Chapter 05: Candidates for President, The Legacy of the Division System, and Final Thoughts on Surgery's Evolution at MD Anderson

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Chapter 05: Candidates for President, The Legacy of the Division System, and Final Thoughts on Surgery's Evolution at MD Anderson

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Dr. Copeland and Dr. Balch [oral history interview] begin this chapter with comments on the fact that they both were candidates to be president of MD Anderson when Dr. Charles LeMaistre [oral history interview] stepped down, noting Dr. John Mendelsohn’s [oral history interview] suitability for the position. Next, Dr. Copeland comments on Dr. Balch’s impact on the institution, pointing to the role Dr. Balch served in building research and formalizing the disease-oriented approach to treatment. They discuss turbulence in the Division of Surgery when Dr. Mendelsohn stepped down as president. Next, Dr. Balch talks about organizing a committee in 1992 to create a strategic plan to develop research at MD Anderson. In the final moments of the interview, Drs. Copeland and Balch talk about the value of collecting the interviews, the origin of the idea for a cancer center like MD Anderson, and early classifications of patients according to their ability to pay. They discuss lessons about healthcare to be learned from the institution in the 40s and characterize surgeons as visionaries and risk-takers who laid the foundation for the institution.

Identifier

CopelandE_01_20190409_C05

Publication Date

4-9-2019

Publisher

The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

Building the Institution; Building/Transforming the Institution; Multi-Disciplinary Approaches; Professional Practice; The Professional at Work; Gender, Race, Ethnicity, Religion; Leadership; On Leadership; MD Anderson History; MD Anderson Snapshot; Research

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History | Surgery

Transcript

Charles Balch, MD

So listen, here’s the last thing I wanted to cover. You and I also have one other common intersection in history in that you and me and John Mendelsohn [oral history interview] were the finalists to become the president of MD Anderson to succeed Mickey [Charles] LeMaistre. I wonder if you have any comments of recollections about that time when you were a candidate for being president, and how the environment had changed from when you left in 1982, until that time in 1986.

Edward Copeland, MD

I was obviously honored to be a candidate. [I think, however, for my candidacy, history has proven that the committee made an appropriate selection. Nerveless, I have noted throughout my career that if an internal candidate is qualified, as were you, the institution is better off going with the internal candidate. He brought research programs to MDAH, but you had already established research as a primary responsibility of the institution. As an example, there were no clinical trials done while I was on the faculty. Some great observational research was done, but no national clinical trials. I point to the Sun Belt Melanoma Trial run by you as an example of your value. Our group at the MDAH had already established that a circumferential 5 cm excision around a melanoma was not necessary, but the exact margins of excision were established by your group using a multi-institutional trial.]

Charles Balch, MD

[ ]

Edward Copeland, MD

[ ]

Charles Balch, MD

[ ] .

Edward Copeland, MD

[ ]

Charles Balch, MD

Ted, I wanted to just go back on your recollections. In 1987, you received the distinguished alumnus award from MD Anderson. Any recollections about that and do you have any photos from that time?

Edward Copeland, MD

I actually came across the booklet that has all the information with my picture and Mel Samuels and whoever else got it at the time. The radiologists at our place were fascinated because it’s two of them that had three years of general service, so they knew what to do. We didn’t really have CT scans and all that stuff. We had barium enemas, so being able to discuss a case with a radiologist who was a surgically trained radiologist was a step way, way ahead and one of the guys with me was one of those radiologists and I can’t think of his name. I’ll send you that if you would like.

Charles Balch, MD

[ ]

Charles Balch, MD

[ ]

Charles Balch, MD

One final question. It’s going to be hard for me to talk about my time, from ’85 to ’95, but from the distance of what you saw at the University of Florida and your connections with people like Eva Singletary, Raph Pollock, David Ota and others, do you have anything that we could put on the record, of the time period from ’85 to ’95?

Edward Copeland, MD

Yes. [I have already alluded to your qualifications to replace Mickey LeMaistre. I witnessed your transformation of the department of surgery into one that appreciated clinical research. Others got extramural research grants, exampled by Kim Jessup, David Ota and Lee Ellis. Lee was offered the chairmanship of Florida when I stepped down and to my disappointment elected to stay at MDAH. You were directly responsible for the transformation of the thinking of surgical faculty members. I can take some credit for Kim, David and Lee, but you allowed them to mature into accomplished academicians. I sewed the seed and you harvested it. Mendelsohn must have been a good leader but he inherited the raw material. To give him his due, look what happened when he stepped down. The department of surgery imploded.] That’s why Peter Pisters is your new president or is the new president, to get things back together again. [ From my perspective, Peter represents a regime that worked. He will refine and restore the principals that have been proven valuable over the years to work.]

Charles Balch, MD

To my knowledge there were no active clinical trials in the entire Division of Surgery at the time.

Edward Copeland, MD

You could say your job was easy, because there weren’t any there, so whatever you did was “unique,” but you had to get the people to do it and you had to get the supportive staff around you so you made it easy enough for the people to put their patients into the studies. So you did all that and I predicted it. Now, I’m not going to take any credit for anything but knowing you, I predicted that’s exactly what would happen. We were great in looking up retrospective stuff and that kind of thing, and made a lot of very good points, but in terms of proving something on the front end, it didn’t happen, you did that. [One more Hickey vignette. Dick Martin retired about a year after I left for Florida. Hickey called me and said, “You don’t want this job do you?” I didn’t want the job, or I would have not left MDAH in 1982, already knowing Dick’s retirement plans. I was popular with the faculty and support staff at MDAH and somebody probably had mentioned my name as Dick’s replacement. I should have told Hickey, “Yes, by all means” It would have scared him to death!]

Charles Balch, MD

One thing I’m really proud of, which you would be also, is the first two hires in what was the Department of General Surgery was Eva Singletary and Raphael Pollock. They really brought a support and a dimension for both translational research, especially Raph and Eva, in the area of improving our clinical delivery system in breast cancer, making it truly multidisciplinary and embracing clinical trials.

Edward Copeland, MD

That’s exactly right, and one of the reasons that cancer surgery has evolved into a --rather than everybody doing everything-- into a focus of single disease processes, is because there’s so much available to do now. The techniques are so much better, and we broke the genetic code, et cetera. If you want to be an operating surgeon, then you don’t necessarily need to be in a cancer institute, I mean an operating surgeon that does everything. You need to train them to do everything, so there are people to go out and do that, but from the standpoint of working at a cancer group or cancer institution, I agree with the disease-oriented approach that you started there. [ ]

Charles Balch, MD

[ ]

Edward Copeland, MD

[ ]

Charles Balch, MD

So, Ted, the other part that you were engaged in, if you remember the SSO, our home base, the Society of Surgical Oncology, was really in the decline.

Edward Copeland, MD

Well, I’ll just interrupt you. You were the first person that I’m aware of, to think there ought to be boards of surgical oncology. Well, there may have been thought processes about that, but you were the first one to organize the committee that actually sat down and looked at it. As I recall, that meeting took place in Atlanta.

Charles Balch, MD

Yes, and Alfred Ketchum was the chair then, or the president, who was one of my mentors. Then when I became president, we had the strategic planning meeting here at MD Anderson over two days, and that strategic plan really transformed the society, including starting a new journal of changing the annual meeting to be more research oriented, of expanding the membership beyond Memorial and MD Anderson, and quite a few changes. But the strategic planning for that occurred right here at the MD Anderson in 1992.

Edward Copeland, MD

Also, Charlie, I need to record that it was under your leadership that that happened. It would have happened eventually but it wouldn’t have happened nearly as soon if you hadn’t been the person. It’s like you biting on the end of my shirt sleeve by my dog, you wouldn’t turn it loose.

Charles Balch, MD

Well, but just for the record, I think the reason it happened is Alf Ketcham allowed me, as the president elect, to make a lot of decisions. Then Don Morton, who came right after me, said the three of us, Alf Ketchum, me and Don Morton, really mapped out a multiyear plan during our three successive presidencies, because as you know, you can’t make transformational changes in one year as a president; it has to be embraced by your predecessors and your successors.

Edward Copeland, MD

It does but you know, I’m patting you on the back. They received a pat or two but you received the bulk of them, I was there.

Charles Balch, MD

Yes, you were. You actually became the associate editor with me when we started the Annals of Surgical Oncology.

Edward Copeland, MD

Exactly. Stop and take a look at the Annals of Surgical Oncology. One person gets credit for that, and it’s you. Now, a lot of people had joined in, and had to do the work, and had to have all the committees but my goodness, Charlie, you were the sole person who, you generated that idea, you pushed that idea and you wouldn’t turn loose and there you sent, and the surgical oncology.

Charles Balch, MD

And actually one memory I have is a concern that there were other surgery journals, including the Red Journal, that was run by Courtney Townsend, and whether we could actually compete with a new journal, and we did.

Edward Copeland, MD

Competed with all of them.

Charles Balch, MD

That was part of the risk you take, is whether you can succeed in this.

Edward Copeland, MD

[ ]

Charles Balch, MD

Both Murray and I are down there as emeritus, along with you.

Edward Copeland, MD

[ ] Is David Winchester still an editor?

Charles Balch, MD

No.

Edward Copeland, MD

Is he an associate editor?

[01:34;13]

Charles Balch, MD

He’s also stepped down.

Edward Copeland, MD

Has Kirby stepped down?

Charles Balch, MD

No.

Edward Copeland, MD

(inaudible) is 76 years old for god sakes.

Charles Balch, MD

Yes I know.

Edward Copeland, MD

That makes no sense, so I tried to start a trend [by becoming emeritus at about 65years old. Let other qualified people have a chance to shine. The trend didn’t work. All those “old” guard remained as associate editors. In retrospect, I was probably a bit too generous in letting others take my place. I didn’t follow the political adage “once you have a job, don’t give it up until forced to do so”.]

Charles Balch, MD

I’m proud to say that I finally retired after 25 years, in order to pass the baton to a capable person and Kelly McMasters is doing a great job.

Edward Copeland, MD

Let me tell you, you’ll be judged. I happen to be a Christian and I think you’ll be judged in heaven, but I think you’re going to be judged by somebody as to what you left behind.

Charles Balch, MD

Exactly. All right, we have been one hour and 55 minutes.

Tacey A. Rosolowski, PhD

We have.

Edward Copeland, MD

Go have lunch.

Charles Balch, MD

Ted, this was a very rich encounter. I really appreciate your memories, and I think as we start to record the history, it’s not just on the facts that aren’t an interesting thing, but the stories about people, who they were and so forth, and their vision in different phases in the growth of MD Anderson. Of course for me, the person with the biggest vision of all was R. Lee Clark.

Edward Copeland, MD

Of course, yes.

Charles Balch, MD

It’s amazing—

Edward Copeland, MD

Or, whoever decided to fund the Cancer Institute [and had the vision to hire Lee Clark]. Let me tell you Charlie, we spent the last five minutes, while I was there, we had a Vice President for Outreach. I can’t remember who it was and you may still have them but let me tell you, every single medical school sent a representative to that thing because they were fearful they were going to lose their state funding for cancer. Once it became clear that they weren’t going to lose their state money for cancer, nobody ever came back to the meeting again. I went and I was sitting there, but if you could dig back into the history of who thought all that, who decided to let the patients --the people of Texas who didn’t have any money-- have a place to go, that would be funded by the state, and have it evolve into the MD Anderson Hospital, I mean that’s another whole story. That’s the story of how you can probably fix healthcare funding [today. Everybody got superb medical care; there were no “second class citizens” we made money and cured a horrible disease. I do have one more story which speaks to this very issue. The housekeeper of a good friend in Houston had uterine cancer. She had no insurance and had difficulty finding health care providers for the treatment she needed. I told my friend that the MDAH was sitting there in her hometown to provide such care. The patient got the needed operation and was housed postoperative in the new Lutheran Pavilion in a corner room with a beautiful view. My friend had had a similar operation in another hospital in the Medical Center. She came to visit her house keeper and was shocked at the gorgeous, well-appointed and medical equipment supply her house keeper had when compared to her room in the other hospital.]

Charles Balch, MD

Well, and also the legislature wrote into this that MD Anderson will take care of all Texas citizens irregardless of their ability to pay, and made appropriations every year to pay for those indigent patients who came to MD Anderson. So it was really, that was the predecessor to Medicare and Medicaid.

Edward Copeland, MD

We had A, B, C, and D classification,s and C and D classifications were for people who either had no money or very little money. A and B patients were people with insurance. Initially when I got there, the faculty operated on the As and Bs and residents didn’t, and we operated on the Cs and Ds as fellows, with all the guys either helping us or not helping us, as we fellows saw fit, it always helped me, I was able to learn something. Eventually it evolved into what you see now, you know, as the residents do, like any other institution, but that rule was followed. The MD Anderson, there are a lot of lessons to be learned here in delivery, from the days of the forties.

Charles Balch, MD

When I tell this story, Ted, the surgeons had an enormous role, starting with Bill Bertner, who was a surgeon and who had the vision for the Texas Medical Center beyond MD Anderson. Then I have a letter that the Board of Regents had to get approval to start MD Anderson, and I have a letter from Truman Blocker, who was also a surgeon and at the time was the president of UTMB, who gave permission for the UT Board of Regents to initiate the UT MD Anderson Cancer Center when it was just a vision.

Edward Copeland, MD

Well, that’s a whole other story. You don’t want a book to be too big, nobody will read it.

Charles Balch, MD

No, no, but the point is that surgeons at that time were risk-takers, they had the vision. If you look at Dr. Bertner, Dr. Blocker, Lee Clark, these people really laid the foundation.

Edward Copeland, MD

I’m worried about the current crop coming up through the ranks, but that’s a whole other story.

Charles Balch, MD

That’s another story.

Edward Copeland, MD

Truman Blocker was actually the interim president of the University of Texas Medical School at Houston.

Charles Balch, MD

He was a force also.

Edward Copeland, MD

A nice guy. All right buddy.

Charles Balch, MD

Thank you so much.

[End of Interview]

Chapter 05: Candidates for President, The Legacy of the Division System, and Final Thoughts on Surgery's Evolution at MD Anderson

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