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0:02 - Segment 00B: Interview Identifier

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Partial Transcript: "There we go. Okay. So we are now officially recording, and the time is 9:45, and I’m in the Historical Resources Center Reading Room this morning with Dr. Raymond Alexanian. Today is the fifth of June, 2014."

Segment Synopsis: Interview session information

Keywords:

Subjects:

0:22 - Segment 10: Threats to MD Anderson’s Status: Losing Focus on Innovative Research and Problems with Regulatory Procedures

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Partial Transcript: "And before we turned on the recorder, you mentioned an issue that you wanted to address, an observation you’d made, and I wondered if you would kind of continue making that point for the record."

Segment Synopsis: In this section, Dr. Alexanian comments on the uneven focus on innovative research among the faculty during his years at MD Anderson.

He explains innovative clinical researchers in many sections were not promoted or recognized for their work and often left the institution. He cites several areas that are making innovative contributions and acknowledges that factors outside the institution create fluctuations in national standing and research contributions.

Dr. Alexanian next sets some context for the research activities at MD Anderson, beginning with Dr. R. Lee Clark’s desire to build a research mission into every department at the institution. He lists factors that accelerated research progress in the 60s, though he notes that many faculty were hired to be clinical experts in their field and had no desire or capacity to do research, leading to conflicts between clinical and research faculty. He uses the treatment of Hodgkin’s disease as an example of a conflict.

Keywords:

Subjects: 1. Segment Code -- B: Critical Evaluation 2. Story Codes --A: The Researcher A: Critical Perspectives A: Professional Values, Ethics, Purpose A: The Clinician B: Beyond the Institution B: Critical Perspectives on MD Anderson B: Institutional Processes B: MD Anderson and Government B: MD Anderson History B: Obstacles, Challenges C: Professional Practice C: The Professional at Work

18:35 - Segment 11: Regulatory Procedures: A Critical View

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Partial Transcript: "And one of the second peeve—well, not peeve—second issue that you may wish to bring up with others is that as the years have developed, the regulatory climate has become more oppressive so that it has become much more difficult to develop new programs or new treatments or new techniques, and there is a sense that the regulatory machinery is maintained more to follow the process of review rather than attempting to expedite the research. It used to be the original period, the regulatory review was, say, well, how can we improve that research, how can we add more resources, and how can we add more departments to your combined therapy project? That was the internal review."

Segment Synopsis: Dr. Alexanian offers his views on the “regulatory climate” at MD Anderson, another source of difficulties for the institution.

He explains the reasons why MD Anderson has created an increasingly cumbersome set of regulations for clinical research. He notes that early regulatory mechanisms facilitated research, but the current system exists for future government review processes. As an example of how current review processes may hinder research, Dr. Alexanian offers the example of Dr. Bart Barlogie’s use of thalidomide (most likely without regulatory approval, he notes) to successfully treat patients dying of myeloma. He contrasts two attitudes toward clinical research: “Do no harm” versus “Try only after exhaustive review and delay.”

Dr. Alexanian also explains that because of complex internal regulatory procedures, MD Anderson is often the last institution to enter patients into multi-center clinical trials.

Keywords:

Subjects: 1. Segment Code -- B: Critical Evaluation 2. Story Codes: --A: The Researcher A: Critical Perspectives A: The Clinician B: Beyond the Institution B: Critical Perspectives on MD Anderson B: Institutional Processes B: MD Anderson and Government B: MD Anderson History B: Obstacles, Challenges C: Professional Practice C: Research, Care, and Education C: The Institution and Finances C: The Professional at Work C: Understanding the Institution

29:02 - Segment 12: Chief of the Myeloma Section, 1998 – 2004: Leveraging Resources and Mentoring Young Faculty

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Partial Transcript: "Would you like to talk now about some of the administrative roles that you served?"

Segment Synopsis: At the beginning of the segment, Dr. Alexanian and the interviewer review CV entries for relevance to the discussion. Next, Dr. Alexanian explains the evolution of the focus on the Myeloma Section. He explains that he was the only person working with myeloma between 1964, when he arrived at MD Anderson, and 1984, when Bart Barlogie joined the institution. They next formed an association with the Transplant Department, and Dr. Alexanian notes the “easy melding” of departments at MD Anderson where credit and projects were shared. He next sketches his activities as section chief –largely leveraging resources already in existence. Dr. Alexanian talks about the advantages that MD Anderson offers the researcher.

Keywords:

Subjects: 1. Segment Code -- B: Building the Institution 2. Story Codes --A: The Researcher A: The Administrator A: The Clinician B: MD Anderson Culture B: Multi-disciplinary Approaches C: Mentoring

39:52 - Segment 13: Mentoring Young Faculty in Research Flexibility and Writing Skills

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Partial Transcript: "And one of the issues, somebody can say, “Well, I can’t do any research because we can’t do this special test here.”

And I’d say, “How can you say that? You don’t have to do that particular new thing. How about these other things as a young person you could develop that’s already here? "

Segment Synopsis: In this segment, Dr. Alexanian explains how he would advise young faculty to be flexible in their research and pace their careers, taking advantage of existing resources whenever possible. He notes the importance of mentoring to careers. He also stresses the importance of writing skills to a research career.

Keywords:

Subjects: 1. Segment Code -- A: The Educator 2. Story Codes --A: The Mentor C: Mentoring D: On Research and Researchers

43:35 - Segment 14: The Research Committee; The Surveillance Committee

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Partial Transcript: "Would you like to tell me a bit about some of these committees that you were working on? Because they kind of came at interesting times. One of them was, that you were on pretty early, 1971, various times over the course of your career into the mid-eighties was the Research Committee. What exactly was that?"

Segment Synopsis: Dr. Alexanian explains the roles of the Research and Surveillance Committees in this segment. He begins with the Research Committee and notes that it was most likely established by Dr. Clark to advise faculty on their research projects and make sure that projects did not overlap. He describes how the process worked and gives some examples of issues discussed.

Dr. Alexanian explains that the Surveillance Committee was created when the NIH required that institutions evaluate their patient protection procedures and contracted with institution individually to formalize these procedures.

Keywords:

Subjects: 1. Segment Code -- B: An Institutional Unit 2. Story Codes --B: Institutional Processes B: Building/Transforming the Institution B: Devices, Drugs, Procedures B: Institutional Mission and Values B: MD Anderson Culture B: MD Anderson History B: MD Anderson Impact B: MD Anderson Snapshot B: Multi-disciplinary Approaches C: This is MD Anderson

50:27 - Segment 15: “The Research Report”: an Innovative Communication Device for MD Anderson

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Partial Transcript: "So when you first came on, were you—the committee was formed in 1970—well, that’s—"

Segment Synopsis: In this segment, Dr. Alexanian talks about activities of the Research Committee, particularly its publication of MD Anderson’s yearly Research Report, which helped build cooperation between departments and also documented faculty activities even if they were not publishing. He recalls learning at a conference that “other centers did not have the process as well-oiled” and their faculty were amazed at the activities and contributions of the Research Committee. He also tells a story of reporting this to R. Lee Clark, who “beamed.”

Dr. Alexanian briefly sketches Dr. Clark’s vision and notes that MD Anderson was founded because of un-met cancer care needs in Texas, particularly in the area of women’s cancers.

Keywords:

Subjects: 1. Segment Code -- B: Building the Institution 2. Story Codes -- B: MD Anderson History B: Devices, Drugs, Procedures B: Institutional Mission and Values B: Institutional Processes B: MD Anderson and Government B: MD Anderson Culture B: MD Anderson Impact B: MD Anderson Snapshot C: On Texas and Texans C: Portraits C: This is MD Anderson

59:37 - Segment 16: The Faculty Classification Committee and Related Issues with Tenure and Promotion

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Partial Transcript: "Let’s see. There’s also this—I didn’t know what this committee was—Faculty Classification. What was that about?"

Segment Synopsis: In this segment, Dr. Alexanian discusses the Faculty Classification Committee and its activities standardizing the guidelines for promotion and tenure across departments. He notes that MD Anderson’s guidelines were less stringent than at Harvard or Yale Universities. Next he explains MD Anderson’s term tenure system, made necessary when MD Anderson formally came under the governance of the University of Texas System. He describes the Committee’s roles in the tenure process.

Keywords:

Subjects: 1. Segment Code -- B: Building the Institution 2. Story Codes --B: MD Anderson Culture B: Building/Transforming the Institution B: Institutional Processes

78:53 - Segment 17: The Patent Committee

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Partial Transcript: "I’m looking at some of the other committees you were on. Wow. You were on the Surveillance Committee for a while. Then there was the Patent Committee. Was that interesting [unclear]?"

Segment Synopsis: In this segment, Dr. Alexanian talks about the Patent Committee, designed to provide early documentation of innovations which would late be patented. He gives an example of a device invented by the nursing service to administer chemotherapy.

Keywords:

Subjects: 1. Segment Code -- B: Building the Institution 2. Story Codes -- B: MD Anderson Culture B: Building/Transforming the Institution B: Discovery and Success B: Institutional Processes

83:46 - Segment 18: The Transfusion Task Force and National Transfusion Standards

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Partial Transcript: "What about the Transfusion Task Force?"

Segment Synopsis: In this segment, Dr. Alexanian talks about his work on the Transfusion Task Force (1997 - 2004). He explains that it was set up to establish criteria for giving transfusion and he set about simplifying the guidelines. He also notes that the Task Force set up blood rallies and organized the first employee blood drive. He also gives background on the waiver that all patients sign on intake to MD Anderson which allows transfusions.

Keywords:

Subjects: 1. Segment Code - B: An Institutional Unit 2. Story Codes -- B: Institutional Processes A: Critical Perspectives B: Education B: Growth and/or Change B: MD Anderson Culture

89:34 - Segment 19: The Summer Students Program; Changes in MD Anderson Culture

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Partial Transcript: "Let’s see. I’m looking at were there any others that stick in your mind? Because we have just a few other committees, but do you think we’ve hit the big ones?"

Segment Synopsis: In this segment, Dr. Alexanian talks about the Summer Students Program that brings high school students into MD Anderson to conduct their own research programs.

Keywords:

Subjects: 1. Segment Code -- B: An Institutional Unit 2. Story Codes -- B: Institutional Processes A: Critical Perspectives B: Education B: Growth and/or Change B: MD Anderson Culture

93:07 - Segment 20: The Value of Committee Work; Changes in MD Anderson Culture and the Need for Mentoring

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Partial Transcript: "Any other observations you want to make on committees at this point?"

Segment Synopsis: In this segment, Dr. Alexanian explains that committee work is not “a waste of time” as so many faculty believe. He notes that committee discussions with conflict can be very helpful in bringing important issue to the foregrounds for resolution.

In the final minutes of this segment, Dr. Alexanian notes changes in MD Anderson culture: Department heads no longer mentor as actively nor do they foster as much exchange among faculty. He explains what is needed in a good mentoring relationship.

Keywords:

Subjects: 1. Segment Code -- B: Critical Evaluation 2. Story Codes -- B: Institutional Processes A: Critical Perspectives A: The Mentor B: Education B: Growth and/or Change B: MD Anderson Culture C: Mentoring

102:22 - Segment 21: Retirement and Contributions

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Partial Transcript: "Why did you decide to retire when you did in 2004?"

Segment Synopsis: Dr. Alexanian begins this segment with an explanation of why he cut back his work schedule to two days a week for seven to eight years, taking full retirement in 2013. He lists the activities he participates in now, noting that he plays tournament bridge and holds the rank of Silver Life Master.

Next Dr. Alexanian notes that he has made important contributions to medicine and his field as well as helping the institution evolve and become the leading cancer center in the world. He explains some of his reservations about the Moon Shots Program initiated under Ronald DePinho.

Keywords:

Subjects: 1. Segment Code -- A: View on Career and Accomplishments 2. Story Codes -- A: Career and Accomplishments A: Character, Values, Beliefs, Talents A: Critical Perspectives A: Personal Background A: Post Retirement Activities

0:00

 ROSOLOWSKI:

There we go. Okay. So we are now officially recording, and the time is 9:45, and I'm in the Historical Resources Center Reading Room this morning with Dr. Raymond Alexanian. Today is the fifth of June, 2014.

So thank you very much, Dr. Alexanian, for coming in again this morning.

ROSOLOWSKI: +

And before we turned on the recorder, you mentioned an issue that you wanted to address, an observation you'd made, and I wondered if you would kind of continue making that point for the record.

ALEXANIAN:

Yes. You invited comments on any areas that might be of interest and might be different from those normally explored, and one issue has been over the years that there are many sections that have a cadre of scientists and clinical leaders who are exploring new research opportunities either in basic research or in clinical trials or in new therapies such as transplant or immunotherapy, and are making progress in their areas, but are often not recognized for their work and either not promoted in a timely manner or attracted elsewhere as other centers recognize the competence of these individuals, and therefore we lose on our own standing. And this is not across the board. Many of our department, since we're dealing with more than a hundred different types of cancer, there are many areas of focus.

So some areas are holding their own in terms of national standing and competition for new knowledge, where others steadily fall behind because of perhaps resources or patients or personnel or, in some cases, the inclination of the department heads not to embark on certain research programs that might deflect from the clinical missions, and therefore staff is required to spend more time on patient care, and often the patient care is no better than what's in the community, whereas others embark on newer things that have a chance of improving welfare at the same time as maintaining the best possible care and opportunities for patients and programs.

ROSOLOWSKI:

Are you able to share basically some divisions that you feel are making enormous headway in new knowledge versus others that have been more entrenched?

ALEXANIAN:

Well, in my particular area, I have felt that in myeloma we have made progress, and leukemia is one of our star departments in terms of transplant department, has melded their technique and technology and resources with those of other departments so that there are strong cooperative links with the other departments that use transplant opportunities. Certain clinical departments such as medical [unclear] are leaders in the field or recognized, and the departments that are recognized are pretty well known to the staff because there is national recognition and awards and so on. So my comments suggest primarily those in hematology, and these comments change, so that's from decade to decade, obviously. So some—

ROSOLOWSKI:

Right. I was going to ask you that, yeah.

ALEXANIAN:

—become leaders and some fall behind, and a lot depends on the personnel, the resources in terms of grants and patients and other things, so that this is not a consistent opinion, so there's variability.

ROSOLOWSKI:

I mean, I was curious because you came to the institution in 1964 and obviously were very involved in developing a research focus at that time and were working very actively with people who were busy pushing the envelope with treatment. So as you're thinking decade to decade, I mean, what was this problem like in the mid-sixties, you know, and did you see changes in that balance? Did the institution, in your view, have a better record, you know, a greater percentage over time of faculty who were involved in that kind of pioneering research or has it remained the same? I mean, what's your diagnosis over time?

ALEXANIAN:

My view of it is maybe different from that of others, but in the 1960s when I was recruited, Dr. Clark recognized that there was a potential for important breakthroughs in cancer that were stimulated by the National Cancer Institute and their funding outlets that became more generous, so that he attempted to instill in departments the research mission, even though he himself was not that directly involved, although he may have been in his earlier years. But he felt that since the funding resources became more generous and expansion of the hospital in terms of physical stability and patient referrals were rising, that here was an opportunity to build up the research cadre, and there were also new technologies like CAT scans and MRI scans, transplant, new drugs, new combinations of new and old drugs, and so on, so that he was able to craft this thrust into these new areas. So I think that's what I recognize, although I was very junior here, and I had the sense that this was the reason that I was hired here, you might say.

ROSOLOWSKI:

But it sounds like it was also a little bit of a cultural shift, that maybe the people who were already hired here, there were a good number of them who hadn't anticipated that their careers would be required to take this kind of a turn.

ALEXANIAN:

Well, those who were here, already here, were those staffed initially by Dr. Clark as clinical staff, and they were expert clinicians in their field. Many of them did not have an interest in research or the capacity for it, had no training in that area, and so there was, depending on department, by department, some resistance to that notion. "Why should my patients go into this program when he's doing okay this way?" and so on.

So in order to create something new, you have to clash in some ways, educate, you might call it, and so there were often a series of mini confrontations in this sense, and usually these were resolved very amicably because of the family nature of the hospital that was kind of in a—that the team sense tended to balance the righteous new research push sense, you might say. There was a melding of interests so that as time went on, it was clear that the new ways were successful, and therefore they were pursued with different intensities or vigors.

And, of course, we're talking about not just one disease or area. We're talking about differences in different areas so that as with progress in many places, the advances came in, little steps in each different area at different times, so that sometimes there would be steps forward in one disease and then another disease and so on and so on.

Like one of the first controversies I remember was the treatment for Hodgkin's disease. Hodgkin's disease was a disease that was usually untreatable and incurable, and with the development of combined therapy such as chemotherapy, radiation therapy, staging, so that one could determine who would be potentially curable with radiation alone, who required combination therapy, and so on, this type of approach where medical and radiation therapy and possibly transplant-supported therapies were integrated could be done more easily at a center like MD Anderson, where all of these resources were available and where there was equivalent motivation by individuals in these different areas.

But it wasn't easy. There was a period of steps and years of education, although it became accomplished here so that we were one of the first centers to apply such combined therapies, so that we now look on Hodgkin's disease as cured in a large fraction of patients. And similar approaches were applied to lymphoma and leukemias and so on that were combined therapies and new therapies such as treatment of or prevention of meningeal leukemia, such as in children, so that children's leukemia, which was once incurable, is now cured. I'm not saying that we were the pioneers in that particular area, but we certainly—our group followed up on advances elsewhere. So each area had its own pace of progress.

ROSOLOWSKI:

Now, obviously a key player in bringing—or key group of players in bringing this research focus to the fore at MD Anderson were all of the personalities involved with Developmental Therapeutics. And I guess, you know, one of the reasons I'm so glad you brought this up is that I have assumed that once developmental therapeutics came in and there was a period of adjustment to this new perception and there were certain administrative changes, that basically the commonly held mission of the institution to do pioneering work filtered out through the entire faculty. And I guess what you're telling me is that is not necessarily the case.

ALEXANIAN:

No, I think Developmental Therapeutics were the leaders in the program I just mentioned.

ROSOLOWSKI:

Right.

ALEXANIAN:

With Dr. Frei and Dr. Freireich, the combined therapy was carried by them from the NIH, where they had originally done this work, and therefore applied here. Hodgkin's disease is one of the examples I mentioned, and leukemia the second. These were developed through Developmental Therapeutics, so they were the leaders in the field, but the other aspects such as radiation therapy—and here is where you might want to interview Dr. Fuller, Lillian Fuller, because she was one of the leaders in combined therapy.

The other parts of hematology, like myself, learned from developmental therapeutics and tried to apply those principles in myeloma and other diseases related to myeloma, and I think the same principles were then also applied to breast cancer and other solid tumors where chemotherapy is often given first in order to reduce the bulk of cancer, so that resection may be more complete and then followed with radiation therapy. So the combined modality approach was pioneered by the Developmental Therapeutics here, but the application was done through each department separately so that while they were the leaders, I think it's a mistake to say that they were the only group who were pursuing this.

ROSOLOWSKI:

Right. I didn't mean to imply that, if that's what you thought I said. I guess what I was thinking, more of a shifting, shifting the focus of the institution, that there became more and more individuals at MD Anderson who were doing that kind of work—

ALEXANIAN:

Yes, that's right.

ROSOLOWSKI:

—rather than focusing strictly on clinical care, as you said the original staff did.

ALEXANIAN:

Yes. And also, as travel became easier, we were also influenced by other centers' work and so that we were more aware of what might be useful elsewhere, although we considered ourselves the leaders. Of course, that may be an ego expression. So there was more interchange and we became more aware of other people's work as we not only heard their presentations but also reviewed their papers before they were published. So we learned rapidly what was happening.

But we also—it's not just learning, but you have to then say, well, we have to then apply it ourselves and push it through our own system.

ALEXANIAN: +

And one of the second peeve—well, not peeve—second issue that you may wish to bring up with others is that as the years have developed, the regulatory climate has become more oppressive so that it has become much more difficult to develop new programs or new treatments or new techniques, and there is a sense that the regulatory machinery is maintained more to follow the process of review rather than attempting to expedite the research. It used to be the original period, the regulatory review was, say, well, how can we improve that research, how can we add more resources, and how can we add more departments to your combined therapy project? That was the internal review.

Now the review is more focused on are we following the rules so we don't make any mistakes, so that we don't approve drugs that shouldn't be approved, or we're focusing on if we make a mistake and we're audited by the FDA, are we going to be disciplined. There's more of a self-protective emphasis rather than an original emphasis.

Of course, I'm speaking as an old-timer here, so that I recognize that we need the regulatory review because there are throughout the country a small percentage, perhaps less than 5 percent, of scientists who abuse the rules, who do improper things, avoid getting consent, and cut corners and this. It's like police work, when we have police mainly to protect 95 percent of the people from the 5 percent who speed or rob or steal or do other mischievous things. That's why we have police. So now we have a regulatory group to protect us from the 5 percent, but then we, in a way, impede the other 95 percent. You have not heard that before?

ROSOLOWSKI:

Oh, I have heard that before. I mean, there are a number of individuals who've talked about the regulation processes and some—I mean, I interviewed Ralph Friedman [Oral History Interview], who obviously was very involved in institutional review boards and very concerned about these ethical issues. And there have been a number of people who've spoken about, you know, the poisonous things that can happen when people do cut corners and what can happen to the individual who's found out.

ALEXANIAN:

Do they mention poisonous things happening here?

ROSOLOWSKI:

Yes, they have mentioned some things. I mean, never by name, but issues that have arisen.

ALEXANIAN:

Well, there's always a small—there's always a thief among you when there's so many people. And the question is—you might look into the history of—like, for instance, you've heard of the drug Thalidomide.

ROSOLOWSKI:

Oh, yes.

Raymond Alexanian MD

Thalidomide used to cause birth defects. But then when Dr. Barlogie was here with me, and then had since moved to Arkansas, he was faced with a patient who was dying from multiple myeloma, and he looked for an opportunity to treat this patient. And I have enormous respect for him because he is one of the more adventurous scientists who has led us forward in this area. So he had heard from another scientist in Boston that this old drug, Thalidomide, would do certain things in the test tube that might help patients with myeloma because of its particular features.

So it happened that Thalidomide had already been commercially approved to treat some rare skin problems that patients with HIV had, so he could then give it to patients with myeloma, which he did. And I won't go into whether he had regulatory approval or not. I suspect he didn't, as I would not have. And he found that it was successful and it was effective. Then that class of drugs became one of the major classes of drugs that were used as effective treatment for myeloma. And although one could have followed a regulatory pathway which might have taken several years to develop in terms of approvals and grants and money and drug and so on and so on, here this was given empirically and found to be effective. So I'm not saying this is what you trade off for in terms of the regulatory things.

ROSOLOWSKI:

Well, there's no doubt that very complicated and increasingly complicated ethical dilemmas and research dilemmas arise as you're investigating novel treatments.

ALEXANIAN:

Well, you know, the ethical dilemma, there was a man called Hippocrates who said, "Do no harm." Let's say, as an example, you have something that might be useful but has no harm, no side effects that you know of, [unclear] others, and has not been tested in such a process. The ethical dicta was do no harm, not don't try anything because it might do some unknown harm we hadn't seen.

So I have tremendous respect for Dr. Friedman, but the "do no harm" thesis when applied across the board means "do not try" or "try only after we have had exhaustive reviews and approvals and delays." It probably shouldn't surprise you that when there are clinical trials that are multi-center trials, that in these multi-center approvals that we are usually the last institution to get our approvals through the mill, that many times a trial has been completed by the time we even enter it.

ROSOLOWSKI:

Why is that?

ALEXANIAN:

I think it's because our regulatory—unless it's changed in the last couple of years, our regulatory apparatus is so oppressive that, first of all, many of our scientists know that and don't even bother joining, saying, "Well, don't wait for us. We have all this and that to do." Or, "Okay, we've started," and by the time the trials are moving on, the trial needs fifty patients in the trial and they have already enrolled forty-five, says, "Okay, we'll enroll one or two at the end." So it's very oppressive, so it's not worth—and it might be useful for somebody to get a poll on how many multi-center trials we are participating in—

ROSOLOWSKI:

Interesting.

ALEXANIAN:

—and how late they—from the time it was approved and from the time to when we were allowed to enter, that time frame is the longest; has been.

ROSOLOWSKI:

Interesting, yeah. I wasn't aware of that. You're the first person who's mentioned that lag.

ALEXANIAN:

In contrast, when the trial is initiated here and, therefore, we have the, let's say, resources of drug support or grant support and begun here and we are asking others to join us, at those trials we're the first. So I'm talking about—so there's some variability. Certain trials, if they're initiated here, we're the first. If they're initiated elsewhere, we're often the last. So there's a mixed—

ROSOLOWSKI:

Right. Interesting. Very interesting.

ROSOLOWSKI: +

Would you like to talk now about some of the administrative roles that you served?

ALEXANIAN:

Oh, sure. Well, I don't think I've done much administration here. I've been on lots of committees.

ROSOLOWSKI:

Yeah, and I was interested in those committees, actually, because, I mean, for when they were and what they focused on, but I guess I wanted to start with your role as deputy head and head of section, just to kind of get a handle on what you did there. From 1980 to 1983, you were deputy head of the Division of Cancer Medicine, as I understand.

ALEXANIAN:

Well, that was, I think, an administrative appointment, where deputy means when the chairman cannot attend a meeting, you attend in his place. So I would say that was more of a title.

ROSOLOWSKI:

More of a title. And was that the same situation from '95 to '98 with deputy head of hematology as well?

ALEXANIAN:

Yes.

ROSOLOWSKI:

Okay. But from 1998 to 2004, you were head of the section of lymphoma and myeloma, correct?

ALEXANIAN:

No, I don't think that's right. Well, was I? 1998 to—

ROSOLOWSKI:

2004.

ALEXANIAN:

I would say my primarily administrative would be the head of myeloma.

ROSOLOWSKI:

Okay. And that would—maybe that's the [unclear].

ALEXANIAN:

I don't even think it was a title.

ROSOLOWSKI:

Yeah, it says section chief, myeloma.

ALEXANIAN:

When I began here, I was the only one doing myeloma for quite a number of years, maybe twenty years, and therefore I was the head of myself. (laughter) I shouldn't say that, because when patients were sick and had to be hospitalized, we had our whole department, small department, rotated in caring for patients who needed hospitalization. But in the clinic I was the only one to see these patients for twenty years, and then Dr. Barlogie joined me, and I'm trying to remember the year. Must be in the 1980s sometime.

ROSOLOWSKI:

Yeah, if that was twenty years, then it's around '84 or something like that.

ALEXANIAN:

Something like that.

ROSOLOWSKI:

Yeah. Okay.

ALEXANIAN:

Then he and I worked together as partners, and he was the inspiration for many of the new things. However, I continued also building on many of the things I had begun so that the publication record speaks for itself on who did what, I think, and so we were a very good team. Then the transplant service joined our team somewhere in there, and the papers reflect the timing of that, and so that—

ROSOLOWSKI:

What was the transplant service attached to before joining [unclear]?

ALEXANIAN:

No, no, they didn't join. They were independent.

ROSOLOWSKI:

Okay.

ALEXANIAN:

Dr. Dicke, Karl Dicke, D-i-c-k-e, developed that section, and he had a small cadre of people that worked with him, and then this expanded as the successes became evident in a number of areas. Then Dr. Champlin came to replace Dr. Dicke, and the dates of that I'm not clear on, and I think the papers would reflect that.

ROSOLOWSKI:

Now, so was the transplant group, was that—

ALEXANIAN:

Separate.

ROSOLOWSKI:

—formally called the Transplant Group?

ALEXANIAN:

Yes, it's a transplant department.

ROSOLOWSKI:

Transplant department. Okay.

ALEXANIAN:

Yes. As you know from in the transplant—we're talking about bone marrow transplant and then stem cell transplant, so not organ transplant.

ROSOLOWSKI:

Mm-hmm. Yeah, you talked about your transplant work last time.

ALEXANIAN:

Yeah. So that's one of the advantages of a center like ours, is the sense that there was an easy melding of departments where there was shared opportunities and shared credits in terms of papers and grants and so on, so whereas this was easier for us than for many other outside centers.

ROSOLOWSKI:

Mm-hmm. Mm-hmm. And this was also prior to the period of enormous growth so [unclear].

ALEXANIAN:

This was at the time during the—now I'm talking—the first combined was with radiation and then transplant, so that there were different techniques. And now we're talking about immunotherapy, different newer techniques that are showing promise.

ROSOLOWSKI:

Mm-hmm. So as head of section, when you kind of took on that role formally, were there any specific changes in the power that you were given to make decisions, the resources that you were given to develop the areas? What happened with that?

ALEXANIAN:

Well, you try to exploit the opportunities you have in terms of personnel, patients, techniques, financial support, and so you decide, first of all, what is the most promising area of research and advance in your field, and then see how you can apply what you have to make those advances, and then show in terms of papers and studies and larger numbers of patients—see, one of the advantages here, the major advantage of MD Anderson is a large numbers of patients with diversity, with diverse features, combined with the resources in terms of diverse technologies and techniques, and so that one can apply these so that one can—just a small number of people, like myself and Dr. Barlogie, with the numbers of patients we see and applying the new methods quickly, we can develop better treatments and better ways of understanding. And Dr. Barlogie also provided a special laboratory support in terms of—I was going to say DNA, RNA, and typing facilities that he was able to apply to patients with myeloma.

ROSOLOWSKI:

So in 1998, when you were given the title of section chief, did you have resources from the administration that enabled you act on some of those strategic pathways?

ALEXANIAN:

As I mentioned, resources are the number of patients—when we're dealing with drugs and laboratory, we have samples and bone marrow studies, and the laboratory—see, the laboratory was able to do cytogenetics, and we could do special technology procedures with some of the staff in laboratory medicine. Laboratory medicine is a crucial part of the work in myeloma, in terms of special tests, one test called electrophoresis, and that's very important in myeloma studies.

So our work with the clinical special chemistry and bone marrow, the facilities were already there, the application of certain programs to the patients who were also already there, and one thing that I always felt, which I commented on before, is that for every new patient that I saw, there was a database. His data was recorded in a database in terms of his clinical and laboratory features and so on, so that the follow-up could be done more easily. So there was no special providing of—that's one of the great advantages of a place like this, you have the resources.

ROSOLOWSKI:

Mm-hmm. They're already available.

ALEXANIAN:

And one of the issues, somebody can say, "Well, I can't do any research because we can't do this special test here."

And I'd say, "How can you say that? You don't have to do that particular new thing. How about these other things as a young person you could develop that's already here? Don't look for something that might not come here for five years. You have your own career to develop. You need to get some papers written. Why don't you do with what you have first as you simultaneously work on getting the other things for five years?" So there's a kind of a—you have to in some ways inspire people to look to your career, make your discoveries with what you have as rapidly as you can, get a name for yourself gradually, and then if you have some—I guess what I'm saying is get your singles and doubles in as a young person and then get the home run when you're a little bit on more secure ground and have everything.

ROSOLOWSKI:

Interesting, yeah, a strategic plan for a career.

ALEXANIAN:

Yeah. That's why many people get discouraged too easily because they're not—I don't think some of them may not be led in the way that I would do. And also another painful thing is that many people, when they have a finding, made an observation, I say, "You've got to have this presented at a meeting and have a paper, write it up," they'll say, "Oh, I don't know how to write. I'm too lazy to write. I can't do this and that and so on."

I say, "Never mind. I want to see a draft next month summarize this, this, this," and next month comes and very little is done. "Look, I'm serious. I want something in writing. This is your job," and blah, blah, blah, blah. You have to work with young people in terms of writing. Writing comes hard. Even Ernest Hemingway took weeks to write; it didn't come in an hour. You have to work at things. So writing is one of the important aspects that I have a focus on. I think it's important to get it right, get the draft written, get it accepted, and even then when you submit a paper, it's not the end of it. You get critiques. You have to do some things over again and so on. You have to work hard with the system. And too little of that is done now. There's a certain laziness, I call it, to writing, even though the observations are there, and very little happens. Then what do you find? You open the journal, then you find, oh, Mayo Clinic just wrote the same thing that you had all the data on for two or three years, and there it is.

ROSOLOWSKI:

Yeah, the missed opportunity.

ALEXANIAN:

And it's gone.

ROSOLOWSKI:

Would you like to tell me a bit about some of these committees that you were working on? Because they kind of came at interesting times. One of them was, that you were on pretty early, 1971, various times over the course of your career into the mid-eighties was the Research Committee. What exactly was that?

ALEXANIAN:

Yes. In those days, the Research Committee, that was first established by Dr. Clark so that representatives from different disciplines, surgery, radiation, so on, could advise a doctor on his research project to see if they could participate, they could make some suggestions. This was not like the Regulatory Committee now. It was, as I mentioned earlier, to offer improvements and suggestions.

Part of it was developed so that—part of the rationale was that if there were some research in an area, that it wouldn't offend or step on the toes of another department that was also—instead of operating, they were radiating or something like that. So it was a way of keeping peace among departments. He transformed the wording in terms of contributing to the work, but in the background it was not muscling in on my territory. If I don't want to give radiation and I just want to operate, I just want to operate. Or if I want to give radiation, I just want to radiate, so, blah, blah, blah, blah. So it was meant to meld the group, and this was a very healthy process.

ROSOLOWSKI:

Interesting.

ALEXANIAN:

There was some heads clashed and so—

ROSOLOWSKI:

Do you remember some incidences, some specific incidences where—I mean. (laughs)

ALEXANIAN:

Yeah. It's so long ago. I guess as the chairman I was considered the peacemaker since I—in those days, the forces of the clashing was surgery and radiation. Chemotherapy was kind of new, but then as chemotherapy became more and more successful, as I mentioned with the combined therapy, you see the combined therapy led to cures, whereas before, the individual therapies did not. So it was a transforming model, Hodgkin's disease. So then as much as possible, this was incorporated, and then—

ROSOLOWSKI:

So then how did it work? I mean, so someone would come—

ALEXANIAN:

Submit a project in writing, and this would be reviewed by two people, and that would be presented to the committee with the sponsoring person present. He would hear the clash of—I think that's the way it went. And as a moderator, I would devote certain time, and also since you'd have the written opinions of the critiques, you'd try to see how much common ground could be covered.

Sometimes it was something like, oh, what's a good way of getting funding for this, or who's the funding agency, or could we work with some other centers or cooperative center. So it was a way of—or there may have been some need for another hospital nearby who had a procedure that we couldn't do, like kidney biopsies. This is something we didn't do here but could be done at other centers. So we would discuss these. I'm not saying that [unclear]. So at least it was meant to be a scientific clinical discussion of what would be the best way of moving this forward, and then at the same time we would try to give the investigator newer, maybe go a little further, go a little faster, go a little in this direction. So it was a resource.

Then as the years went by and the regulatory apparatus from the NIH required what we called patient protection, evidence of patient protection, and so we had what we called a Surveillance Committee.

ROSOLOWSKI:

I noticed that too, right.

ALEXANIAN:

I was on that too.

ROSOLOWSKI:

Yeah. That was [unclear].

ALEXANIAN:

Those were two different committees at the time. So in some ways we've continued that. We call it something—another name.

So the project that you'd submitted would pass the Research Committee, then would come to this other committee to make sure that the requirements that we had—each center makes a contract with the NIH in terms of how they are going to protect patients. It's called—the document is called something. It's a contract, and I don't know what you call it. So you work out—in other words, you say you have to meet the criteria that are set up by the NIH, and each center has these. So there are about several thousand of these throughout the country, and each center is unique. It doesn't have the same one. So it indicates that you're going to have a written consent for any new procedure, and then you have the consent forms. You have consent forms for each of the procedures. So it goes through all the requirements. So that was the second committee, the Surveillance Committee.

ROSOLOWSKI:

So when you first came on, were you—the committee was formed in 1970—well, that's—

ALEXANIAN:

That's when I was appointed [unclear] proceeded, yeah.

ROSOLOWSKI:

That's when you were on it, 1971. Okay. So what were some of the activities that you took part—that the committee was addressing when you came on? Were they still working out the details of this contract or—

ALEXANIAN:

No, no. I guess—I'm curious to know whether we saved minutes from those committees.

ROSOLOWSKI:

Oh, I'm sure they must be someplace in the archives, yeah.

ALEXANIAN:

You could look back on a couple of the minutes. I forget what some of the details—but it was really many of the projects were—and there was a roster of projects that were approved, and then there's more to it than that. The projects that were approved as research projects had to every two years submit a report of what was accomplished, and these were put into a book called the Research Report.

ROSOLOWSKI:

The Research Report. Yeah, those are still being published. (laughs) So that was part of the—that came under the Research Committee?

ALEXANIAN:

That came under that, right, so it was under the research part. Then this required the investigator either to—well, he had to make a research report if he wanted to keep the project going, and if he didn't, he could remove it or delete it. So in a way, the person's record of accomplishment, even if he didn't have publications in outside journals, you had this record of what he was doing, and so I'm sure this was useful to the department heads and the administrator as to what is this man doing here, you know, what is he working on, so he could look it up and see what he's doing and who was he doing it with. Then the other departments could see, "Well, he's doing this. Why don't I do work with him on this," and so on and so on.

So the attempt was made to get a more cooperative—that's why, as the years went by, it was easy for some departments who wished to, to make these co-op arrangements with other departments because you knew what everyone else was doing in a way or what they were interested in. You attended the meetings or saw the Research Report or saw all these things.

ROSOLOWSKI:

Interesting.

ALEXANIAN:

Whereas other centers didn't have this process as well oiled. In fact, I remember some years ago, I think I was on the Research Committee, and as the chairman, I think I was called to a national meeting of cancer centers in terms of their research procedures. And I sort of vaguely remember that when I described how we were doing it—and I was a very young person, and this had already been established before I became chairman. I mean, I didn't develop this. But when I described our process, they were amazed at the interdepartmental connections and discussions and processes that we had already established here.

And it turns out that Dr. Clark asked me, "Well, how did the meeting go?"

And I said, "Dr. Clark, they were all praising the way we were doing things here."

And he just beamed with pride. He says, "Well, that's great. I'm glad to hear it."

And I was just a young fellow, and said, "Well, I'm really proud to be part of this."

He says, "That's great news." (laughs)

ROSOLOWSKI:

And you got to bring him the good news. (laughter)

ALEXANIAN:

So maybe that's why he appointed me to so many committees. (laughter)

ROSOLOWSKI:

Yeah. Well, it's really interesting. What do you think made—you said that Dr. Clark had actually established, founded the Research Committee.

ALEXANIAN:

Well, he must have.

ROSOLOWSKI:

He must have.

ALEXANIAN:

I mean, I can't imagine, and I don't know the beginning. You'd have to look at the very first minutes, which go to the sixties or fifties.

ROSOLOWSKI:

Yeah, because it really is pretty amazing to keep getting these bits of evidence that from the very beginning the institution was created with the goal in mind of creating these interdepartmental linkages, collaborations [unclear].

ALEXANIAN:

You have to also be sensitive to his motivations. As a state-funded institution, at that time all the support or dominant part of the support came from the state, and so that he would have to go to the state legislature and show some evidence that we were not just doing what everyone else was doing, that we were a leader in the field and that, therefore, more funding and more resources, more building that he would have to show some evidence of that. And because the MD Anderson was founded because of unmet needs in cancer in the state, as you know, the history evolved from the fact that many women were dying of cervical cancer, and MD Anderson himself, as a gynecologist—not MD Anderson, Dr.—

ROSOLOWSKI:

Ernst Bertner?

ALEXANIAN:

—Bertner. Thank you. (laughs) Dr. Bertner was sensitive to—you've heard all this before.

ROSOLOWSKI:

Oh, no, go ahead.

ALEXANIAN:

Well, my understanding and my recollection was that he was sensitive to the fact that cervical cancer could not be detected with smears and that many of these women, especially poor women in the valley, could be cured if they were recognized early and so on. So this was one of the lead-ins to the development of MD Anderson. I'm sure there's more to the story than that.

ROSOLOWSKI:

But clearly it is very much tied to the state.

ALEXANIAN:

The state. Right. And this was new, because, as I understand it, the only other facility of its type was at Sloan-Kettering in New York, which was not state, which was developed by private philanthropy. So he was the first to do it from the state, and therefore, by showing the state evidence of progress—and you can imagine every two years he has to show that this is the progress we've made, and he has this Research Report book—I'm sure he brought it with him—and for distribution. So it was all in writing, all of these things. And the Research Report had all the grants, awards, and papers that were published. The whole thing was laid out there. So I would imagine he found this useful.

ROSOLOWSKI:

Interesting. Yeah, very interesting. I hadn't heard the story in quite that way.

ALEXANIAN:

It may not be exactly that way. That's the way I—

ROSOLOWSKI:

No, but it's your perspective, absolutely.

ALEXANIAN:

My perspective, yeah.

ROSOLOWSKI:

Yeah, and I think it's interesting, because nobody else has mentioned the Research Report playing that kind of role as an internal communication device and as a communication device with the legislature.

ALEXANIAN:

Well, the Research Report was also distributed and sent to clinicians throughout the state and saying, "Look, this is what we're doing with these cancers. Send us your patients if you have problems." This was meant to be a vehicle for patient management and potential advance. There were many uses of all of it. And that's not the only doc. I'm sure there are many other documents, I mean newsletters and all this stuff.

ROSOLOWSKI:

Right. Very interesting.

ALEXANIAN:

And also he was very aware of the press, a person of that position.

ROSOLOWSKI:

Let's see. There's also this—I didn't know what this committee was—Faculty Classification. What was that about?

ALEXANIAN:

In order to have promotions, it used to be that if a department head wanted to promote a staff person, he could just promote him if the head administrator agreed and there was funding to support that new rank. Then it was decided—and I don't know who it is, probably Dr. Clark or somebody like that said that we needed a committee for this review because why should such-and-such and his department promotes such-and-such a person who has done nothing, whereas this person who has done so much is overlooked. So there was a standardization by having a committee that would apply or attempt to apply consistent standards for promotion and appointments of people who come from elsewhere, who were appointed or promoted within the ranks, and that included tenure.

Now, the tenure is a whole different area of controversy we could talk about if you wanted to. It's a whole historical story in itself. But the promotion required certain criteria for promotion, and this committee—and I think I was one of the first chairmen, I'm not sure, to have set certain standards for promotion. This included recommendations from your department head, but also a certain requirement for publications, sometimes grants, and national and international recognition somehow, by being appointed to committees or giving talks in Paris or something like that, so there's some record, and so that this committee reviewed that and made a recommendation to the president that such-and-such be promoted or not promoted.

ROSOLOWSKI:

How controversial was this?

ALEXANIAN:

It could be very controversial. As time went on, most submissions were approved because department heads knew, were familiar with the criteria and says, "Oh, you could get by. You have this." So, however, there were some who, since the committee was constituted by other senior people who also had their own junior staff who desired promotion, everyone was very anxious to apply the same standards across the board, said, "Don't promote him if you don't promote him." So there was this general level of consistency. However, every so often, maybe once or two people every meeting, there was controversy and that person was not approved. That doesn't mean he was forever—this is not approved at this year, but let's wait for next year or the next year. So it was not approved for that at that time. So as time went on, most people were easily approved.

ROSOLOWSKI:

Were the guidelines themselves or the criteria [unclear]?

ALEXANIAN:

They were written down.

ROSOLOWSKI:

But were they themselves controversial?

ALEXANIAN:

I don't think so. I would say, in general, our criteria were less stringent for sure than Harvard or Yale or the most distinguished medical schools, so that promotion at this center was clearly easier than at a leading medical school. However, it had to be that way, because if you didn't, then your staff would depart for another place. So, many times people were proposed for promotion and the department says, "This man has had offers from here, here, here, and here," and say, "Look, if he's not promoted, I'm going to lose him." So that wasn't the sole criteria. We still tried to be consistent, because you couldn't allow or permit somebody to be promoted just because the department head says he thinks he's going to lose him. He may not be. Who knows what the facts are.

ROSOLOWSKI:

Right.

ALEXANIAN:

And says, "Well, how could you lose him? He hasn't written anything. Harvard's not going to appoint him, so where's he going?"

So he says, "Well, he may go into private practice." So, well, maybe that's where he belongs.

ROSOLOWSKI:

Now, you mentioned the tenure issue.

ALEXANIAN:

The tenure issue was a very controversial issue for a number of years, and it may still be. I don't know.

ROSOLOWSKI:

When was that, about?

ALEXANIAN:

Along the way, the title of the hospital became, instead of the MD Anderson Hospital, became the University of Texas MD Anderson Hospital. When you use the term "University," then there's a standardization of that term across all the universities in the State of Texas and perhaps around the country, that a university, if you're going to call it a university, has to fulfill certain functions that include both research and education.

The research part was easy to fulfill. The education was a little more difficult because we did not have medical students, we had primarily postgraduate trainees, and so that the focus of education was on postgraduate trainees. And that didn't mean you couldn't get promoted just from the research, you could, certainly, as many Harvard professors don't do any teaching, they just write books and write something like—so you could do the research and you didn't have to do education. But let's say if you were weak in research and you did a large amount of rounding with the residents, going to the medical school for lectures and all that, that counted as a balance for your research.

But then another requirement came, and this came somewhat suddenly—at least it seemed suddenly to me—the question of tenure. Tenure at most universities in the country is lifetime tenure for a faculty professor, and so therefore the State of Texas had to decide among the universities whether this would be a standard. The University of Texas at Austin and the major centers said, "Of course it has to be lifetime. We could not attract anyone here if it weren't that." So the major universities had lifetime tenure.

However, Dr. Clark objected to this. I think that's public information. I don't think that's a secret. Dr. Clark and, I think, one other place in Texas—it could have been a place in West Texas, Permian Basin, something like that, I don't know, one other place objected. So they appealed this decision, and they compromised on, "All right. Well, you're a special case. We will permit seven-year tenure." And Dr. Clark didn't want any tenure.

ROSOLOWSKI:

Interesting.

ALEXANIAN:

Of course, as the founder and somewhat dominant figure, if you have tenure, then you lose control, right?

ROSOLOWSKI:

Right.

ALEXANIAN:

I may have it wrong. He accepted seven-year tenure. And the reasoning, there are lots of critics of lifetime tenure as people just have it and don't do anything for years, right?

ROSOLOWSKI:

Mm-hmm.

ALEXANIAN:

You could have that, and in your career you've probably run into it more than I have. But the professors, I haven't known any like that.

ROSOLOWSKI:

I've known remarkably few, actually. I've known remarkably few who do that.

ALEXANIAN:

There are a few.

ROSOLOWSKI:

There are a few, but not as many, I think, as people imagine.

ALEXANIAN:

Imagine, yes.

ROSOLOWSKI:

And particularly at an institution like this where people come here because they're driven.

ALEXANIAN:

Yeah, they're driven. But in some universities, they must have. They said they call it the woodwork?

ROSOLOWSKI:

Yeah, deadwood.

ALEXANIAN:

The deadwood. Okay. So every university must have one or two like that, right?

ROSOLOWSKI:

Yeah.

ALEXANIAN:

Okay. So Dr. Clark didn't want any of that, so he accepted seven-year tenure, and therefore the Faculty Classification would approve that feature, and that usually went automatically with a rank of associate professor or higher, the seven-year tenure. However, there were controversies even on that, because the—let me think if I remember. There was a loyalty component to tenure that as the Promotions Committee chairman, that was new to me, the loyalty factor.

ROSOLOWSKI:

Tell me more about that. I'm not sure what you mean.

ALEXANIAN:

I wasn't sure either, so I said, "What do you mean? What is a loyalty factor?"

Well, the loyalty factor is here's a person in a person's department who has the criteria for associate professor, he's written a lot, but he is in a constant state of dispute with his chairman. He's a rival. And the chairman refuses, he wants to dismiss him if he can, but he can't. He's very productive, he has grants, he's a big-shot in his own way. He could be a department head anywhere. This didn't come up very much. It did come up, though. He says, "Well, I'm not going to do it."

So I says, "Why?"

So he says, "Oh, well, it's going to be a mess here."

So we couldn't resolve that, of course. What the faculty chairman had to understand that that was a factor he had to deal with.

ROSOLOWSKI:

Was that something that people actually called it, they called it the loyalty factor, or is that your term for it?

ALEXANIAN:

There was someone on our committee who used that. I mean, that's an extreme example. There are other things like that. Let's say somebody who's doing work but is not working as a team person, he's doing his own thing but would not cooperate fully. He wants to do his own way and is not working in the cooperative way I mentioned. So it's really the department head's choice. He's faced with the challenge more than the Faculty Classification, but we would hear as these recommendations would come, recommendation for promotion but not tenure. See, there's two parts to it.

ROSOLOWSKI:

So you didn't hear the tenure cases.

ALEXANIAN:

We didn't hear the tenure.

ROSOLOWSKI:

Okay.

ALEXANIAN:

Well, no, we would. We would just hear the recommendation. Then, however, there's also a timeframe. If a person is on the staff and doesn't have tenure by a certain time period, by the sixth year, they will never get the tenure. So there's a clock.

ROSOLOWSKI:

A tenure clock. Right.

ALEXANIAN:

Clock. So we are aware of this clock, and so you have to make the judgment on these difficult cases. "Look, the clock is running out here." So in many cases, the department head is not aware as much as our committee is aware, and so he's informed that there's a clock ticking.

ROSOLOWSKI:

Okay. So you kind of were [unclear].

ALEXANIAN:

Well, let's say it's a newly appointed department head who doesn't bother with all these, newly appointed. He has to learn quickly as the staff is coming to promotion time what each person's clock is. They learn this fairly quickly, and they also realize that you can do the promotion without the tenure or you can do them together. You can't do the tenure without the promotion, because unless you're at associate grade—so you can't do—then there are curious things. There are assistant professors who are always assistant professors. They don't do any research, because you have to have a professorial rank here [unclear], and that was also a requirement for the university title, all the semantics. I may have it garbled, but that's essentially what I had to learn.

So there are people who are permanent assistant professors, and then the question is tenure. And the response is, well, if he's only an assistant professor, we don't usually give tenure if he doesn't qualify for promotion. And these are people who are just doing only clinical work in the different departments, only, and they don't write, they don't teach, they don't do anything else but see patients. And I don't have to—it's not any great secret that I don't think these people belong here, but they are hired to do the work, and I think they're hired because the department head doesn't exert enough effort to get some young person who's motivated and ambitious to replace these people. And there's a certain inertia on personnel dealing that department heads have, as you may know. They just don't want to fuss with it.

ROSOLOWSKI:

Mm-hmm, mm-hmm. What were some of the effects that tenure had? I mean, when this new tenure [unclear].

ALEXANIAN:

It's for seven-year blocks. Then you're renewed.

ROSOLOWSKI:

Right. But once that happened and the faculty understood that that was the new environment they were working in, did it stimulate people to do research? Did people leave? I mean, what [unclear]?

ALEXANIAN:

No, I don't think it made—I think it satisfied. Those who met the tenure standard, who were tenured, didn't care. They'd just get automatically renewed after seven years. They were usually the people working anyway. Now, sometimes a person, you reach a point—well, like for myself. I knew I was going to retire in, let's say, at a certain time, and my time, the clock ran out two years before. I said, "Oh, don't bother applying. Don't send the paperwork in. It's not worth it. Just let it go."

ROSOLOWSKI:

It is a cumbersome process.

ALEXANIAN:

Yes.

ROSOLOWSKI:

I'm looking at some of the other committees you were on. Wow. You were on the Surveillance Committee for a while. Then there was the Patent Committee. Was that interesting [unclear]?

ALEXANIAN:

No, it wasn't.

ROSOLOWSKI:

Poor you. (laughs)

ALEXANIAN:

Well, it was, at the time—I'm trying to remember what we did. Now, the Patent Committee, it was kind of—at first I thought it would be very boring, but occasionally there was an interesting problem would come up because if somebody felt that there was the potential for a patent, that person wanted to have some institutional protection that was evident in writing or something, so that the institution couldn't really protect you too much legally, I guess, but at least it would be registered as an idea that was in writing, that was recorded, so that as that person is sometimes working with a drug company or other equipment company, to negotiate the terms for this patent. There was a lawyer on our committee, too, as you can imagine, so that this staff person could negotiate with some legal backing that was provided by the Patent Committee and its lawyer to work with you.

Otherwise, this person would run to the lawyer and work out something, and the lawyer would say, "I don't know what you had. How do I know?" So they'd come to this committee, and the committee would substantiate that this was worthwhile and, therefore, had the stamp of our committee, and now you can set up some work with them.

ROSOLOWSKI:

Did that paper trail also help establish, you know, the date or origin? Because I can imagine that, you know, in a complicated—

ALEXANIAN:

Yes, I'm sure it did. I don't know how much of that, something—it wasn't so much—it doesn't even have to be a medical [unclear]. I remember that the Nursing Service came to our committee, and I said, "Well, that's unusual." Well, they had a device. When you're giving chemotherapy, you have these multipronged accesses. Now everyone sees it, but in those days, that was new. So they had something that would give three or four inputs to an IV line in a different sequence, but which also partly depended on the drugs going through. So there was a device that someone in their department devised, and there was an apparatus company that was interested in it, and so they said, "Well, what do we do now?"

They were told to come to the Patent Committee and we'll say, "Here's your patent." Something like that developed. This was years ago, and I just don't have the details and I don't even know what happened to it. But you can see that something can develop like that.

ROSOLOWSKI:

Sure. And just for the record, you were on that committee from '83 to '86, so I imagine those processes must be very, very different now, I mean [unclear].

ALEXANIAN:

Probably. I don't think we met every month, either. Maybe every two months.

ROSOLOWSKI:

Oh, really? Wow. Wow. I can just imagine that's incredibly active now.

ALEXANIAN:

Yeah, probably.

ROSOLOWSKI:

What about the Transfusion Task Force?

ALEXANIAN:

Transfusion Committee, that was an interesting committee. There's a committee after this, wasn't there?

ROSOLOWSKI:

[unclear].

ALEXANIAN:

They called it Task Force, yeah. That was of interest because as the years evolved, in order to provide a transfusion to a patient, you had to provide some sort of written justification. There was a box, a kind of a checkbox. In the old days, you could just order it and pay no attention to anyone, just say transfusion of red cell, platelets, whatever. But then the national transfusion bodies—there must be a body; I don't know what it's called—required all centers who are approved by them to set up criteria for transfusion. So this body, we set up criteria for transfusing red cells, platelets, so on and so on.

But it got to be sort of complicated because it wasn't just transfusion for a certain number. It was sometimes transfusion in preparation for an operation or to get platelets up to a level that you could avoid bleeding during a procedure or biopsy or things like that. So there were yet a set criteria, but we didn't want the criteria—I was trying to reduce the requirements for the staff to explain themselves in this area because our department gave lots of transfusions. So I focused on making it as simple as possible so that there would be a checkbox, and that the checkbox could be one that was eventually either by a physician assistant or Nursing Service checkbox, that the doctor didn't have to do everything, because a lot of it was pretty automatic unless there was some very special thing.

So I was trying to—and the Transfusion Department wanted a very firm high standard to meet their standards nationally. They wanted to show that they were doing a complete job. And, of course, they didn't do the transfusion. They just did the cross matching and all that, but they wanted to make sure that the requirements were met. So a small amount had to do with donating your own blood, for example, in preparation, and some of it had to do with whose—let's see.

ROSOLOWSKI:

Yeah, because this was in the eighties and into the—or, I'm sorry, in the nineties. I mean, AIDS had already become an issue and there's a lot of discussion, yeah.

ALEXANIAN:

Yes, that's right. So, yeah, AIDS and hepatitis, and, of course, we were dealing with the indications for transfusion more than—the transfusion laboratory dealt with the "who doesn't qualify" part. But we also tried to help on rallies for blood donations from the staff, in other words, that we have a big family here. Well, how many employees? Ten thousand. So surely there are a lot of donors here. So I think we organized the first employee donor groups.

I'm trying to remember what else. Also the consent, that every patient—so this was a real stick. They wanted that every patient who came to the hospital had to sign a waiver for transfusions. I said, "Every patient? Suppose he's just coming to see us once and is not going to have an operation, nothing." So I kind of resisted. I said, "Which patient?"

"Every patient."

Okay. So it turned out that it was easier to have every patient sign a waiver for transfusion, because if you make it selective, then it doesn't work. That's why when you come to register, you sign the waiver for transfusion.

ROSOLOWSKI:

Interesting. Huh.

ROSOLOWSKI: + Let's see. I'm looking at were there any others that stick in your mind? Because we have just a few other committees, but do you think we've hit the big ones?

ALEXANIAN:

Yes. May I see the list?

ROSOLOWSKI:

Sure.

ALEXANIAN:

Well, the summer students, I was active. I always had a summer student working with me. These were high school seniors—

ROSOLOWSKI:

Oh, really? Huh.

ALEXANIAN:

—who were going to college. Applications were submitted throughout the state, they came from everywhere, and we selected about—I think about fifteen or twenty in those days. I don't what it is now. So in the summertime when you see a young person with a blue thing, they're usually a volunteer, and they're assigned. In those days, we had to match up the laboratory with the student. Each student was assigned a laboratory. So I, as the chairman, or a member would try to identify doctors who were willing to take a student. I said, "Not just to help you. They have to have a project, they have to submit an outline of the project, and they have to work on the project, and this project has to come up with something maybe a little bit at the end of the summer, so that they can say, 'I've done this. I've done that.'"

ROSOLOWSKI:

So it's a research-focused—

ALEXANIAN:

It's a research-focused project.

ROSOLOWSKI:

Now, how did that project—how did that summer program get started then, and what was the purpose of it?

ALEXANIAN:

This began before I got there. The purpose was— (laughs) It's one of Dr. Clark's ideas, I'm sure, is to get young people interested in—he's full of these ideas to the legislature. I always think he's trying to get money for it.

ROSOLOWSKI:

Yeah, yeah.

ALEXANIAN:

Maybe this is—of course, there was no money. I think there was a stipend, maybe $100 a month, something like that. And they had to provide their own housing here too.

ROSOLOWSKI:

Oh, wow.

ALEXANIAN:

So they had to have a facility to stay here, whether it was an aunt or an uncle. And they're still doing that.

ROSOLOWSKI:

Let me just say for the record that the years we're talking about, this is the Curriculum Committee for Summer Students, and that was 1970 to 1974.

ALEXANIAN:

Yeah, for four years.

ROSOLOWSKI:

And from '72 to '74, you were chairman of that committee, yeah.

ALEXANIAN:

So you recruit labs and stuff, and then you go through and you get about one hundred applications for fifteen positions or twenty. So you go through them. And many of these students went on graduate school, medical school. Some of them are now on our staff.

ROSOLOWSKI:

Oh, wow.

ALEXANIAN:

(laughs) So, in fact, sometimes someone would run into me, says, "You remember me?"

And I says, "Yes, I remember." So I had that difficulty; I didn't remember.

ROSOLOWSKI:

That's very interesting.

ALEXANIAN:

[reading list, whispering].

ROSOLOWSKI:

Any other observations you want to make on committees at this point?

ALEXANIAN:

I think one thing that it's important for committees to do is to—first of all, most of the faculty doesn't want to do committees. They feel it's a waste of their time. And that's unfortunate, because they can learn a lot on committees. On the face of it, it may seem uninteresting, and hours can be spent on boring things, but I think that committees have a useful purpose, especially when there's a clash of divergent views. And the stronger the clash, the better it is and the better the outcome, because if there's a clash, there's something important that someone's clashing about, and if you can resolve it in a way that satisfies both parties, then only good can come from it. So I like to see clashes. I participate in clashes if I can.

I think that too much of our work is pro forma work. Fortunately, the committees are now more streamlined, so that I think—I'm not sure—that many times certain modest amendments or adjustments on a protocol can be just cleared by the chairman without going through a committee, and I think that's good. In the old days, everything would have to go through the committee. And committee work should be streamlined. Unfortunately, as I mentioned, too much of our internal review board committees are meant to protect the hospital rather than to expedite research.

ROSOLOWSKI:

It seems to be a common view.

ALEXANIAN:

Also, there are even, I'm told—I don't know if it's true—that even some departments don't have—well, that's not true. They probably do have. Do you know, for example, do all departments now have departmental meetings of their staff?

ROSOLOWSKI:

I believe so, yeah. I think that's pretty much standard process.

ALEXANIAN:

Is that standard process?

ROSOLOWSKI:

Yeah, pretty much standard practice, yeah. I think a lot of those kind of things have evolved as the institution has become larger and more complicated, because I think when it was smaller, you could rely on people having face-to-face contact in situations and passing information, but now the institution is so large that you have to have a formal meeting in order to get basic communication done.

ALEXANIAN:

How many of those meetings do you suppose people present their research work to each other?

ROSOLOWSKI:

Well, that's a different issue. That's a completely different issue.

ALEXANIAN:

See, in those days, in the old—we used to expect that—

ROSOLOWSKI:

Wow.

ALEXANIAN:

—for each meeting, have a short presentation of some something interesting. Could be an interesting patient or an interesting idea or a result of your own work, just for ten minutes. I have a feeling none of that is done.

ROSOLOWSKI:

Right. I think other venues have to be created to do that, because people do talk a lot about how the institution has changed. And actually, that's a question I wanted to ask you, because you left, you retired in 2004, so you were here during the huge expansion.

ALEXANIAN:

Yeah. Well, who knows more about a particular department's research? Don't you think other people in the department would be more familiar, should be more familiar?

ROSOLOWSKI:

Mm-hmm.

ALEXANIAN:

Well, I think that work is being done in departments that are not even known about by other department members. They don't even know about it.

ROSOLOWSKI:

When did you start seeing that happening in the history of the institution?

ALEXANIAN:

Oh, I think I can't—it's hard to pinpoint it. Maybe twenty years ago. Some departments do make a point of having—because all of the doctors are included on a project, for example. They're all colleagues. But somebody may be working on a project, say, in his laboratory or on a few patients on his own protocol that other people in the department aren't aware of. Then what's even more is that after a year of progress, the person is working, no one knows where he is in the project. Maybe it's successful and no one knows about it, and he's published. The world knows about it. The people in the department don't know about it. Can you imagine that?

ROSOLOWSKI:

Yeah, I can. I can, actually. I can. [unclear]. (laughter)

ALEXANIAN:

So I say, why is that?

ROSOLOWSKI:

Well, that's really a measure of growth, you know, and just how large the institution has become.

ALEXANIAN:

Well, I mean, all right, that's an excuse, and I think—

ROSOLOWSKI:

Oh, really? So what's your view?

ALEXANIAN:

I think it's the department head is so busy, probably with personnel and other things or his own work, that he doesn't clash heads or inform, have this exchange, and doesn't many times look after the progress of the younger staff or the new fellows, say, "What are you working on? Tell me about your work."

You know, in the old days in medical schools, I would be in some departments when, let's say, the student and the department head would ask you to come to his office, and, of course, we knew it would be our turn. And the student would meet with the department head. These are busy department heads, and these are students, medical students, third-year students. And he would meet with you for ten or fifteen minutes and ask you, "What did you see that was interesting in my department, and what did you learn from it? Tell me what you read about it," one-on-one with the department head to a medical student. It's probably not that anymore.

ROSOLOWSKI:

Yeah. I mean, those days are long gone.

ALEXANIAN:

And I know that it's not done very much here, but I think that it doesn't take that much time to require each member of a department, let's say, every three to four months to make a presentation for ten minutes, fifteen minutes. I don't think that's hard. Then it's amazing how many new things, things that can be done to—why don't you do it this way? Why don't you ask such-and-such to do it? [unclear].

ROSOLOWSKI:

Mm-hmm, fostering that collegiality and [unclear].

ALEXANIAN:

Yeah. And look, if you [unclear], maybe I'm happy to—"If you're having trouble writing, well, send me a draft, I'll just edit it and don't give me any credit. I'll be happy to work it over for you." We don't hear that.

ROSOLOWSKI:

Have there been some other big cultural changes that you've noticed that concerned you and are concerning you?

ALEXANIAN:

Well, not anymore since I'm retired. (laughs)

ROSOLOWSKI:

You're retired. Right.

ALEXANIAN:

In my final years, I would comment on many of these things. I said, "Look, why don't you do this or do that."

Of course, no one pays any attention, and then say, "Well, that's the old-fashioned way. We don't do that anymore."

ROSOLOWSKI:

Why did you decide to retire when you did in 2004?

ALEXANIAN:

Let's see. First of all, my wife was after me for the previous five years to say, "Why are you continuing to work so hard?" So I don't really work that hard. I never brought work home, except for writing, but I never brought any special work home. Then she pointed out, "You know, you're working for nothing, because your retirement package gives you the same salary as if you worked."

So I said, "I know that, but it keeps me busy."

She said, "Oh, okay, well."

Of course, I was periodically invited abroad and she would come with me to different places, and she liked that, and she was supportive of what I was doing. But then I think—let's see. 2004?

ALEXANIAN:

I think I had a minor illness. I had a retinal hole that required surgery, successful, and that sort of set me back for maybe a month or so. Then I continued to write papers, as you saw my bibliography from '04 to last year, and so I wanted—I felt that I still had something to contribute that I wanted to keep writing about, and I was seeing a large number of patients, and my patients, many of them, were terrified I was going to retire. I tried to prepare them every year, "It could be." Oh, they were terrified. Some of them even wrote to the president saying, "Please discourage him." And so I just kept on going, writing the papers, coming in. I didn't come in at eight o'clock. I took my time. I came in when I wanted to and went home when I wanted to.

ROSOLOWSKI:

Was this before 2004?

ALEXANIAN:

2004.

ALEXANIAN:

That was when I was part-time.

ROSOLOWSKI:

When you were part-time, okay. So in 2004, you went to part-time?

ALEXANIAN:

Part-time. Two days a week.

ROSOLOWSKI:

Okay, two days a week. And then how long did you stay on that schedule before you—

ALEXANIAN:

Well, I retired last year.

ROSOLOWSKI:

Oh, I didn't know.

ALEXANIAN:

It was about seven, eight years of two days.

ROSOLOWSKI:

Oh, okay.

ALEXANIAN:

Isn't there somewhere recorded?

ROSOLOWSKI:

Maybe. Maybe it is. Okay. I'm sorry I missed that.

ALEXANIAN:

Maybe it was 2005.

ROSOLOWSKI:

Okay. So 2004, you kind of went to like 20 percent time?

ALEXANIAN:

There were about seven, eight years of that, of the two days a week.

ROSOLOWSKI:

Okay, and seven, eight years. Okay. So last year, you retired definitively.

ALEXANIAN:

Yeah, last—this is all I got. In fact, this is a story about it. Dr. Weber, who works with me, said, "We have a gift to give you." So she handed me, at my ceremony, a computer.

I says, "I don't need a computer, Donna."

She says, "Well, the other choice was to have a watch."

This was back in September. I says, "Well, I'd rather have the watch, because the one I have is wearing out."

ROSOLOWSKI:

Lovely watch.

ALEXANIAN:

So then she said, "Well, there's a watch I can't give you now, because it has to be returned within seven days if you don't like it."

I says, "Okay." So I said, "And I don't know if I'm going to be here to see you exactly seven days, whether you have enough, because I'm here two days a week."

So she put it off a long time. Finally, last week she gave me the watch.

ROSOLOWSKI:

That's so funny. It's a beautiful brushed-steel watch. Yeah.

ALEXANIAN:

It's a beautiful watch. Yeah, yeah.

ALEXANIAN:

So I have to show it to her for the first time. [unclear] in a box, so I'm wearing it today.

ROSOLOWSKI:

Yes, very nice.

ALEXANIAN:

So I said, "I want a watch with a date, that keeps the right date." And I don't even know if it keeps—is it the right date, or is it off?

ROSOLOWSKI:

It's the fifth. Nope, one day off.

ALEXANIAN:

One day off, okay. So I'll figure out how to fix this. Maybe there's—

ROSOLOWSKI:

Nice gift.

ALEXANIAN:

So do I have it right?

ROSOLOWSKI:

Let's see.

ALEXANIAN:

I don't have my glasses on.

ROSOLOWSKI:

Let's see. Oh, that turns that one. Usually if you push it partway in, it turns. Oh, there it goes. There it goes. Oh, god.

ALEXANIAN:

You got it?

ROSOLOWSKI:

Almost. There it goes.

ALEXANIAN:

I'm told you can only do it in the morning if you—

ROSOLOWSKI:

Oh, okay. (laughs) So it'll probably turn it.

ALEXANIAN:

We'll see what happens.

ROSOLOWSKI:

We'll see what happens, yeah.

ALEXANIAN:

So that's my little gift.

ROSOLOWSKI:

So for those seven, eight years—

ALEXANIAN:

That was two days a week. I saw patients, wrote papers, went to conferences. I wasn't on any committees.

ROSOLOWSKI:

What do you feel you accomplished during those seven or eight years?

ALEXANIAN:

I think that I helped the younger staff, especially Dr. Wang and Dr. Weber. She was already more established. I helped them in their work. And then I wrote a number of papers. I gave talks. I helped at conferences the management of lots of patients. That's what I'm going to now. There's six patients to be presented at noon.

ROSOLOWSKI:

Wow. And this is at Grand Rounds or—

ALEXANIAN:

This is a myeloma patient presentation. You can come if you like.

ROSOLOWSKI:

Oh, I can't. (laughter) I would have been interested, but I can't. (laughs)

ALEXANIAN:

They just present difficult cases that they're getting. So I find this fulfilling. I also enjoy my hobby, which I play a lot of tournament bridge.

ROSOLOWSKI:

Oh, interesting.

ALEXANIAN:

As you saw on my résumé, I'm what's called a Silver Life Master, which is kind of moving up in the ranking.

ROSOLOWSKI:

And is that related to bridge?

ALEXANIAN:

Yeah, bridge, in bridge. And I play in tournaments three times a week here in Houston, and this weekend is a big, big tournament, and I find that interesting.

ROSOLOWSKI:

How did you get interested in bridge? What's that about?

ALEXANIAN:

I played a little bit in college and sort of enjoyed it. My mother taught me, and I never played much of it until the last, say, fifteen years with my wife, who then learned to play bridge, and she was my partner for many years. She's also a Life Master.

ROSOLOWSKI:

What else are you doing with your retirement time?

ALEXANIAN:

Well, I go to the gym every day. I like to do lap swims, and I swim every day almost. Let's see. I used to travel periodically several times a year. Sort of kind of cut that down to taking cruises several times a year, sort of the lazy way of traveling.

ALEXANIAN:

I like to go out to dinner. Let's see. We have neighbors we visit with a lot. Come in here today.

ROSOLOWSKI:

Well, just on a slightly different tack, as you look back on the work that you did here at MD Anderson and are still doing, what do you feel you've left behind that you're satisfied with, very content with?

ALEXANIAN:

I feel very fulfilled. I think I've made some important contributions to medicine and especially to my field. I have helped educate many young doctors. I've helped the institution evolve in several ways on committees and processing, and I feel comfortable that my role has contributed to this hospital to being a leading cancer center in the world. That's why I want to keep it that way if I can, which I can't, but if it happens that way, because it's very competitive and nothing comes easy. You have to work hard. You have to study hard, work hard, put the energy in, put the thought in, educate younger people, get a team to work together, have them clash and work it out, fight it out, and then get things done.

Idleness—by "idleness" I mean just doing standard things—is easy to drift to, very easy to drift to, that you have to make a concerted effort to overcome that. I see less and less of that, not markedly less, but just a slow easing less. You don't hear that, though?

ROSOLOWSKI:

Well, I guess it may be people are very caught up. I mean, I was just going to ask you your impression, for example of the Moon Shots Program, which is extremely ambitious.

ALEXANIAN:

Ambitious.

ROSOLOWSKI:

So to me, the message I'm getting is that there are ambitious things, but I don't—what is your view of that particular approach to—

ALEXANIAN:

Well, I think that it's better to try something than not to try it, so I certainly endorse the concept. And if the resources are there, which I understand there are, from a benefactor or two, well, then, go for it.

Now, when it comes down to the choice of the Moon Shots, which has a more promising avenue to making—because when you use the term "Moon Shot," you're talking about a homerun, and homeruns don't come out of the blue. They come out of little steps. I mean, Thomas Edison didn't have the light bulb just [demonstrates]. I mean, there's all kinds of, you know, physics and electricity and all those things. That took a long time.

So I guess the term "Moon Shot" is meant to be dramatic. Certainly the press likes it. And so I'm not familiar enough with the components of the Moon Shot and how they are evaluated competitively. I don't know. I assume if it were a true Moon Shot, that this would be completely evaluated externally, that no one from here would be part of the evaluation. I don't know how it's being done. So if it's being done only here, then I'm sure there's a lot of politics, and you'll get yours and I'll get mine and all that stuff, which will happen all the time. It happens on our Research Committee and all that.

ROSOLOWSKI:

Right.

ALEXANIAN:

And if it all comes out to work—yet if I were doing it, I'd have the Moon Shots, I'd have them evaluated by an external group who are sufficiently motivated to do it for nothing if they can, and I think they'd be happy to. I mean, I'd be happy to review someone else's projects just to read it over and come up with an evaluation and critique it. Maybe you could help the Moon Shot the next time. Nothing helps a project so much as criticism. Criticism is the life of science. All the great discoveries, even after they were made, were heavily criticized. If you want to look at the—read the life of Pasteur on his germ theory, they thought he was nuts to imagine these invisible things causing fermentation or whatever. "It can't be. I don't see them." You know, those kind of things.

So I don't think we have enough. I don't know how—so I like the Moon Shot concept. If it's heavily critiqued, it's great, and if the successful ones go up, but the unsuccessful ones should be strengthened for the next time, because who knows whose turn it is.

ROSOLOWSKI:

Right. Exactly. Exactly. Is there anything else that you'd like to add?

ALEXANIAN:

You've been so kind and so good. I don't know how you do this. You have to sit with some people like me for two hours at a time.

ROSOLOWSKI:

(laughs) It's a pleasure.

ALEXANIAN:

Is it fun to you?

ROSOLOWSKI:

Oh, yes, absolutely.

ALEXANIAN:

Is it fun?

ROSOLOWSKI:

(laughs) Absolutely. If you had to do it, you'd say, "Kill me now"? (laughs)

ALEXANIAN:

Kill me. You have amazing patience and you're so kind.

ROSOLOWSKI:

Oh, well, thank you. But I'm serious. Do you have anything else you'd like to add? We have a few minutes left, I mean, if there's—

ALEXANIAN:

Oh, I just can't—

ROSOLOWSKI:

And that's fine. If you don't, you can say no.

ALEXANIAN:

Well, I can't think of anything. Anything I've said, you can include.

ROSOLOWSKI:

Sure. Well, thank you.

ALEXANIAN:

I have no secrets. No secrets.

ROSOLOWSKI:

Thank you. Well, you'll get a copy of your transcript for review.

ALEXANIAN:

How will you possibly—will you meld the different—sometimes we talked about something in different timeframes, so you'll try to meld it together?

ROSOLOWSKI:

Yeah. Well, let me turn off the recorder, and then I can tell you a bit about that.

ALEXANIAN:

Yeah, okay.

ROSOLOWSKI:

So we're closing out the interview, and I want to thank you very much for participating in the project.

ALEXANIAN:

Yes, you're welcome.

ROSOLOWSKI:

And I'm turning off the recorder at 11:45.

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