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and the bad news was that her marrow never came back either . She eventually died , leaving behind her husband and two young children , as we hoped against hope that her marrow would recover from complications of infection .
“Perseverance [ in science ] is key . Don ’ t do things because they ’ re easy to do ; do things because they ’ re important .” Caring for her was a moving experience . We had failed her and her family . Although we had the best intentions , I felt culpable because she ultimately died from complications of our treatment – not from her leukemia . Our patients deserve better ; this patient and her beautiful family didn ’ t deserve to deal with this out-ofthe-blue , fatal disease .
This experience represented the confluence of many factors that led me to pursue hematology : the need to apply a rigorous metric that I learned from Dr . Collier , the fascination with the science of blood disorder that was spawned by Dr . Bunn , and the desire to help people instilled by my parents . Caring for her was the crystallizing event of my career , and it ’ s why I do what I do today .
How has hematology changed since your experience caring for that patient ? That was in 1985 , when we had no clue about the genetic basis for diseases like myeloid leukemias or myelodysplastic syndrome . We could see translocations through cytogenetics , but we did not know whether those translocations were causal or what genes were
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involved in them . This also was more than a decade before the first version of the human genome sequence was released .
Today , of course , we have a near-complete catalog of every single mutation that contributes to the development of leukemia . For me , it ’ s exciting to have come from a time when we didn ’ t know the identity of a single gene that caused acute leukemia , to today , when we know what those genes are , how they function , and how we can target those genes and reactivate the immune system .
We ’ re able to help patients in new ways . We can take the progress that has been made about the genetics and molecular biology of the cancer itself – how the tumors are able to suppress the immune system and how we can override that to the benefit of patients – and translate those into clinically meaningful advances for our patients .
And , though I ’ m a bit more removed from the clinical frontlines than I used to be , part of the joy of being in hematology today is hearing from patients whose disease – which they were told was fatal – is responding well to the treatment they ’ re receiving at our center . When patients or their family members stop by my office to say thank you , it puts a lot of sunshine into any day , which counts for a lot in Seattle .
Now that the opportunity is there , what do you think are the barriers to bringing these curative approaches to patients ? There are a broad range of challenges for us . One , of course , is the complexity of the science . We need a deep understanding of the DNA sequence , the expressed gene products , and the epigenetic changes that happen in cancer . We are generating massive datasets ; now we need to develop the analytic tools to integrate terabytes of data with clinical patient information to understand how the data and the sequence relate to each other .
Funding issues are a serious concern , as well . I spend more time than I ’ d like working with our legislators on this issue . Generally , we enjoy wonderful bipartisan support on medical research funding . However , when ill-advised policymakers suggest that we should be cutting the NIH budget by 18 percent at a time when we are at an inflection point in developing curative approaches to cancer , that is a travesty – and , in my opinion , unconscionable .
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Policymakers appear to be attacking the finance of administration rates and the real costs of doing research . Recently , I testified before the House Appropriations Committee on the indirect cost rates , their importance , and why we can ’ t cut them . We will ultimately get to the point where we are curing cancer , but cutting funding means we will get there slower . There are people who died from cancer while I was testifying on the Hill ; that ’ s the sense of urgency that we need to feel going forward . There also is a bit of a mental obstacle to overcome among some hematologists and oncologists who have been in the field for a long time . We have been stuck in the frame of mind that , based on everything we have witnessed in clinical practice , once a patient ’ s cancer become metastatic , it can ’ t be cured . We use the euphemism , “ We can treat your cancer ” – the implication being that we can ’ t cure it . But , today , we can say that there are curative approaches for some of our patients .
“When patients or their family members stop by my office to say thank you , it puts a lot of sunshine into any day .” It ’ s a different way of thinking , and , honestly , it might be a little scary for some of us . Accepting that we have therapies with curative potential puts the burden of responsibility on the healthcare system and health-care professionals to make sure that we implement them . We have to make sure that we have that shared vision moving forward .
The important thing to remember
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is it is possible . The science shows we can get there . The fun part is seeing hematologists and oncologists as thrilled as I am about the responses we are seeing . The crowd of believers is growing rapidly .
You worked in the pharmaceutical industry for five years before returning to academic medicine . How did that experience change your perspective ? That experience was incredibly helpful for me , both to gain insight into how the pharmaceutical industry functions and the value that it brings . It was a humbling experience for me because I think many people assume that academicians are smarter , more passionate , and more compassionate than people in industry , but I learned firsthand that that ’ s not true . I think people don ’ t always appreciate how important the pharmaceutical industry is . We wouldn ’ t have the drugs that we have today without their help .
What do you enjoy doing outside of medicine ? I enjoy playing piano – it was torture for me when I was young , but I ’ ve grown to love it . My wife and I also love to go camping , although these days that takes its toll on the body more than it used to . We recently took a trip to Denali National Park in Alaska , and we ’ ve been to Yellowstone National Park about 25 times – we love it there . It ’ s our favorite place to camp and fly-fish . It ’ s also a place where we can just get away from the outside world ; there are only a few areas in the park with cell service , which we assiduously avoid .
What would people be surprised to learn about you ? In all areas of science , one is expected to have a relatively extroverted personality – big handshakes , big smiles , self-confidence – to help push success forward . We speak with patients , we talk at scientific meetings , we work with philanthropists , we meet with our local politicians . This is all part of being successful in my role as a representative of Fred Hutch . In reality , though , I am deeply private and value the quiet time that I have away from the manic crowd . That ’ s why I find camping in the middle of nowhere or tuning out from the rest of the world by playing piano so enjoyable . Then I come back , put on my game face for upcoming meetings , and switch back into extrovert mode . ●
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