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Four interview sessions: 3 March 2015, 6 May 2015, 6 July 2015, 7 July 2015
Total approximate duration: 3 hours 45 minutes
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, email@example.com
About the Interview Subject:
Ethan Dmitrovsky, MD came to MD Anderson in 2013 to serve as the institution’s Provost and Executive Vice President. He has a faculty appointment in the Department of Thoracic/Head and Neck Medical Oncology in the Division of Cancer Medicine.
Dr. Dmitrovsky’s translational research areas include: retinoid differentiation-based therapy for acute promyelocytic leukemia (APL); developed the molecular genetic test used to detect the PML/RARalpha transcript from the APL t(15;17) rearrangement; retinoid mechanisms leading to cell cycle arrest and repair of DNA damage in normal/malignant lung epithelial cells; engineered transgenic mouse models that express wild-type or proteasomal degradation-resistant cyclin E species in the lung; derived lung cancer cell lines leading to a new model to assess activity of lung cancer therapy and chemopreventive agents (antineoplastics).
Major Topics Covered:
Personal and educational background; overseas experience and inspiration
Research: cell differentiation; retinoids in leukemic differentiation; lung cancer studies
The Role of the Provost; personal goals; institutional mandate; detailed of plans
MD Anderson’s ten-year strategic plan
Research in an environment of changing economics and health care delivery
The Institute for Applied Cancer Science and a new model of research
The Provost’s Office: support for faculty, leadership training, research support
Global Academic Programs and international partnerships
Conflict of interest; ethics; social responsibility; institutional transparency
MD Anderson mission and culture
Cancer as a problem of humanity
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: 3 March 2015
An Early Desire to Be a Physician and Focus on Difficult Illnesses
Chapter 01 / Personal Background
College Influences: A Research Project, a Book, and Working as an Orderly
Chapter 02 / Educational Path
Medical School and a Life-Changing Experience as a Physician Volunteer near the Cambodia-Thailand Border
Chapter 03 / Professional Path
A Fellowship and a Risky and Successful Study of Cell Differentiation
Chapter 04 / The Researcher
A Faculty Position and a New Laboratory to Study the Role of Retinoids in Leukemic Differentiation
Chapter 05 / The Researcher
Shifting Focus to Lung Cancer
Chapter 06 / The Researcher
Coming to MD Anderson to Have a Broader Impact on Health
Chapter 07 / Joining MD Anderson/Coming to Texas
Views on MD Anderson’s 10-Year Strategic Plan and the Role of the Provost
Chapter 08 / Building the Institution
Creating A New Way of Conducting Research and Caring for Patients in a Changing Environment
Chapter 09 / Building the Institution
Interview Session Two: 6 May 2015
The Provost’s Office: Acting on a Mandate and A Personal Goal
Chapter 10 / An Institutional Unit
Making Changes in an Institution: Goals, Following Up, A Philosophy of Communication
Chapter 11 / The Administrator
The Provost’s Office: Creating Support for Emerging Leaders
Chapter 12 / An Institutional Unit
Evolution as a Leader
Chapter 13 / Professional Path
The Provost’s Office: Supporting Faculty Promotions
Chapter 14 / Building the Institution
Interview Session Three: 6 July 2015
The Institute for Applied Cancer Science: The Research Model
Chapter 15 / An Institutional Unit
Global Academic Programs: the Advantages of Collaboration Part I
Chapter 16 / Beyond the Institution
Global Academic Programs: the Advantages of Collaboration Part II
Chapter 17 / Beyond the Institution
Interview Session Four: 7 July 2015
Global Academic Programs: a Review of International Collaboration
Chapter 18 / Beyond the Institution
Cancer is a Problem for All Humanity: A Truth that Inspires Faculty
Chapter 19 / Institutional Mission and Values
Addressing Perceived Conflict of Interest
Chapter 20 / Institutional Processes
The Next Ten Years: Goals for MD Anderson Research and Faculty
Chapter 21 / Building the Institution
The Next Ten Years: Stewardship and Building a Culture of Care for Faculty and Staff
Chapter 22 / Building the Institution
Interview Session One: 5 March 2015 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
An Early Desire to Be a Physician and Focus on Difficult Illnesses (listen/read)
Dr. Dmitrovsky begins this chapter by describing his close, 1950s-style family. His father was a chemical engineer who was frequently relocated for his job. Dr. Dmitrovsky explains that he learned to connect with people and make friends quickly through this early experience.
Dr. Dmitrovsky also explains that even at a young age, he was interested in becoming a physician and helping people. He aspired to having a life of purpose and meaning, and felt that medicine, particularly with a focus on very difficult illnesses, would provide this.
Chapter 02 (Educational Path)
College Influences: A Research Project, a Book, and Working as an Orderly (listen/read)
Dr. Dmitrovsky begins this chapter by explaining how he selected Harvard University for his undergraduate education (AB, MA conferred 1976). He explains that he majored in biochemistry, an honors major, because it afforded him the opportunity for in-depth experience with research and writing an honor’s thesis.
This was one of three very significant college experiences, and Dr. Dmitrovsky next describes his research project, which focused on the communication junctions between cells. Current theories held that cell communication influenced cell malignancy. Dr. Dmitrovsky also wanted to work with Dr. Goodenough’s laboratory because of the state of the art molecular imaging in use. He goes into detail about his research.
Next, Dr. Dmitrovsky explains that he also wanted to have some clinical experiences to confirm that he should pursue a career in medicine, so he worked as an orderly at a geriatric hospital. Being able to see through the eyes of patients and their families provided him with a second significant experience. Dr. Dmitrovsky talks about witnessing the “grace of families” who cared for their elderly loved ones and how that convinced him of the importance of involving families in care.
Dr. Dmitrovsky concludes that these experiences convinced him that he wanted to make progress with complex medical problems and have an impact on patients and families. He then talks about a third influence on view of a medical career, the book Stay of Execution: A Sort of Memoir, by Stewart Alsop, who was diagnoses with a rare form of leukemia. Dr. Dmitrovsky says that this book showed him how scientific discovery influenced medicine and patient experience. He also notes that he became intrigued that there could be a hospital that focused specifically on rare and difficult to treat disease.
Chapter 03 (Professional Path)
Medical School and a Life-Changing Experience as a Physician Volunteer Near the Cambodia-Thailand Border (listen/read)
Dr. Dmitrovsky begins this chapter by explaining why he chose to attend Cornell University Medical College (MD conferred in 1980). He notes that he did research studies as well as a rotation at the National Cancer Institute. Next Dr. Dmitrovsky talks about volunteering to travel to Cambodia the summer after medical school. For three months he worked with the International Rescue Committee and saw difficult cases in the Khao-I-Dang Holding Center on the Cambodia-Thailand border. He talks about the diseases and conditions he say, many of which American doctors never diagnose. He talks about his triage experience. He also tells an anecdote about being invited back to Cambodia last year to give a graduation speech and meeting a patient who had been treated at the Holding Center. He notes that his experience had a “huge effect” on him, solidifying his desire to have a career of service.
Chapter 04 (The Researcher)
A Fellowship and a Risky and Successful Study of Cell Differentiation (listen/read)
In this chapter, Dr. Dmitrovsky talks about the research project that would set him on the path to discover the effectiveness of retinoids in treating acute promyelocytic leukemia. He begins by noting that at the end of his residency, he had decided to focus on hematology/oncology and took a Research Fellowship (’83 – ’86) at the National Cancer Institute, Navy Medical Oncology Branch, in Bethesda, working with Dr. Ilan Kirsch. He explains why he enjoyed working with patients with terminal disease during the initial, clinical, year.
Next, Dr. Dmitrovsky explains that, at the time, he still believed he would enter private clinical practice. This is the reason that he took on a risky research project during his final two years of protected laboratory time. He explains that the study was to use dimethyl sulfoxide (DMSO) to influence the role of the c-Myc oncogene in controlling leukemic differentiation (how undifferentiated cells become differentiated and capable of malignant growth) with the intention of developing treatments. He explains the technical challenges of conducting this study (the primary reason why all the other fellows at the NCI had declined the project). He talks about the success of the study and the discovery, after publishing the results in Nature, that two other groups had reached the same results, a fact that convinced him of the role of serendipity in scientific discovery.
Chapter 05 (The Researcher)
A Faculty Position and a New Laboratory to Study the Role of Retinoids in Leukemic Differentiation (listen/read)
Dr. Dmitrovsky begins this chapter by noting that his successful study of DMSO and the c-Myk oncogene enabled him to secure his first faculty position at Memorial Sloan-Kettering Cancer Center in the Division of Hematology/Oncology.
He then talks about the evolution of his research, beginning by sketching academic medicine’s conventional research path. Dr. Dmitrovsky then explains that the next step in his research would build on his work with DMSO and leukemia, so he posed the question, Can you cause cancer cells to mature? He explains why DMSO was not a viable treatment option for this process in humans, and so he built his “nascent lab” around studies of retinoic acid. He cites another example of serendipidity: within a few months, receptors for retinoic acid were discovered, giving credence to his hypothesis. He began to study how retinoids could cause germ cells to mature and become tumors. Dr. Dmitrovsky then says that he heard about a Chinese study of the use of all-transretinoic acid to treat acute promyelocytic leukemia. He embarked on the first American clinical trial that showed success in using retinoids to treat APL, and then collaborated with Dr. Ron Evans to clone the Retin-A receptor.
Dr. Dmitrovsky then explains that the APL’s molecular and genetic mechanisms became widely studies, and so he decided to change his research focus.
Chapter 06 (The Researcher)
Shifting Focus to Lung Cancer (listen/read)
In this chapter, Dr. Dmitrovsky talks about how he built on his studies of retinoids and leukemia treatment and began to investigate treatments for lung cancer. He decided to focus on retinoic acid’s role in causing the destruction of a cancer-causing protein. He explains why he selected lung cancer and why it was important to him that lung cancer affects both men and women.
Dr. Dmitrovsky says that his initial question was, Can we use retinoic acid to prevent lung cancer? He explains his first experiment, which showed that after treatment with retinoic acid, immortalized cells did not become malignant when exposed to tobacco carcinogens. He talks about studies that revealed the molecular pathways involved in this process, challenges that arose in creating a targeted approach (because of a silencing of β-receptor for Retin-A), and how these obstacles were overcome over a ten year period, enabling him to eventually discover a survival advantage. Dr. Dmitrovsky explains that he found activity in a very resistant form of lung cancer for which survival without treatment is 4 – 6 months and with retinoid treatment, 1 – 4 years.
Dr. Dmitrovsky then says that he compared his results with those obtained by colleagues at MD Anderson who were involved in the BATTLE trial. They had similar results. He says he hopes to find an even better retinoid.
Chapter 07 (Joining MD Anderson/Coming to Texas)
Coming to MD Anderson to Have a Broader Impact on Health (listen/read)
In this chapter, Dr. Dmitrovsky outlines the factors that led to him leaving Dartmouth and taking a position at MD Anderson. He begins by sketching the faculty positions he held and mentions that he was appointed to the Board of Scientific Counselors at the NCI, serving as Chair of the Board.
Next he explains that a family member was diagnosed with cancer and this gave him a different perspective on what cancer could do to an individual and family and opened his mind to what he might next do with his career. When his term as Chair of the Board of Scientific Counselors ended and his five clinical trials came to an end, he decided to do more with his administrative experience.
At this point he was approached by MD Anderson as the institution conducted a search for a new Provost and Executive Vice President. He notes that he feels a deep sense of commitment to MD Anderson’s mission.
Next, Dr. Dmitrovsky describes his acquaintance with Dr. Ronald DePinho and explains that his conversations about the Provost’s position were mainly conducted with executive leadership.
Chapter 08 (Building the Institution)
Views on MD Anderson’s 10-Year Strategic Plan and the Role of the Provost (listen/read)
In this chapter, Dr. Dmitrovsky speaks about the value of developing a ten-year Strategic Plan for MD Anderson. He first explains that the plan allows the MD Anderson community to come together to take account of the institution’s resources, to recognize that MD Anderson can’t do everything, and to make decisions about where energy and resources should be focused. He says that MD Anderson has an opportunity to make a full accounting of where it is and where it wants to be. He talks about areas where MD Anderson can improve, such as patient experience, provider experience, administrative systems and support structures. He gives examples of process improvements.
Chapter 09 (Building the Institution)
Creating A New Way of Conducting Research and Caring for Patients in a Changing Environment (listen/read)
In this chapter, Dr. Dmitrovsky provides an overview of how MD Anderson must operate in the new environment of research and healthcare economics. He begins by explaining that scientific endeavors traditionally rely on decisive discoveries by individual investigators that also reveal opportunities to development treatments. Today, he says, this process moves ahead via team- and interdisciplinary science, and the institution must educate the next generations of researchers in this way of conducting research. At the same time, MD Anderson must operate in a context of a flat NIH budget while responding to the new economics of the Affordable Care Act.
Next, he notes that MD Anderson is supporting the education of the next generation by making investments in junior faculty with the R. Lee Clark Fellowship Program. He explains the award (juried by experts outside of MD Anderson).
Next Dr. Dmitrovsky notes that reductions are being made to the length and complexity of informed consent forms so faculty can spend less time on paperwork and more time for their primary activities. He then speaks briefly about faculty recruitment and retention efforts.
Then Dr. Dmitrovsky talks about strategies used to encourage interdisciplinary investigation. He speaks in detail about finding ways to provide team members with proper recognition for their contributions (when contribution is traditionally measured by first or last author status) and linking credit to faculty promotion. He also talks about empowering team members to initiate investigations and provides some examples.
Interview Session Two: 6 May 2015 (listen/read)
Interview Identifier (listen/read)
Chapter 10 (An Institutional Unit)
The Provost’s Office: Acting on a Mandate and A Personal Goal (listen/read)
Dr. Dmitrovsky begins by sketching the major functions of the Provost’s Office and then talks about initiatives he has undertaken to address low faculty morale.
He talks about the importance of listening and explains how he set about hearing faculty concerns. He first explains initiatives set in place to address the faculty’s impression that the depth and scope of excellence among the current faculty is unrecognizethe R. Lee Clark Fellowship Program; the Clinical Innovator Award Program. He discusses investments made to relieve the monetary burden of running clinical trials and conducting genomic testing. Using examples, he explains the measures taken to relieve many instances of regulatory burden.
Chapter 11 (The Administrator)
Making Changes in an Institution: Goals, Following Up, A Philosophy of Communication (listen/read)
Dr. Dmitrovsky notes the overall goals of the changes he has made to the institution. He also reflects on the processes by which changes have an impact and are recognized by an organization’s community. He discusses the round of meetings he conducted to report back on measure taken to address faculty concerns and reflects on communication within a large organization.
Dr. Dmitrovsky notes his observation that faculty have a skepticism about administration and that they were not speaking their minds in meetings. He explains how he addressed this.
Chapter 12 (An Institutional Unit)
The Provost’s Office: Creating Support for Emerging Leaders (listen/read)
Dr. Dmitrovsky explains how he addressed the need to build the leadership of MD Anderson at the department and division levels. He discusses changes to recruiting processes for heads at these levels, stressing that search committees are looking for individuals “who care more about others than themselves” (and notes the challenges involved). Dr. Dmitrovsky explains the leadership support that is provided for new department and division heads, stresses the “huge” commitment of resources that is being made in them.
Chapter 13 (Professional Path)
Evolution as a Leader (listen/read)
Dr. Dmitrovsky discusses key moments in his own development as a leader. He notes that he became a department chair in his forties, a relatively young age. He says that he had opportunities to learn negative leadership lessons by observing others. He also learned to reach out to individuals with great leadership skills to learn directly from them. He talks about a mentor, James Wright, former president of Dartmouth College.
Chapter 14 (Building the Institution)
The Provost’s Office: Supporting Faculty Promotions (listen/read)
Dr. Dmitrovsky discusses issues involved in supporting faculty promotions in a term-tenure system.
He explains the overall situation: faculty must prove themselves, but lack tools to move effectively through the tenure process. He observes that faculty with clinical responsibilities experience the most anxiety.
Dr. Dmitrovsky describes measures taken: providing department chairs with guidelines for providing support and mentoring; providing financial support to develop publications; holding information sessions to create transparency about tenure requirements and how to create a strong portfolio.
Dr. Dmitrovsky addresses recent questions from the faculty about tenure decisions that have been overturned.
Interview Session Three: 6 June 2015 (listen/read)
Interview Identifier (listen/read)
Chapter 15 (An Institutional Unit)
The Institute for Applied Cancer Science: The Research Model (listen/read)
Dr. Dmitrovsky talks about the model of research set in place at the Institute for Applied Cancer Science [IACS].
He begins by stating the mission of developing multi-disciplinary teams, noting that “the future of science is collaboration” and that discoveries will emerge in the lines between disciplines. He gives the example of genomic medicine.
Dr. Dmitrovsky sketches the barriers to moving discoveries to the bedside then talks about the model of IACS research, biotech people and processes are imbedded in research design to speed up discovery and facilitate dissemination via regional care centers and sister institutions.
Chapter 16 (Beyond the Institution)
Global Academic Programs: the Advantages of Collaboration Part I (listen/read)
Dr. Dmitrovsky explains the benefits of international collaborations for MD Anderson and for the institutions overseas.
He notes that Global Academic Programs is a unique model of relationships with over thirty institutions. He explains how these connections further MD Anderson’s mission and also provides opportunities for clinical trials, research collaborations, and new knowledge. He gives the example of a recent trip to visit Hunan Cancer Hospital in Changsa Province, China. He explains that MD Anderson will provide support with smoking cessation and prevention. He also talks about making rounds of a clinic where traditional Chinese medicine is practiced in concert with Western medicine.
In response to a question, Dr. Dmitrovsky underscores that Global Academic Programs does not establish relationships with a commercial motive in mind. They are part of the ten-year plan of furthering MD Anderson’s mission of assuming social responsibility for the health of populations.
Chapter 17 (Beyond the Institution)
Global Academic Programs: the Advantages of Collaboration Part II (listen/read)
Dr. Dmitrovsky explains MD Anderson’s link with the biotech company, Ziopharm Oncology as an example a relationship established with a commercial venture in mind.
He then underscores the differences between relationships established to further MD Anderson’s social responsibility and mission versus explore opportunities to commercialize discoveries. He gives examples of consulting relationships set up through GAP and talks about what makes a desirable partner. He talks about Hunan Cancer Hospital, a potential partner, noting that it is centrally located in China and would enable dissemination of cancer knowledge and care to a vast number of people.
[The interview is terminated.]
Interview Session Four: 7 July 2015 (listen/read)
Interview Identifier (listen/read)
Chapter 18 (Beyond the Institution)
Global Academic Programs: a Review of International Collaboration (listen/read)
Dr. Dmitrovsky summarizes the benefits of international collaborations for MD Anderson and international partners by talking about his recent trip to visit the Hunan Cancer Hospital in Changsa Province, China. He explains that MD Anderson will provide support with smoking cessation and prevention. He also talks about making rounds of a clinic where traditional Chinese medicine is practiced in concert with Western medicine. He talks about the possibilities for a smoking cessation/prevention program, including one for schoolchildren.
Dr. Dmitrovsky underscores that the future of medicine is about partnership.
Chapter 19 (Institutional Mission and Values)
Cancer is a Problem for All Humanity: A Truth that Inspires Faculty (listen/read)
In response to a question about how intercultural experiences can have an impact on faculty, Dr. Dmitrovsky notes that his experience working near the Cambodian border early in his career made him understand that cancer is a problem for all humanity. He talks about how knowing this gives meaning to all faculty and employees who work at MD Anderson. He explains that people are inspired and empowered by meaningful goals and offers the view that faculty experiences with global partners can reinforce these larger goals, which can get lost in the details of daily work.
Chapter 20 (Institutional Processes)
Addressing Perceived Conflict of Interest (listen/read)
Using hypothetical examples, Dr. Dmitrovsky explains mechanisms for addressing instances of perceived conflict of interest in the new era of research collaborations between academic institutions, pharma and the biotechnology industry.
He first stresses MD Anderson’s responsibility to adhere to high standards of transparency. He notes that MD Anderson has examined best practices from other institutions. Next he stresses that actual instances of conflict of interest are addressed and resolved via mechanisms already in place. He then talks about the need to develop processes for addressing perceived conflict of interest.
He gives two hypothetical examples of perceived institutional conflict of interest. The first involves involvement of an academic institution in developing a drug after it has contributed to the Phase One clinical trial to validate knowledge about the agent. In another example, he talks about how an institution might respond if it has commercialized intellectual property, which then generates revenue: he sketches how those profits could be used to avoid perceived conflict of interest.
Dr. Dmitrovsky then notes how valuable research collaborations are to advancing MD Anderson’s mission, bringing down the cost of health care, and attracting new biotechology industries to the region.
Chapter 21 (Building the Institution)
The Next Ten Years: Goals for MD Anderson Research and Faculty (listen/read)
Dr. Dmitrovsky sketches his plans for MD Anderson research and faculty in the next ten years. He begins by discussing mechanisms for supporting the institution’s research portfolio, given decreasing federal support.
Chapter 22 (Building the Institution)
The Next Ten Years: Stewardship and Building A Culture of Care For Faculty and Staff (listen/read)
Dr. Dmitrovsky shares his personal view of what he would like to see achieved at MD Anderson in the next ten years. He first discusses the privilege he feels working at MD Anderson and being guided by the institution’s mission and core values. He explains that he would like to see the institution develop a culture of care that extends beyond patients and operates among the faculty and staff. He then talks about his goal of recruiting leaders who are servant leaders and emotionally intelligent. He talks about the support he would like to continue to build for faculty.
Finally, Dr. Dmitrovsky talks about the importance of the Oral History Project in strategic planning for the future.