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Submitted: 7 January 2015
Two interview sessions: 15 April 2014, 5 June 2014
Total approximate duration: 3 hours 50 minutes
Interviewed by: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, firstname.lastname@example.org
About the Interview Subject:
Dr. Raymond Alexanian (b. 8 June 1932, Queens, New York) joined MD Anderson in 1964 as an Assistant Professor of Medicine and served as Section Chief of Myeloma for many years. He retired in 2013 and holds Emeritus status. Dr. Alexanian achieved a national reputation through his work on erythropoietin, then shifted his specialization to cancer and to myeloma. At MD Anderson he innovated combination therapies for the disease. In collaboration with Bart Barlogie, MD, PhD, he developed a treatment combining chemotherapy and stem cell transplantation. Most recently he has written on the difficulty of defining “cure” in myeloma. In 2001 he received the Waldenström Award for his work in myeloma research.
Major Topics Covered:
Personal and educational background
Evolution of research on erythropoietin
Evolution of research and contributions to treatment of myeloma
History of medical education
History of myeloma treatment
Committees at MD Anderson: Research Committee, Surveillance Committee, Transfusion Task Force, Faculty Classification Committee
The research and cultural environment of MD Anderson under Dr. R. Lee Clark
Changes with growth of MD Anderson
The impact of regulation on research and innovation
Regarding the Transcript and Audio Files
In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject.They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 15 April 2014
An Early Interest in Medicine: Seeking a Well-Rounded Liberal Education
Chapter 01 / Educational Path
College, Medical School, and a Brief History of Medical Education in the U.S.
Chapter 02 / Educational Path
Committed to Academic Medicine
Chapter 03 / Professional Path
Early Research on Stem Cells and Erythropoietin
Chapter 04 / The Researcher
MD Anderson In The mid-Sixties
Chapter 05 / MD Anderson Past
Focusing on Myeloma and Perspectives on Myeloma Research and Treatment
Chapter 06 / The Researcher
Myeloma: Breakthroughs with Transplant Supported Chemotherapy
Chapter 07 / The Researcher
A Breakthrough Myeloma Treatment with Thalidomide
Chapter 08 / The Researcher
The Challenge of Defining “Cure” in Oncology; Views of Research Approval Processes
Chapter 09 / Overview
Interview Session Two: 5 June 2014
Threats to MD Anderson’s Status: Losing Focus on Innovative Research and Problems with Regulatory Procedures
Chapter 10 / Critical Evaluation
Regulatory Procedures: A Critical View
Chapter 11 / Critical Evaluation
Chief of the Myeloma Section, 1998 – 2004: Leveraging Resources and Mentoring Young Faculty
Chapter 12 / Building the Institution
Mentoring Young Faculty in Research Flexibility and Writing Skills
Chapter 13 / The Educator
The Research Committee; The Surveillance Committee
Chapter 14 / An Institutional Unit
“The Research Report”: an Innovative Communication Device for MD Anderson
Chapter 15 / Building the Institution
The Faculty Classification Committee and Related Issues with Tenure and Promotion
Chapter 16 / Building the Institution
The Patent Committee
Chapter 17 / Building the Institution
The Transfusion Task Force and National Transfusion Standards
Chapter 18 / An Institutional Unit
The Summer Students Program; Changes in MD Anderson Culture
Chapter 19 / An Institutional Unit
The Value of Committee Work; Changes in MD Anderson Culture and the Need for Mentoring
Chapter 20 / Critical Evaluation
Retirement and Contributions
Chapter 21 / View on Career and Accomplishments
Interview Session One: 15 April 2014 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Educational Path)
An Early Interest in Medicine: Seeking a Well-Rounded Liberal Education (listen/read)
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 from the time he was a child, motivated by a childhood illness and exposure to doctors, and by his mother’s stories of his great uncle, who was a famous dental surgeon.
Chapter 02 (Educational Path)
College, Medical School, and a Brief History of Medical Education in the U.S. (listen/read)
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. He 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 (Professional Path)
Committed to Academic Medicine (listen/read)
Dr. Alexanian begins with a discussion of his military service (US 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, he 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 (1962−1963) 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 the chapter, Dr. Alexanian talks about his comic book collection.
Chapter 04 (The Researcher)
Early Research on Stem Cells and Erythropoietin (listen/read)
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 Past)
MD Anderson In The mid-Sixties (listen/read)
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 (The Researcher)
Focusing on Myeloma and Perspectives on Myeloma Research and Treatment (listen/read)
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 (The Researcher)
Myeloma: Breakthroughs with Transplant Supported Chemotherapy (listen/read)
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 (The Researcher)
A Breakthrough Myeloma Treatment with Thalidomide (listen/read)
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 (Overview)
The Challenge of Defining “Cure” in Oncology; Views of Research Approval Processes (listen/read)
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. PMCIPMC3366198.
[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.
Interview Session 2: 5 June 2014 (listen/read)
Interview Identifier (listen/read)
Chapter 10 (Critical Evaluation)
Threats to MD Anderson’s Status: Losing Focus on Innovative Research and Problems with Regulatory Procedures (listen/read)
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 (Critical Evaluation)
Regulatory Procedures: A Critical View (listen/read)
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 (Building the Institution)
Chief of the Myeloma Section, 1998 – 2004: Leveraging Resources and Mentoring Young Faculty (listen/read)
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 (The Educator)
Mentoring Young Faculty in Research Flexibility and Writing Skills (listen/read)
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 (An Institutional Unit)
The Research Committee; The Surveillance Committee (listen/read)
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 (Building the Institution)
“The Research Report”: an Innovative Communication Device for MD Anderson (listen/read)
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 (Building the Institution)
The Faculty Classification Committee and Related Issues with Tenure and Promotion (listen/read)
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. Next he explains MD Anderson’s term tenure system, made necessary when MD Anderson formally came under the governance of the University of Texas System. He describes the Committee’s roles in the tenure process.
Chapter 17 (Building the Institution)
The Patent Committee (listen/read)
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 (An Institutional Unit)
The Transfusion Task Force and National Transfusion Standards (listen/read)
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 (An Institutional Unit)
The Summer Students Program; Changes in MD Anderson Culture (listen/read)
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 (Critical Evaluation)
The Value of Committee Work; Changes in MD Anderson Culture and the Need for Mentoring (listen/read)
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 (View on Career and Accomplishments)
Retirement and Contributions (listen/read)
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.
Next Dr. Alexanian notes that he has made important contributions to medicine and his field as well as helping the institution evolve and become the leading cancer center in the world. He explains some of his reservations about the Moon Shots Program initiated under Ronald DePinho.
This interview with Dr. Raymond Alexanian (b. 8 June 1932, Queens, New York) takes place over two sessions in spring of 2014 (approximate total duration 3:50).
Dr. Alexanian joined MD Anderson in 1964 as an assistant professor of medicine. He served in many roles during his time at MD Anderson, including Section Chief of Myeloma. He retired in 2013 and now holds Emeritus status. The interview sessions take place in the Historical Resources Center Reading Room in the Research Medical Library on the 21st floor of Pickens Tower on the Main Campus of MD Anderson. Tacey A. Rosolowski, Ph.D. is the interviewer.
Dr. Alexanian received his AB in Medicine from Dartmouth College in Hanover, New Hampshire in 1952. He received his MD (1953) at the Dartmouth Medical School and continued at the Harvard Medical School in Boston, receiving an MD in 1955. From 1955 to 1956 undertook a clinical internship at King County Hospital in Seattle, Washington. He did his clinical residency in internal medicine at the University of Washington School of Medicine in Seattle (1958−1960). He held a research fellowship in hematology at the same institution from 1960 to 1962. He then held a research fellowship in radiobiology at the Christie Hospital and Holt Radium Institute, in Manchester, England (1962−1963). From 1963 to 1964, Dr. Alexanian worked as a research instructor of medicine at the University of Washington School of Medicine in Seattle, at which point he was recruited to MD Anderson. Dr. Alexanian achieved a national reputation through his work on erythropoietin, then shifted his specialization to cancer and to myeloma. At MD Anderson he innovated drug combinations and combination therapies for the disease, which at the time had very limited treatment options. In collaboration with Bart Barlogie, MD, PhD, he successfully developed a treatment combining chemotherapy and stem cell transplantation. Most recently Dr. Alexanian has published on the difficulty of defining “cure” in myeloma (Alexanian R, Delasalle K, Wang M, Thomas S, Weber D. “Curability of multiple myeloma.” Bone Marrow Research 2012:916479, 2012. e-Pub 5/2012.) In 2001 he received the Waldenström Award for his work in myeloma research.
In this interview, Dr. Alexanian traces the evolution of his research and contributions to the understanding and treatment of myeloma. In the process, he provides perspective on the history of medical education and the history of myeloma treatment. He also provides a portrait of the research and cultural environment of MD Anderson under Dr. R. Lee Clark (the institution’s first president) as well as changes that have taken place as MD Anderson has expanded. Dr. Alexanian served on a number of significant committees (Research Committee, Surveillance Committee, Transfusion Task Force, Faculty Classification Committee) that had an impact on the administrative processes. He provides perspective on the impact that regulation has had on research and innovation.