This is my first-ever blog post, and I am probably as surprised by writing it as you are by reading it. In this virgin attempt at social media, I will tell you a bit about myself, how I was encouraged to initiate this blog, a brief history of my re-involvement in ASCO, and a recent “tipping point” (at least for me) involving clinical research.
I came from a blue-collar background, got into a private Catholic University by accident, went to UCSF largely because it was the “local” medical school, and landed at NIH for fellowship mainly because that was the major career path available at that time to academic medicine (read “clinical research”).
I was lucky enough to arrive in Tucson in 1977 at the time its Cancer Center was taking off, and where I spent 12 highly productive years as a clinical researcher. And, of course, there was my fateful decision in 1989 to accept a position at UC Irvine as Cancer Center Director-in-waiting and, against all odds, leading the effort to NCI designation in 1994 and Comprehensiveness in 1997. I finished this stint in 2012 after 23 years, and here I am marveling at how the years have flown by.
And yet, when at age 60, a colleague asked me how I remained calm during a very visible verbal assault, I had no answer... but I do now. But, enough about myself... more later when I get to know you better!
Simply put, my muse and I chose my inaugural blog post title, “White Coat Conversations,” to reflect who I am: a clinical researcher with a deep interest in science and its application... bench to bedside and back again. I, like many of my generation, share a deep concern about the disappearing “physician scientist.” Although many colleagues have moved on to retirement, pharma, or narrowed pursuits in medicine or science, this physician-scientist is still punching (although there are days when it feels like the 14th round), and thus, my participation in this blog, or “White Coat Conversations” as I see it. Ultimately, doing this blog is a good opportunity to share my perspectives on being a physician-scientist in an ever-changing field.
Although an ASCO member since the early days—I had been minimally involved in the Society since 1997—so was quite surprised in 2011 to be asked if I would be interested in being Chair-Elect of the Prevention Committee. I could only wonder if someone was playing a joke on me, as I had previously launched the Prevention Committee in the year 1990 at the request of then President-Elect Coltman; the committee, however, was discontinued in 1994.
But I am glad that I answered the call. When I initially joined ASCO, it was almost like a secret club. Now ASCO has grown to 35,000 plus members with over 10,000 who are “international” (more on that term in the future). ASCO is no longer joined at the hip with AACR, and now larger by a factor of two and still growing; no longer just embracing “treatment” or “drugs”; and struggling to determine how to fully engage prevention, screening, genetics, genomics, risk, and newly emerging technologies (nano, Big Data, EMRs) into its portfolio.
Clearly in 2011, the Prevention Committee, then in the 10th year of its reincarnation, was struggling to find its place in the world of ASCO. I almost didn’t assume the mantle of Chair-Elect, but will be forever grateful that I did, as it propelled me—along with a similar offer to join C-Change and an opportunity to re-engage in a leadership position with SWOG—into the larger arena of national influence and the difficult continually evolving area of health care reform and its impact on all aspects of oncology. As a life-long clinical researcher (in modern parlance, translational), I began to think harder about the ever-expanding compliance, IRB, HIPAA, and ethical “guidelines,” and to ask broader questions.
In a memorable encounter two years ago following a superb lecture on the Accountable Care Act by the Director of HH District 9, I asked “What accommodations does the ACA have for clinical research or trials?” Dead silence. I have asked this question repeatedly in many other venues. Again... dead silence.
With the total reorganization and contraction of the national cooperative groups and the morphing of their activities into the National Clinical Trials Network (NCTN) and the National Community Oncology Research Program (NCORP), several questions needs to be asked repeatedly and in different ways: Whither clinical trials? What is their future, if any, in health care reform? Will genomics make clinical trials passé? Are we headed to the clinical trial of N=1? How will the oncologist keep up with all this data? Have EMRs been worth it? And on and on . . .
As I became more articulate about these issues, ASCO staff began encouraging me to start a blog. And the “tipping point” that I mentioned earlier? I attended ASCO’s recent Cancer Research Committee as the Prevention Committee Liaison and also signed up to attend ASCO’s Community Oncology Research Forum the next day.
I became aware that to move forward, I needed to be engaged in the national dialogue. I was received warmly at the evening reception and again at the meeting the next day. Nearly 100 community oncologists attended, and I was one of only three academically based oncologists present. The conversations and concerns of the community oncologists were similar to those of the academic community. But, they had the additional concerns of “small businesses,” since medical practices are now being re-engineered as large Accountable Care Organizations or with giant hospital systems, both trends that have limited physician engagement and influence.
As we move forward in an era of fiscal restraints and health care reform and with the support of biomedical research stalled, we need to remember that clinical oncology embraces a wide spectrum of individuals: physicians, nurses, pharmacists, caregivers, rehab specialists, technologists, and others. And how should we deal with “Big Business”? There is strength in numbers and diversity and the community and academic oncology community need to act as one to:
- Educate our diverse cultural communities regarding what is at stake
- Inform the decision-makers about what is really at risk short- and long-term
- Recognize that population health needs to be emphasized
- Sort out what really works and is cost effective
And, of course, we just wave the proverbially magic wand and all these issues will be solved!
Welcome to my blog, my “White Coat Conversations,” if you will. Civil feedback is welcome. Please add your comments below.