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Benjamin (Robert S.), MD, Oral History Interview: Home

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Scroll down this page to explore this interview in several ways.

  • An Interview Profile summarizes this individual’s role, specialization, and contributions to MD Anderson.
  • A Table of Contents shows the range of topics covered in each interview session: each chapter title links to a chapter summary.
  • Chapter Summaries describe the specific topics treated in each section; each summary links to the corresponding recording so you can listen to the chapter.
  • Here is a link to the full transcript so you may browse and search. (link)

 

Interview Profile

 

 

Interview Information:

Three interview sessions: 12 December 2014, 16 January 2015, 6 March 2015
Approximately 5 hours 50 minutes total duration

Interviewer: Tacey A. Rosolowski, PhD.

 

For supplementary materials:

Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, jjgarza@mdanderson.org

 

About the Interview Subject:

Robert S. Benjamin, MD (b. 20 April 1943, Brooklyn, New York came to MD Anderson in 1974 as a fellow in the Department of Developmental Therapeutics.  He is now a Professor in the Department of Sarcoma Medical Oncology. He first focused his research in the entirely new area of the pharmacology of cancer drugs.  After a few years at MD Anderson, however, Dr. Benjamin shifted his focus to sarcoma medical oncology, and conducted landmark studies establishing chemotherapy treatments for the disease, leading to limb salvage and multi-modality treatment approaches.  Dr. Benjamin served as Chair of the Department of Melanoma/Sarcoma and then the Department of Sarcoma—from 1993 to 2012.  He has been known within MD Anderson culture as “King Pin” because of many pins patients have given him to wear on his lab coat. 

 

Major Topics Covered:

Personal and educational background

History of research into the pharmacology of cancer drugs

Research: landmark work on the cardiac toxicity of Adriamycin intra-arterial delivery of Cisplatin to treat osteosarcoma

Culture of Department of Developmental Therapeutics Emil J Freireich, MD [Oral History Interview]

Research collaborations with surgeons building a multi-disciplinary service

History of the Departments of Melanoma and Sarcoma

The Melanoma/Sarcoma Center

A clinician’s critical perspective on institutional changes under Dr. Ronald DePinho 

 

 

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.

 


 

Table of Contents

 

Interview Session One: 12 December 2014

 

An Educated Family and an Early Interest in Science
Chapter 01 / Personal Background

 

Experiences at Williams College
Chapter 02 / Educational Path

 

An Interest in People
Chapter 03 / Personal Background

 

A Rounded Education During Medical School
Chapter 04 / Professional Path

 

A Mentor in Medical School Teaches Important Research Lessons
Chapter 05 / Professional Path

 

Clinical Experiences and Learning to be a Doctor
Chapter 06 / Professional Path

 

Plans to be a Cardiologist and a Key Fellowship with the NIH
Chapter 07 / Professional Path

 

Stories about Work with Cancer Patients and a Switch to Oncology
Chapter 08 / Professional Path

 

NIH Fellowship: Researching Drugs with Amazing Effects on Patients
Chapter 09 / The Researcher

 

A Lesson on Sharing Credit with Colleagues
Chapter 10 / The Leader

 

The Path to Developmental Therapeutics at MD Anderson
Chapter 11 / Joining MD Anderson/Coming to Texas

 

Interview Session Two: 16 January 2015

 

Family Life and Life Balance
Chapter 12 / Personal Background

 

Developmental Therapeutics in the 1970s: A Place of Optimism
Chapter 13 / MD Anderson Past

 

The Research Environment in Developmental Therapeutics
Chapter 14 / An Institutional Unit

  

Memories of J Freireich
Chapter 15 / Key MD Anderson Figures

 

Research Projects at MD Anderson: A Shift from Clinical Pharmacology to Sarcoma
Chapter 16 / The Researcher

 

Studies of Adriamycin and Cardiac Toxicity
Chapter 17 / The Researcher

 

Studies Relating to Sarcoma Treatment
Chapter 18 / The Researcher

 

Anthracyclines and Liver Function
Chapter 19 / The Researcher

 

The Controversy over Randomized Trials
Chapter 20 / The Researcher

 

Drug Treatments and Multi-disciplinary Treatments for Sarcoma; A View on the Moon Shots Program
Chapter 21 / The Researcher
 

 

Studies of Gastro-Intestinal Stromal Tumor
Chapter 22 / The Researcher

 

Limb Salvage; an Informal Connection with an Italian Institute
Chapter 23 / The Researcher

 

Assessment of Response to Therapy
Chapter 24 / The Researcher

 

Interview Session Three: 6 March 2015

 

The Section of Melanoma/Sarcoma; A History of Reorganization at MD Anderson
Chapter 25 / An Institutional Unit

 

From Section to Departments: Reorganizing Melanoma and Sarcoma
Chapter 26 / An Institutional Unit

 

The Melanoma/Sarcoma Center: An Early Multi-Disciplinary Center
Chapter 27 / Building the Institution

 

The Clinical Research Committee
Chapter 28 / Building the Institution

 

Changes at MD Anderson Under New President, Ronald DePinho
Chapter 29 / Institutional Change
 

 

Major Contributions and On Being “King Pin”
Chapter 30 / View on Career and Accomplishments

 


 

Chapter Summaries

 

Interview Session One: 12 December 2014 (listen/read)

 

Chapter 00A
Interview Identifier (listen/read)

 

Chapter 01 (Personal Background)
An Educated Family and an Early Interest in Science (listen/read)

 

Topics Covered

  • Personal Background
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Funny Stories

In this chapter, Dr. Benjamin talks about the influence of his parents.  His father, Bernard, was a pediatrician who had his office in their home.  His mother, Helen, was a PhD biochemist who eventually taught physiology at Hunter College.  They instilled in him a love of learning, and listening to the babies screaming in his father’s office convinced him not to be a pediatrician.  His father taught him about chemistry before he took it in school and Dr. Benjamin explains what he found fascinating about the subject.

 

Chapter 02 (Educational Path)
Experiences at Williams College (listen/read)

 

Topics Covered

  • Personal Background
  • Professional Path
  • Influences from People and Life Experiences

In this chapter, Dr. Benjamin explains his selection of Williams College for his undergraduate studies in chemistry (BA conferred in 1964).  He also explains why this small and rurally located institution was not suited to him and made him realize that he is a “city person.”  Dr. Benjamin talks about his love of music, his first experiences with opera, and the cultural advantages that growing up in New York City offered.  He notes that Williams College had few cultural opportunities and the student body was not as intellectually driven as he would have liked.  He explains that he took summer school courses throughout his education and fondly recalls a language immersion program at Colby College, where he also met his wife, Nancy, whom he asked to marry him after only nine days. 

 

Chapter 03 (Personal Background)
An Interest in People (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Professional Path
  • Influences from People and Life Experiences
  • Cultural/Social Influences
  • Women and Diverse Populations
  • Experiences of Injustice, Bias

Dr. Benjamin begins this chapter by noting that he elected to go into medicine during college because laboratory work in chemistry made him realize that he is a “people person.”  He talks about his mother’s influence on this part of his character.  She taught him to “stand up for what he believes in.”  Dr. Benjamin also comments on his growing awareness of the Civil Rights Movement when he was in college and he describes an “incredibly moving” experience of attending a lecture by Martin Luther King on campus.  He notes that he grew up in a largely black neighborhood in Brooklyn and is to this day color blind when he deals with people.  Dr. Benjamin also explains his support of women, another influence from his mother.  He sketches some of his wife, Nancy’s, career, experiences with sexism, and her current with a Federal law court. 

 

Chapter 04 (Professional Path)
A Rounded Education During Medical School (listen/read)

 

Topics Covered

  • Personal Background
  • Professional Path
  • Character, Values, Beliefs, Talents

Dr. Benjamin begins this chapter by explaining that he elected to go to New York University School of Medicine because he wanted to return to a big city (MD conferred in 1968).  He also explains that he always took summer school courses to round out his education: he was interested in a liberal education.  Dr. Benjamin explains that in college he took music electives and this is where his interest in music, particularly opera, developed. 

 

Chapter 05 (Professional Path)
A Mentor in Medical School Teaches Important Research Lessons (listen/read)

 

Topics Covered

  • The Researcher
  • Influences from People and Life Experiences
  • Formative Experiences
  • On Research and Researchers
  • Understanding Cancer, the History of Science, Cancer Research

Dr. Benjamin begins this chapter by describing how well his memory serves him in recalling details of patient histories.  He also notes that while working in laboratories during the summers of his medical school education he met Dr. Max Schubert, who put him to work on glycosaminoglycan.  Through this research, Dr. Schubert taught him the importance of having the right controls in research and not accepting what books say about results until you have collected the data, a lesson that Dr. Benjamin says holds true in medicine.  He talks about the need to exercise flexibility when interpreting research results.

 

Chapter 06 (Professional Path)
Clinical Experiences and Learning to be a Doctor (listen/read)

 

Topics Covered

  • Professional Path
  • Evolution of Career
  • Professional Practice
  • The Professional at Work
  • The History of Health Care, Patient Care
  • Patients, Treatment, Survivors

Dr. Benjamin begins this chapter by explaining why he elected to go into internal medicine rather than surgery.  He explains the differences in the mindsets of surgeons, who fix problems, versus internists, who are diagnosticians and need to know the origins of problems.  He underscores that clinical rotations taught him to be a physician.  Dr. Benjamin tells a story about treating “Bowery bums” at Bellevue Hospital during his internship.  He describes the stress of dealing with emergency room situations and the benefits of hands-on acute medicine, which he came to like.  He also notes that in the late sixties, physicians held the belief that there was nothing to be done about cancer. 

 

Chapter 07 (Professional Path)
Plans to be a Cardiologist and a Key Fellowship with the NIH (listen/read)

 

Topics Covered

  • Professional Path
  • Evolution of Career
  • Professional Practice
  • The Professional at Work
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences

In this chapter, Dr. Benjamin explains that he planned to be a cardiologist when he got his medical degree in 1968.  He applied for a public health fellowship with the NIH to avoid going to Vietnam and got into a program at the Baltimore Cancer Research Center treating septic shock in leukemia patients. He believed that this experience would be transferable to cardiology patients.  He notes that he was selected because of his laboratory experience, but he negotiated opportunities to work with cancer patients during his laboratory year as well as his clinical year.  Dr. Benjamin then describes the Cancer Center in Baltimore and how the staff knew very little about oncology (as the field was in its infancy).  He says that, because of his training during his internship and residency, “I was perfect for it,” though others were very stressed by working with the cancer patients.

 

Chapter 08 (Professional Path)
Stories about Work with Cancer Patients and a Switch to Oncology (listen/read)

 

Topics Covered

  • Professional Path
  • Character, Values, Beliefs, Talents
  • Evolution of Career
  • Professional Practice
  • The Professional at Work
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Discovery and Success
  • Human Stories
  • Offering Care, Compassion, Help
  • Patients
  • Cancer and Disease
  • Formative Experiences
  • Patients, Treatment, Survivors
  • The Life and Dedication of Clinicians and Researchers

In this chapter, Dr. Benjamin tells stories of his work with cancer patients at the Baltimore Cancer Research Center, work that convinced him to focus on oncology.  He first tells a story about a patient with stage four Hodgkin’s disease who achieved a long-term complete remission with the MOPP treatment.  He next tells a story of a lung cancer patient “who had more effect” on Dr. Benjamin “than anybody.”  After treatment with Adriamycin, this patient lived for eight months.  Dr. Benjamin is very affected by telling these stories and stresses the “life and death” issues that working with cancer patients brings to the surface.  He notes that the standard practice at the time was to withhold a cancer diagnosis and specifics of the prognosis from patients (and demonstrates with an anecdote).  Dr. Benjamin stresses that patients are “smarter than you think” and that transparency is important.  He mentions the film “Ikiru,” by Akira Kurosawa, that tells the story of a man with stomach cancer and shows the “strength of the human spirit.”  Dr. Benjamin stresses that the dilemmas of cancer patients “are moving, people are important.”

 

Chapter 09 (The Researcher)
NIH Fellowship: Researching Drugs with Amazing Effects on Patients (listen/read)

 

Topics Covered

  • Professional Path
  • Character, Values, Beliefs, Talents
  • Evolution of Career
  • Professional Practice
  • The Professional at Work
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Discovery and Success
  • Human Stories
  • Offering Care, Compassion, Help
  • Patients
  • Cancer and Disease
  • Formative Experiences
  • Patients, Treatment, Survivors

In this chapter, Dr. Benjamin talks about his work with anthracyclines and daunorubicin at the Baltimore Cancer Research Center.  Dr. Benjamin determined the pharmacology of the recently introduced drug, Adriamycin.  He describes the protocol and comments on the policies regarding consent forms at that time and now.  He then talks about the results, which showed that Adriamycin was the most active drug in solid tumors up to that point.  He tells a very dramatic story of the effects on a patient with metastatic sarcoma.

Dr. Benjamin next explains that he became involved studying the pharmacology of cancer drugs and that no one had really done that before.  He stayed an extra year on this fellowship to continue his studies.  He explains changes in credentialing rules that resulted in his time with the NIH to satisfy the requirements for both Internal Medicine and Oncology.

 

Chapter 10 (The Leader)
A Lesson on Sharing Credit with Colleagues (listen/read)

 

Topics Covered

  • The Researcher
  • The Clinician
  • The Administrator
  • The Educator
  • The Leader
  • The Mentor
  • Formative Experiences
  • Leadership
  • Mentoring
  • On Leadership

In this chapter Dr. Benjamin tells a story about Dr. Nick Bachur presenting the results of the studies of Adriamycin in his laboratory.  Dr. Bachur stated, “All the work was done by Dr. Benjamin.”  This made a deep impression on Dr. Benjamin, who learned about the importance of giving credit to junior people.  This is one of the “tricks” he says of an effective department chair.

 

Chapter 11 (Joining MD Anderson/Coming to Texas)
The Path to Developmental Therapeutics at MD Anderson (listen/read)

 

Topics Covered

  • Professional Path
  • MD Anderson History
  • The Researcher
  • MD Anderson Culture

In this chapter, Dr. Benjamin explains how he first took an assistant professorship at the University of Southern California.  After an “unproductive year,” Dr. Jeff Gottlieb at MD Anderson told him the institution needed a clinical pharmacologist.  Dr. Benjamin came to MD Anderson in 1974 thinking he would work with Dr. Gottlieb, who also studied Adriamycin, but Dr. Gottlieb passed away.  Because of his interest in sarcoma, Dr. Benjamin joined the Department of Developmental Therapeutics and he took over the area of sarcoma in 1975.  Dr. Benjamin ends the interview session describing some of the working conditions in the department.  He explains that he took on more patient care responsibilities and eventually eased out of clinical pharmacology.

 

 

Interview Session Two: 16 January 2015 (listen/read)

 

Chapter 00B
Interview Identifier (listen/read)

 

Chapter 12 (Personal Background)
Family Life and Life Balance (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Character, Values, Beliefs, Talents
  • The Life and Dedication of Clinicians and Researchers

In this chapter, Dr. Benjamin talks about his children and his family life.  He begins by talking about the career choices his sons have made and why they chose not to go into medicine.  He then talks about the commitment to patients that a medical career demands.  Dr. Benjamin then explains how his very close family relationships have enabled him to do the very emotional work of practicing medicine with cancer patients.

 

Chapter 13 (MD Anderson Past)
Developmental Therapeutics in the 1970s: A Place of Optimism (listen/read)

 

Topics Covered

  • MD Anderson History
  • MD Anderson Snapshot
  • Institutional Mission and Values
  • MD Anderson Culture
  • Institutional Politics
  • Controversy  

In this chapter, Dr. Benjamin notes that the MD Anderson was intellectually challenging and exciting when he arrived in 1974.  His colleagues, he says, had “incredible optimism that we were going to make a difference.”  He explains that since not much was known about cancer at that time, they did not feel they had to abide by accepted standards of care and were always looking to improve care.  In the Department of Developmental Therapeutics (DT), in particular, each faculty member had patient care responsibilities but their primary purpose was to improve care and each patient was part of an experiment.  He also notes that DT was an insular department.  He sketches the history of the founding of DT and its relationship to the Department of Medicine.

 

Chapter 14 (An Institutional Unit)
The Research Environment in Developmental Therapeutics (listen/read)

 

Topics Covered

  • Institutional Processes
  • Institutional Mission and Values
  • Building/Transforming the Institution
  • Research, Care, and Education

In this chapter, Dr. Benjamin explains the climate for research that Dr. Emil J Freireich [Oral History Interview] created in the Department of Developmental Therapeutics.  He begins by explaining the approval process for conducting research studies –a much simpler process than today’s.  He notes that all patients were provided with care, irregardless of ability to pay, and that this obligation was written into the institution’s bylaws. Next he explains how the clinical and research territories were divided among faculty members.  Dr. Benjamin then describes the “noon meetings” held in DT to review cases and determine treatments.  He describes the “no holds barred discussions” and recalls how Dr. Freireich handled these meetings.  He recalls that there was “remarkable cohesion” in the department, despite the antagonism that could break out.

 

Chapter 15 (Key MD Anderson Figures)
Memories of J Freireich (listen/read)

 

Topics Covered

  • Portraits
  • Mentoring
  • MD Anderson Impact
  • Professional Values, Ethics, Purpose
  • Ethics
  • On Research and Researchers
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Healing, Hope, and the Promise of Research
  • Patients, Treatment, Survivors
  • Patients

In this chapter, Dr. Benjamin talks about the impact of Dr. J Freireich on researchers in Developmental Therapeutics and outside the institution.  He explains that Dr. Freireich “made you think” and refers to “Freireich’s Laws” first presented when Dr. Freireich gave the Karnofsky lecture in 1976.  He explains Dr. Freireich’s perspective on statistical models and gives his version of the Hippocratic Oath, which stressed the urgency of caring for a patient in the here and now. 

[Redacted]

 

Chapter 16 (The Researcher)
Research Projects at MD Anderson: A Shift from Clinical Pharmacology to Sarcoma (listen/read)

 

Topics Covered

  • The Researcher
  • Evolution of Career
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care

In this chapter, Dr. Benjamin explains that he spent his first two years at MD Anderson establishing how to evaluate the function of various cancer drugs.  He notes that clinical pharmacology was a nascent field at that time.  He then explains that Dr. Jeff Gottlieb’s clinical areas were divided and he inherited sarcoma. At the same time, the faculty’s clinical responsibilities were increasing.  Dr. Benjamin focused more on sarcoma and less on clinical pharmacology. 

 

Chapter 17 (The Researcher)
Studies of Adriamycin and Cardiac Toxicity (listen/read)

 

Topics Covered

  • The Researcher
  • Discovery and Success
  • Patients, Treatments, Survivors

In this chapter, Dr. Benjamin talks about his clinical studies aimed at reducing the cardiac toxicity of Adriamycin.  He explains how his work was based on pathology studies conducted at Stanford University.  He talks about how he adapted the protocols and discovered how to modify the administration of the drug.  He talks about the results that were published, noting in particular those achieved when the drug was administered by continuous infusion.  He notes that this protocol has been used at MD Anderson since the 1970s, though it is now being supplanted by a cardio-protective drug.    

Dr. Benjamin then notes that MD Anderson had no interventional cardiologist on staff in the seventies, however the faculty interested in cardiac toxicities were able to learn how to do cardiac biopsies. In collaboration with Interventional Radiology, he went on to develop a technique for the intra-arterial delivery of Cisplatin. 

 

Chapter 18 (The Researcher)
Studies Relating to Sarcoma Treatment (listen/read)

 

Topics Covered

  • The Researcher
  • Discovery and Success
  • MD Anderson Impact
  • Overview

In this chapter, Dr. Benjamin explains that he worked in collaboration with Interventional Radiology to develop a technique for the intra-arterial delivery of Cisplatin to treat osteosarcomthis became the standard of care at MD Anderson and at least one other institution.   Dr. Benjamin explains the goals of the treatment of osteosarcoma treatments based on the fact that patients die of lung metastasis.

 

Chapter 19 (The Researcher)
Anthracyclines and Liver Function (listen/read)

 

Topics Covered

  • The Researcher
  • Overview
  • Definitions, Explanations, Translations
  • Discovery and Success

In this chapter, Dr. Benjamin describes studies he did to show that anthracyclines could be successfully used to treat cancer patients with compromised liver function.

 

Chapter 20 (The Researcher)
The Controversy over Randomized Trials (listen/read)

 

Topics Covered

  • The Researcher
  • Controversy
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Patients, Treatment, Survivors
  • Ethics
  • On Research and Researchers
  • Professional Values, Ethics, Purpose
  • Critical Perspectives

Dr. Benjamin begins this chapter by commenting on how today’s research approval processes would hinder studies of anthracylines in patients with abnormal liver function.  He states the research philosophy at MD Anderson: treat everyone, regardless of how sick they are and determine why they are ill.  Dr. Benjamin then talks about the belief held in the Department of Developmental Therapeutics that randomized trials were unethical. 

 

Chapter 21 (The Researcher)
Drug Treatments and Multi-disciplinary Treatments for Sarcoma; A View on the Moon Shots Program (listen/read)

Topics Covered

  • The Researcher
  • Overview
  • Definitions, Explanations, Translations
  • Discovery and Success
  • Multi-disciplinary Approaches

In this chapter, Dr. Benjamin talks about his research focus on sarcoma treatments, neoadjuvant therapy, and the treatment of metastatic disease.

Next, he talks about collaborations resulting in multi-disciplinary treatments. He notes that as the Division of Medicine was divided into disease groups, it was easier to build collaborations.

Dr. Benjamin describes results achieved by treating bone tumors with intra-arterial Cisplatin.  He describes the “one of the most amazing results” that saved a patient from having a hemi-pelvectomy.

With such successes, Dr. Benjamin says, it was easy to convince surgeons of the benefits of collaboration.  He also notes that multi-disciplinary treatments were aided by advances in imaging.

Finally, Dr. Benjamin offers some comments on the Moon Shots Program.

 

Chapter 22 (The Researcher)
Studies of Gastro-Intestinal Stromal Tumor (listen/read)

Topics Covered

  • The Researcher
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Overview
  • Definitions, Explanations, Translations
  • Discovery and Success

In this chapter, Dr. Benjamin talks about the area where the greatest advances have been made: gastro-intestinal stromal tumor (GIST).  He explains that these advances built on the work of Jeffrey Gottlieb in the 1970s.  He explains the successful treatments with Gleevec and notes that this is an example where the “low hanging fruit” idea associated with the Moon Shots paid off.

Next Dr. Benjamin explains the value of developing good, non-toxic treatments that will inhibit the majority of pathways that become dominant in cancer.  He advocates a poly-targeted approach, acknowledging that the clinician’s view is that all drugs have toxicity and putting toxic drugs in combination is not as easy as it looks.

 

Chapter 23 (The Researcher)
Limb Salvage; an Informal Connection with an Italian Institute (listen/read)

Topics Covered

  • The Researcher
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Overview
  • Definitions, Explanations, Translations
  • Discovery and Success
  • Beyond the Institution

In this chapter, Dr. Benjamin gives an overview of his work with limb salvage treatments, based on the osteosarcoma model.  This work was greatly facilitated by advances in prosthetics, he observes.  He notes that in 1974, MD Anderson was just beginning to do limb salvage work in connection with radiation therapy.  He then explains how limb salvage works with chemotherapy.  He cites an important study of limb salvage conducted at the Instituto Ortopedico Rizzoli in Bologna, Italy.  He explains that faculty from the Instituto learned chemotherapy from MD Anderson in the 1980.  He explains some of the good results they achieved using MD Anderson techniques.

Next, Dr. Benjamin talks about the national and international community of individuals who focus on sarcoma.

 

Chapter 24 (The Researcher)
Assessment of Response to Therapy (listen/read)

 

Topics Covered

  • The Researcher
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Overview
  • Definitions, Explanations, Translations
  • Discovery and Success

Dr. Benjamin talks about his focus on assessing responses to therapy.  He explains why this is a complex process, giving examples of confusing results that a clinician might confront.  For example, GIST tumors only reduce slightly in size with treatment, but change structure.  He describes a study in which patients responded well to Imatinib, but there was no way to document their improvement with the current guidelines.

Dr. Benjamin says he collaborated with Dr. Choi in studying GIST tumors, work leading to the creation of the Choi Criteria for assessing therapy.  These criteria, he says, have had some impact, then talks about the challenges of getting the model out and accepted.  Dr. Benjamin explains what is needed for the model to be improved and expanded. 

 

 

Session Three: 6 March 2015 (listen/read)

 

Chapter 00C
Interview Identifier (listen/read)

 

Chapter 25 (An Institutional Unit)
The Section of Melanoma/Sarcoma; A History of Reorganization at MD Anderson 
(listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • The Clinician
  • The Administrator
  • Professional Values, Ethics, Purpose
  • Critical Perspectives
  • MD Anderson History
  • Building/Transforming the Institution
  • Growth and/or Change
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy
  • Portraits

In this chapter, Dr. Benjamin explains the administrative structure in which the Section of Melanoma/Sarcoma was situated.  He talks about political issues at work in the merging of Developmental Therapeutics and Internal Medicine in the early eighties.  He explains why he was a good choice to head the section of Melanoma/Sarcoma.  He says that as section chief he tried to build an adequate group of people to do clinical research and care for patients.  He observes that the section was always behind in staffing, as sarcoma is not considered a high priority at the institution, despite the fact that the section/department is the most productive in the country.  He explains the section initially conducted many clinical trials and succeeded very well, also providing leadership to national organizations.  Dr. Benjamin notes that he is one of the founding members of the Connective Tissue Oncology Society.

Looking back at his administrative roles, Dr. Benjamin acknowledges that this area of service was not his top priority and he was ultimately a better clinician than administrator.

Dates of Administrative Service:

Section Chief, Melanoma-Sarcoma, Departments of Internal Medicine and Developmental Therapeutics 9/1981-8/1983

Section Chief, Melanoma-Sarcoma, Department of  Internal Medicine 9/1983-8/1985

Section Chief, Melanoma-Sarcoma, Department of Medical Oncology 9/1985-8/1991

Section Chief, Sarcoma, Department of Medical Oncology 1/1991-1/1992

 

Chapter 26 (An Institutional Unit)
From Section to Departments: Reorganizing Melanoma and Sarcoma (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Obstacles, Challenges
  • Institutional Politics
  • Growth and/or Change

Dr. Benjamin sketches the reorganizations that led to the division of Melanoma and Sarcoma into different departments.  He explains why, for political reasons, Dr. Irwin Krakoff asked him to serve as Chair of the Department of Melanoma/Sarcoma.

Next he explains that the combined department was split in 2000 and a new person recruited to head Melanoma, while Dr. Benjamin continued as Chair of Sarcoma.  He explains that the only rationale for the two specialties being together was they could not be associated with a disease site.

Dr. Benjamin then talks about his role as chair, stressing again that because of his personality and commitment to patients, he did not allow his administrative role to decrease his clinical work.  

 

Chapter 27 (Building the Institution)
The Melanoma/Sarcoma Center: An Early Multi-Disciplinary Center (listen/read)

 

Topics Covered

  • The Clinician
  • The Administrator
  • Discovery and Success
  • MD Anderson History
  • Building/Transforming the Institution
  • Growth and/or Change
  • Patients
  • Patients, Treatment, Survivors
  • The History of Health Care, Patient Care
  • Institutional Mission and Values
  • MD Anderson Culture
  • Multi-disciplinary Approaches
  • This is MD Anderson

In this chapter, Dr. Benjamin talks about the evolution of the Melanoma/Sarcoma Center --one of the first multi-disciplinary centers at MD Anderson.  He headed the Center from 1996 to 2006.

Dr. Benjamin talks about the culture of collaboration between surgeons and oncologists that made the Center possible.  He also notes that the tradition goes back farther, to earlier studies of amputation and then radiation as sarcoma treatments.[1]  He tells some of the history of multi-modality treatments.

Dr. Benjamin then talks about why the Center is a model of patient care.  He speculates on the future of cancer treatment.  He says he expects there will always be some kind of surgery, but that radiation treatments and cyto-toxic chemotherapy will be replaced with targeted medical treatments.

 

Chapter 28 (Building the Institution)
The Clinical Research Committee 
(listen/read)

 

Topics Covered

  • Contributions
  • Institutional Processes
  • MD Anderson Culture
  • Research, Care, and Education

In this chapter, Dr. Benjamin talks about a major contribution he made to the institution by setting up a Clinical Research Committee to administer detailed protocol review.  He explains why this was necessary at the time, as there lay people on the institutional review boards were not able to fully review clinical trials.  Dr. Benjamin notes that current CRC is the one he established.  He sketches some changes in the roles and connections between the IRB and CRC. 

 

Chapter 29 (Institutional Change)
Changes at MD Anderson Under New President, Ronald DePinho (listen/read)

 

Topics Covered

  • Growth and/or Change
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy
  • Critical Perspectives
  • Institutional Mission and Values
  • MD Anderson Culture

Dr. Benjamin begins this chapter on change by noting that Dr. John Mendelsohn served as president.  He explains that Dr. Mendelsohn brought an emphasis on scientific accomplishments of the faculty, in addition to clinical work and patient care.

Next, Dr. Benjamin offers “the perspective of a clinician” on changes that have occurred since Dr. Ronald DePinho took over as the fourth president of the institution. 

He explains the revenue-generating burdens that have been shifted to physicians to pay for research and a growing administrative structure.  He then talks about the deterioration of morale among clinical faculty, who feel they must meet quotas rather than focus on delivering optimal care for patients.

Dr. Benjamin next talks about the institution’s budget process to explain the broader arena in which the rift between the faculty and administration came from. 

Dr. Benjamin then gives his view of what the current situation means for MD Anderson’s future.  He explains that he has “always felt that MD Anderson would succeed despite its leadership,” but this depends on a committed faculty.  Dr. Benjamin says that he feels his time would be better spent teaching young faculty and gives examples of the training he would provide.

 

Chapter 30 (View on Career and Accomplishments)
Major Contributions and On Being “King Pin” (listen/read)

 

Topics Covered

  • Career and Accomplishments
  • Post Retirement Activities
  • Character, Values, Beliefs, Talents
  • Personal Background
  • The Researcher

Dr. Benjamin lists his most important contributions to patient care.  He then talks about his collection of pins, many of which he wears on his lab coat and which earned him the nickname, “King Pin.”

Dr. Benjamin then talks about his plans to retire to part time so he can select the projects he wishes to work on.  He will teach and write up current projects.  He notes that he likes what he does and wants to keep doing it.


[1] Dr. Benjamin mentions Dr. R. Lee Clarks article: Clark, Jr, RL, Martin, RG, White, EC.  Clinical aspects of soft-tissue tumors.  AMA Arch Surg. 1957 Jun 74(6): 859-870.

 

Original Profile

 

This interview with sarcoma medical oncologist, Robert S. Benjamin, MD (b. 20 April 1943, Brooklyn, New York) takes place over three sessions in 2014/2015.

Dr. Benjamin came to MD Anderson in 1974 as a fellow in the Department of Developmental Therapeutics.  He is now a Professor in the Department of Sarcoma Medical Oncology, where he served as Chair from 1993 to 2012.  He is also the P.H. and Fay E. Robinson Distinguished Professor in the Division of Cancer Medicine. The sessions are conducted in Dr. Benjamin’s office in the Department of Sarcoma Medical Oncology in the Faculty Center on the main campus of MD Anderson.  Tacey A. Rosolowski, Ph.D. is the interviewer.

Dr. Benjamin received his BA in Chemistry from Williams College in 1964 and continued at the New York University School of Medicine, receiving his MD in 1968.  He undertook his Medical Internship at NYU Bellevue Med. Center in 1969 and his Medical Residency at the same institution in 1970.   Dr. Benjamin then had a Fellowship in Medical Oncology, with a focus on chemotherapy at the NCI Baltimore Cancer Research Center from 1970 to 1973.  Dr. Benjamin then took a position as an Assistant Professor of Medicine in the Section of Oncology at the University of Southern California School of Medicine in Los Angeles (1973-19740).  Dr. Benjamin came to the MD Anderson Hospital and Tumor Institute in 1974 as an Assistant Professor of Medicine in the Department of Developmental Therapeutics.  He first focused his research in the entirely new area of the pharmacology of cancer drugs.  After a few years at MD Anderson, however, Dr. Benjamin shifted his focus to sarcoma medical oncology, and conducted landmark studies establishing chemotherapy treatments for the disease, leading to limb salvage and multi-modality treatment approaches.  Dr. Benjamin served as Chair of the Department of Melanoma/Sarcoma and then the Department of Sarcoma—from 1993 to 2012.  He has been known within MD Anderson culture as “King Pin” because of many pins patients have given him to wear on his lab coat.

This interview provides a portrait of very dedicated clinician and a critical observer of MD Anderson.  Dr. Benjamin provides a picture of the early days of research into the pharmacology of cancer drugs and the fertile environment of MD Anderson’s Department of Developmental Therapeutics under the leadership of Emil J Freireich, MD [Oral History Interview].  Dr. Benjamin explains the shifting institutional structure that first linked melanoma and sarcoma and then split them.  He tells the story of how successes in treating sarcoma with chemotherapy helped pave the way for cordial and very collaborative relationships with surgeons, causing sarcoma to become one of the first sections/departments to function in a fully multi-disciplinary manner.  He explains the unique dimensions of the Melanoma/Sarcoma Center, which grew from this collaborative culture and which Dr. Benjamin helped develop into a model of how patients should be treated.  Dr. Benjamin also talks about his landmark work on the cardiac toxicity of Adriamycin and his collaboration with Interventional Radiology to develop a technique for the intra-arterial delivery of Cisplatin to treat osteosarcoma, an approach that became the standard of care at MD Anderson.  Dr. Benjamin also provides a clinician’s critical perspective on changes that the institution had undergone since Dr. Ronald DePinho [Oral History Interview] assumed leadership.