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Submitted: 6 June 2014
Two interview sessions: 24 February 2012, March 1, 2012
Total approximate duration: 4 hours 25 minutes
Interviewer: Tacey A. Rosolowski, Ph.D. (email)
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, email@example.com
About the Interview Subject:
Ralph S. Freedman, M.D., Ph.D. (b. 1941, Capetown, South Africa) joined the Department of Gynecologic Oncology as a Fellow in 1976 and was hired the following year as an Assistant Professor (’87 Full Professor). He has a joint appointment in the Division of Surgery. Dr. Freedman specializes in immunological approaches to ovarian and cervical cancer. Later in his career he became involved with policy-making. He served on the National Cancer Advisory Board and worked for many years on the MD Anderson Cancer Center’s Institutional Review Board. When he retired in 2007, he was Director of the Laboratory of Immunology and Molecular Biology in the Department of Gynecologic Oncology. Since retirement, he has served on the Oncologic Drug Advisory Board.
Major Topics Covered:
Personal and educational background; experiences in native South Africa
MD Anderson history and culture in the seventies and since
Research: immune mechanisms and gynecologic cancers; vaccines, T-cells, monoclonal human antibodies, inflammatory system, ecosinoids and inflammatory responses to tumors.
Department of Gynecologic Oncology: building immunology research
Institutional Review Board at MD Anderson
Lyndon Baines Johnson Hospital and indigent care
The National Cancer Panel, the Drug Advisory Board
Institutional change and growth
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: 24 February 2012
An Early Desire to Enter Medicine and a Growing Interest in Oncology
Chapter 01 / Professional Path
Discovering a Rich and International Community at MD Anderson in the Seventies
Chapter 02 / Joining MD Anderson/Coming to Texas
Research into Treatment for Gynecologic Cancers
Chapter 03 / The Researcher
Interview Session Two: March 1, 2012
Setting Up Testing Laboratories and Clinics and Building Research
Chapter 04 / Building the Institution
Building A Departmental Focus on Immunological Approaches to Gynecologic Cancers
Chapter 05 / Building the Institution
Two Decades Overseeing Human-Subject Research
Chapter 06 / Building the Institution
Service On the National Cancer Advisory Board and Other National Bodies
Chapter 07 / A: Professional Service beyond MD Anderson
Working with LBJ Hospital and Indigent Care
Chapter 08 / Post-Retirement Activities
MD Anderson Growth and Changes to Institutional Culture
Chapter 09 / Institutional Change
Session One: 24 February 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Professional Path)
An Early Desire to Enter Medicine and a Growing Interest in Oncology (listen/read)
In this segment, Dr. Freedman talks about his family life and education in South Africa, noting that his family physician inspired him to enter medicine. He explains the differences of the South-African, British-based educational system and then, during the next twenty-five minutes he turns to his growing interest in endocrinology (Ph.D. on breast feeding habits on maternal disease of the endometrium) and cancer. He explains that he applied for an Eli Lily fellowship (instead of going to England, as was more usual for South African residents and post-doctoral fellows) because “the future was more in the States than in Britain.” Dr. Freedman explains that he came to the U.S. to work with Dr. Joseph Sinkovics in 1976. He talks about how South Africa’s apartheid system affected his medical training: his exposure to the variety of uterine diseases among Black South African women led him to do a Ph.D. and to collaborate with virologists on a variety of studies of uterine cancer. Immunology, virology, endocrinology, and his interest in cancer coalesced at exactly the right time to create a new research path leading to MD Anderson, working with on cervical cancer cell lines, a precursor to his work on vaccines and cytokines and immunotherapy.
Chapter 02 (Joining MD Anderson/Coming to Texas)
Discovering a Rich and International Community at MD Anderson in the Seventies (listen/read)
Dr. Freedman begins this segment with a fuller discussion of how he came to MD Anderson. He also comments on his family’s adjustment to life in the United States and the social life of MD Anderson in the mid-Seventies, with its international faculty.
Chapter 03 (The Researcher)
Research into Treatment for Gynecologic Cancers (listen/read)
In this segment, Dr. Freedman discusses his “travels in the lab,” first explaining how his Fellowship work on cell lines transitioned to the development of vaccines for gynecologic cancers. He talks about the prevalence of these cancers, explaining the special challenge of ovarian cancer. He explains the logic behind the vaccine strategies tested (e.g. intra-peritoneal injection) and the immune mechanisms stimulated, and also notes the clinical challenges faced, which led to work on an approach using T-cells. He then details his work with T-cells, describing some of the equipment used, the procedures attempted, and his evaluation of those procedures, concluding that his work added “building blocks” to the understanding of the immune system, as well as the creation of a mono-clonal human antibody. Dr. Freedman then goes on to talk about the relationship between the immune system and the inflammatory system and his work with ecosinoids and inflammatory responses to tumors. It may be possible, he explains, that if the inflammatory response can be stopped, a tumor will stop growing. He notes that his research has given him new respect for how difficult it is to treat cancer, pointing out that mortality rates for cancer has not changed substantially over the past years. He discusses the difference between private practice and academic medicine then describes what it was like to establish his own laboratory after working collaboratively in others’ labs. He offers his views on translational research. Dr. Freedman then talks about how he dismantled his lab and projects when he decided to retire.
Interview Session 2: March 1, 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 04 (Building the Institution)
Setting Up Testing Laboratories and Clinics and Building Research (listen/read)
In this segment, Dr. Freedman explains how he came to assume the positions of Director and Chief of Immunology and Molecular Biology Research (’88-‘07). This narrative brings together various details: treatment of rare gynecological cancers, billing practices, regulation of laboratory testing, and research.
Chapter 05 (Building the Institution)
Building A Departmental Focus on Immunological Approaches to Gynecologic Cancers (listen/read)
Dr. Freedman begins this segment by sketching the hopes he had as Director and Chief: to understand the biology of the diseases from an immunological perspective and try to identify new strategies to treat ovarian and uterine cancer, with their (continued) dismal outcomes (in comparison to advances made with cervical and endometrial cancer). He notes that the main contribution IMBR made to ovarian cancer was to demonstrate that T-cells can be activated in the patient, a fact indicating that a vaccine approach might potentially be used. He goes into detail about the biological mechanisms of the tumors and of the patient’s immunological system. He notes that it is important for researchers to determine adequate ways to measure clinical benefit of treatments.
Chapter 06 (Building the Institution)
Two Decades Overseeing Human-Subject Research (listen/read)
In this segment, Dr. Freedman discusses his more than twenty years of experience overseeing human subject research on the Institutional Review Board (IRB). He sketches the history of human subject guidelines and clarifies IRB procedures, potential conflicts of interest (between IRB members and the institution), and the kinds of research protocols of concern to the IRB, whose primary function is the protection of human subjects. He then discusses his belief that regulation is very necessary, but that it has currently gone too far. He points out that different protocols represent different levels of risk, some of which may not require IRB regulation, such as experiments in which the main risk is to patient privacy. Dr. Freedman offers rich detail about the challenges to researchers and describes systems that might satisfy the public’s need for privacy and information security while easing the burden on researchers who want to move ahead quickly with their work. “We needed these systems yesterday,” Dr. Freedman asserts. He gives examples of how his understanding of the need for regulation and its potential complexity evolved as his experience as a researcher grew, then expands his focus again and discusses how regulation can influence how a researcher focuses his or her career.
Chapter 07 (Professional Service beyond MD Anderson)
Service On the National Cancer Advisory Board and Other National Bodies (listen/read)
In this segment, Dr. Freedman discusses his role as a presidential appointee to National Cancer Advisory Board (President Bill Clinton, ’00 – ’06). He begins with a brief sketch of the birth of the NCAB (and the National Cancer Institute) in the National Cancer Act, then covers NCAB review processes and grant procedures and compares the different styles of the Directors of the National Cancer Institute, who work with the NCAB. He shares his view that all the institutes need to reconsider the kinds of clinical research they are supporting. This discussion leads naturally to his post-retirement role on the Oncologic Drug Advisory Board (since ’09), “one of the most productive Boards at the FDA,” in Dr. Freedman’s words. He notes that he had to divest himself of certain stocks and remove himself from committees to satisfy the Board’s conflict of guidelines. He also talks about the Board’s procedures for questioning drug companies, offering several examples (including a drug company’s challenge to a rejection). He concludes that “They [the FDA] do a terrific job of protecting the public.”
Segment 08 (Post-Retirement Activities)
Working with LBJ Hospital and Indigent Care (listen/read)
In this segment, Dr. Freedman talks about the Lyndon Baines Johnson Hospital in Houston, a public county hospital that has many MD Anderson faculty who work part or full time. Dr. Freedman has worked with the gynecological oncology resident training program since his retirement: a choice he made to continue seeing patients, which he felt he could not do at MD Anderson under conditions where patients required continuous monitoring. He notes the economic burden that indigent patients represented for MD Anderson in the past; he has also had an opportunity to note how many more women physicians are in the field.
Segment 09 (Institutional Change)
MD Anderson Growth and Changes to Institutional Culture (listen/read)
In this segment, Dr. Freedman shares his observations about the growth of MD Anderson since he came to the institution in 1975. He notes its particular strength in clinical research and multi-disciplinary approaches (gynecologic oncology being one of the first Departments to put together multi-disciplinary fields). He hopes that MD Anderson will continue to always do the right thing for patients, “since we are there for them, not for ourselves.” In the final minutes of the interview, he talks about going to Galveston, Texas, to fish and enjoy the water, as he did when he was young, in Capetown, South Africa. Since retiring, he has been able to indulge his love of history and travel, talking about his trip to Russia. “It’s a good thing to leave some time,” he says, to have a chance to do other things besides work.
Dr. Ralph S. Freedman, M.D., Ph.D. (b. 1941, Capetown, South Africa) speaks about his career in this interview of 4 hours 25 minutes conducted over two sessions in spring of 2012. Tacey A. Rosolowski, Ph.D., interviews Dr. Freedman at his home in Houston, Texas.
Dr. Freedman is a gynecologic oncologist who joined the faculty of MD Anderson in 1976. When he retired in 2007, he was Director of the Laboratory of Immunology and Molecular Biology in the Department of Gynecologic Oncology. He was also a Professor in that Department and continues to hold a position as a Clinical Professor in the Division of Surgery (the same department). Dr. Freedman specializes in immunological approaches to ovarian and cervical cancers; later in his career he became involved with policy-making related to cancer, serving on the National Cancer Advisory Board and working for many years on the MD Anderson Cancer Center’s Institutional Review Board. Since retirement, he has served on the Oncologic Drug Advisory Board. Among his awards are MD Anderson’s Distinguished Service Award (’07) and Educator of the Month (’03). Since retirement, has been teaching residents in gynecologic oncology at the Lyndon Baynes Johnson County Hospital in Houston.
Dr. Freedman earned his MBBCh (Bachelor of Medicine and Bachelor of Surgery; Latin Medicinæ Baccalaureus et Baccalaureus Chirurgiæ) in 1965 at the University of the Witwatersrand, Johannesburg, South Africa. He did Internships at Johannesburg General Hospital, Baragwanath Hospital, and the Johannesburge Group of Teaching Hospitals, the latter residency (’68-’71) for Obstetrics and Gynecology. Dr. Freedman was on the faculty of the University of Witwatersrand before earlning his Ph.D. in Medicine in 1975 at the same institution, after which he came (in 1976) to MD Anderson as a Fellow in the Department of Gynecology. He was hired as an Assistant Professor in Gynecologic Oncology the next year (’81 tenure; ’87 Full Professor).
In this interview, Dr. Freedman discusses his research and his administrative roles at MD Anderson and also covers his advisory and oversight roles on the National Cancer Panel, MD Anderson’s Institutional Review Board, and the Drug Advisory Board. Dr. Freedman is a very candid and thorough interview subject who sketches details of experimental and biological processes very clearly. His interest in history shows in his ability to provide relevant context for his discussions of research, various departments, and his own decision making as a researcher. It is no surprise that he served for so long on the Institutional Review Board and takes part in national advisory boards that safeguard public safety and health: Dr. Freedman is clearly interested in the ethical dimensions of medicine, as he demonstrates in a fascinating discussion of how he distributed tissue samples to other researchers when he closed down his own laboratory.