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Submitted: 16 June 2014
Three interview sessions: 5 October 2011, 6 October 2011, 11 October 2011
Approximate total duration: seven hours
Interviewer: Tacey A. Rosolowski, Ph.D. (e-mail)
About the Interview Subject:
Dr. Emil J Freireich (b. 16 March 1927, in Chicago, Illinois) came to MD Anderson in 1965 to serve as Chief of Research (Hematology) in the Department of Development Therapeutics.
Dr. Freireich is best known for developing an effective treatment for childhood acute lymphoblastic leukemia, effectively curing that disease. Very early his research proved value of combination therapies. He served as head of Developmental Therapeutics from 1972-1983, when he became Chairman of the Department of Hematology. Since 1985, he has served as Director of the Adult Leukemia Research Program.
Major Topics Covered:
Personal and educational background
Research: the continuous flow-blood separator; innovations in chemotherapy
Collaboration with Dr. Emil Frei, III
Building the research culture and training researchers at MD Anderson
History of cancer medicine, clinical research, translational research and education
MD Anderson presidents and the history and expansion of MD Anderson
The Department of Developmental Therapeutics
Institutional Grand Rounds
The Core Curriculum
The Physician’s Assistant Training Program
Regarding the Transcript and Audio Files
In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One:
A New Idea and A Controversy: Transfusing Platelets in Leukemia Patients
Chapter 01 / The Researcher
Building the Continuous-Flow Blood Separator
Chapter 02 / The Researcher
MD Anderson Changes Under Charles LeMaistre: Expansions in Leukemia Research
Chapter 04 / Institutional Change
New Chemotherapy Treatments for Breast Cancer and Cultural Challenges to Research Innovation
Chapter 05 / The Researcher
Interview Session Two: 6 October 2011
A Commitment to Training and Education: A Failed Battle for an MD Anderson Medical School
Chapter 06 / Professional Path
Building the “Best Graduate Medical Education Program in the Country”
Chapter 07 / Building the Institution
A History of Institutional Grand Rounds, The Core Curriculum, and the Physician’s Assistant Training Program
Chapter 08 / Building the Institution
Creating Patient-Oriented Research in a Complex Scientific and Institutional Context
Chapter 09 / Building the Institution
Advocating for Patient-Oriented Research and Patients
Chapter 10 / Professional Service Beyond MD Anderson
Interview Session Three: 11 October 2011
A Critical Need to Fund Patient-Oriented Research
Chapter 11 / Overview
The FDA as a Barrier to Research Innovation
Chapter 12 / Overview
Leukemia as a Key to Understanding Cancer
Chapter 13 / Overview
The Partnership Between Basic Science and Clinical Research
Chapter 14 / Overview
A Legacy of Strong Faculty and Advances in Blood Cancers; Awards; Cancer as a Disease and MD Anderson Presidents
Chapter 15 / View on Career and Accomplishments
A Life of Work with the Support of a Strong Wife and Family
Chapter 16 / Personal Background
Interview Session 1: 5 October 2011 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (The Researcher)
A New Idea and A Controversy: Transfusing Platelets in Leukemia Patients (listen/read)
Dr. Freireich begins this segment by explaining the origin of his first name, “J”. Next, he describes how he worked with pediatric patients in the fifties, noting that he would see blood sprays on the walls of childrens’ hospital rooms from their hemorrhages. This led to his decision to treat the patients with massive doses of platelets. Dr. Freireich gives detailed accounts of the patients’ physiology, the technical challenges to overcome when giving patients blood from donors (as opposed to a bank blood), as well as the clinical trails he ran to determine the treatment’s efficacy. Dr. Freireich explains in very dramatic terms, how treating leukemia patients was influenced by confrontations between those who advocated for laboratory over clinical research, as well as by intra-institutional political conflicts. What results is a full and realistic portrait of how scientific and clinical paradigms shift in complex social/political contexts.
Chapter 02 (The Researcher)
Building the Continuous-Flow Blood Separator (listen/read)
In this segment, Dr. Freireich describes treating infections by transfusing white blood cells. He goes over the technical difficulties of separating white cells from platelets. (He describes his lab at NCI, festooned with 50 feet of tubing.) Here he also specifies why a continuous flow of blood was needed: using the analogy of an artificial kidney, he explains that leukemia patients required a huge number of either platelets or white blood cells, so the aim was to process a donor’s entire blood supply, while mobilizing the donor’s body to replace the elements removed for the transfusion. The next phase of the blood separator story begins when an IBM engineer, Al Judson, appears and asks if there’s something he might do to help cure leukemia. (His son was afflicted by the disease.) Dr. Freireich describes the materials and technical challenges of creating an instrument that would channel blood from a donor into a centrifuge, collect the proper layer of separated elements for the patient, and deliver plasma back to the donor.
Chapter 03 (The Researcher)
Perfecting the Blood Separator in the Department of Developmental Therapeutics; Shifting MD Anderson Culture to Innovative Research (listen/read)
Dr. Freireich explains why the slow evolution of the blood separator made it necessary for him to leave the NCI and join MD Anderson in 1965. He speaks at length about R. Lee Clark, “a giant of a person” (who visited Dr. Freireich’s family at home in order to convince him to come to Houston). He compares leukemia treatment services at NCI and the “primitive” situation for clinical research at MD Anderson. The faculty, he notes, saw his treatment/research approaches as potentially disruptive. He illustrates Dr. Clark’s political skill in the face of this enmity: Dr. Clark rented a mobile home and set it up in a parking lot, where Dr. Freireich and Dr Frei (his close colleague from NCI who also joined MD Anderson in the sixties) established the new Department of Developmental Therapeutics. Dr. Freireich describes the process of establishing a fully functioning program in two years. He also describes tensions in the institution as Developmental Therapeutics presented a new model of innovative research on treatments other than surgery. He explains how they finalized the design of the continuous blood separator (Model 2997), and he describes how the device and innovations it stimulated led to a revolution in stem cells transfusion.
Chapter 04 (Institutional Change)
MD Anderson Changes Under Charles LeMaistre: Expansions in Leukemia Research (listen/read)
In this segment, Dr. Freireich covers several topics, among them changes in MD Anderson’s administration when Charles LeMaistre became president, departmental reorganizations, and clinical experiments with “life islands” and granulocyte transfusions.
Chapter 05 (The Researcher)
New Chemotherapy Treatments for Breast Cancer and Cultural Challenges to Research Innovation (listen/read)
In this segment, Dr. Freireich discusses his work on breast cancer chemotherapy, simultaneously reflecting on cultural trends in the United States that work against the spirit of innovation.
Interview Session Two: 6 October 2011 (listen/read)
Interview Identifier (listen/read)
Chapter 06 (Professional Path)
A Commitment to Training and Education: A Failed Battle for an MD Anderson Medical School (listen/read)
This segment begins with Dr. Freireich’s reflections on the circuitous path that took him to hematology. He describes the unique clinical oncology program he helped set up at MD Anderson, and the “best and brightest” fellows who came to train. He traces the creation of graduate education at MD Anderson. He weaves in discussion of how growth at MD Anderson was tied to debates over bringing a medical school to Houston.
Chapter 07 (Building the Institution)
Building the “Best Graduate Medical Education Program in the Country” (listen/read)
Dr. Freiriech next traces the growth of education at MD Anderson when Dr. Charles A. [Mickey] LeMaistre took over as president from Dr. R. Lee Clark. He describes his close collaboration with Dr. Emil Frei, III. He explains how the Department of Developmental Therapeutics evolved because of initial connections with Japanese and Mexican Fellowship students. He explains his role in taking medical oncology to Japan and to Mexico. Dr. Freireich also sheds light on the development of the administrative structure governing clinical and basic research and explains how he established the Institutional Grand Rounds, a contributor to what he calls “the best graduate medical education program in the country.”
Chapter 08 (Building the Institution)
A History of Institutional Grand Rounds, The Core Curriculum, and the Physician’s Assistant Training Program (listen/read)
In this segment, Dr. Freireich explains the Institutional Grand Rounds in greater detail, focusing on how it offers a multi-disciplinary perspective on a topic to appeal to a broad audience within MD Anderson. He discusses how he established the Core Curriculum, a program that all graduates students at MD Anderson are required to take and which he describes as the “best program in the country” because of the comprehensive view of cancer it provides. He also discusses how he believed that the new idea of a “physician’s assistant” was worth pursuing, leading to the Physician’s Assistant Training Program.
Chapter 09 (Building the Institution)
Creating Patient-Oriented Research in a Complex Scientific and Institutional Context (listen/read)
Dr. Freirech begins this segment by discussing the importance of research funding and the creation of the Association for Patient-Oriented Research. He sketches the “structural problem” that research funding through the NIH channels funds to basic scientists when “100% of our ability to manage diseases in man began at the bedside with a doctor.” He speaks at length about the bias he perceives against physicians and clinically based research and the limitations of basic research to reveal the intricacies of disease in patients, despite the “ethos” in medicine and in the country to view clinical research as secondary because it merely applies discoveries revealed by basic research. Dr. Freireich talks about the origin of the K-series NIH grants for physicians. He then gives examples of how the bias against clinicians has influenced funding and administrative organization at MD Anderson. He speaks about the Physician Scientist Program (funded by a K-30 grant) and the Patient-Based Research Program. He talks about the challenges arising from the fact that MD Anderson does not administer its own Graduate School.
Chapter 10 (Professional Service beyond MD Anderson)
Advocating for Patient-Oriented Research and Patients (listen/read)
Dr. Freireich begins this segment by sketching the educational opportunities that MD Anderson offers. He then talks about his continued commitment to education and his pride in one of his trainees, Dr. Hagop Kantarjian, who now heads the Department of Leukemia. Dr. Freireich then further discusses the bias he perceives operating when it comes to awarding grants and awards to physician-scientists. He sketches the history of science in medicine, beginning with the founding of the Association of American Physicians and leading to his role in founding the Society of Patient-Oriented Research in 1998. He sketches the challenges the struggling organization is facing. He stresses that MD Anderson is set up to allow physicians to focus on their specialty, which means their minds are always immersed in their research area as well.
Interview Session Three: 11 October 2011 (listen/read)
Interview Identifier (listen/read)
Chapter 11 (Overview)
A Critical Need to Fund Patient-Oriented Research (listen/read)
Dr. Freireich begins this segment by reflecting on the role that national and international organizations have served in furthering research in his field (the fifties to the present), circling back to the main theme of Session Two by pointing out that the character of these organizations again demonstrates that basic research is valued more highly than clinical research. He also presents his belief that funding research on cures for cancer will be more effective than funding preventative measures.
Chapter 12 (Overview)
The FDA as a Barrier to Research Innovation (listen/read)
In this segment Dr. Freireich stresses that cancer will only be cured by funding clinical research into cures for cancer and offers his personal belief that the population at large understands this. (He uses the example of AIDS activists, who were successfully organized and lobbied for effective treatments.) He talks about the role of the FDA, which he sees curtailing physicians’ ability to make progress by restricting the use of experimental drugs in dying patients. He sums up the effect of what he sees as bureaucratic conservatism: “If there’s no drug, there’s no danger, and there’s no progress.”
Chapter 13 (Overview)
Leukemia as a Key to Understanding Cancer (listen/read)
In this segment, Dr. Freireich presents his theory that the ability to control cancer (determining which cancers will metastasize and kill) will come from research in leukemia because leukemia is a systemic cancer and everything discovered about it is immediately transferable to solid tumors. He talks about molecular and genetic advances in understanding cancer. He notes that we don’t need to understand the source of cancer, since will never eradicate it, we need to understand how cancer operates so it can be controlled. At the end of this segment, Dr. Freireich observes that individuals understand that tobacco and alcohol have an impact on cancer and health but it is a slow process to regulate against their use.
Chapter 14 (Overview)
The Partnership Between Basic Science and Clinical Research (listen/read)
In this segment, Dr. Freireich further clarifies his view of the relationship between clinical and basic research. “I want to spend double the money on basic research. The problem is the translation. If you don’t have the clinical arm, it’s like trying to play the piano with one hand. We need basic sciences to do the rhythm and the clinical scientists to do the melody and then we get music.” He talks about some of his collaborations with basic sciences, but also gives examples of how, contrary to popular opinion, patient-oriented research is basic research. He explains why global oncology should be a lower priority than other missions: e.g. funding clinical research, targeted therapy.
Chapter 15 (View on Career and Accomplishments)
A Legacy of Strong Faculty and Advances in Blood Cancers; Awards; Cancer as a Disease and MD Anderson Presidents (listen/read)
Dr. Freireich begins this segment by listing some of the key faculty he has brought to MD Anderson. He then reviews advances in blood cancers that have been made during his time at the institution. He next compares the three presidents of MD Anderson and speculates that incoming president Dr. DePinho has “the same genes” as R. Lee Clark, and may prove a visionary leader. Next Dr. Freireich talks about demographics and cancer and the fact that cancer is not a disease that can be eradicated. At the end of this segment, he talks about his awards, noting that the Charles F. Kettering Prize from the General Motors Cancer Research Institute (awarded 1983) meant the most, because it enabled him to relieve his family of debt.
Chapter 16 (Personal Background)
A Life of Work with the Support of a Strong Wife and Family (listen/read)
In this very personal segment, Dr. Freireich reflects on his lifelong focus on work. He speaks at length about his relationship with his wife and beloved partner, Haroldine Freireich (née Cunningham), whom he married on a Saturday morning when there were no samples to count. He talks about the importance of his family and notes that his children and grandchildren in providing distraction from intense focus on his research life.
In three sessions (totaling approximately seven hours), Dr. Emil J Freireich (b. 16 March 1927, in Chicago, Illinois) is interviewed as a follow-up to sessions conducted a decade ago. Tacey A. Rosolowski, Ph.D. interviews Dr. Freireich in his office in the Main Building of the University of Texas MD Anderson Cancer Center, Main Campus. Dr. Freireich earned his B.S. in Medicine at the University of Illinois’ College of Medicine, in Chicago, Illinois in 1947 and his M.D. at the same institution in 1949. His did his Clinical Internship at Chicago’s Cook County Hospital from 1949−1953 and his residency in Internal Medicine at Presbyterian Hospital in Chicago from 1950−1953. Dr. Freireich is now a Distinguished Teaching Professor at The University of Texas MD Anderson Cancer Center. He holds the Ruth Harriet Ainsworth Chair in Developmental Therapeutics. He also serves as Director of Special Medical Education Programs and of the Adult Leukemia Research Program. He has received numerous honors and awards, among them the Albert Lasker Medical Research Award (1972), the Outstanding Investigator Award from the National Cancer Institute (1985), The President's Award from the M. D. Anderson Cancer Center (2000), and the Edward H. Ahrens Jr. Award (2010).
In this wide-ranging interview, Dr. Freireich first tells the story of his best known innovation, the continuous flow blood separator developed while he was at the National Cancer Institute in Bethesda, Maryland (’55-’65). He discusses his close collaboration with Dr. Emil Frei, III and their creation of the Department of Developmental Therapeutic on coming to MD Anderson. He offers insights into the development of Institutional Grand Rounds, the Core Curriculum, the Physician’s Assistant Training Program, and efforts to develop patient-oriented research methods. Throughout, Dr. Freireich offers layered responses to questions that weave together medical information, historical context, institutional policies and politics, and his views on the central role of clinical research in making advances against cancer forms a major theme in this interview. Throughout his professional career, Dr. Freireich has championed the view that research proceeds from “Bedside to Bench and Back.” Dr. Freireich is articulate, candid, and a skillful (often humorous) storyteller. This interview showcases a strong personality. It’s not surprise that his irrepressible optimism that cancer can be cured comes through in this interview, since he believes that “hopelessness is the greatest trauma a human being has to suffer."