Two interview sessions: 24 May 2012, 24 October 2012
Total approximate duration: three hours and forty-five minutes
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, firstname.lastname@example.org
About the Interview Subject:
Charles Aubrey LeMaistre, M.D. (b. 10 January 1924, Lockhart, Alabama) came to MD Anderson in 1978 as president of the institution after serving for seven years as Chancellor of the University of Texas System. He served as president until 1996. Early in his research career, Dr. LeMaistre developed tetracycline-like antibiotics and treated patients with tuberculosis and other pulmonary diseases. Dr. LeMaistre established MD Anderson’s Division of Cancer Prevention. Dr. LeMaistre received the President’s Award from the American Lung Association in 1987, the American Medical Association’s Distinguished Service Award in 1996, and the American Cancer Society’s Medal of Honor in 1998. He also served on first U.S. Surgeon General’s Advisory Committee on Smoking and Health, contributing to a landmark report (1964) identifying smoking as a major health hazard.
Major Topics Covered:
Personal and educational background
Contributions to the anti-smoking movement
Leadership of MD Anderson
Cancer prevention at MD Anderson
Developing outpatient services
Managed care crisis
The Board of Visitors
Research on keratin
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: 24 May 2012
MD Anderson: “Easily the Greatest Cancer Center Ever Put Together”
Chapter 01 / Overview
A Pioneer in the Anti-Smoking Movement
Chapter 02 / The Researcher
Assuming Leadership of MD Anderson
Chapter 03 / Building the Institution
Establishing a Focus on Cancer Prevention
Chapter 04 / Building the Institution
Instituting Multi-Disciplinary Care: Outpatient Services and the Brain Center
Chapter 05 / Building the Institution
Navigating the Managed Care Crisis
Chapter 06 / Institutional Change
A Brief History of MD Anderson; The Board of Visitors Uses Its “Voice Power”
Chapter 07 / MD Anderson Past
MD Anderson Presidents and Other Institution Leaders
Chapter 08 / Key MD Anderson Figures
Dr. LeMaistre’s Administration: Controversial Issues
Chapter 09 / Institutional Change
Leadership Philosophy and Leadership Stories
Chapter 10 / The Administrator
Interview Session Two: 24 October 2012
A Philosophy of Teaching: Equalize Skills
Chapter 11 / The Educator
Growing Careers by Stressing Patient Care; The Retirement Program and Term Tenure
Chapter 12 / Building the Institution
A Reluctant Leader
Chapter 13 / The Administrator
Meeting Fiscal Challenges with Many Approaches
Chapter 14 / The Finances and Business of MD Anderson
Growth During Downsizing
Chapter 15 / Building the Institution
People Contributing to an Unusual Institution
Chapter 16 / Key MD Anderson Figures
The Board of Visitors and Donors
Chapter 17 / An Institutional Unit
Rectifying Failures of Communication and the Press
Chapter 18 / Overview
The Roots of MD Anderson
Chapter 19 / MD Anderson Past
Looking Back; A View on the Moon Shots; Remembering Patients; and a New Book
Chapter 20 / View on Career and Accomplishments
Helping Patients Get Access to MD Anderson; The Promise of Keratin
Chapter 21 / Post-Retirement Activities
Interview Session One: 24 May 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Overview)
MD Anderson: “Easily the Greatest Cancer Center Ever Put Together” (listen/read)
In this Chapter, Dr. LeMaistre offers is perspective on what makes MD Anderson unique. He says first that MD Anderson employees are all the people who are completely dedicated to doing the best for the Cancer Center’s patients. He states that MD Anderson is a “jewel for the state of Texas,” and offers a reminder of the financial benefits this two billion a year institution gives to the state. He also lists the many areas of cancer treatment in which MD Anderson has offered leadership for the nation and the world.
Chapter 02 (The Researcher)
A Pioneer in the Anti-Smoking Movement (listen/read)
In this Chapter, Dr. LeMaistre talks about the evolution of his interest in the anti-smoking movement and briefly sketches the career path that took him into administration and to MD Anderson, when he was completely happy as an academic physician treating patients (an activity he misses). He became interested in the effects of smoking when he was operating a large service at the University of Texas Southwestern Medical School in Dallas, and saw many cases of pulmonary disease and lung cancer. He gives background on the first Surgeon General’s Advisory Committee on Smoking and Health, run under Luther Terry during the Kennedy administration. Dr. LeMaistre was invited to become a member of this committee in 1962. He describes the controversial nature of the Committee (as most individuals saw no need for the study), how President Kennedy came to endorse the study, how committee members were selected, and how the committee selected the cancers to study and organized its activities –including requesting special studies to fill in gaps in the existing scientific literature. He notes that the report submitted in 1964 was a landmark identifying smoking as a major health hazard and goes on to talk about the reaction from the tobacco industry, which prevented the Public Health Service from moving any anti-smoking related legislation through Congress. Dr. LeMaistre confirms that his experience on this committee refocused his interests; he encouraged colleagues to increase their study of smoking.
Chapter 03 (Building the Institution)
Assuming Leadership of MD Anderson (listen/read)
In this Chapter, Dr. LeMaistre talks about coming to MD Anderson as president. He says that he had to begin by “undoing” some of Dr. R. Lee Clark’s initiatives, such as his plan to create a frozen food factory. He talks about Vice President of Research, Dr. Frederick Becker, and his active recruiting of basic scientists to build MD Anderson’s reputation. Dr. LeMaistre recalls going to speak with each scientist at the institution and asking ”What are you researching” and “What would you like to be researching,” only to discover that money was preventing scientists from pursuing their true research goals. He describes how he increased support for research, criteria for excellence, and also provided the faculty with generous retirement plans.
Chapter 04 (Building the Institution)
Establishing a Focus on Cancer Prevention (listen/read)
In this Chapter, Dr. LeMaistre talks about the process of establishing a cancer prevention program at MD Anderson. During his first months at MD Anderson, he looked at the innovative programs in place and those needed. He discovered that preventive strategies were studied, though not in a centralized program. There was also the perception that prevention belonged in the category of public health. However, since “the most difficult cancers to treat are caused by things we can prevent,” Dr. LeMaistre worked for a centralized program. He drew attention to the issue by announcing early that he wanted to make MD Anderson a smoke-free environment. (On 1 Jan 1989, MD Anderson became the U.S.’s first smoke free hospital.) He also notes that he recruited Dr. Guy Newell, M.D., Deputy Director of the National Cancer Institute, to develop the new Division of Cancer Prevention, and he initiated several collaborative projects with the School of Public Health.
Chapter 05 (Building the Institution)
Instituting Multi-Disciplinary Care: Outpatient Services and the Brain Center (listen/read)
In this Chapter, Dr. LeMaistre talks about key instances of institutional reorganization around the idea of multi-disciplinary care. He begins by talking about how he decided to create an Outpatient Service and how this was made possible when MD Anderson’s Department of Developmental Therapeutics invented a miniature pump that allowed patients to self-administer their chemotherapy spurred the creation of out-patient services. In a touching anecdote, Dr. LeMaistre describes visiting Station 19, where chemotherapy was administered in an open setting: “If one patient vomited,” Dr. LeMaistre says, “ten people did.” This observation led to the building of a new Outpatient Department, a process Dr. LeMaistre describes briefly, and one structured around the view that “we need to stop thinking about departments, but about what the cancer needs.” Dr. LeMaistre also describes how the Brain Center was created around the idea of multi-disciplinary. Finally, Dr. LeMaistre describes admitting himself to MD Anderson as a patient under a fictitious name and experienced first-hand the unwieldy bureaucracy. He worked with others to create one admitting form that “revolutionized the front door for a short while.”
Chapter 06 (Institutional Change)
Navigating the Managed Care Crisis (listen/read)
In this Chapter, Dr. LeMaistre discusses the managed care crisis of the mid-eighties that had “destroyed great institutions and could have diverted all MD Anderson patients somewhere else.” He describes his goals of cutting costs and increasing efficiency, then describes the key bill he and others pushed through the Texas Legislature that repealed the requirement for physician referrals (so patients could self-refer) and allowed MD Anderson to take bids for services and equipment as well as offer early retirement for non-productive faculty. He describes the intensive process of gaining the support of individual legislators, including activities of Board of Visitors members, who pressured legislators in their districts. (This resulted in a unanimous vote in both the House and Senate.) He notes the learning curve the institution had to go through in all fiscal and management affairs as changes were implements to insure MD Anderson viability. He notes the creation of a Vice President of Fiscal Affairs
Chapter 07 (MD Anderson Past)
A Brief History of MD Anderson; The Board of Visitors Uses Its “Voice Power” (listen/read)
In this Chapter, Dr. LeMaistre reviews some history of MD Anderson, beginning with its origins in Dr. Ernst Bertner’s dissatisfaction with how cancer was treated in the 1940s and his first approach to the Trustees of Monroe D. Anderson’s estate to create a cancer center. Dr. LeMaistre describes how R. Lee Clark established the Board of Visitors: Dr. LeMaistre helped recruit important corporate leaders to the Board when he was Chancellor of the UT System. He discusses the role of the Board of Visitors and its role in acquiring the land which would become Research Park, and Vice President David Bachrach’s key role in its development. This section ends with Dr. LeMaistre’s comments on the dedication of the Board of Visitor members and an explanation of the origin of the name. (Harvard University also has a “Board of Visitors.”) He also explains the role of the Board in moving ahead key initiatives, including the one convincing the Texas Legislature to pass the bill allowing patients to self-refer to MD Anderson.
Chapter 08 (Key MD Anderson Figures)
MD Anderson Presidents and Other Institution Leaders (listen/read)
In this Chapter, Dr. LeMaistre reflects on the role of the president of MD Anderson and various administrative issues. He begins by observing that R. Lee Clark had a “talent of looking into the future like few I’ve ever known.” Dr. LeMaistre notes a number of Dr. Clark’s radical notions, including his vision of a research park— well before there was any political support to implement the project.
Chapter 09 (Institutional Change)
Dr. LeMaistre’s Administration: Controversial Issues (listen/read)
In this Chapter, Dr. LeMaistre discusses controversial decisions he made during his presidency. He first speaks about his conflict with the Department of Developmental Therapeutics over their insistence that they control the administering of chemotherapy: Dr. LeMaistre instituted a policy through which all specialties and departments learned to administer chemo. He then reflects on elements of his administrative philosophy. One over-riding rule was to make no decisions about patients and to reserve to himself only the right of veto. (He tells an anecdote about one stark exception –his assertion that any employee caught smoking at MD Anderson would be fired, and if the supervisor/boss refused to fire that individual, the supervisor would be fired.)
Chapter 10 (The Administrator)
Leadership Philosophy and Leadership Stories (listen/read)
In this Chapter, Dr. LeMaistre talks about his philosophy of leadership. He explains that he believed in delegating authority to those who best understood a situation and allowed his Vice Presidents a credit of $10,000 per day to solve problems with patients. He speaks briefly about the new president, Dr. Ronald DePinho, then recalls some personal lesson in humility he learned as a young man. He summarizes these by saying, “No eagle flies so high he can’t drop.”
Interview Session Two: 24 October 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 11 (The Educator)
A Philosophy of Teaching: Equalize Skills (listen/read)
In this Chapter Dr. LeMaistre talks about his commitment to teaching and how it influenced his leadership style. He first reflects on his teaching experience at Cornell Medical College and describes how gratifying he found it to build the skills of less prepared students so they could succeed. He then notes that his teaching experience helped him learn to evaluate individuals’ potential and to delegate tasks responsibly. He offers an example from his time at Cornell Medical College during a period when the Admissions Committee did not focus on admitting women students.
Chapter 12 (Building the Institution)
Growing Careers by Stressing Patient Care; The Retirement Program and Term Tenure (listen/read)
Here Dr. LeMaistre notes that R. Lee Clark envisioned MD Anderson as an institution where physicians would stay for their entire careers. The advantage, he notes, is that the institution preserves and develops the potential of each individual. Dr. LeMaistre facilitated this situation by insuring that MD Anderson retirement plans were comparable with corporations (even if salaries are less). He also greatly expanded financial support for basic scientists, whose salaries were not equivalent to competitors or to the talent of the individuals at MD Anderson. He notes that MD Anderson creates a pool of money earned by clinicians that is then spread among faculty, which also helps support both clinicians and basic scientists to keep them at the institution, though he stresses that faculty must meet the test of putting patients first. He then speaks about the term tenure system that he instituted when he was Chancellor of the University of Texas System and discusses the pros and cons of term tenure to different types of institutions.
Chapter 13 (The Administrator)
A Reluctant Leader (listen/read)
Here Dr. LeMaistre recalls his early commitment to clinical practice and research in antibiotics. He tells an anecdote from his time at Cornell Medical College that demonstrates his reluctance to take on administrative roles, then recounts the pathway that led him to assume exactly that kind of responsibility, culminating in his presidency at MD Anderson.
Chapter 14 (The Finances and Business of MD Anderson)
Meeting Fiscal Challenges with Many Approaches (listen/read)
In this Chapter Dr. LeMaistre talks about a number of ways that MD Anderson met the financial challenges of the late 80s and 90s. He first talks about his strategies for dealing with the Texas Legislature. It was most important, he notes, to make legislators understand what was in the best interest of Texas and to provide transparent cost accounting. The Legislature was very supportive when managed care came in, and reviews the report prepared of initiatives that would allow MD Anderson to function as a private institution (including a plan for dealing with indigent care). He also describes how he asked a group of eighty faculty to take a business course at Rice University to build management skills and lists some of the effects. Finally, he talks about creating the Vice President of Fiscal Affairs. He compares the much smaller MD Anderson run by R. Lee Clark and notes that the growing institution required more oversight. He describes how the VP of Fiscal Affairs was created and the hiring of David Bachrach.
Chapter 15 (Building the Institution)
Growth During Downsizing (listen/read)
In this Chapter Dr. LeMaistre talks about the areas of MD Anderson that continued to expand during the financial crisis and downsizing created by HMOs. He tells the story of searching for individuals to build the departments of immunology and metastasis, resulting in the hiring of Dr. Joshua Fidler and Dr. Margaret Kripke (husband and wife). He describes taking a leadership role in building the basic sciences by hiring new faculty and technicians who created the foundation for clinical trials and, in turn, attracted new faculty with M.D., Ph.D., closing the “bench to bedside” loop. He also describes establishing a relationship with a medical center that would become MD Anderson Orlando, Florida, noting the reasons for establishing a center in that location. Dr. LeMaistre comments that good oversight allows MD Anderson to expand and address serious cancers.
Chapter 16 (Key MD Anderson Figures)
People Contributing to an Unusual Institution (listen/read)
Here Dr. LeMaistre tells two anecdotes about women who have contributed to making MD Anderson an unusual institution. He first discusses Renilda Hilkemeyer (hired by R. Lee Clark to serve as Director of Nursing at MD Anderson), who developed the code of standards for oncology nursing. He then recalls a woman (an MD Anderson volunteer) who created a rose garden on MD Anderson grounds and who gave every patient a rose each day. He then comments on the importance of volunteers in general, noting that many faculty and staff volunteer after their retirements.
Chapter 17 (An Institutional Unit)
The Board of Visitors and Donors (listen/read)
In this Chapter Dr. LeMaistre notes that the Board of Visitors is an unusual body in the University of Texas System. He then describes how Board members offered business wisdom during times of financial stress. He then talks about Ben Love who served as Board President during the Fulfill the Promise Capital Campaign. He offers two anecdotes of how Mr. Love leveraged his business networks to benefit MD Anderson. At the end of the Chapter, he talks about Alfred Alkek, who gave money to build a new hospital.
Chapter 18 (Overview)
Rectifying Failures of Communication and the Press (listen/read)
In this short Chapter, Dr. LeMaistre talks about the importance of communicating clearly with the press to avoid controversy. He tells an anecdote about dealing with journalist Marvin Zilder, who exaggerated the findings of a health department inspection of MD Anderson’s cafeteria. Marvin Zilder eventually became a donor to MD Anderson.
Chapter 19 (MD Anderson Past)
The Roots of MD Anderson (listen/read)
In this Chapter Dr. LeMaistre describes the founding of MD Anderson in inspirational terms. He begins with an anecdote about a group of women who marched the halls of the Texas Legislature in 1941, demanding that they create a state hospital. He praises the willingness of this group for saying, “We’re not leaving until you do this.” He then talks about Dr. Ernst Bertner organizing the first five faculty members to establish the hospital on the Baker Estate, noting that “There’s magic in almost everything that happens here.”
Chapter 20 (View on Career and Accomplishments)
Looking Back; A View on the Moon Shots; Remembering Patients; and a New Book (listen/read)
In this Chapter, Dr. LeMaistre talks about the legacy that first president Dr. R. Lee Clark left and notes a few of his own experiences leading MD Anderson. Next he comments on his accomplishments and leadership, projects he feels are incomplete, and the prognosis for Dr. Ronald DePinho’s “moonshot” attack on serious cancers. He first underscores that he received a great deal from expressing commitment and love to patients and their families. He feels that his efforts in cancer prevention are incomplete: excellent research has been completed, but applications remain to be made. (He offers some examples.) He speaks about the work that remains to be done in the anti-smoking campaign. He positively evaluates Dr. DePinho’s strategy of directing a great deal of money toward curing key cancers. He notes that “cancer is an unnecessary disease” and that work needs to be done to determine how to intervene in it. He uses the example of smoking and the challenges of intervening in behavior to prevent cancer. He briefly discusses how politics has an impact on the control of tobacco and previews material in his forthcoming book (working title: The Untold Story of the 1964 Report on Smoking and Health: The Beginning of the End of the Tobacco).
Chapter 21 (Post-Retirement Activities)
Helping Patients Get Access to MD Anderson; The Promise of Keratin (listen/read)
In this Chapter Dr. LeMaistre speaks briefly about the spiritual commitments of his family, then turns his ongoing projects. He and his wife, Andreae, are currently working with about seventy patients, helping them get access to what they need at MD Anderson. He also speaks about a research and development venture with keratin, a natural product that heals burns very quickly and that can be used to coat materials implanted in the body, preventing rejection. He describes the biological effects and notes that he is helping a company to start up and develop keratin’s therapeutic uses.
 Company name, Keraplast, http://www.keraplast.com (date of access, 29 October 2012).