Submitted: 24 June 2014
Four interview sessions: 14 February 2012, 17 February 2012, 20 February 2012, 28 February 2012
Total approximate duration: 9 hours and 20 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:
Dr. C. Stratton Hill, Jr., M.D. (b. 28 July 1928, Humbolt, Tennessee; d. 2015) came to MD Anderson in 1963 as an oncologic endocrinologist with a specialty in thyroid cancer. By the 1980s, his career had expanded to include pain management, the work for which he is perhaps best known. Dr. Hill served as the Associate Director of the Ambulatory Care Clinics from 1974-1979. In 1981 he set up the Pain Clinic (now the Pain Management Center) and served as its director until 1992. In 1996 Dr. Hill received the American Cancer Society Humanitarian Award, given for his dedication to improving cancer control and for his accomplishments in human welfare. Post retirement, Dr. Hill has worked with the Open Door Mission Foundation for Recovery and Rehabilitation in Houston. He is a Professor Emeritus and Internist Emeritus in the Department of Symptom Research. Dr. Hill retired in 1996. He passed away in December 2015.
Major Topics Covered
Personal and educational background; faith
Research: thyroid cancer; pain management and policy
MD Anderson history and culture: research innovation
Pain management: development of field; first book on; cultural and social factors influencing use of opioids
Developing the Ambulatory Care Clinic
Hospice and MD Anderson
The Texas Cancer Council; Texas Cancer Pain Initiative
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.
Interview Session One: 14 February 2012
Early Experiences with Physicians and Illness
Chapter 01 / Personal Background
Developing Interests in Oncology and Pain Management
Chapter 02 / Professional Path
An Evolving Specialty and Coming to Texas
Chapter 03 / Joining MD Anderson/Coming to Texas
Thyrocalcitonin –Confirming the Marker for Thyroid Cancer
Chapter 04 / The Researcher
MD Anderson in the Sixties –A Culture of Innovation
Chapter 05 / MD Anderson Past
Collaborations with Dr. R. Lee Clark and the Climate for Research at MD Anderson
Chapter 06 / The Researcher
Interview Session Two: 17 February 2012
Publishing the First Book on Pain Management
Chapter 07 / The Researcher
Understanding the Problem of Pain Management in the 70s and 80s - at MD Anderson and Beyond
Chapter 08 / Building the Institution
A Pain Clinic for MD Anderson
Chapter 09 / Building the Institution
Pain Management and Opioids: Today and in Historical Perspective
Chapter 10 / Overview
Interview Session Three: 20 February 2012
A Brookhaven Laboratory Study in the Marshall Islands
Chapter 12 / The Researcher
The Emerging Need for an Ambulatory Care Clinic
Chapter 13 / Building the Institution
Setting Up the New Ambulatory Clinic (Mays Clinic) –And Re-Designing It
Chapter 14 / Building the Institution
Remembering MD Anderson Presidents and Dr. Eleanor MacDonald
Chapter 15 / Key MD Anderson Figures
Preserving the MD Anderson Brand Despite Global Growth
Chapter 16 / Institutional Change
The Texas Cancer Council and the Texas Cancer Pain Initiative
Chapter 17 / Professional Service beyond MD Anderson
The Open Door Mission for Rehabilitation and Recovery; Awards
Chapter 18 / Post-Retirement Activities
Interview Session Four: 28 February 2012
A Southern Baptist Background Inspires a Life of Service
Chapter 19 / Personal Background
Hospice and MD Anderson
Chapter 20 / The Clinician
Expanding MD Anderson’s Reputation
Chapter 21 / Building the Institution
An Endowment for Education, More Research, and a Think Tank
Chapter 22 / Post-Retirement Activities
Interview Session One: 14 February 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
Early Experiences with Physicians and Illness (listen/read)
In this segment, Dr. Hill links his choice of career to his own bout with osteomyelitis as a youngster and the care that his family physician provided. He gives an interesting portrait of disease in the thirties/forties–including being anaesthetized with cocaine—and the role of the small-town doctor.
Chapter 02 (Professional Path)
Developing Interests in Oncology and Pain Management (listen/read)
In this segment, Dr. Hill sketches his professional training, including his experiences in the 8th Air Force Strategic Air Command base in Plattsburg, New York, where he became Chief of Professional Services and encountered cancer cases that convinced him to apply for a residency at Memorial Sloan-Kettering Cancer Center. He then talks about the New York phase of his early career. He paints an interesting picture of the state of medicine and of different hospitals in New York at the time.
Chapter 03 (Joining MD Anderson/Coming to Texas)
An Evolving Specialty and Coming to Texas (listen/read)
Dr. Hill begins this segment by describing how the politics of building a new medical school in Jersey City influenced his career path. He talks about meeting Dr. Ray Houde, who studied analgesics and spurred his early interest in pain medications. He also met Roulon Rawson who had treated thyroid cancer and radioactive iodine and “that rubbed off on everyone who worked with him.” He rotated through the general endocrine service at Bellevue Hospital, which helped convince him to focus on that specialty. He talks about the professional connections that alerted him to a position at MD Anderson.
Chapter 04 (The Researcher)
Thyrocalcitonin –Confirming the Marker for Thyroid Cancer (listen/read)
In this segment, Dr. Hill talks about his work in the Department of Medicine when he first arrived at MD Anderson in 1963. He describes discovering a “treasure trove” of cases of medullary thyroid cancer. He sketches his epidemiological studies of families and his study of the nature of thyroid cancers, then goes into much greater detail on his study of calcitonin in the thyroid, determined to be a marker for thyroid cancer, as well as gene-related calcitonin.
Chapter 05 (MD Anderson Past)
MD Anderson in the Sixties –A Culture of Innovation (listen/read)
In this segment, Dr. Hill compares MD Anderson to Memorial Sloan-Kettering and the Mayo Clinic (Dr. Clark’s model for MD Anderson), noting that, at the time, MD Anderson could not replicate the cultures and traditions of these well-established services. Dr. Hill comments on Dr. Clark’s leadership style and vision and the innovative ideas he implemented at MD Anderson.
Chapter 06 (The Researcher)
Collaborations with Dr. R. Lee Clark and the Climate for Research at MD Anderson (listen/read)
In this segment, Dr. Hill talks about the research connections he shared with Dr. R. Lee Clark, also a thyroid surgeon. He talks about standard procedures for treating thyroid cancers. Dr. Hill concludes the interview with some comments on how basic and clinical scientists collaborated very informally during his first years at MD Anderson.
Interview Session Two: 17 February 2012 (listen/read)
Chapter 07 (The Researcher)
Publishing the First Book on Pain Management (listen/read)
In this segment (which begins when the Interviewer switches on the recorder during an informal discussion) Dr. Hill talks about his efforts to publish the first book on his work in pain management, Drug Treatment of Cancer Pain in a Drug-Oriented Society. He explains that pain management is a complex societal and medical issue that is “like trying to pick up a greased watermelon out of a swimming pool.”
Interview Identifier (listen/read)
Chapter 08 (Building the Institution)
Understanding the Problem of Pain Management in the 70s and 80s –at MD Anderson and Beyond (listen/read)
In this segment, Dr. Hill talks about pain management issues at MD Anderson. He begins by talking about the Pain Clinic, an ad hoc clinic that undertreated pain, a typical approach at the time, since chronic pain is a problem for patients who live, and cancer patients were just starting to live longer. He explains the three major causes of pain for the cancer patient and talks about his philosophy of addressing “pain in the cancer patient,” rather than cancer pain. He talks about the knowledge base about pain that needed to be created, including information about dosages, drug mechanisms and administration protocols, the individuality of patients, etc.
Chapter 09 (Building the Institution)
A Pain Clinic for MD Anderson (listen/read)
Dr. Hill begins this segment by explaining why he left the Directorship of the Ambulatory Care Clinics (Mays Clinic) specifically to start a true Pain Clinic with a multidisciplinary team of practitioners, including a therapist who worked with relaxation (inspired by the model of Dr. John Bonica). Throughout this discussion he mixes observations about administration, clinical practice and research to give a portrait of how he began to explore effective use of opioids, culminating in his realization that cultural/societal beliefs prevented other physicians from aggressively treating pain with opioid drugs.
Chapter 10 (Overview)
Pain Management and Opioids: Today and in Historical Perspective (listen/read)
In this segment, Dr. Hill explains that American culture does not easily distinguish between the abuse and legitimate use of opioid drugs. He summarizes points he made in an interview he gave for the television program, 60 Minutes related to a controversial colleague in pain management, Dr. William Hurwitz. Dr. Hill explains that misunderstandings about the nature of what addiction effect physicians, pharmacists, law enforcement agents, media and, of course, patients. To set context for this discussion, Dr. Hill sketches the history of drug regulations and the study of pain, going back to the Civil War (and the understanding of phantom pain), describing pain and pain control mechanisms (e.g. the ‘gate theory’) in vivid terms. He tells several stories about patients grappling with pain (at times to the point of suicide attempts), and the treatments he explored to ease their suffering.
Chapter 11 (Overview)
Pain, Opioids and the Challenge of Working with Patients –and with Government Regulations (listen/read)
Dr. Hill begins this segment by explaining the problem that triplicate prescription forms present to pain management. Since one copy of a prescription for an opioid goes to the police, physicians can be reluctant to prescribe (adequate) pain medication for fear of legal prosecution. Dr. Hill then talks about his related work with Texas Lt. Governor Bill Hobby to write the “Intractable Pain Treatment Act” (1989), adding many observations about how politics can influence medicine. He also talks about lawsuits against physicians who prescribe opioids and the lengths patients will go through to acquire adequate medication. He discusses “My Word Against Theirs”…Narcotics for Cancer Pain Control (1990-’91), an award winning video ("Heart of Wisdom Award" SMF "Gold Award" [First Place] for the Eighth Biennial John Muir Medical Film Festival in the category of "Patient Care") he produced with the MD Anderson Media services and a 1996 episode of 60 Minutes, during which he discussed a lawsuit against physician William Hurwitz for prescribing narcotics. Dr. Hill then talks about obstacles that still prevent the medical profession from adequately treating chronic pain. He also discusses the need to teach pharmaceutical companies how to tailor medications to maximize pain relief and avoid toxicity.
Interview Session Three: 20 February 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 12 (The Researcher)
A Brookhaven Laboratory Study in the Marshall Islands (listen/read)
In this segment Dr. Hill speaks about his involvement (and that of other MD Anderson personnel) with the Brookhaven National Laboratory studies of the effects of nuclear fallout in the Marshall Islands. He describes his work with patients in the Islands. He then talks about how MD Anderson became an important treatment center for thyroid cancer because of the use of the “avant garde therapy” of radioactive iodine, noting that Dr. Clark was responsible for bringing the significant researchers together.
Chapter 13 (Building the Institution)
The Emerging Need for an Ambulatory Care Clinic (listen/read)
In this segment, Dr. Hill explains that the need for a new clinic grew in part with the increasing use of (the controversially) aggressive chemotherapy promoted by Dr. Emil J Freireich [Oral History Interview], Emil Frei and others in the new Department of Developmental Therapeutics. He talks about the tension created between MD Anderson’s “Old Guard” as this “New Guard” increased the institution’s reputation and patient volume.
Chapter 14 (Building the Institution)
Setting Up the New Ambulatory Clinic (Mays Clinic) –And ReDesigning It (listen/read)
In this segment, Dr. Hill offers a comprehensive view of his work setting up the Ambulatory Care Clinics and serving as Director from 1974 to ’79 (noting that he learned to work with Dr. Clark’s leadership style effectively during this period). A new Clinic was needed to serve the crowds of patients standing around as if “in feedlots.” Dr. Hill discusses several topics: MD Anderson’s acquisition of the land and money to build the new clinic; the challenges of dealing with a new building whose architects had not planned well for specific medical uses and needs; personnel upheavals; evaluating the function of the building and staff once the departments moved in; his work writing educational materials for patients on the procedures they would undergo; change in the policy of allowing patients to handle their records. Dr. Hill also describes his working relationship with Dr. R. Lee Clark, president of the institution at the time. He talks about calling a key meeting held to address design elements of the clinic that resulted in dehumanizing treatment of patients that was “not the way that anyone here wants to practice medicine."
Chapter 15 (Key MD Anderson Figures)
Remembering MD Anderson Presidents and Dr. Eleanor MacDonald (listen/read)
Dr. Hill begins this segment by noting that Dr. Clark supported any change that would improve efficiency and positive effects for patients. He then goes on Eleanor MacDonald [Oral History Interview], an epidemiology specialist with a visionary sense of records organization: she established a system of data and records-keeping for MD Anderson that influenced the entire medical system in Texas. Dr. Hill notes that Miss MacDonald’s work guaranteed the quality of MD Anderson research. He then offers additional observations about Dr. Clark, comparing his leadership style to Dr. Charles LeMaistre’s [Oral History Interview] and discussing the transition as Dr. Clark stayed at MD Anderson during the beginning of Dr. LeMaistre’s presidency of the institution. He recalls working with Roman Arnoldy, an engineer who organized the building of Rotary House (built on the model of a hotel attached to the Cleveland Clinic), which provides convenient and medically appropriate accommodations for patients. He also evaluates Dr. Mendelsohn’s [Oral History Interview] leadership style with the previous presidents, praising his science as well as his administrative and fundraising skills.
Chapter 16 (Institutional Change)
Preserving the MD Anderson Brand Despite Global Growth (listen/read)
In this segment, Dr. Hill discusses financial challenges that MD Anderson currently faces: challenges in expanding the MD Anderson culture beyond Houston while preserving the culture of care; competition between service providers. He also speaks about the new president, Dr. Ronald DePinho –what he appears to offer and also his lack of experience in the operation of clinical services.
Chapter 17 (Professional Service beyond MD Anderson)
The Texas Cancer Council and the Texas Cancer Pain Initiative (listen/read)
In this segment, Dr. Hill talks about his appointment (by Lt. Governor Bill Hobby) to the Texas Cancer Council (President, 1992-94, 1994-6) and sketches his work starting up the Texas Cancer Pain Initiative (which began in the 1980s with an organizational meeting funded by the Hobby Foundation), an organization that lent its name to the attempts Dr. Hill and others were making to revise legislation with an impact on pain management. Reviewing the organization’s educational efforts (in the late 80s or early 90s), he explains the political and financial reasons why it is more difficult to change pain management practices now than in the past.
Chapter 18 (Post-Retirement Activities)
The Open Door Mission for Rehabilitation and Recovery; Awards (listen/read)
In this segment, Dr. Hill talks about his involvement with the Open Door Mission for Rehabilitation and Recovery, where volunteers his time now that he is retired. He talks about his various awards, hoping that they bring attention to issues that need further attention and funding. He speculates that his interest in relief of pain came from his upbringing. [The interview cuts off]
Interview Session Four: 28 February 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 19 (Personal Background)
A Southern Baptist Background Inspires a Life of Service (listen/read)
In this segment, Dr. Hill speculates that his commitment to care is rooted in his upbringing. He notes that he was raised Southern Baptist by practicing parents who had basic beliefs in a religion of love and service to others. (Dr. Hill believes all religions share these values; he is studying comparative religion now that he is retired).
Chapter 20 (The Clinician)
Hospice and MD Anderson (listen/read)
In this segment, Dr. Hill focuses on his work with the Hospice Movement. He describes the beginning of the Hospice movement in the U.S. (Dr. Hill attended the movement’s first meetings; he serves on the Board of Houston Hospice.) He explains why Dr. Clark was anti-Hospice at the time. He describes some basic beliefs of the group he worked with, primary psychologists, and shares a number of stories that show how he helped shape how Hospice in Houston functioned and evolved into a centralized institution. He again notes that Dr. Clark was against Hospice and such efforts as “Reach to Recovery.” He contextualizes Dr. Clark’s attitude in the anti-MD Anderson movement in Texas (fueled by MD Anderson’s fee-for-service policy) and explains why his attitude eventually shifted, though he stresses that MD Anderson “does not exist to preside over anyone’s death.”
Chapter 21 (Building the Institution)
Expanding MD Anderson’s Reputation (listen/read)
Dr. Hill begins this segment by explaining why so many ENT cancers were referred to MD Anderson to have the successful, less disfiguring surgeries for people “who were supposed to be dead.” (He vividly describes the process of “walking a flap [of skin]” to perform reconstructive surgery.) He recalls that MD Anderson’s reputation was secured via non-surgical interventions of radio- and chemotherapy, and compares it to the more surgical focus of Memorial Sloan-Kettering. He also illustrates Dr. Clark’s “political moxie… that doctors in general don’t have” –a key factor in MD Anderson achieving prominence. Dr. Hill next returns to his own work on thyroid cancer, offering two specific cases in which he and other MD Anderson physicians were better able to diagnose cancer than others. He talks again about how he started up studies of families.
Chapter 22 (Post-Retirement Activities)
An Endowment for Education, More Research, and a Think Tank (listen/read)
During this segment, Dr. Hill talks about the endowment he made (1998) to MD Anderson for education in Pain Management that would show the complexity of pain associated with cancer. He talks about current plans to discuss toxicities from cancer treatment, “the backdoor of treating symptoms from cancer treatment,” and hopes that the money will be used to support a “think tank” about symptom relief tied to individualized therapy.
Dr. C. Stratton Hill, Jr., M.D. (b. 28 July 1928, Humbolt, Tennessee) is a Professor Emeritus and Internist Emeritus in the Department of Symptom Research at the MD Anderson Cancer Center.
This interview is conducted over four sessions for a total of 9 hours and 20 minutes. Dr. Hill came to MD Anderson in 1963 as an oncologic endocrinologist with a specialty in thyroid cancer. By the 1980s, his career had expanded to include pain management, the work for which he is perhaps best known. Dr. Hill retired in 1996. These sessions, conducted by Tacey A. Rosolowski, Ph.D., are conducted at Dr. Hill’s home in Houston, Texas during February of 2012.
Dr. Hill was awarded his BA from Rhodes College in Memphis, Tennessee, and went on to the University of Tennessee’s College of Medicine, where his M.D. was conferred in 1954. He had a clinical clerkship in Scotland before joining the Air Force, where he was Chief of Professional Services from 1956-’58. At MD Anderson, Dr. Hill served as the Associate Director of the Ambulatory Care Clinics from 1974-’79. In 1981 he set up the Pain Clinic (now the Pain Management Center) and served as its director until 1992. In 1996 Dr. Hill received the American Cancer Society Humanitarian Award, given for his dedication to improving cancer control and for his accomplishments in human welfare. Post retirement, Dr. Hill has worked with the Open Door Mission Foundation for Recovery and Rehabilitation in Houston: in 2010 he was awarded the Mayor’s Volunteer Houston Award (by Mayor Annise Parker).
In this interview Dr. Hill covers his three-part career in thyroid cancer research, administration, and pain management. He also traces the broad networks of people he has worked with (and whose help he has leveraged) in these areas. He worked closely with Dr. R. Lee Clark for many years and here offers insight into Dr. Clark’s attitudes and leadership style. Dr. Hill is candid, quick to point out political contexts of medical events, and equally quick to share a vivid anecdote to illustrate a personality a patient’s condition, or a medical dilemma.
 There is occasional background noise as the phone rings or members of Dr. Hill’s household converse.