Chapter 02: Impressions of MD Anderson Culture: Old Guard versus New Risk Takers
Dr. Balch begins this chapter by commenting that he hired Dr. Grimm and Dr. Roth because they were risk takers and then sketches his vision for the growth of research in the Division of Surgery and at MD Anderson. Dr. Grimm confirms the alignment of her vision with his, and goes on to sketch some research successes. She discusses her receipt of a training grant for a fellowship program in Cancer Biology, notes that she received the first SPORE in melanoma in 2012, and describes her early translational research activities at MD Anderson. Next, Drs. Grimm and Balch talk about differences in attitudes toward research expressed by the older members of the faculty and the newer hires. Dr. Grimm explains her sense of responsibility to conduct research advancing oncology treatments and care of the citizens of Texas.
The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center
Building the Institution; Overview; Multi-Disciplinary Approaches; Growth and/or Change; MD Anderson Culture; Working Environment; Institutional Missions and Values; Leadership; On Leadership; The Researcher; Discovery and Success; Professional Values, Ethics, Purpose; Institutional mission and Values; Education; On Education
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History of Science, Technology, and Medicine | Oncology | Oral History | Surgery
Charles Balch, MDThe other thing I’d add is Jack and Liz were very important to me. They were risk takers. We had a vision, but we didn’t have the program, and we had to say, “We’ll give you the resources and the opportunities, but you will have to create the program.” That’s a very special thing: that people will agree with vision and take the risk, that we can accomplish that vision and thrive at MD Anderson Cancer Center, and change the culture. As we talked about before, in the previous talk with Jack, my charge was to come and bring translational research and clinical trial-based research and Board-certified thoracic surgeons, and to change the training program into training academic leaders who did bona fide research in education, in addition to being excellent clinicians. So, symbolically, bringing these two people here as the first recruits made a giant statement about that vision, and having partners to help us begin the implementation of that grand vision.
T. A. Rosolowski, PhDDid you have a sense that that’s what you were brought here to do? I mean, to what degree was Dr. Balch articulate about that view?
Elizabeth E. Grimm, PhDOh, clear, clearly. I had no doubt. I think we had the same mindset about the research, about the potential of the human immune response, about details of how to get it done. And, as Charles said, his laboratory members when I got here were already doing some of these things, and we were just on the same wavelength about that. I had been in a laboratory that had focused almost completely on T cells, and discounted the NK, by the way, and I think Steve Rosenberg (laughs) still does that a little bit. It’s coming back again. And I was defining the cells functionally, and you were defining them with some markers, the CD86 [bright?] or [it was different?]—
Charles Balch, MDWell, you think about it, Elizabeth Grimm was in a tenured position in the government. She did not have to write grants. Yet she took the risk to come here and start a new program, including getting grant funding, and building her own program here from scratch. So coming from a very secure position into something like this is something I always will give you great appreciation for: being an early partner with us to develop these programs.
T. A. Rosolowski, PhDNow I have a question for you … But you look like you’re on the verge of saying something from your CV, so please share that. (laughter)
Elizabeth E. Grimm, PhDI was just going to see if this fit in the timeline. So not only did I get NIH grants right away, and I followed in those footsteps, I also got a, NIH T32 training grant for the first ever Cancer Biology Program, which had a class --a graduate school class-- but did not have a formal structure and support. So Charles got the first surgical oncology fellowship … I’m blessed with many fellows from there in my lab, and some we still keep in touch with a lot. Then Jack had the Thoracic Surgery Training Grant fellowship; and then I wrote the T32 for the cancer biology fellowship, which I kept going for over ten years, and then turned it over to the Cancer Biology Department that Josh Fidler was leading and was [ripe?], because I was getting … And this is what I’m looking at right now—(laughs) the first SPORE in melanoma. I think it started in 2012—that’s my notes here— and Charles was my first External Advisory Board Director for that SPORE. You had moved on.
Charles Balch, MDYes.
Elizabeth E. Grimm, PhDAnd I’d—
Charles Balch, MDI was at Johns Hopkins in [ASCU?] at the time.
Elizabeth E. Grimm, PhDYeah, yeah. So this led to big things. So the vision of having translation with clinicians, accessing material from clinical trial and patients, and using that material to ask those absolutely critical questions: what happens when patients respond to therapy, or live a long time due to some natural history, molecular unknown, that we could use as markers, biomarkers, versus those that did poorly. All this was continuing, and it led to this SPORE, and I was the first woman here to have a SPORE, one of the first women in the country, and my co-leader is Jeffrey Lee. He’s from Surgical Oncology. [ ] You recruited him, right?
Charles Balch, MDYes, I did.
Elizabeth E. Grimm, PhDAnd I don’t know that he’s spoken here yet about that history—
Charles Balch, MDNo, he hasn’t. So one thing to add, because this was transformational, is there were no NIH-supported training grants in surgery ever. We put in the first one, which I think was for something like sixteen—it was the largest NIH training grant ever given. It’s now in its 36th year or something like that.
Elizabeth E. Grimm, PhDIt’s wonderful.
Charles Balch, MDJack Roth came alongside with an NIH thoracic surgical oncology training program, and Liz had her NIH training program. And the point is we were able to compete with national dollars to provide the salaries and the research support for clinicians and PhDs doing research in the lab. Now, Mickey LeMaistre [oral history interview] gave us some positions, but if you’re really going to expand in any volume and transform your program, you have to have training grants to pay for people’s salaries while they’re in the lab, and some of their laboratory overhead to do that. So those three grants really enabled us to deliver with the new recruits who became faculty members, but also a statement that we could compete with national dollars to grow the programs.
T. A. Rosolowski, PhDNow, obviously, you—this was a great collaboration to really transform the culture. What was your read—because you’re bringing this new current, this new current of thinking and activity and risk taking, into the institution. What was your read on old guard versus newcomers? Were there problems that arose? Did you find unexpected collaborations? You know, kind of give us the lay of the land there.
Elizabeth E. Grimm, PhDOh, of course. (laughs) I think everything was changing, and the old guard, as often is the case, were entrenched and were not so happy because this was a change. There had not been a lot of laboratory research at MD Anderson, and I think that there was some concern that it was going to drain whatever the clinicians were doing, and they were separated, was my feeling. I thought at first that parts of it were separate—here’s clinical and here’s research. I come and, as Charles and as my husband and a few other people from the PhD side, want to collaborate with clinicians. I think that from some perspectives—not from the clinicians but from the other scientists-- I was maybe more of a lower-class researcher, because I wasn’t doing cutting-edge molecular, whatever it was, even though I did that also. I think the record shows that. Our whole institution is going that way now. I mean, the fact—the realization that we are a cancer institute, and the research we should be doing, from my perspective, as a state of Texas institution is for the cancer patients in the state of Texas. If they want to do—I won’t name but—certain types of research in other diseases or other areas, then you can go to a university, or you can go to a drug company, or you can go... We still need to get people with expertise in all sorts of different areas, so sometimes there’s overlap, and that’s fine. But as long as the researcher really has their major focus in cancer, and uses the state resources for the goal of helping cancer patients—I speak up about that, and I don’t think some of the people really believed in me. They thought there should be a basic science, that whatever comes from it would be knowledge that would apply to cancer. I think they should not take space for those who want to do cancer-related work, if it were high quality. So we had that tension going on. We had a research council. We argued over things. We argued over space. We argued over hiring. I mean, that’s typical. It was all good in the end, but that was one tension: the research had not become the focus in the way that it did ultimately.
T. A. Rosolowski, PhDWell, it’s an interesting view of kind of the patchwork of value systems that’s coming together. Because I know when I first started interviewing for the project, the theme that emerged is really the institution’s deep commitment to Texas, and to the population of Texas, and what are we doing with these State dollars. And so you come in very much with a mindset that’s aligned with that, but apparently that was not universally-held. Quite an interesting—
Elizabeth E. Grimm, PhDRight, right.
Charles Balch, MDLet me see if I can articulate this a little bit, too, because there was also the culture that clinicians can’t be good clinicians and do laboratory research, especially to a level as funded by the NIH. Jack Roth and I were the first in the history of MD Anderson to be both clinical surgeons and to have R01-funded laboratory basic science research.
T. A. Rosolowski, PhDWell, you guys were kind of a new entity. I mean—
Charles Balch, MDWe were a—
Elizabeth E. Grimm, PhDWe were, we were.
T. A. Rosolowski, PhD—the physician-scientist was a new creature.
Grimm, Elizabeth A. PhD; Balch, Charles M. MD; and Rosolowski, Tacey A. PhD, "Chapter 02: Impressions of MD Anderson Culture: Old Guard versus New Risk Takers" (2019). History of Surgery - Interview Chapters. 35.
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