Submitted: 7 September 2012
Three interview sessions: 20 April 2012, 17 August 2012, 31 August 2012
total approximate duration: 3 hours 30 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. Norman Jaffe (b. 25 September 1933, Johannesburg, South Africa) came to MD Anderson in 1978 to become Chief of the Section of Solid Tumors in the Department of Pediatrics. His research has focused on clinical treatments for solid tumors, the long-term effects of chemotherapy and radiation therapy on developing bodies, and the psychosocial challenges of long-term survivors. From 1992-’94 he served as Chief of the Pediatric Outpatient Clinic and from 1996-2000 he was Chief of the Long Term Surveillance Clinic for Pediatric Patients Cured of Cancer. Dr. Jaffe retired in 2006 and holds the title of Professor Emeritus of Children’s Cancer Hospital at MD Anderson Cancer Center.
Major Topics Covered
Personal and educational background
Working with Dr. Sidney Farber at the Sidney Farber Cancer Institute in Boston
Cancer in pediatric patients; “total care” of pediatric patients; special challenges
Research: solid tumors, osteosarcoma, eradicating metastasis with methotrexate
The Department of Pediatric Oncology: history and evolution
Pediatrics and survivorship
Long-Term Surveillance Clinic
Ski Rehabilitation Program
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: 20 April 2012
Cancer in Pediatric Patients
Chapter 01 / Overview
A Clinician Who Seeks Broad Knowledge and Connections with Patients
Chapter 02 / Personal Background
Working for Sidney Farber
Chapter 03 / Professional Path
An Important Contribution to Treatment: Eradicating Metastasis with Methotrexate
Chapter 04 / The Researcher
MD Anderson and The Department of Pediatric Oncology in the Late Seventies
Chapter 05 / MD Anderson Past
Interview Session Two: 17 August 2012
Survivorship: A New Section of Pediatrics
Chapter 06 / Building the Institution
Survivorship: A New Section of Pediatrics II
Chapter 07 / Contributions to MD Anderson
Solid Tumors and the TIOS Protocols (Treatment and Investigation of Osteosarcoma)
Chapter 08 / The Researcher
The Chiefs of Pediatrics at MD Anderson
Chapter 09 / An Institutional Unit
The Ski Rehabilitation Program
Chapter 10 / Building the Institution
A Satisfying Career and Children who are Physicians
Chapter 11 / Overview: Career and Accomplishments
Interview Session Three: 31 August 2012
The Long-Term Surveillance Clinic
Chapter 12 / An Institutional Unit
Building Collaborations and Treating Patients from Around the Globe
Chapter 13 / Beyond the Institution
Healing Children: An Emotionally Complicated Task
Chapter 14 / View on Career and Accomplishments
Interview Session One: 20 April 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Overview)
Cancer in Pediatric Patients (listen/read)
In this segment, Dr. Jaffe provides sketches the problem of treating cancer in children, a disease with dramatic effects on all family members. He concludes this brief (seven-minute) section with the statement that cancer in children is tragic because “children are our most precious commodity.”
Chapter 02 (Personal Background)
A Clinician Who Seeks Broad Knowledge and Connections with Patients (listen/read)
In this segment, Dr. Jaffe describes his family life and education in Johannesburg, South Africa. He expresses his gratitude to his parents, who ensured that he (and five siblings) got a good education, despite the family’s modest means. He also speculates that his caretaking role as the oldest child pointed him toward pediatrics, though he took the opportunity to rotate through all four specialties to round out his experience once he qualified as a physician. He talks about his roles (residency and Chief of Pediatrics) at Bagwanath Hospital for Black South Africans, where he had broad experience of diseases. When asked, Dr. Jaffe confirms that he was deeply affected by Apartheid in South Africa, noting that as a Jew, he felt compassion for the persecuted Black South Africans. He also briefly describes how other Jewish doctors were involved in anti-Apartheid activism. Dr. Jaffe next describes his commitment to working with his patients, noting his insistence over the years that he be called anytime a patient died so he might comfort the parents and assure them they could not blame themselves for their child’s death. Medicine, he notes, is “a hard mistress.”
Chapter 03 (Professional Path)
Working for Sidney Farber (listen/read)
In this segment, Dr. Jaffe discusses his move to the U.S. and his roles at the Stanley Farber Cancer Institute (Fellow in Tumor Therapy) and the Children’s Cancer Research Foundation (Fellow in Pediatrics). Dr. Jaffe was disappointed to discover no real fellowship program under Stanley Farber. He was also distressed by the state of treatment for cancer and had not desire to treat dying children. He tells an anecdote about Farber blocking him from resigning his fellowship. He describes Stanley Farber’s character and his strategy of moving Dr. Jaffe into administration. Dr. Jaffe very candidly says that Farber “took advantage” of him and he felt locked in the “vice” of the job, though he and Farber became close over the years. This section closes with his recollections of testifying in the House and Senate on behalf of funding for the Children’s Cancer Research Foundation on Farber’s death.
Chapter 04 (The Researcher)
An Important Contribution to Treatment: Eradicating Metastasis with Methotrexate (listen/read)
In this segment, Dr. Jaffe talks about building upon Dr. Farber’s work with methotrexate to treat pulmonary metastases from osteosarcoma. He first reviews Dr. Farber’s work with Wilms’ Tumor and the discoveries that led him to his own research on treating metastasis. He also reveals that he went into oncology because he had no choice at the time, working with Dr. Farber. Next Dr. Jaffe talks about osteosarcoma. At the time there was no treatment for osteosarcoma but amputation. Dr. Jaffe describes the process of discovering how to eradicate the metastasis with high doses of methotrexate combined with leukovorin to mitigate high-dose toxicity –still a recognized treatment. Dr. Jaffe asserts that this work represents his greatest contribution to the treatment of pediatric cancers.
Chapter 05 (MD Anderson Past)
MD Anderson and The Department of Pediatric Oncology in the Late Seventies (listen/read)
In the last twenty minutes of this session, Dr. Jaffe talks about his decision to leave the Farber Institute and his recruitment to MD Anderson in 1978 to replace Wataru Walter Sutow, who was retiring as Chief of the Section of Solid Tumors. He was also to step in as a new Chief of the Long Term Surveillance Clinic for Pediatric Patients Cured of Cancer and to develop the service along the lines of a similar program created at the Farber Institute. (He describes how he maintained an enduring relationship with the latter service’s Chief at the time, Dr. Hugh Ried.) In this section Dr. Jaffe tells some funny anecdotes about the people he met at MD Anderson; he comments on the leadership styles of Dr. Charles LeMaistre and Dr. John Mendelsohn.
Interview Session Two: 17 August 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 06 (Building the Institution)
Survivorship: A New Section of Pediatrics I (listen/read)
In this segment Dr. Jaffe explains that he was recruited to MD Anderson to replace Dr. Wataru Walter Sutow because of his deep experience in pediatric oncology. He also notes that he left Harvard because of the limited opportunities for promotion.
Chapter 07 (Contributions to MD Anderson)
Survivorship: A New Section of Pediatrics II (listen/read)
Dr. Jaffe explains that he was recruited to MD Anderson to expand the solid tumor section in the Department of Pediatrics and to develop new initiatives to work with survivors of childhood cancer, based on his previous work at the Dana-Farber Institute. He lists complications that patients develop after cancer treatment: reproductive issues, effects on growth and cognitive function (for children given head and neck treatments). He notes that the new survivorship initiative at MD Anderson produced twenty publications, and that it was a unique entity, an entirely new section of pediatrics.
Chapter 08 (The Researcher)
Solid Tumors and the TIOS Protocols (Treatment and Investigation of Osteosarcoma) (listen/read)
In this segment, Dr. Jaffe describes one of his major roles as Chief of the Solid Tumor section in Pediatrics: establish new protocols for treatment of cancers in children. He notes that this was an assignment he was given by the Department, but also one he assigned to himself. His main work was in the treatment of osteosarcoma. He named his series of protocols TIOS (Treatment and Investigation of Osteosarcoma), and developed three protocols before shifting focus to support a colleague’s study of a promising drug. He then goes on to give more details on the TIOS protocols, which used thee three main drugs for treating osteosarcoma. The first protocol used high-dose methotrexate, and Dr. Jaffe explains that the treatment –and its results—were not accepted at first. He says that “it is almost as if doctors couldn’t accept that osteosarcoma could be cured.” With the protocols he has designed, he explains, survivorship has increased from about 20% to 65%, and when his protocols are combined with multidisciplinary interventions the survivorship increases to 75-80%. He explains why no progress has been made beyond that point. Dr. Jaffe gives more detail on his procedure: they rely on intra-arterial drug delivery to destroy the sarcoma at its site –an essential step in limb salvage procedures.
Chapter 09 (An Institutional Unit, Program)
The Chiefs of Pediatrics at MD Anderson (listen/read)
At the beginning of this segment, Dr. Jaffe explains that when he began as Chief of the Solid Tumors section, he had responsibility for musculoskeletal tumors, Wilm’s tumors and a number of others, including neuroblastoma, which he eventually ceded to a colleague. As a leader, he notes, he believes that “if you are doing a good job, continue,” and he is very proud that the Solid Tumor section “ran like a well-oiled machine.”
Dr. Jaffe then describes the sequence of Chiefs of Pediatrics, beginning with the first chief, Grant Taylor, who developed a comprehensive pediatric department, focusing on clinical initiatives and benchwork. He continued to check in on the progress of the Department after he retired and Dr. Jordan (Dan) Wilbur took over. Dr. Jordan is known for the VAC (vincristine, actinomycin, cyclophosphamide) chemotherapy protocol for soft tumors in children that has not changed in the past forty years. Dr. Jan Van Eys took over from Dr. Wilbur and brought a different outlook. This was when Dr. Jaffe was recruiteDr. Van Eys enhanced the solid tumor section. He also focused on the psychosocial and religious aspects of patient care. He believed religion was a major mechanism of support for patients. Dr. Pat Sullivan was Chief for one year, then Dr. Ka Wa Chan served as interim director for 5 years, until Dr. Archie Bleyer took over and attempted to change the department in ways that Dr. Jaffe feels were not well received. Dr. Eugenie S. Kleinerman then assumed the position of Chief of Pediatrics and enhanced investigation of sarcoma. Dr. Jaffe notes Dr. Kleinerman’s laissez-faire approach toward department members who are performing well. He then talks about the areas in which the Department of Pediatrics has made particular contributions to pediatric oncology, going into particular detail about value of conventional therapeutic therapies and the rapid, intra-arterial deliver of chemotherapy developed by the Department.
Chapter 10 (Building the Institution)
The Ski Rehabilitation Program (listen/read)
In this segment Dr. Jaffe speaks in detail about MD Anderson’s Ski Rehabilitation Program, an innovative initiative run yearly in Winter Park, Colorado, to build the long-term confidence and competence of amputees. He describes criteria for selecting the patients for the first week-long program (health mattered more than age), as well as the decision to have a parent accompany each child. Parent participated in conferences during the week, providing MD Anderson staff with their evaluation of their child’s treatment. The main problems mentioned were communication and the timing of treatments, and Dr. Jaffe notes that this information was valuable in improving patient care. The costs of the trip for the children and parents were funded by MD Anderson. Later the trips were funded by the Children’s Art Project. Dr. Jaffe notes that there are not enough funds for the 2013 trip, but many parents and children are paying their own way, because the trip is so important for them. Dr. Jaffe also describes the effects of the week long experience on the children –notably a dramatic increase in their sense of “prowess.” He also goes into detail about the activities provided and how these have changed over the years to include one-on-one training, races, and prizes. He reports that children who have participated in this program mainstream easily, and have gone on to become very successful. (Ten have become physicians.)
Chapter 11 (View of Career and Accomplishments)
A Satisfying Career and Children who are Physicians (listen/read)
Dr. Jaffe looks back at a very satisfying career at MD Anderson (though he originally wanted to be a surgeon). He explains why his sons and his daughter chose not to go onto oncology. He expresses his deep regret at the patients he lost over the years.
Session Three: 31 August 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 12 (An Institutional Unit, Program: Nature and Function)
The Long-Term Surveillance Clinic (listen/read)
In this segment, Dr. Jaffe talks about his work with MD Anderson’s Long Term Surveillance Clinic. The Clinic was already in existence when he came to MD Anderson in 1978, however he was recruited in part to expand the Clinic, based on his experience with a similar unit at the Dana-Farber Cancer Institute (established in ‘72/’73). (Dr. Jaffe wrote the first paper on radiation and survivorship [published in ’75] and he suspects this was instrumental in the creation of a number of survivorship clinics.) He notes that with the use of radiation and chemotherapy, the numbers of pediatric cancer survivors grew exponentially, and they also exhibited many complications from their treatments. The Clinic monitored all the complications and referred patients to the service that could address them. Dr. Jaffe then talks about the many people involved in the Clinic. When Dr. Jaffe arrived, Dr. Hubert Ried directed the Clinic with the assistance of nurse practitioner, Hallie Zietz (whom he describes as “the heart and soul” of the Clinic). The three of them worked together to expand services and write papers. Dr. Jan Van Eys, he explains, was an advocate of monitoring nutrition in survivorship. He explains why nutrition is and issue and how his experience with patients with such afflictions as kwashiorkor in South Africa sensitized him to malnutrition in cancer patients. Dr. Jaffe also credits Dr. Van Eys with establishing psychosocial support as a key element in the survivorship clinic. Donna Copeland was Chief of Psychosocial Services. Dr. Jaffe gives several examples of the kinds of challenges children face. He also explains that Dr. Van Eys developed the position of the Child Life Worker to help children adjust. He describes the role of the Child Life Worker –who might, for example, go to a child’s school to sensitize other children to why a cancer survivor might not look like other children or might have some kind of disability. This kind of support role owes a great deal, Dr. Jaffe explains, to Dr. Sidney Farber’s concept of total care. He talks about how pediatric patients are dealt with differently now than in the past: for example, efforts have to be made now to obtain a child’s permission for treatment, and he gives examples of how a procedure might to explained to a very small child of four or five. He also returns to the example of the Ski Program, run through the Survivorship Clinic, and notes that the video, Amputation is no Barrier, was produced to showcase the Ski Program and the activities it offered to survivors.
Chapter 13 (Beyond the Institution)
Building Collaborations and Treating Patients from Around the Globe (listen/read)
Dr. Jaffe quips that when he realized he wasn’t going to win the Nobel Prize he began to turn his mind to how to ensure that what he had learned about treating pediatric sarcoma and survivorship would be passed on. In this segment he speaks about the many collaborations he has sustained with physicians internationally over the last fifteen or twenty years. For the past ten years, for example, he has helped physicians in many cities in Mexico establish programs for solid tumors and survivors. Many hospital programs in different nations in South America have requested his expertise. He has many contacts across Europe, has been involved in EURAMOS, the European and American Osteosarcoma Study group, and for the past fifteen years has sustained contacts in Germany, Norway and Sweden. He tells an interesting anecdote about hosting several doctors from Slovenia who contacted him about coming to observe practices at MD Anderson. Dr. Jaffe hosted them at his home during their visit of 6-8 weeks. One physician noticed how many surgical instruments MD Anderson discarded, and it was arranged that she could take home a crate of instruments for use in their hospital. In another anecdote, Dr. Jaffe describes he was invited to Egypt several times and then asked by an ambassador to write a report about the poor treatment for cancer in that country. That document resulted in the creation of the Friends of Egyptian Children with Cancer group, which hosts various fundraisers to provide children with improved care. [redacted] In another anecdote, Dr. Jaffe talks about his hesitancy to accept an invitation to Saudi Arabia because of his (Jewish) faith. He was very impressed at his treatment, however, and surprised that they offered him a position.
Chapter 14 (View on Career and Accomplishments)
Healing Children: An Emotionally Complicated Task (listen/read)
In this segment, Dr. Jaffe reflects on the fact that he has practiced medicine for fifty years, finding the career both enjoyable and devastating. He reflects on the opportunities he has had to train many talented individuals, most of whom have succeeded in their fields. He explains that his own faith has been important in shaping his attitudes toward his work, citing the sanctity of life in the Jewish faith. He ends this segment by paraphrasing a Talmudic expression that counsels never to deprive any individual of mercy.
This interview with Dr. Norman Jaffe (b. 25 September 1933, Johannesburg, South Africa) takes place over three sessions in 2012 for a total of 3 hours and thirty minutes. Dr. Jaffe is a hematologist oncologist and a specialist in pediatric cancer and today hold the title of Professor Emeritus (Pediatrics) of Children’s Cancer Hospital at MD Anderson Cancer Center in Houston, Texas. Dr. Jaffe joined MD Anderson in 1978 as a Professor of Pediatrics in the Department of Pediatrics. He also served as Chief of the Solid Tumor Service; prior to his retirement he was also Chief of the Long Term Surveillance Clinic for Pediatric Patients Cured of Cancer. He retired in 2006. This interview takes place in the Historical Resources Center Reading Room in Pickens Tower on the main campus of MD Anderson. Tacey A. Rosolowski, Ph.D. is the interviewer.
Dr. Jaffe received his M.D. (MBCh) in 1956 from the University of the Witwatersrand Medical School, in Johannesburg, South Africa. He interned Coronation Hospital, Johannesburg (’57) and did his residency (’58) at Baragwanath Hospital, where he went on to work as teaching resident from 1959-’61. From 1966-‘67 he was a Fellow in Tumor Therapy at the Sidney Farber Cancer Institute in the Harvard Medical School and also a Fellow in Pediatrics at the Children’s Cancer Research Foundation and Harvard Medical School (‘66-’71). In 1971 he became an Assistant Prof of Pediatrics at that institution, advancing to Associate Profess in 1974. He became Chief of the Pediatric Solid Tumor Service at the SFCI in 1976. In 1978 Dr. Jaffe left Harvard to become Chief of the Section of Solid Tumors in the Department of Pediatrics at MD Anderson. From 1992-’94 he served as Chief of the Pediatric Outpatient Clinic and from 1996-2000 he was Chief of the Long Term Surveillance Clinic for Pediatric Patients Cured of Cancer.
In this interview, Dr. Jaffe traces his lifelong work with the “total care” of pediatric cancer patients: he has focused broadly on research to find clinical treatments for solid tumors, to investigate the long-term effects of chemotherapy and radiation therapy on developing bodies, and to address the psychosocial challenges that long-term survivors face. He has nurtured connections with physicians globally in order to ensure that his discoveries benefit the treatment of children in many nations. This interview offers a wide ranging history of Dr. Jaffe’s career and commitment. It also offers a portrait of his relationship with Dr. Sidney Farber during the time he worked at the Sidney Farber Cancer Institute in Boston. Dr. Jaffe offers insights into the history of the Department of Pediatrics at MD Anderson and offers observations on the first three presidents of the institution, with whom he worked fairly closely. Dr. Jaffe also discusses how treating cancer in children is both very gratifying and devastating: the loss of a life just beginning is always tragic, and a severe illness always has long-term effects on the child who survives, as well as his/her family.