Research and an Early Research Success

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus begins this chapter about his educational path with some comments about his origins in a family of immigrant stock.He notes that his mother decided that he should go to a private Catholic school, and Dr. Arlinghaus worked at a local pharmacy to make money for the school's tuition.He explains why he elected to attend the College of Pharmacy (B.S. 1957) at the University of Cincinnati, (Cincinnati, Ohio,).

Dr. Arlinghaus next talks about his decision to work for his Master's and then his Ph.D. in biochemistry.He describes his dissertation research on the structure of collagen.His comments are very revealing of his approach to research problems and laboratory methods.He explains his unique discovery: that his analysis revealed a new amino acid in collagen."Pretty good for a guy who just got off the turnip truck," Dr. Arlinghaus says.The new amino acid was named, 3 Hydroxyproline.That discovery, he says, made him "the most advanced person in that department."
Chapter 09: Fellowships and More Creative Research

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Arlinghaus describes the research he conducted under the mentorship of Dr. Richard Schweet while he was on fellowship at the University of Kentucky College of Medicine, Lexington, Kentucky (1962-1963 and 1964 - 1965).

Dr. Arlinghaus describes how he came to work on the mechanisms of peptide bond formation in ribosomes in hemoglobin.He describes the theory of this process at the time "that long chains of proteins were assembled.

Dr. Arlinghaus's research revealed a different and more complex, two-stop mechanism involving ribosomes, messenger RNA and translocation processes.

Dr. Arlinghaus notes that this ribosome mechanism is now in textbooks and, at the time, it won him national recognition.He recalls giving a talk in Atlantic City, noting that he wasn't nervous, but confident because "I knew what no one in this room knew and I was going to tell them about it." Dr. Arlinghaus states that he had knowledge and creativity and he reflects on where his abilities and research success came from: keeping up with the latest technique, luck, being "simple minded," open minded, and aware that thing might be different than reported in textbooks.
Chapter 10: A Critical Point in a Career: Crisis and Key Decisions

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Arlinghaus talks about his process of choosing a job after his Fellowship period at the University of Kentucky.He recalls a key event at a Gordon Conference where he was "grilled" about his discovery of the ribosome process.He notes that he was shy and unsure of himself, despite his professional success, so when he met a researcher from the Plum Island Animal Disease Laboratory in Greenport, NY, he decided to take a job there (1965 - 1969).

Dr. Arlinghaus reflects on the fact that it was a mistake not to take an assistant professorship, but to take a safe route at Plum island after being "beat up" at the Gordon Conference.He talks about another factor: his wife, Barbara, was diagnosed with chronic myeloid leukemia and died thirty months later, in 1967.

Dr. Arlinghaus states that he also needed to take a safer career route because of this family tragedy and insecurity (he was working two jobs).

Dr. Arlinghaus ends this chapter with the observation that he has always conducted unique research.
Chapter 11: Research Projects: Working on an HIV Vaccine; Lipocalin 24p3; How CML Causes Uncontrolled Growth of Blood Cells

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Arlinghaus describes the research project he has conducted since returning to MD Anderson in 1986.He provides context by describing work on an HIV vaccine work he conducted at Johnson and Johnson then talks about his work on lipocalin 2.He explains how his research into the role of lipocalin 2 has evolved and how he is addressing the research hypothesis that when a tumor forms, an environment is created that is also invaded by normal cells.Some of these battle the tumor, and other come in and secrete lipocalin 24p3, killing other normal cells.

Dr. Arlinghaus then turns to his work on how CML causes uncontrolled growth of blood cells and what this demonstrates about the host's involvement in the disease (a paper was published in 1995).He explains connections between this work and his other studies of Janus kinase 2, and the BCR-ABL.He goes on to describe unpublished work on how the BCR-ABL protein phosphorylates and thereby activates Janus kinase 2 in an uncontrolled mechanism.
Chapter 12: Reflections on a Research Style; Collaborating with Clinical Trials

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

Dr. Arlinghaus first explains some of his research approach, noting that he uses intuition and logic to attack a problem as if he "peels back an onion."Next he talks about his contributions to clinical trials.He begins with trial to improve treatment of CML patients with Imatinib with period doses of a compound that would inhibit production of Janus kinase 2.He also talks about his work developing an assay to determine whether a patient is in remission or not based on the number of leukemia cells present.[The recorder is paused]Dr. Arlinghaus next sketches several other projects in progress: his collaboration with Dr. Xiaoyan Jian and her work on Janus kinase 2;his continued work on lipocalin 23p2 and host involvement in the spread of cancer;the role of BCR-ABL proteins in Janus Kinase 2 activation.He notes he is currently writing a proposal to extend current NCI grant funding after 2015 and explains that funding is much more competitive today.
Chapter 13: A View of MD Anderson Presidents

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Arlinghaus offers his views of the four MD Anderson presidents. He describes Dr. R. Lee Clark as a "true visionary" who realized surgery wasn't sufficient to address cancer and other specialties were needed to unravel its mysteries.

Dr. Arlinghaus confirms that Dr. Charles LeMaistre was very supportive of him.He talks about some tensions among department chairs and comments on his own leadership style.He recalls the influence of his mother, Loretta, on his character and behavior.

Dr. Arlinghaus next talks about Dr. John Mendelsohn.[The recorder is paused]Dr. Arlinghaus notes that Dr. Mendelsohn's discovery of a new cancer drug was a "remarkable achievement" and that he added to the strength of the institution.Next he talks about Dr. Ronald DePinho, offering the view that the institution will grow under his leadership.
Chapter 14: A Memorable Student and Advice to Students/Professionals

Ralph B. Arlinghaus PhD and Tacey A. Rosolowski PhD

In this chapter, Dr. Arlinghaus reflects on his career at MD Anderson, noting that he is very pleased with the people he has trained.He recalls in particular, Guzi Jamjun [SP?], a graduate student from Saudi Arabia who trained at the Graduate School of Biomedical Science.

Dr. Arlinghaus describes how Mr. Jamjun was able to help him in his own thinking about laboratory technique and methods, noting how rare it has been for him to find someone to discuss work deeply.At the end of the chapter, Dr. Arlinghaus gives advice to students and professionals: work hard, be honest, only publish what you believe.He also says that he doesn't know how to instill drive and a sense of mission in people, but notes that "if it's a hobby, it's not enough."He advises leaders to attract bright people and to listen to them.
Chapter 01: A Modest Middle Class Upbringing that Stressed Education

Walter F. Baile MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Baile talks about growing up in a white middle class neighborhood as one of five sons. He talks about his father (Franklin), a factory worker, the origin of the name Baile, and his amazement that his father was able to provide such a comfortable life on one income. He talks about his respect for unions and his father’s view that education offered a pathway to success.

Next, he talks about his mother (Marie), raised by a very devoutly Catholic older sister. He talks about what his daughter, Danielle, is currently doing in college. He briefly discusses his own interest in photography and his plans to pursue photography once retired.
Chapter 02: Early Education and a Transformational Experience in Italy

Walter F. Baile MD and Tacey A. Rosolowski PhD

Dr. Baile begins by describing the educational experiences and support he received at Catholic elementary and preparatory schools. He notes that he was a “late bloomer” and did not have the advantage of a family background of scholarship: he had to “make it on his own,” he says. He talks about choosing to major in psychology at St. Peter's College (Jersey City, NJ; BA conferred 1966) and how, in his junior year, he met Angelo Dannizino who encouraged him to apply to medical school, which led him to the University of Pavia School of Medicine in Pavia, Italy, (MD conferred, 1972). Italy provided him with a “transformational” experience. He discusses the impact of living and studying in Italy and notes that he has sustained his friendships in Italy and travels back there to conduct workshops on communication.
Chapter 03: Some Background on Psychiatry and a Fellowship

Walter F. Baile MD and Tacey A. Rosolowski PhD

Dr. Baile observes that he has always worked at the interface between psychiatry and medicine. He begins by telling how he met Rob Buckman, who wrote a book on how to break bad news. He talks about working with him to develop videos on communication for the iCARE program at MD Anderson.

Next, Dr. Baile gives a brief history of psychiatry, noting that the first generation prior to Freud were neurologists. Freud represented a paradigm shift that had particular impact in the United States, and he notes that he had three psychoanalytic supervisors. Then, in the late 70s and early 80s, the interests of the field returned to neuro-psychiatric discussions and psychoanalysis waned. As an example of the interface between medicine and psychiatry, Dr. Baile explains that breast cancer patients who are particularly traumatized by their cancer often have trauma or abuse in their backgrounds. He talks about the “beauty of being a psychiatrist” and being able to work closely with a patient. Next Dr. Baile discusses his fellowship period at the Laboratory of Behavioral Sciences, Gerontology Research Center, National Institute on Aging, Baltimore, where he worked with Bernard T. Engel (1976-1978). He also talks about working with the The Sexual Behavior Consultation Unit during his residency at Johns Hopkins (1973-1976).
Chapter 04: A Role as Psychiatric Services Liaison and Reflections on Justice and Care of the Mentally Ill

Walter F. Baile MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Baile talks about his first position as Director, Consultation/Liaison Service, Department of Psychiatry, Johns Hopkins Bayview Hospital, Baltimore (1978-1983), where he also served as Director of Psychiatric Education in the General Internal Medicine Residency Program (1980-1983). He notes the “steep learning curve” and his enthusiasm for applying what he had learned about group dynamics and systems theory as he educated the staff about the need for mental health treatment. Next Dr. Baile talks about attitudes toward treatment of mentally ill patients (particularly those in prison) and compares general treatment practices with the excellent community treatment and support offered at that time through Bayview Hospital. He notes that the question, What is justice, “guides my heart” and approach to psychotherapy. He talks about his commitment to helping people who have been disadvantaged by their life experiences.
Chapter 05: Chronic Pain, Working with Cancer Patients, and a Digression on Photography

Walter F. Baile MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Baile first touches briefly on his next job (Director, Maryland Center for Pain Management at the University of Maryland Hospital in Baltimore, Maryland, 1983-1986), discussing current psychiatric theories of pain as well as his own theory that chronic pain sufferers had conversion disorder. He describes the Pain Unit and notes a publication he placed. He notes the period of depression he suffered after the Pain Unit was closed. Dr. Baile then focuses on his next role as Chief of the Psychosocial Medicine Service at the H. Lee Moffitt Comprehensive Cancer Center and Research Institute (South Florida School of Medicine, Tampa, 1987-1994). He observes that his is “imaginative and creative” and able to take on different roles. Dr. Baile then digresses and discusses his interest in photography, mentioning several photographs he has taken. He then returns to the topic of his work at the Comprehensive Cancer Center. He talks about the overall, crisis theory approach to working with cancer patients, noting that the quality of interaction with patients makes the biggest difference to them. He discusses the “powerful role” that caregivers have on patients, who experience not merely grief, but extreme loss.
Chapter 06: restricted

Walter F. Baile MD and Tacey A. Rosolowski PhD
Chapter 07: A New Specialization in Oncology Communication Skills

Walter F. Baile MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Baile discusses how his career flourished from 1994 to 1998, despite administrative challenges he faced as he entered the evolving field of communication skills in oncology (i.e. teaching oncologists to communicate effectively). He talks about how he met a team of people interested in this subject and they received a K Award from the NIH to develop workshops for oncologists, offered at retreats in Aspen, Colorado. He explains how the workshops were organized around role playing and notes the uniqueness of this model. He describes how Amy Zuckerman came from the New York Times to write an article on the program (becoming aware of it via Oncotalk videos, see http://depts.washington.edu/oncotalk/videos/) and witnessed a very poignant scene. He then explain how they wrote a grant to teach communications skills, describing how the workshops were organized.
Chapter 08: Teaching Communications to Larger Groups

Walter F. Baile MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Baile talks about how he spent the next seven years developing strategies to teach communications to larger groups, basing his approach on the work of Rebecca Walters and John Nolte’s use of psychodrama and sociodrama to explore communcations and emotional issues. Dr. Baile illustrates his approach by talking about psychodrama retreats he held in Italy, in particular a workshop for forty hospice workers addressing end of life communications. He discusses the warm up exercises needed and the way that psychodrama techniques are based on role-reversals.

Next, he describes challenges that participants confront and the opportunities for transformation that psychodrama offers –experiences that he finds very gratifying to offer to clients. Dr. Baile then talks through how psychodrama works, using the example of a nurse who was taken off a case without any explanation for why. Dr. Baile then talks about differences between teaching in Italy, where participants can come for multi-day retreats, and the more skill-based approach he takes at MD Anderson, where participants can only spend an hour or two.
Chapter 09: The iCare Program [Interpersonal Communication And Relationship Enhancement]

Walter F. Baile MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Baile talks about how he developed MD Anderson’s iCare Program [Interpersonal Communication And Relationship Enhancement], serving as the founding director since 2007. He explaining how he left the position of Head of the Section of Psychiatry, a move that came just after he had applied for money from the University Cancer Foundation to make communications videos available via a website. Dr. Baile observes that there was a lot of interest in communication skills at the time and he explains that he adapted his conceptual model of teaching communications via socio- and psycho-dramatic examples. He talks about the different audiences for communication teaching within MD Anderson and the evolution of the program. He explains that, for the last three years, he has been training medical oncology fellows by videotaping them breaking bad news and then giving feedback. He notes that he plans to retire in 2018 and hopes to offer one on one feedback sessions before that time. He explains why some doctors are reluctant to take communications training in contrast with nurses, who are more often willing to do so.

Next, Dr. Baile comments on “MD Anderson silos,” noting that a lack of collaboration can result in ineffective programs. He uses the “Language of Caring” initiative as an example. (He was not consulted, though he feels he was uniquely placed to contribute.)
Chapter 10: Work with Faculty and Academic Development and Other Communications Projects

Walter F. Baile MD and Tacey A. Rosolowski PhD

Dr. Baile then comments on his contributions to the Department of Faculty and Academic Development. He gives examples of personal leadership coaching he has done, commenting that physicians are leaders in the institution and must be nurtured. He notes that academic medical institutions tend to place untrained individuals into leadership positions. Dr. Baile notes that i*CARE is housed within Faculty and Academic Development. He then talks about new projects he is conducting. In partnership with Diagnostic Imaging he is developing a program to connect behavior of faculty and staff with institutional core values. He also talks about a program for Surgical Oncology fellows addressing communication challenges in surgery consults.

Next, Dr. Baile comments on how his interest in communications evolved, noting that he likes the creativity of new projects and the opportunity to “give birth.” Next segues to a conversation about a number of photos he has taken.
Chapter 11: Communication, Propaganda, and the Need for Self-Awareness

Walter F. Baile MD and Tacey A. Rosolowski PhD

The beginning of this interview is strongly influenced by the 2016 election season. Following up on a question about why individuals may not communicate well, Dr. Baile starts this chapter by quickly sketching the qualities that define emotional intelligence. He then notes that personal insecurities drive people to be judgmental. He then begins to discuss propaganda and how that can play out at a national level. He comments on how to encourage people to develop rapport and trust in communicative settings. He offers comments on presidential candidate, Donald Trump.
Chapter 12: Clinicians and Communication: Challenges and Obstacles to Good Rapport

Walter F. Baile MD and Tacey A. Rosolowski PhD

Dr. Baile begins this chapter by affirming that physicians have the ability to bring hope and comfort to people. He explains how the caregiver is defined within crisis theory. He then sketches the many challenges that get in the way of good communication so they can live up to that potential. He notes: “the beauty of medicine is that we get to know people at a time of crisis” and then discusses empathy. Dr. Baile then critiques the resources and support that MD Anderson has so far devoted to communication issues, comparing it (unfavorably) with the Cleveland Clinic. Dr. Baile notes that he has trained the trainers at the Cleveland Clinic. He notes that MD Anderson does not prioritize interactive time spent with patients and families. He points to several markers that the institution prioritizes research. He also explains that MD Anderson is a good place to build an academic career, but the interested clinician must use his/her own time to communicate with patients.
Chapter 13: Reflections on Communications

Walter F. Baile MD and Tacey A. Rosolowski PhD

Dr. Baile begins this chapter by listing the accomplishments he is really proud of, then sets his work on communications in the context of a changing institution. He explains that he has seen advances in research and treatment options, but not corresponding advances in the people side of medicine. He notes that leaders can serve as models to promote these advances. He then shares his own thought process as he looks at his own career, wondering “have I failed at not making this a priority?” He discusses a 2014 institutional initiative, “The Language of Caring” that failed, noting that the faculty was too busy to take part and advance it.
Chapter 14: Final Thoughts on Institutional Change and a ‘Job that Is Not My Life”

Walter F. Baile MD and Tacey A. Rosolowski PhD

In this chapter, Dr. Baile talks about anticipating retirement and shares some final thoughts about MD Anderson. He notes that he is now in a “letting go processes” and wonders about the fate of the iCARE program he build, given the powerful effect of shifting institutional priorities. He notes how pleased he is that he has helped many people and has far exceeded what he believed he would do, though he does not want to continue to practice in the current institutional environment. He tells an anecdote to illustrate current culture, then offers some final words on his career a MD Anderson.

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