Skip to main content

Keating (Michael), MD, Oral History Interview: Home

Interview Navigation Materials

Interview Navigation Material

 

Interview Profile

 

Submitted: 16 January 2015

 

Interview Information:

Two interview sessions: 13 May 2014, 20 May 2014
Approximate duration, 4 hours
Interviewer: Tacey A. Rosolowski, Ph.D.

 

For supplementary materials:

Please contact, the Historical Resources Center, Research Medical Library:

Javier Garza, MSIS, jjgarza@mdanderson.org

 

About the Interview Subject:

Michael Keating, M.D. (b. 1 July 1943, Melbourne, Australia) came to MD Anderson as a Fellow in the Department of Developmental Therapeutics in 1974 and joined the faculty as an Assistant Professor in 1978.  Today he is a professor of medicine in the Department of Leukemia in the Division of Cancer Medicine.  Dr. Keating established his reputation with his investigations into the natural histories of chronic lymphocytic leukemia and his collaborative work on drug treatments, combination treatments, and multi-modality treatments for leukemia, a number of which became standard of care.  Dr. Keating served as Associate Vice President for Patient Care in Clinical Investigations from 1990 – 1995.  From 1995 to 1999 he served as Associate Head for Clinical Research in Leukemia.  He is currently co-leader of the Chronic Lymphocytic Leukemia Moon Shot Program.  Dr. Keating is also the Founding President and CEO of the Global Research Foundation, a non-profit organization supporting research into Chronic Lymphocytic Leukemia.  The interview sessions take place in a conference room in the Department of Leukemia in the Faculty Center on the Main Campus of MD Anderson. Tacey A. Rosolowski, Ph.D. is the interviewer.

 

Major Topics Covered:

Personal and educational background

Faith, values, and the practice of medicine

Research: combination therapies, Fludarabine, Cytarabine

Impact of research on patients; patient commitment to treatment

Setting up leukemia databases at MD Anderson

The history of translational research at MD Anderson

The Department of Developmental Therapeutics

MD Anderson culture

Changes at MD Anderson with growth

The Moon Shots Program

Leadership at MD Anderson

Global Research Foundation

 

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.

 


 

Table of Contents

 

Interview Session One: 20 May 2014

 

 

An Australian Education; Inspired by Patients and Service More than Disease
Chapter 01 / Educational Path

 

MD Anderson in the Seventies; Developing a Focus on Hematology and Leukemia
Chapter 02 /Professional Path

 

Looking for Research Opportunities at MD Anderson
Chapter 03 / Joining MD Anderson/Coming to Texas

 

A Fellow at MD Anderson: A View of Developmental Therapeutics in the Early Seventies
Chapter 04 / MD Anderson History

 

A Faculty Associate: Research and Clinical Responsibilities
Chapter 05 / The Researcher

 

Investigating Remission Percentages, Expanding Research Interest in Leukemia, and Developing Databases and New Research into Blood Malignancies
Chapter 06 / The Researcher

 

Faith and a Loving Family Support a High-Stress Career
Chapter 07 / Personal Background

 

R. Lee Clark’s Vision and Changes in MD Anderson Culture
Chapter 08 / Critical Evaluation

 

 

 

Interview Session Two: 20 May 2014

 

 

A History of Translational Research at MD Anderson
Chapter 09 / Overview

 

Studying Fludarabine (Part I)
Chapter 10 / The Researcher

 

Institutional Restructuring under Charles LeMaistre and the Effect on Research
Chapter 11 / Institutional Change

 

Research Advances with Fludarabine and Cytarabine
Chapter 12 / The Researcher

 

Drug Treatments, Stem Cell Transplants, and Immunology Issues
Chapter 13 / The Researcher

 

Viruses, Genetics, Designer Drugs, and other Advances
Chapter 14 / The Researcher

 

Leading Initiatives to Improve Research Quality
Chapter 15 / The Administrator

 

Associate Head for Clinical Research in Leukemia; The Global Research Foundation
Chapter 16 / The Administrator

 

Changes in MD Anderson Culture with a New Administration
Chapter 17 / 
Critical Perspectives on MD Anderson

 

Retirement Plans and a View of “The Crown Jewel” of the Texas Medical Center
Chapter 18 / View on Career and Accomplishments

 

 


Chapter Summaries

 

 

Interview Session One: 13 May 2014 (listen/read)

 

Chapter 00A
Interview Identifier (listen/read)

 

Chapter 01 (Educational Path)
An Australian Education; Inspired by Patients and Service More than Disease (listen/read)

 

Topics Covered

  • Personal Background
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Character, Values, Beliefs, Talents
  • MD Anderson History

Dr. Keating begins this Chapter by briefly sketching his family background and talking about the important his Catholic faith in his life and medical practice.  He then traces his educational path, stressing that because his family was “upper-level poor,” he relied on financial scholarships for his education: he notes how fortunate he was that Australia paid for medical training.  He explains the Australian educational and scholarship system. 

Dr. Keating next explains that he decided to become a physician when he was in high school.  He describes the system of secondary education in Australia and the comprehensive exams.  He notes that he thought he would never be bored practicing medicine. He recalls observing physicians at work when he was young, noting with interest how they sorted out family dynamics and complex problems.

Next Dr. Keating talks about his medical education in Australia, explaining that the patients always interested him more than their diseases.  He explains the system of clinical education in Australia and how this fostered a sense of altruism among physicians which was eroded through changes to the system in the 1970s.

 

Chapter 02  (Professional Path)
MD Anderson in the Seventies; Developing a Focus on Hematology and Leukemia (listen/read)

 

Topics Covered

  • Professional Values, Ethics, Purpose
  • Influences from People and Life Experiences
  • The Clinician
  • The Professional at Work
  • Offering Care, Compassion, Help
  • Mentoring
  • Professional Path
  • Inspirations to Practice Science/Medicine
  • Character, Values, Beliefs, Talents
  • Definitions, Explanations, Translations

Dr. Keating begins this Chapter by noting that Dr. R. Lee Clark set up at MD Anderson to ensure that physicians were not motivated by monetary gain as they treat patients.  He then recalls the culture of MD Anderson when he first joined the institution as a Fellow in 1974. 

Next, stepping back in time, he notes that just prior to coming to the United States, he was running the Leukemia Program in Saint Vincent’s Hospital in Melbourne.  He explains how, during this period, he came to focus on leukemia research.  He describes his mentor, Carl Degruschy, a hematologist. Dr. Keating explains how he took over the hematology malignancy program when Dr. Degruschy left Saint Vincent’s.  He also tells how he shifted from a surgical specialization to hematology.  He briefly describes the conditions of the fellowship that brought him to MD Anderson in 1974, then talks about his valuable experience setting up a database at Saint Vincent’s.  He tells how he came to leave this institution, though he was very happy there, and describes how his research clinical and research interests shifted to hematological malignancies.  He briefly reviews the treatments available at the time for blood diseases, and notes that since he “liked to solve problems” he found these diseases very interesting.  Dr. Keating observes that his ADHD facilitates his problem solving skills in a very positive way and suggests that MD Anderson’s Moon Shots Program draws on the same kind of thinking habits.

Dr. Keating explains his concept of translational research, likening it to “falling in love.”  He describes the process of learning a different research language while working as a collaborator.

Dr. Keating talks about his research collaborator, William Plunkett, Ph.D. [interviewed for the oral history project, 2013), who taught him to think about disease. 

 

Chapter 03 (Joining MD Anderson/Coming to Texas)
Looking for Research Opportunities at MD Anderson (listen/read)
 

Topics Covered

  • Joining MD Anderson
  • The Researcher  
  • Understanding Cancer, the History of Science, Cancer Research

Dr. Keating begins this Chapter by explaining that, in Australia at the time, chemotherapy was first being used to treat solid tumors.  He explains his decision to come to the United States and the financial conditions of his fellowship. 

 

Chapter 04 (MD Anderson History)
A Fellow at MD Anderson: A View of Developmental Therapeutics in the Early Seventies (listen/read)

 

Topics Covered

  • Joining MD Anderson
  • MD Anderson History
  • The Researcher  
  • Portraits
  • Understanding Cancer, the History of Science, Cancer Research
  • Research, Care, and Education
  • Discovery, Creativity and Innovation

In this Chapter, Dr. Keating gives an overview of thet state of research into blood malignancies in the early seventies and the exciting environment for research he discovered when he came to MD Anderson in 1974 as a fellow in the Department of Developmental Therapeutics.  He then tells an anecdote about Dr. Emil J Freireich (interviewed for project, 2012), notes his charisma, then explains that he created the first “translational scenario” in the Department of Developmental Therapeutics.  He explains that because there was no established treatment for most diseases at the time, the Department often used an “n of 1” study, “making it up from first principles,” an approach that was very exciting to him.  He notes that the NCI controlled the direction of research at the time, as it controlled the drugs.

 

Chapter 05 (The Researcher)
A Faculty Associate: Research and Clinical Responsibilities (listen/read)

 

Topics Covered.

  • The Researcher  
  • The Clinician
  • Understanding Cancer, the History of Science, Cancer Research
  • Research, Care, and Education
  • Discovery, Creativity and Innovation

In this Chapter, Dr. Keating explains how fellows became involved in research projects and notes that he took on leukemia research about nine months after arriving at MD Anderson, when he also became a Faculty Associate.  He explains the responsibility for patients that this new status allowed, allowing for more continuity of care.  He describes his fellowship as a “baptism of immersion.”  He notes that he read Cancer Medicine to fill in his knowledge gaps.

 

Chapter 06 (The Researcher)
Investigating Remission Percentages, Expanding Research Interest in Leukemia, and Developing Databases and New Research into Blood Malignancies (listen/read)

 

Topics Covered

  • MD Anderson Snapshot
  • Professional Practice
  • Contributions to MD Anderson
  • MD Anderson Impact
  • MD Anderson History
  • Beyond the Institution
  • Understanding the Institution
  • Portraits
  • Controversies
  • Ethics

Dr. Keating begins this Chapter by noting that in 1975, researchers at MD Anderson reported that they were getting a seventy percent remission on acute leukemia, but he believed these results were inflated.  Dr. Keating describes a natural history study he conducted to gather actual percentages.  This involved setting up his first big database at MD Anderson.  He cataloged treatments and outcomes, resulting in the most complete database at the institution, involving nine thousand acute patients: databases have also been compiled for chronic lymphocytic leukemia and all the acute leukemias.  Dr. Keating was able to show that the seventy-percent remission rate was actually fifty-four percent (still the best in the world).  He describes the studies that came out of the database project, including studies of prognostic factors that could indicate the likelihood that a patient would respond to conventional treatments.  He notes that Dr. Richard Simon of the NCI wrote that this predictive model was the best ever devised.  Dr. Keating states that he and his team also realized that there were genetic subsets of patients that made their prognostic model even more complex.

Dr. Keating next explains why the medical community was resistant to believing the information they presented, noting that there was always jealousy of MD Anderson and the success of a leukemia program that had started out so small under the leadership of Drs. Emil Frei and Emil J Freireich.

Dr. Keating notes that Dr. Freireich was “militantly against” randomized trials because they took too long. He also explains that Dr. Freireich believed MD Anderson should develop new concepts and leave it to other institutions to confirm these ideas, an idea that some found elitist.  (He notes that Dr. Emil Frei and Dr. Emil J Freireich set up the Southwest Oncology Group.)  Dr. Keating describes Drs. Frei and Freireich and goes on to talk about the latter’s innovative platelet transfusions to treat childhood leukemia.

Next, Dr. Keating explains how Dr. Freireich came to be accused of fraud and then absolved of any blame by Dr. Gordon Zubrov.  Dr. Keating talks about Dr. Zubrov’s value system and religious faith.

 

Chapter 07 (Personal Background)
Faith and a Loving Family Support a High-Stress Career  (listen/read)

 

Topics Covered

  • Personal Background
  • Influences from People and Life Experiences
  • Character, Values, Beliefs, Talents
  • Evolution of Career
  • Funny Stories
  • Faith
  • Offering Care, Compassion, Help

Dr. Keating begins this Chapter by observing that burnout is a challenge in a career where “medicine is your mistress.”  He describes the stresses that his career placed on his family admits he was a “largely absent husband.” 

Dr. Keating next observes that faith plays a bigger part in everyday life in the United States than in Australia.  He tells a funny story about a patient shouting for Jesus’s help while Dr. Keating searched for a vein to give her medication. 

Next Dr. Keating explains why he and his family returned to Australia in 1977−1978, only to return to the United States and to MD Anderson in 1978.  (Dr. Keating served as a Senior Lecturer, Department of Medicine, St. Vincent's Hospital, Melbourne during that year.)  He had come to love his work more than his country and his family, he says.  He describes a conversation with his sister, Maureen, who helped him make the difficult decision to leave Australia.  Dr. Keating observes that he has never had a sense of not being loved, an important element of his ability to stay on his evolving career path.

 

Chapter 08 (Critical Evaluation)
R. Lee Clark’s Vision and Changes in MD Anderson Culture (listen/read)

 

Topics Covered

  • MD Anderson History
  • Growth and/or Change
  • MD Anderson Culture
  • Critical Perspectives on MD Anderson  
  • Ethics
  • The Life and Dedication of Clinicians and Researchers
  • Faith

Dr. Keating begins this Chapter with a brief description of his return to MD Anderson to replace Dr. McCreadie.  He then describes MD Anderson as a unique place where it was as important to study the operation of cancer in humans as in the lab.  He explains that the institution’s first president, Dr. R. Lee Clark, wanted to increase cross-fertilization between physicians and researchers.  He also describes Dr. Clark’s “genius” for establishing a work structure that would relieve the faculty of worry so they could concentrate on cancer.  He compares that environment to the situation today, in which health care is governed by corporate entities.  He notes the problems with ethics that this can breed and the loss of a sense of altruism among physicians.  Looking at MD Anderson, he notes the difference between the “luxury” of the public spaces, and the problems that faculty have getting basic material to support their work.  He shares that he “prays for wisdom in our executive leadership.”

 

Interview Session 2: 20 May 2014 (listen/read)

 

Chapter 00B
Interview Identifier (listen/read)

 

Chapter 09 (Overview)
A History of Translational Research at MD Anderson (listen/read)

 

Topics Covered

  • Overview
  • MD Anderson History
  • Building/Transforming the Institution
  • Controversy
  • Ethics
  • On Research and Researchers
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • MD Anderson Impact
  • MD Anderson and Government

In this Chapter, Dr. Keating sketches the history of translational research at MD Anderson beginning with the “pioneers” Dr. Emil Frei, III and Dr. Emil J Freireich.  He notes that in the late 60s and early 70s, the NCI was supporting research into the biology of cancer and the role of drugs in treatment and their impact on DNA.  Dr. Keating quotes Dr. Freireich’s characterization that cancer is a “disturbance of growth,” and that the investigation of cancer can shed light on the growth of normal cells in the host as well.  Dr. Keating then explains that many patients with cancer actually die of infection or comorbidities, a fact that led Dr. Freireich to study the phenomenon of hemorrhage in leukemia.  Dr. Keating explains how this work let to his eventual development of platelet transfusion.  He then lists other lines of research that evolvedrug studies, assays of drug levels and correlations with clinical outcomes, the relation of the immune system to cancer, investigations of spontaneous remission

Next Dr. Keating explains that all this knowledge came together at MD Anderson, and he notes that he found it “stunning” to come to the institution and find people who “knew diseases back to front.”  He lists the issues that examined in the areas of immunology, stem cell transplant, and chemo therapy.  Dr. Keating points out that MD Anderson was originally focused on surgery and radiation, but the need for systemic treatments quickly became evident in metastatic disease.  He notes an attitude at the institution of “trying something different,” though also acknowledges controversies at the time about the ethics of experimenting on people.  He explains that this attitude changed when drug studies achieved dramatic patient responses to drug treatments.

Next, Dr. Keating compares translational research in these early days with what is going on today.  He lists the areas in which knowledge grew, making it possible to do “a therapeutic dissection” of disease.  He then speaks about the current push toward targeted therapy, which involves cataloguing genetic changes in all of the cancers and moving away from treating tumors, to treating molecular processes as tumors mutate.  Dr. Keating explains that some processes involving proteins are common to different cancers.  He then discusses the use of antibodies to intervene in molecular processes. 

Dr. Keating next explains that patients at MD Anderson are willing to try almost anything.  He then notes that the clinicians at the institution are extremely experienced and can interpret observations in patients to discover new opportunities for treatment and knowledge creation.  He praises the Texas State Legislature for creating the institution.  He notes that MD Anderson has made an enormous impact by training physicians who carry their knowledge out into Texas and the world.

 

Chapter 10 (The Researcher)
Studying Fludarabine (Part I) (listen/read)

 

Dr. Keating explains that he came to focus on chronic lymphocytic leukemia because of a disagreement with Dr. Deisseroth over the mission of MD Anderson.  He notes that, at the time, it was impossible to eliminate CLL cells from the body and he began to examine the effectiveness of Fludarabine –the first investigator to do so. 

 

Chapter 11 (Institutional Change)
Institutional Restructuring under Charles LeMaistre and the Effect on Research (listen/read)

 

Topics Covered

  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy
  • The Researcher  
  • Professional Path
  • Obstacles, Challenges
  • Career and Accomplishments
  • MD Anderson Impact
  • Multi-disciplinary Approaches
  • Professional Practice
  • Collaborations
  • The Professional at Work

Dr. Keating explains that he came to focus on chronic lymphocytic leukemia because of a disagreement with Dr. Deisseroth over the mission of MD Anderson.  In this Chapter, Dr. Keating next explains the administrative restructuring that took place under Dr. Charles LeMaistre, who divided the Department of Developmental Therapeutics into a number of different departments.  Dr. Emil J Freireich (former head of DT), became head of Hematology, and “apostles” from Developmental Therapeutics filtered throughout MD Anderson, bringing a “try anything” attitude to other departments.  Dr. Keating expresses his sadness at the loss of the Department of Developmental Therapeutics and says that the “silo-ing” effect at that time had created a special environment for collegiality and research. 

 

Chapter 12 (The Researcher)
Research Advances with Fludarabine and Cytarabine (listen/read)

 

Topics Covered

  • The Researcher  
  • Discovery and Success
  • Patients, Treatment, Survivors
  • Professional Path
  • Obstacles, Challenges
  • Career and Accomplishments
  • MD Anderson Impact
  • Multi-disciplinary Approaches
  • Professional Practice
  • Collaborations
  • The Professional at Work

In this Chapter, Dr. Keating explains how he became interested in Fludarabine, which had been tested for use with rapidly dividing cells.  He explains how his studies (early eighties) with the drug worked against acute leukemia and slow-growing CLL and hairy cell leukemia, and notes toxicities, the relatively small number of patients involved in trials, and the remarkably short time frames in which results were obtained.  Dr. Keating notes how much he learned from his collaborator, William Plunkett, Ph.D. (interviewed for project, 2013), particularly regarding the effects of the drug inside the cell.  Dr. Keating sketches the research questions behind his studies and briefly explains work integrating the drug Cytarabine into his trials.  He notes that the research into these drugs led to an very sophisticated understanding of molecular processes, leading to a targeted therapy approach to CLL.  He also lists some challenges that arose in understanding how to block enzymes and pathways, noting that concepts are continually being developed and added.

Dr. Keating then lists the milestone discoveries emerging from his work on Fludarabine, noting that the drug created remission with CLL, with twenty to thirty percent of patients manifesting complete remission.  He then explains how the drug regimen was expanded to include Cyclophosphamide, resulting in a new standard of care.  He explains that Dr. Plunkett demonstrated that Fludarabine prevented the DNA damage created by other drugs.  He notes that he has a small percentage of patients who have survived for twenty years beyond treatment.

 

Chapter 13 (The Researcher
Drug Treatments, Stem Cell Transplants, and Immunology Issues (listen/read)

 

Topics Covered

  • The Researcher
  • The Clinician
  • Definitions, Explanations, Translations
  • Patients, Treatment, Survivors
  • Healing, Hope, and the Promise of Research

Dr. Keating then sketches the principle of combination therapy: use drugs with different mechanisms of action.  He talks about Dr. William Plunkett and his contributions to these efforts and also explains that antibodies use a very different mechanism and do not damage the patient’s immune system or DNhe explains results with the FCR regimen.

Dr. Keating next explains another feature of Fludarabine that allows its use in conjunction with stem cell transplants, preventing tissue rejection and allowing transplants to be done on elderly and fragile patients.  He then talks about the financial burden that transplants ( six to seven hundred thousand dollars at MD Anderson) and cancer place on patients and how he suggests that some patients go to Israel for transplants.  He compares insurance coverage in different nations.

 

Chapter 14 (The Researcher)
Viruses, Genetics, Designer Drugs, and other Advances (listen/read)

 

Topics Covered

  • The Researcher
  • The Clinician
  • Definitions, Explanations, Translations
  • Patients, Treatment, Survivors
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care

In this Chapter, Dr. Keating talks about discoveries about viral control of cancer and work that shows how genes control enzymes, leading to development of designer drugs to turn off enzymes.  Other studies explore how to expand the patient’s immune system.  Dr. Keating says he discovered that second cancers are driven by viruses and he developed a program that takes a patient’s cells, modifies them, then returns them to the patient.  He talks about an unusual collaboration with Baylor College of Medicine, where researchers are developing virus-specific immune cells that may target CLL cells lingering after other treatments.

Next, Dr. Keating sketches his other research studies with Retuximab, Lenalomide [Revlimid®], an inhibitors that work on B-cell signaling pathways.  He explains how the latter are involved in pathways that can kill CLL cells.  He also talks about drugs that interfere with “survival proteins” that keep CLL cells alive. [ [CLIP   These are the “new building blocks” in treatment, he says.  He anticipates doubling the cure fraction in the next few years and notes how quickly patients respond, with their faces shining like a healthy person’s (in comparison with the sickly appearance of chemotherapy patients). Dr. Keating notes that patients who receive targeted therapy feel sorry for chemo patients with acute leukemia.]

Dr. Keating notes that in the future he wants to write a book on CLL and plans to hand his practice over to his daughter, Dr. Anna Franklin.  He expresses his pleasure that his children are happy in their work.

 

Chapter 15 (The Administrator)
Leading Initiatives to Improve Research Quality (listen/read)

 

Topics Covered

  • The Administrator
  • Critical Perspectives on MD Anderson  
  • Obstacles, Challenges
  • Controversy
  • Growth and/or Change
  • MD Anderson and Government
  • Critical Perspectives
  • MD Anderson Culture

In this Chapter, Dr. Keating discusses his roles as Associate VP for Clinical Investigations (1990−1995).  He begins the Chapter noting the lack of formal administrative structure in the Department of Developmental Therapeutics, where there were no real heads for the different types of solid cancers: once the Department was dissolved, Dr. Keating headed the leukemia family.

Next, Dr. Keating describes his work as Associate VP for Clinical Investigations, which involved examining protocols from all departments in the institution.  He looked at the quality of research, the treatment of patients, and how each project fit in with the mission of the institution, setting up committees to improve research and guarantee patient safety.  Dr. Keating explains why he accepted this role, sketching in the process a difficulty that Dr. J Freireich had with a clinical trial and the administration’s lack of support for the research project.  Dr. Keating expresses his believe that “bureaucracy kills.”  He sketches recent changes at MD Anderson that have increased bureaucracy and elevated the cost of running clinical trials.

Next, Dr. Keating talks about his passion for improving the quality of research and lists the areas in which he feels he had the biggest impact during his role in Clinical Investigations.   He talks about the high cost of running clinical trials because of the price of drugs. 

 

Chapter 16 (The Administrator)
Associate Head for Clinical Research in Leukemia; The Global Research Foundation (listen/read)

 

Topics Covered

  • The Administrator
  • Character, Values, Beliefs, Talents
  • Professional Values, Ethics, Purpose
  • Building/Transforming the Institution
  • Critical Perspectives on MD Anderson
  • Beyond the Institution
  • On Research and Researchers

Dr. Keating begins this Chapter by explaining that he left his role with Clinical Investigations because the Leukemia group needed more leadership and he disagreed with the new emphasis Dr. David Hone was placing on randomized trials.  He wanted a more inventive way of doing things and accepted the role of Associate Head for Clinical Research in Leukemia (1995−1999).  He sketches his leadership principles of allowing individuals free rein and lists the areas in which he had an impact of research, providing a “more free-flowing environment” for research innovation.  Dr. Keating expresses his dissatisfaction with following rules: he tells a story about a patient running into difficulties with getting information about clinical trials and notes that it demonstrates how excessive adherence to rules “betrays the intelligence of the institution.” 

Dr. Keating next discusses how he set up the CLL Group, hiring Susan Lerner as research coordinator.  He explains how effective she was at creating a humane work environment.  He then goes talks about a group he founded about a decade ago, The CLL Global Research Foundation, which awards about three million dollars yearly in research grants.  He explains that the money comes from former patients and that he is a “schmoozer” who offers a good product.  He describes the unusual environment of transparency at the bi-annual meetings when the researchers share their research and results.

 

Chapter 17 (Critical Perspectives on MD Anderson)
Changes in MD Anderson Culture with a New Administration (listen/read)

 

Topics Covered

  • Critical Perspectives
  • Critical Perspectives on MD Anderson 
  • MD Anderson Culture
  • MD Anderson History
  • Controversy
  • Portraits
  • Obstacles, Challenges
  • Post Retirement Activities
  • MD Anderson in the Future

In this Chapter, Dr. Keating offers his views on how MD Anderson has changed since Dr. Ronald DePinho took over as the institution’s fourth president in 2011. 

He begins by talking about the CLL Moon Shots Program, noting that it has become increasingly evaluated by individuals with little experience with clinical research and who are primarily concerned with generating income.  Dr. Keating states that MD Anderson finds itself at a crossroads following the transfer of leadership to Dr. DePinho.  To set context for his evaluation, he first speaks about the institution as Dr. R. Lee Clark, MD set it up and changes that come when Dr. Charles LeMaistre (interviewed for the oral history project) and Dr. John Mendelson (interviewed for the oral history project) were each installed as presidents.  Under Dr. Mendelsohn, he states, the institution became very legalistic and self-protective and a corporate mentality evolved.  He tells a story related to the donation of funds by T. Boone Pickens, who gave funds to be matcheDr. Keating states that Dr. Mendelsohn drew the matching funds from the Physicians Referral Service.  He talks about the purpose of the PRS.  Next he talks about the growth of institution bureaucracy and compares it to Memorial Sloan-Kettering Cancer Center. 

Next, Dr. Keating talks about the shift in perspective on research, stating that Dr. DePinho stresses science over clinical perspectives.  He also mentions an ongoing controversy of awarding tenure.

Dr. Keating then evaluates the progress of the Moon Shots Program, noting that the expectation for success was too high at the outset.  He provides an example from the Lung Cancer Moon Shot to illustrate.  He recalls his first impressions on meeting Dr. DePinho during his interview process.

 

Chapter 18 (View on Career and Accomplishments)
Retirement Plans and a View of “The Crown Jewel” of the Texas Medical Center (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Activities Outside Institution
  • MD Anderson in the Future
  • Critical Perspectives on MD Anderson
  • Institutional Mission and Values
  • MD Anderson Culture
  • Career and Accomplishments

In this Chapter, Dr. Keating then talks about his intention to retire with a twenty percent appointment, as this will enable him to avoid coping with the institution’s bureaucracy, but expresses his optimism that the institution will survive.  He praises the support staff and states that people at the institution are driven to maintain MD Anderson as the “crown jewel” of the University of Texas.

Original Profile

 

This two-session interview with Michael Keating, M.D. (b. 1 July 1943, Melbourne, Australia) takes place in spring 2014 (approximately 4 hours total duration). Dr. Keating came to MD Anderson as a Fellow in the Department of Developmental Therapeutics in 1974.  He became n Assistant Professor in 1978.  Today he is a professor of medicine in the Department of Leukemia in the Division of Cancer Medicine.  Dr. Keating is also the Founding President and CEO of the Global Research Foundation, a non-profit organization supporting research into Chronic Lymphocytic Leukemia.  The interview sessions take place in a conference room in the Department of Leukemia in the Faculty Center on the Main Campus of MD Anderson. Tacey A. Rosolowski, Ph.D. is the interviewer.

Dr. Keating received his MBBS (the equivalent of the M.D.) in Clinical Medicine, from St. Vincent's Hospital Clinical School in Fitzroy, Victoria in 1966.  In the same year he received his degree in Medicine from the University of Melbourne in Melbourne, Australia.  He continued at Saint Vincent’s (1966 -1974) for his residencies and fellowships, also serving in registrar roles (1967-1968) and served as Medical Registrar at that institution (1969-1970).  In 1970 he was a Fellow at the Royal Australian College of Physicians in Sydney.  During the last years at Vincent's Hospital, Dr. Keating was administering the oncology program and conducting his own research on leukemia and lymphomas.  In 1974-1975 he came to M. D. Anderson Hospital and Tumor Institute as a Fellow in Developmental Therapeutics, advancing to Faculty Associate (1975 – 1976).  He returned to Australia in 1977−1978 to serve as Senior Lecturer in the Department of Medicine at St. Vincent's Hospital.  He returned to MD Anderson in 1978 and became an Assistant Professor of Medicine and Assistant Internist, in the Department of Developmental Therapeutics.

At MD Anderson, Dr. Keating established his reputation with his investigations into the natural histories of chronic lymphocytic leukemia and his collaborative work on drug treatments, combination treatments, and multi-modality treatments for leukemia.  His collaborative investigations of Fludarabine and its combination with other drugs have resulted in regimens that have been or are standard of care.  This work has also increased the understanding of the molecular mechanisms controlling CLL.  Dr. Keating also channeled his commitment to research quality into administrative service.  From 1990 – 1995 he served as Associate Vice President for Patient Care in Clinical Investigations.  From 1995 to 1999 he served as Associate Head for Clinical Research in Leukemia.  He is currently co-leader (with his long-time research collaborator, William Plunkett, Ph.D. –interviewed for this project), of the Chronic Lymphocytic Leukemia Moon Shot Program.

In this interview, Dr. Keating discusses the history of translational research at MD Anderson and the role of the Department of Developmental Therapeutic in establishing that tradition at the institution.  He details the studies he has conducted on CLL.  In the process, he offers a clear portrait of an innovative research mind.   Dr. Keating also offers candid commentary on changes the institution has undergone under four presidents.