Submitted: 30 June 2014
Two interview sessions: 11 June 2012, 12 June 2012
Total approximate duration: 2 hours 35 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:
Benjamin Lichtiger, M.D., Ph.D., M.B.A. [b. 1940, Argentina] came to MD Anderson in 1968 as a Fellow in Pathology. He joined the faculty as an Assistant Professor in the Department of Laboratory Medicine in 1974. Dr. Lichtiger specializes in transfusion medicine and developing quality blood products and processes that work with MD Anderson’s multi-disciplinary care approach. From 1974 to 2001 he served as Chief of Transfusion Medicine, overseeing all functions of MD Anderson’s Blood Bank. He also served as Chair of the Department of Laboratory Medicine from 1999 until his retirement in 2008. At the time of the interview, he continues to work nearly full time at the Blood Bank in his part time role as a clinical professor in the Department of Laboratory Medicine in the Division of Pathology and Laboratory Medicine.
Major Topics Covered:
Personal and educational background
Philosophy of Transfusion Medicine: an integral part of patient care and the diagnostic/treatment team
Transfusion services at MD Anderson; a “boutique blood bank”; individualized patient needs
Bringing business practices to blood services:
Lean manufacturing for MD Anderson blood services
Views of MD Anderson presidents and Emil J Freireich, MD
MD Anderson research culture
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: 11 June 2012
MD Anderson’s Blood Bank and Transfusion Services
Chapter 01 / Overview
A Commitment to Medicine and the Path to Pathology
Chapter 02 / Personal Background
A Pathology Lab Fellow
Chapter 03 / Coming to MD Anderson/Coming to Texas
A New View of Blood Banking
Chapter 04 / Building the Institution
The Boutique Blood Bank and the Details of Transfusion Medicine
Chapter 05 / An Institutional Unit
Blood as a Commodity
Chapter 06 / The Business of MD Anderson
Chair of Laboratory Medicine: Bringing Automation, Customer-Based Services, and Transfusion Guidelines
Chapter 07 / The Administrator
Interview Session Two: 12 June 2012
Clark, LeMaistre, Mendelsohn: Leadership Styles
Chapter 08 / Key MD Anderson Figures
Research Projects and the Future of Blood Banking
Chapter 09 / The Researcher
Lean Manufacturing and Informatics in Transfusion Medicine
Chapter 10 / Building the Institution
An Unbelievable Journey at MD Anderson
Chapter 11 / View on Career and Accomplishments
Interview Session One: 11 June 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Overview)
MD Anderson’s Blood Bank and Transfusion Services (listen/read)
Here Dr. Lichtiger describes the scope of work handled by MD Anderson’s Transfusion Medicine Section/Blood Bank. In a practical sense, the Bank handles patients’ specialized needs for platelets, plasma, white blood cells, and other blood elements, delivering, for example, 12,000-15,000 units of platelets per month. The Section also performs all the infectious disease testing for the institution. Dr. Lichtiger also describes how the Service’s clinical staff participate in planning treatment for patients. All requests for blood products are individually reviewed to make sure they are appropriate for a patient, and clinical staff also meets with patients. Dr. Lichtiger asserts that Transfusion Medicine is a “critical element” in patient care, and he believes that the service has earned the respect of MD Anderson clinicians.
Chapter 02 (Personal Background)
A Commitment to Medicine and the Path to Pathology (listen/read)
Dr. Lichtiger explains that he made the decision to study medicine as he saw his father’s heavy smoking and health problems lead to an early death. He sketches his educational path in Argentina. During his third year of medical school at the University of Buenos Aires, he decided to specialize in pathology ( M.D. conferred in 1964), and came to the U.S. for a fellowship at Michael Reese Hospital in Chicago, Illinois.
Chapter 03 (Coming to MD Anderson/Coming to Texas)
A Pathology Lab Fellow (listen/read)
In the early seventies, Dr. Lichtiger saw that MD Anderson’s reputation was growing and he decide to make the move to Houston. He speaks glowingly of Dr. James Butler, whom he worked under in pathology, and describes how he was the only fellow trusted enough to be left in the frozen section surgical. He notes how Pathology was working on accelerating the diagnosis process, first using electron microscopy. Dr. Lichtiger compares the Pathology Departments at Michael Reese Hospital and MD Anderson, and the unique environment at Houston’s institution convinced him to stay. At this time, he also realized that he missed contact with patients and switched from a purely laboratory path, to a clinical one.
Chapter 04 (Building the Institution)
A New View of Blood Banking (listen/read)
In this segment, Dr. Lichtiger explains the vision for blood banking that he made a reality at MD Anderson. He begins by explaining that when he decided to stay at MD Anderson, the only position available was as Acting Chief of the Blood Bank Section and, as he says, “I hated blood banking.” Nevertheless, he decided to take the job for a year (which has turned into a “Biblical year,” in his words). His first mission was to change the Bank’s mentality and determine what the “customer’s needed.” By the end of 1974, transfusion services were offered 24/7. He also determined that surgeons wanted to use whole blood during procedures when, paradoxically, they only needed specific blood components. Dr. Lichtiger describes how he “cracked that nut” and improved the therapeutic value of the blood products delivered in the process.
Next Dr. Lichtiger explains that he always took a business approach to problems and realized in the nineties that he needed to deepen his understanding of strategic planning, budgeting and information systems to fully address pressing issues in Transfusion Medicine. Dr. Lichtiger earned an M.B.A. in 1998 from the Lady of the Lake University, Houston TX. He notes that his family was in the clothing manufacturing business in Argentina. (His parents were disappointed with his choice of career, as they expected him to enter the family business.)
Dr. Lichtiger then talks about the financial challenges that MD Anderson faced in the 1970s and describes working with Dr. R. Lee Clark, Dr. Denton Cooley, Dr. Michael DeBakey, and Dr. Richard Eastwood, all of whom wanted to form an integrated Texas Medical Center Blood Bank. He shares recollections of Dr. Clark (who always said, “Don’t make small plans, your enemies will cut them down”) and describes his working relationship with this first president of MD Anderson. The initiative to create an integrated blood bank resulted in the formation of the Gulf Coast Regional Blood Center, but Dr. Lichtiger explains how MD Anderson remained separate (the only independent blood bank in the region) so that they could be flexible.
Chapter 05 (An Institutional Unit)
The Boutique Blood Bank and the Details of Transfusion Medicine (listen/read)
Here Dr. Lichtiger details many facets of the Blood Bank’s operations. He first talks about the challenges of running blood drives to acquire necessary blood, noting plans to expand the laboratory and increase the number of community recruiters. He notes that the MD Anderson name inspires many individuals and organizations to respond to blood drives. (He describes conducting drives at the Houston Chronicle at 2 am or 4 am, when the night staff is there to donate.) Dr. Lichtiger next talks briefly about the history of blood banking and describes how the field of Transfusion Medicine transformed it into a clinical practice (in the late 80s). He notes that working with patients over the years has taught him “tricks” for treating patient, and offers the example of treating RH disease in pregnant women. He then talks about cases in which the field’s wisdom about blood transfusion either cannot work well at MD Anderson, or does not apply because of patients’ special conditions. For example, research shows that patients do well with the freshest blood possible, and Dr. Lichtiger describes how quickly blood breaks down and loses its therapeutic power. In addition, though patients are encouraged to bank their own (autologous) blood for procedures whenever possible, cancer patients are often too ill to do so. Autologous blood is recommended to protect the patient from receiving (allogeneic) transfusions from other people whose blood may carry infection. Dr. Lichtiger explains how the Blood Bank guarantees the safety of the blood products made available, going beyond the standard guidelines for safety. They also carefully screen donors and do not accept blood from anyone with a history of cancer.
Next Dr. Lichtiger describes the technological advances that the Blood Bank has adopted to speed up collection of blood from donors (using a device based on an invention by Dr. Emil J. Freireich [Oral History Interview], the continuous flow blood separator). He also explains the ways that MD Anderson surgeons succeed in reducing transfusions during surgery (including using surgical instruments that coagulate blood as they cut). Outpatient services consume 30% of the Blood Banks stores. At the end of this segment, Dr. Lichtiger describes how Transfusion Medicine designed a special transfusion process for a Jehovah’s Witness, whose religion dictated that an individual can never be separated from his/her blood.
Chapter 06 (The Business of MD Anderson)
Blood as a Commodity (listen/read)
Dr. Lichtiger first explains how he thinks about blood as a “commodity” that has a fluctuating price. He goes on to talk about the support that MD Anderson presidents Charles LeMaistre and John Mendelsohn showed Transfusion Services, then comments briefly on the new president, Ronald DePinho. He then sketches the relationship between the Blood Bank and the Blood Center, confirming that they are part of the same service
Chapter 07 (The Administrator)
Chair of Laboratory Medicine: Bringing Automation, Customer-Based Services, and Transfusion Guidelines (listen/read)
In this segment, Dr. Lichtiger outlines his role as Chair of Laboratory Medicine from 1999-2008. He begins by sketching his responsibilities, noting how difficult it was to make decisions about assigning salary raises to faculty, dilemmas that gave him “many sleepless nights” because of their human dimension. He then talks about bringing automation to the Department and developing a concept of a de-centralized laboratory that would be more appropriate to MD Anderson than the centralized system in use. He was not successful in effecting this change, but notes that it is coming: the new operating room and ICU will both have laboratories, for example. From this discussion, Dr. Lichtiger again affirms that Transfusion Medicine services operate from the question “What do customers want and when?” He talks about the frustrations of dealing with new faculty at MD Anderson who do not understand that this institution’s Transfusion Medicine service operates as a collaborative clinical specialty, rather than a lab that blindly fills orders. He mentions the Transfusion Guidelines, created by the Transfusion Committee. He also speaks about his own concept of the “Prospective Review,” a process by which all of a patient’s information is examined to determine which blood products will integrate most therapeutically into the patient’s treatment. At the end of this Chapter Dr. Lichtiger talks about the Fellowship Programs he administers, the difficulty of selecting Fellows with real drive, and the challenge of teaching Fellows clinical interactive skills.
Interview Session Two: 12 June 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 08 (Key MD Anderson Figures)
Clark, LeMaistre, Mendelsohn: Leadership Styles (listen/read)
In this segment, Dr. Lichtiger compares the leadership styles and talents of the first three presidents of the institution. He describes R. Lee Clark’s creativity and big-vision thinking in very detailed terms. He notes Dr. LeMaistre’s [Oral History Interview] ability to operate in political scenes at the state and national levels and Dr. Mendelsohn’s [Oral History Interview] talent for fundraising and building. Dr. Lichtiger also describes how the structure of MD Anderson changed to a more corporate structure after R. Lee Clark retired, making it more difficult to speak directly and at length with the institution’s top administrator to get projects underway. He gives some historical background about the blocks that were thrown in the way of MD Anderson’s growth and confirms that the Blood Bank was part of R. Lee Clark’s vision for MD Anderson.
Chapter 09 (The Researcher)
Research Projects and the Future of Blood Banking (listen/read)
In this segment, Dr. Lichtiger first notes his collaborations with Dr. Emil J Freireich [Oral History Interview] in the Department of Developmental Therapeutics and the Adult Leukemia Research Program. He describes Dr. Freireich and explains that his work is part of Dr. Ronald DePinho’s Moon Shots initiative that involves the work on leukemia.
Dr. Lichtiger next evaluates Dr. DePinho’s plan to treat cancer by developing drugs that target the molecular structures of the different cancers. This “very imaginative” plan that moves toward personalized care, he says, will require a complete shift in thinking and practice at MD Anderson. He states that success in this plan will dramatically reduce the need for transfusion services, for example, but Dr. Lichtiger predicts that the patient need will not disappear, as most therapies have an impact on bone marrow and, thus, blood products. Transfusion Medicine will concentrate on generating better products and “shelf products” for patients. He predicts a major transformation in blood banking in the next ten years. He describes the exciting and promising example of harvesting stem cells from a patient, growing platelets, and then transfusing them back into the patient.
Dr. Lichtiger next sketches his own research, noting that he always worked collaboratively with others, providing equipment for blood banking, as well as sampling and processing services. He made a conscious decision not to aggressively pursue a research career, because he needed time to spend with his family and had watched as colleagues’ families broke up.
In the last portion of this segment, Dr. Lichtiger again talks about working with Fellows and the importance of mentoring.
Chapter 10 (Building the Institution)
Lean Manufacturing and Informatics in Transfusion Medicine (listen/read)
In this segment, Dr. Lichtiger talks about two significant changes instituted while he was Chair of Laboratory Medicine. He first talks about his participating in the selection of the Informatics System that enables Transfusion Medicine to handle all information about a unit of blood from the moment it is contributed by a donor, through all of the production and testing, to its final delivery to a patient. This system facilitated automation of the services, accelerating the handling of all blood products. Wireless connections also mean that some laboratory services can be made available on patient floors. Next he talks about how in 2004/’05 he spearheaded the move to redesign Transfusion Medicine around the principles of Lean Manufacturing, a series of principles for efficiency and quality derived from the Toyota auto manufacturers in Japan. He describes how every process in the lab was analyzed and most revamped. (For example, analysis revealed that technicians working among various stations walked over a 1 mile/day. Lab redesigns reduced that to 400 feet, saving time.) Each change was analyzed statistically to confirm that it would be a valid change. The result has been hundreds of thousands of dollars of savings. Dr. Lichtiger next talks about adopting strategies to reduce variation from the Sic Sigma program, very important in a laboratory that performs over one million tests per year. He talks about the situation that led him to undertake these redesign project and the $250,000 of support he received from the administration to complete it.
Chapter 11 (View on Career and Accomplishments)
An Unbelievable Journey at MD Anderson (listen/read)
In this final segment, Dr. Lichtiger reflects on the exciting and unexpected career path that MD Anderson gave him. He talks about how he was transformed from a laboratory scientist looking at samples into a clinician who works with “the human element.” Dr. Lichtiger retired in 2008, though he has continued to work nearly full time in the Transfusion Medicine Section. As he looks ahead to genuine retirement, he says he is thinking of getting a law degree or studying Mandarin, to keep his mind active. He sees himself as “one more soldier” at MD Anderson, noting that the institution allowed him to develop a passion for his work. He hopes that the next generation of faculty in Transfusion Medicine will carry on the tradition of seeing the field as a clinical discipline. His personal philosophy, he says, is simply to contribute to efforts to create a world that’s better for everyone.
This 2 hour and 35 minute interview with Dr. Benjamin Lichtiger, M.D., Ph.D., M.B.A. [b. 1940, Argentina], takes place in two sessions conducted in June of 2013. Tacey A. Rosolowski is the interviewer. The interview takes place in a conference room in the Section of Transfusion Medicine in the Main Building on MD Anderson’s main campus.
Dr. Lichtiger is a pathologist and specialist in transfusion medicine who came to MD Anderson in 1968 as a Fellow in Pathology. By 1973 he was a faculty associate in the Department of Laboratory Medicine, serving as Acting Chief of the Blood Bank. In 1974 he became an Assistant Professor and advanced to Section Chief of Transfusion Medicine, a position he held until 2001, overseeing all functions of MD Anderson’s Blood Bank. Dr. Lichtiger also served as Chair of the Department of Laboratory Medicine from 1999 until his retirement in 2008, though he continued as ad interim Chair until 2010, and continues to work nearly full time at the Blood Bank in his part time role as a clinical professor in the Department of Laboratory Medicine in the Division of Pathology and Laboratory Medicine.
Dr. Lichtiger earned his M.D. in 1964 from the University of Buenos Aires, Buenos Aires, Argentina. He did a residency in Pathology at Fernandez Hospital in Buenos Aires in 1955-66, then emigrated to the United States for additional Residency training in Pathology at Michael Reese Hospital in Chicago, Illinois (1966-68). He came to Houston to earn his Ph.D. at the University of Texas Graduate School of Biomedical Sciences (conferred in 1974, at which time he also became an American citizen). Dr. Lichtiger went on to earn an M.B.A. in 1998 from the Lady of the Lake University, Houston TX.
In this interview Dr. Lichtiger gives a detailed look inside the workings of MD Anderson’s transfusion services, the largest in the country and one that operates as a “boutique blood bank,” in his words, serving the highly individualized needs of MD Anderson patients. Dr. Lichtiger is adamant that blood bank services are an integral part of patient care, and that the transfusion medicine pathologist is part of a patient’s diagnostic and treatment team. He gives vivid documentation of how MD Anderson’s Transfusion Medicine services adhere to this mission. His business background hints at another dimension of his approach to clinical medical services. Dr. Lichtiger has streamlined laboratory processes to increase efficiency, accuracy, and ensure a high quality of all blood products. He describes how his business perspective emerged and influenced the Blood Bank seen at MD Anderson today. Dr. Lichtiger is passionate and articulate. In addition to the wealth of detail about Transfusion Medicine at MD Anderson, Dr. Lichtiger speaks with great feeling about R. Lee Clark and the special environment that MD Anderson offered to researchers in the 1970s and early 1980s.