Submitted: 2 July 14
Two interview sessions: 5 December 2012, 12 December 2012
Total approximate duration: 4 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:
John Stroehlein, MD (b.1 July 1940, Anna, Illinois) specializes in cancers of the hollow gastrointestinal tract and was recruited by Dr. R. Lee Clark in 1977 to serve as the second Chief of the Section of Gastroenterology. He held that position until 1982. His research has focused on screening for gastrointestinal cancer, the treatment of cancer with drug combinations, primary and secondary prevention of cancer. Dr. Stroehlein serves as Deputy Chair of the Department of Gastroenterology, Hepatology, and Nutrition. Since 2006, he has also served as Co-Medical Director of the Department of Patient Affairs.
Major Topics Covered:
Personal and educational background; military experience; retirement
Working at Methodist Hospital; MD Anderson in comparison to other institutions
Gastroenterology and oncology: history and evolution; development of team approaches
Department of Gastroenterology: history of
Department of Patient Affairs: functions, organization
Data management initiatives
Quality assurance initiatives
MD Anderson growth; cultural change; changing relationship to Texas/Houston
A note on transcription and the transcript:
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
Interview Session One: 5 December 2012
A Supportive Background and an Early Desire to Be a Physician
Chapter 01 / Educational Path
Oncology: An Open Field for Innovative Work in Gastroenterology
Chapter 02 / Joining MD Anderson/Coming to Texas
Developing a Personal Mission
Chapter 03 / Military Experience
Gastroenterology in the Late Seventies
Chapter 04 / An Institutional Unit
Challenges to Diagnosis and Treatment in the Late Seventies
Chapter 05 / Overview
Building Teams to Diagnose and to Try New Techniques
Chapter 06 / The Administrator
Exploring the Nature of GI Cancers
Chapter 07 / The Researcher
Gastroenterology and Developmental Therapeutics
Chapter 08 / An Institutional Unit
A Changing View of Cancer and the Future of Gastroenterology
Chapter 09 / Overview
The MD Anderson Presidents
Chapter 10 / Key MD Anderson Figures
Interview Session Two: 12 December 2012
The Evolution of Gastroenterology
Chapter 11 / Overview
Research: Slow Work
Chapter 12 / Overview
Teamwork: Handling Complications of Cancer
Chapter 13 / An Institutional Unit
MD Anderson and Methodist Hospital: Communication and Collegiality
Chapter 14 / Beyond the Institution
Awards Recognize a Dedicated Clinician
Chapter 15 / View on Career and Accomplishments
Observations: The Department Name Change and the Fate of Nutrition
Chapter 16 / Institutional Change
The Department of Patient Affairs
Chapter 17 / The Administrator
Projects to Come
Chapter 18 / The Researcher
Developing a Data Manager and Fostering Quality Assurance
Chapter 19 / Building the Institution
MD Anderson Presidents
Chapter 20 / Key MD Anderson Figures
A Humanist and a Team-Builder; Critical Perspectives on MD Anderson
Chapter 21 / View on Career and Accomplishments
Growth and Disconnection from the Texas Community
Chapter 22 / Overview
Writing and Philanthropy
Chapter 23 / Post-Retirement Activities
Interview Session One: 5 December 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Educational Path)
A Supportive Background and an Early Desire to Be a Physician (listen/read)
In this Chapter, Dr. Stroehlein briefly describes his family background and explains that he decided to be a physician when he was a boy. His family was very nurturing and his home community of Jonesboro, Illinois, offered him broadening opportunities to work as a sports editor and radio announcer. He then sketches the educational path that took him to the University of Illinois at Urbana (B.S. ’63) and to the University of Louisville, Louisville, Kentucky (M.D. ’67).
At the end of this Chapter he tells an anecdote about how he came to apply for a program at the Mayo Clinic, a move that led him to specialize in gastroenterology.
Chapter 02 (Joining MD Anderson/Coming to Texas)
Oncology: An Open Field for Innovative Work in Gastroenterology (listen/read)
Here Dr. Stroehlein explains how he came to focus on gastroenterology and then on oncology. He went to the Mayo Clinic to study gastroenterology because the specialty included a broad spectrum of diseases that were not well understood. His interest in oncology evolved because gastroenterology –more than other specialties—intersects with oncology. He describes the knowledge lacking at the time to treat GI cancers and recalls doing the first upper GI endoscopy at the Mayo Clinic. During his advanced clinical residency at the Mayo Clinic, Dr. Stroehlein was becoming known for his work on a fecal occult blood test to screen for colorectal cancer. Dr. R. Lee Clark went to Minnesota to recruit him to become the Section Head of Gastroenterology.
Chapter 03 (Military Experience)
Developing a Personal Mission (listen/read)
Here Dr. Stroehlein describes how his military experience in Vietnam underscored that the role of a physician is to provide the best care possible. He worked at the 24th Evacuation Hospital, the busiest in Vietnam. He tells about meeting Dr. Oscar (Bud) Frazier (to become a noted Houston heart-transplant specialist) and describes friendships formed during the Vietnam War.
Chapter 04 (An Institutional Unit)
Gastroenterology in the Late Seventies (listen/read)
In this Chapter, Dr. Stroehlein describes the Gastroenterology Section in 1977 when he arrived at MD Anderson. There were two faculty members and the section provided diagnostic studies to other departments. Dr. Stroehlein explains that, as the new Section Head, he maintained the clinical services and the joint training program and also recruited a gastroenterologist with laboratory experience to develop the research program and establish a laboratory.
He then describes how institutional politics at the time were shaped by the rift between the Division of Medicine and the new Department of Developmental Therapeutics. Dr. Stroehlein gives an example of how he supported innovative research with animal models to “mend fences” and bridge the two bodies. He also explains that Gastroenterology integrated surgical oncology fellows into their protocols. Fellows in Developmental Therapeutics also became involved in protocols to form cohesive teams that cross cut the two factions.
Chapter 05 (Overview)
Challenges to Diagnosis and Treatment in the Late Seventies (listen/read)
Dr. Stroehlein explains that gastroenterological cancers were very challenging because it was difficult to make a diagnosis before very serious symptoms developed. (He notes that it was only in the past year that definitive research proved that removing adenomas (benign tumors that develop from epithelial tissue) from the colon reduced cancer risk by 50%.) He also describes the technological limitations that hampered diagnosis and treatment, the difficulties of staging the patient (determining the stage of the cancer), and managing complications that affect quality of life. Dr. Stroehlein lists advances: the Enterostomal Nursing Program at MD Anderson is the only approved program in the southwestern U.S.; the current rarity of ostomies; the resection of metastatic disease; and the use of chemo-radiation combination treatments that increase survival rates.
Chapter 06 (The Administrator)
Building Teams to Diagnose and to Try New Techniques (listen/read)
Dr. Stroehlein explains that, as Section Head, he stressed team-building to tap expertise in other areas and train fellows equipped to diagnose cancer early. He also describes how the Section demonstrated the value of resecting metastatic disease, even though this went against accepted wisdom. Dr. Stroehlein then talks about how this new approach helped him and others understand the differences in patterns of cancer, leading to his interest in how the “soil” (or molecular/genetic) environment of the cancer cell influences the disease. (See Interview w/ Dr. Isaiah “Josh” Fidler.)
Chapter 07 (The Researcher)
Exploring the Nature of GI Cancers (listen/read)
In this Chapter, Dr. Stroehlein explains that his research path evolved alongside his competing commitments to clinical care, the operations of his department, and support of other department members. He participated in studies of the effects of chemotherapy. He also used breath hydrogen and methane as indicators of disease states. By working on the influence of GI hormones on GI cancers –and encouraging others to study the phenomena—he helped establish the relevance of gastroenterology for molecular marker studies. He also worked on establishing the diagnostic value of flow cytometry for GI cancers.
Chapter 08 (An Institutional Unit)
Gastroenterology and Developmental Therapeutics (listen/read)
In this Chapter Dr. Stroehlein notes that he conducted joint studies with the Department of Developmental Therapeutics (DT), explaining why that department was controversial at the time and listing operational differences between Gastroenterology and DT. He describes differences of opinion in the institution over offering palliative care. He explains that he tried to identify the positive aspects of DT as he integrated many DT members into teams. He notes that many departments intersected in gastroenterology teams.
Chapter 09 (Overview)
A Changing View of Cancer and the Future of Gastroenterology (listen/read)
At the beginning of this Chapter, Dr. Stroehlein touches on his philosophy of education then switches subject and considers the future of gastroenterology. In research, he says, the future lies with the development of biomarkers which can then be used in developing histories (personal, family and social) to stratify risk factors for disease. The “holy grail” of the field is the development of chemo-preventative measures for disease. Dr. Stroehlein then talks about incidences of different cancers (some rising, some decreasing in frequency) and notes that a great deal of progress has been made in diagnosis and treatment. He notes that medicine continues to be more skilled at structural intervention in the disease and that the greatest boost will come from molecular studies that demonstrate how cells communicate. Dr. Stroehlein next observes that Dr. Ronald DePinho’s Moon Shots program can possibly take advantage of advances that enable researchers to do things faster and less expensively than in the past.
Chapter 10 (Key MD Anderson Figures)
The MD Anderson Presidents (listen/read)
Dr. Stroehlein notes that he has known every MD Anderson president. He characterizes Dr. R. Lee Clark as decisive, fatherly, and disciplined and tells anecdotes to demonstrate Clark’s visionary understanding of cancer research and his ability to deal with the Texas legislature. Dr. Stroehlein then explains that the Mayo Clinic has a more vital sense of its own heritage as an institution than does MD Anderson. He speaks about the need to create a more awareness of the individuals who have contributed to the institution.
Interview Identifier (listen/read)
Chapter 11 (Overview)
The Evolution of Gastroenterology (listen/read)
In this Chapter, Dr. Stroehlein reflects on the development of gastroenterology since he entered the field in the seventies. He explains that faculty in the Division of Medicine at MD Anderson did aggressive therapy and also saw cases of benign disease, while the Department of Developmental Therapeutics focused exclusively on aggressive therapies. He notes that he integrated aggressive options into the Section of Gastroenterology. He acknowledges contributions made by Interventional Radiology and Dr. Sidney Wallace ([Interview #6] and others at MD Anderson to the development of treatments for GI cancers. He then reviews how GI medical oncology is divided into specialties today based on the locations of different cancers and explains the reasoning behind the divisions.
Chapter 12 (Overview)
Research: Slow Work (listen/read)
In this Chapter, Dr. Stroehlein speaks more about his specialty in the hollow GI tract and mentions his collaborations with groups studying screening techniques. He then reflects on the fact that there is no quick fix for cancer, and that it is the nature of research to evolve slowly toward validation. Next, Dr. Stroehlein explains his belief that, no matter how serious a diagnosis, there is always hope for the patient.
He then goes on to explain that the public needs more awareness about the effectiveness of colonoscopies for preventing serious cancers. He tells an anecdote about a colleague who removed a large gastric mass and compares past treatments with today’s more advanced approaches. Dr. Stroehlein explains that he always tried to bring such advances into the Department of Gastroenterology when he was in a leadership role and gives an example of the endoscopic microscope that enables pathologists and surgeons to focus on cells in real time.
Chapter 13 (An Institutional Unit)
Teamwork: Handling Complications of Cancer (listen/read)
Dr. Stroehlein begins this Chapter with some examples of patients with remarkable survivorship periods. He then explains that the Department of Gastroenterology had an impact on developing therapies because they had an appreciation for the negative effects of therapies on patients. He notes that the Department of Developmental Therapeutics was sometimes criticized for ignoring the impact of treatments on patients, and then goes on to describe how the creation of multi-specialty teams built awareness of these effects and helped improve treatments. Dr. Stroehlein says that when he reflects on what he has done in his career, he has had a very positive impact on building teams and integrating members of both the Division of Medicine and the Department of Developmental Therapeutics into the Department of Gastroenterology. This interest in teambuilding has influenced his administrative style as well. He speculates that his abilities to bring people together derive from his experiences growing up in a small town, when was required to interact with many different types of people.
Chapter 14 (Beyond the Institution)
MD Anderson and Methodist Hospital: Communication and Collegiality (listen/read)
Here Dr. Stroehlein talks leaving MD Anderson in 1983 (- 2003) to serve as Head of Endoscopy at Methodist Hospital [Houston, Texas]. The institution was thriving during this period, with one of the finest endoscopy units in the country. Dr. Stroehlein describes some of his work and the lessons learned.
He then shifts to compare and contrast Methodist and MD Anderson. He notes that MD Anderson placed a higher priority on a team approach to care, offered better support services, and developed a system for electronic medical records earlier. He then speaks about the bonuses an institution can reap from collegiality. He describes how good communication processes come from collegiality and he gives an example of how anesthesia services needed a clear understanding of how gastroenterologists perform necessary procedures in order to set up anesthetics properly.
Chapter 15 (View on Career and Accomplishments)
Awards Recognize a Dedicated Clinician (listen/read)
In this Chapter, Dr. Stroehlein first briefly mentions the other roles he served while serving as Head of Endoscopy at Methodist Hospital. He then speaks about the most important honors and awards he has received.
Chapter 16 (Institutional Change)
Observations: The Department Name Change and the Fate of Nutrition (listen/read)
At the beginning of this Chapter, Dr. Stroehlein lists the reasons why he returned to MD Anderson in 2003. He then explains the Department name change to Gastroenterology, Hepatology, and Nutrition. Hepatology, he says, had come into its own with advances in anti-viral therapies. The addition of “Nutrition” to the name reflected the importance of intravenous nutritional support to cancer patients. He then sketches the economic reasons why support for nutrition shrank, despite the fact that the Department was pointed to study what worked nutritionally for patients. He observes that there are few nutrition programs around the country and he has difficulty seeing how MD Anderson will be able to restart its own program.
Chapter 17 (The Administrator)
The Department of Patient Affairs (listen/read)
At the beginning of this Chapter, Dr. Stroehlein explains his main goals while serving as interim chair and now as Deputy Chair of his department: provide motivation and resources for everyone in the Department to be fully involved and productive. He then shifts to a discussion of his role as Medical Co-Director of the Department of Patient Affairs whose mission is to provide assistance to Board of Visitors members who become MD Anderson patients, as well as patients referred by the President’s office and the Legislature. The assistance involves helping the patients assemble their records and schedule appointments. Dr. Stroehlein explains that Robert Morton originally held the role unofficially before Taylor Wharton became the first official medical director of the Department. Patient Affairs assures these patients that the institution is concerned about them.
[Dr. Stroehlein takes a call from Taylor Wharton, the first Head of Patient Affairs. Part of that conversation is recorded.]
Dr. Stroehlein says that he is against having anyone from the Development Department in the Department of Patient Affairs. The latter department nurtures relationships with these patients and sees approximately 65-70 new patients per month. Dr. Stroehlein describes the scope of his role and mentions the contributions of Bob Morton, Lorena Collier, Linda White, and Taylor Wharton, whom he says “walked the hall like a maître d’.” He observes that patient affairs was established at a time when the institution was growing very fast and then goes into a more detailed description of his role: he reviews patients’ medical needs, mentors staff, and advises staff who don’t have his clinical background so they can properly refer patients to the right services.
Dr. Stroehlein notes that MD Anderson must address the challenge of offering a customer friendly face. He acknowledges that the patients served by Patient Affairs probably do get better care than the average patients. He then speaks about how to improve patients’ experiences.
Chapter 18 (The Researcher)
Projects to Come (listen/read)
Dr. Stroehlein describes the projects he will work on in the coming years. He will continue work studying the genetic profiles of different ethnic groups. He notes that there is little written on how to listen effectively and how to be a consultant and work/communicate effectively with other specialists. He would like to provide information these subjects. There are also numerous clinical observations and techniques he would like to describe. He will also continue working with individuals in the laboratory to facilitate translation of research to the bedside.
Chapter 19 (Building the Institution)
Developing a Data Manager and Fostering Quality Assurance (listen/read)
In this Chapter, Dr. Stroehlein talks about two related activities: 1) developing the Department’s data manager that pulls information from all case records into one database and 2) his role as Chair of Quality Assurance. He describes the challenges of setting up the database and also what it will mean for the advancement of research. He then talks about how quality assurance activities will be increasingly important to MD Anderson as the institution requires hard evidence that procedures have a positive outcome for patients. The repository of information in the Department’s evolving database will be key to demonstrating the quality of the Department’s services.
Chapter 20 (Key MD Anderson Figures)
MD Anderson Presidents (listen/read)
In this Chapter, Dr. Stroehlein briefly describes his observations of MD Anderson’s presidents.
Dr. Stroehlein then offers his opinion of Dr. Ronald DePinho’s Moon Shots Program. He says the Program is a great challenge to “do above and beyond.” Even for those faculty members whose specialties are not included in the program, there is much value to be derived from the interdisciplinary teams they created to make competitive proposals for inclusion in the Program. He observes that it is very motivating to attack a common enemy.
Chapter 21 (View on Career and Accomplishments)
A Humanist and a Team-Builder; Critical Perspectives on MD Anderson (listen/read)
Here Dr. Stroehlein notes his most important contributions to the institution and lists the most significant of his awards and honors, including the Stroehlein Professorship of Gastroenterology created in December 2012. He explains that he would like to become more active with the Healthcare Foundation that awarded his 1999 Humanism in Medicine Award, noting that there are few organizations that promote humanism in medicine.
Dr. Stroehlein then notes that the Mayo Clinic is the best example in the world of a humanist medical institution. In order to reach Mayo’s level, he says, MD Anderson much enhance communication between the specialties and break down obstacles that patients encounter in the institution.
Chapter 22 (Overview)
Growth and Disconnection from the Texas Community (listen/read)
Dr. Stroehlein next makes observations on the results of institutional growth. On one hand, the regional care centers are of great benefit to patients. However he says that MD Anderson appears to consider itself separate from the community of Houston and Texas, and until clinicians at MD Anderson reach out and establish relationships with practitioners in the community, referrals from the region will not go up. He lists some strategies faculty can use to foster these connections. Dr. Stroehlein then makes some final comments on MD Anderson, characterizing it as a “remarkable institution” capable of maintaining quality of care with a very high volume of patients.
Chapter 23 (Post-Retirement Activities)
Writing and Philanthropy (listen/read)
Here Dr. Stroehlein notes that his retirement will keep him occupied with writing projects focused on subjects mentioned earlier in the interview (see Chapter 18). He then explains that he will also have the time to become more involved in local organizations such as the Asia Society, Houston Young Artists, and the Pan American Society of Houston. He is fortunate to be in a financial position to give both funds and will continue to support MD Anderson, his undergraduate institution, his medical school and the Mayo Clinic.
Interview Profile #30: John Stroehlein, M.D.
Submitted by: Tacey A. Rosolowski, Ph.D.
Date revised: 2 July 2014
This four and one-half hour interview with Dr. John Stroehlein (b.1 July 1940, Anna, Illinois) takes place in two sessions in December of 2012. Dr. Stroehlein is a specialist in cancers of the hollow gastrointestinal tract. In 1977, he was recruited by Dr. R. Lee Clark to serve as the second Chief of the Section of Gastroenterology and he held that position until 1982. He spent some years away from MD Anderson, returning to the faculty in 2003 and eventually serving as ad interim chair of the Department of Gastroenterology, Hepatology, and Nutrition. He is now the Department’s Deputy Chair. Since 2006, Dr. Stroehlein has also served as Co-Medical Director of the Department of Patient Affairs. The interview takes place in a conference room in the Department of Gastroenterology, Hepatology, and Nutrition. Tacey A. Rosolowski is the interviewer.
Dr. Stroehlein received his B.S. from the Univ. Illinois, Urbana (1963, Chemistry) and his M.D. from the University of Louisville, Kentucky, (1967). He did three residencies at the Mayo Clinic between 1968 and 1974, with the final residency (72 – 74, Advanced Clinical Resident) securing his specialization in gastroenterology. From 1969 -1971 he served in Vietnam (864th Engineer Battalion and the 24th Evacuation Hospital) and at the Dewitt Army Hospital, Ft. Belvoir, Virginia. Since his residencies, his research has focused on screening for gastrointestinal cancer, the treatment of cancer with drug combinations, primary and secondary prevention of cancer. His administrative career evolved simultaneously at MD Anderson and, in 1982, he left the institution to become chief of the endoscopy service at the Methodist Hospital. During his time away from MD Anderson, he also joined the faculty of the University of Texas School of Medicine. ln 2003 he rejoined the MD Anderson Faculty and resumed administrative service in 2007, when he became ad interim Chair of the Department of Gastroenterology, Hepatology and Nutrition. He became Deputy Department Chair in 2009. In 1999 Dr. Stroehlein was appointed to the Dan and Lillie Sterling Professorship in Gastroenterology and that same year received the Humanism in Medicine Award from the Healthcare Foundation of New Jersey. (He was the first UT-Houston recipient.) In 2012, the University of Texas Regents approved the John Stroehlein Professorship in Gastroenterology. Dr. Stroehlein has also been named to many Best Physician’s lists.
In this interview, Dr. Stroehlein discusses the evolution of the field of gastroenterology from the 1970s, when there was very little known about the GI tract and its cancers. In addition to views on evolving research and technology, Dr. Stroehlein reveals his commitment to building teams across departments and specialties to maximize research and clinical potential for the benefit of patients. He also discusses the special role of the Department of Patient Affairs. The hiatus he took from the institution between 1983 and 2003 he compares MD Anderson to other institutions on the basis of direct experience. He is candid in his comparisons and his evaluation of MD Anderson’s role in the community.