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0:00 - Chapter 00B: Interview Identifier

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0:23 - Chapter 06: Early Research that Leveraged the MD Anderson Team Approach

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Segment Synopsis: In this chapter, Dr. Leeds begins to trace the history of the research he conducted at MD Anderson.

He begins by talking about his work (1998-2000) on imaging techniques to differentiate brain tumors from trauma and other causes. He discusses three-dimensional imaging and functional imaging and their roles in this process.

Next he talks about a landmark investigation of the use of dynamic contrast enhancement to identify malignant brain tumors. He notes that this technique became a significant factor in brain surgery.

Dr. Leeds next praises the team, multidisciplinary approach that was important to his research advances and which he says makes MD Anderson unique. He talks about the breadth of experience that MD Anderson faculty bring to research teams, the number of cases they have access to.

He briefly speaks about losing his wife to ovarian cancer.

Keywords:

Subjects: 1. Segment Code - A: The Researcher 2. Story Codes - C: Discovery and Success A: Definitions, Explanations, Translations A: Overview A: Personal Background B: Critical Perspectives on MD Anderson B: Multi-disciplinary Approaches C: Leadership D: On Leadership D: Technology and R&D D: Understanding Cancer, the History of Science, Cancer Research

16:28 - Chapter 07: Research on Brain Necrosis and Work in Neuro-Pediatrics

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Segment Synopsis: Dr. Leeds begins this chapter with the statement that his “real contribution” was in studying the impact of cancer therapy on brain necrosis and its effects on brain tissue. He gives the example of a twenty-two year old patient who died from treatment induced brain necrosis.

Dr. Leeds then comments on how work of this kind demonstrates the value of specialty hospitals that bring together people, teams, and materials. He then talks about the impact of Dr. Raymond Sawaya, chair of Neuro-Surgery.

Dr. Leeds then talks briefly about the difficulty of treating brain cancers, particularly glioblastoma, the successes that have been achieved.

Next, Dr. Leeds turns to his work in neuro-pediatrics. He summarizes his professional path to neuroradiology then explains that he met Dr. Kenneth Schulman who asked him to come to University of Pennsylvania Children’s Hospital [CHOP]. Dr. Leeds explains how children’s cancers differ from those seen in adults, a subject he has investigated. He notes that he helped create a strong pediatric neurology program at CHOP, one that eventually became a leading program in the nation. He notes that MD Anderson’s pediatric neuro-oncology program became stronger over time.

Keywords:

Subjects: 1. Segment Code - A: The Researcher 2. Story Codes - A: The Researcher A: Definitions, Explanations, Translations A: Overview B: Education B: Multi-disciplinary Approaches B: Research C: Cancer and Disease C: Discovery and Success C: Patients C: Patients, Treatment, Survivors D: On Education D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

31:47 - Chapter 08: More Research on Techniques to Determine Physiology

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Segment Synopsis: Dr. Leeds explains that after his work on brain necrosis, he returned to studies focused on physiology. He talks about a book he published with Dr. Juan Tavares on identifying dynamic changes with cerebral angiographs. He notes that angiography created the foundation of his knowledge in the field.

He then turns to more recent work on physiological questions, including interpretation of data from stains. He notes the importance of distinguishing tumors from lesions created by stroke.

Next he talks about the fellowship program and his continued interest in passing on his valuable depth of knowledge to others.

Keywords:

Subjects: 1. Segment Code - A: The Researcher 2. Story Codes - A: The Researcher A: Definitions, Explanations, Translations A: Overview B: Education B: Research C: Discovery and Success D: On Education D: Technology and R&D D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

41:51 - Chapter 09: Perspectives on Serving as an Expert in Lawsuits

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Segment Synopsis: Dr. Leeds begins this chapter by expressing his concerns about the impact that lawsuits brought against physicians can have on research. He discusses two cases in which he was called to provide expert testimony.

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Subjects: 1. Segment Code - A: Overview 2. Story Codes - A: Overview A: Activities Outside Institution A: Critical Perspectives C: Funny Stories C: The Professional at Work D: The History of Health Care, Patient Care

52:52 - Chapter 10: Educating the Next Generation and Concerns about the Future of Healthcare

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Segment Synopsis: Dr. Leeds explains that now that he comes to MD Anderson only one day a week, he focuses on educating fellows and students. He comments on the high quality of the next generation of physicians and researchers.

Next he explains his concern over the rising cost of medicine and the specter of a single-payer system which, he feels, would not offer quality people the financial incentives to stay in medicine.

Keywords:

Subjects: 1. Segment Code - A: Overview 2. Story Codes - A: Overview A: Career and Accomplishments A: Definitions, Explanations, Translations A: Post Retirement Activities B: Education B: Research B: The Business of MD Anderson C: Dedication to MD Anderson, to Patients, to Faculty/Staff C: The Institution and Finances D: On Education D: Technology and R&D D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

62:52 - Chapter 11: Some Views on Change and a Big Vision for the Future of the Neuro-Services

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Segment Synopsis: Dr. Leeds begins this chapter by talking about changes in Neuroradiology when Dr. William Murphy stepped down as chair, succeeded by Dr. Donald Podoloff [oral history interview]. He compares the temperaments and leadership styles of the two men.

Dr. Leeds then talks about a vision he shares with Raymond Sawaya [oral history interview]: to develop a neuro institute that would bring together all the fields working in neuro and would also feature a dining room to bring back some of the congenial feel of the older MD Anderson.

Dr. Leeds expresses the opinion that MD Anderson is too big, and the size creates obstacles to communication and collaboration. He tells a story about successfully getting money for an MR by talking to the CFO over lunch.

Keywords:

Subjects: 1. Segment Code - B: Institutional Change 2. Story Codes - C: Leadership B: Critical Perspectives on MD Anderson B: Growth and/or Change B: MD Anderson Culture B: MD Anderson History B: MD Anderson Snapshot B: Multi-disciplinary Approaches B: Working Environment C: Portraits D: On Leadership

77:03 - Chapter 12: Reflections on a Marriage and Family

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Segment Synopsis: In this chapter, Dr. Leeds shares recollections of his wife, Betty, a woman for whom he had great love and respect. He also talks about his children and grandchildren, sharing advice he gives them.

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Subjects: 1. Segment Code - A: Personal Background 2. Story Codes - A: Personal Background A: Character, Values, Beliefs, Talents A: Influences from People and Life Experiences A: Post Retirement Activities A: Professional Path A: Professional Values, Ethics, Purpose

0:00

ROSOLOWSKI:

OK, we are recording, and the day--date is June 20th, 2017, and I'm in the Reading Room of the Historical Resources Center at MD Anderson Cancer Center in Houston, Texas for my second session with Dr. Norman Leeds. So thank you very much for joining me this morning.

LEEDS:

Thank you.

ROSOLOWSKI:

And just for the record, my name is Tacey Ann Rosolowski. So... Oh, and the time is 25 minutes of 10:00.

ROSOLOWSKI:

+ So we wanted to start with your research, the arc of your research since you came to MD Anderson. Please tell me about that.

LEEDS:

Well, we worked particularly on several things, some of which I supported with my chair funds, a physicist. We worked on looking at diffusion of the spine with MR to evaluate and separate tumors from trauma and other causes, and actually resulted in two papers on the use of MR diffusion of the spine. In addition, we worked on tractography.

ROSOLOWSKI:

Can I interrupt you just one sec? When did you start doing that work with the MR diffusion in the spine?

LEEDS:

Let me think... Probably in--around 1998 to 2000, and then... Then we started to do tractography, which is to define the tracts in the brain with the Physics Department, and--

ROSOLOWSKI:

What does that mean, "tracts in the brain"?

LEEDS:

(laughs) The brain communicates with everything, so therefore there are tracts in the brain--

ROSOLOWSKI:

Oh, I see. So these are neural tracts.

LEEDS:

Neural tracts in the brain, and we identified them, and looked at them, and an excellent paper came out on 3D imaging, which we were able to also perform here with the aid of an excellent researcher to get 3D maps of the tracts of the brain. And this also was presented at national meetings.

ROSOLOWSKI:

Now, what is the significance of that for neurooncology?

LEEDS:

Oh, very significant, because it determines where you can operate, where you can't operate, where function is. We're looking about, defining--we do functional imaging, which is where the various centers are: speech, motor, vision, etc. And to identify speech and motor is critical to determine the approach to use for surgery, and areas you probably should avoid, or prepare the neurosurgeon to do an awake craniotomy because of the proximity of the tumor to these important tracts that you don't want to damage. So we did that. And then, in 1998, one of the significant things we developed, which led to a lot of others following our footsteps, was called--let's see, what title did I give it? It's... It is looking at the contrast... DCE, it's called, dynamic contrast enhancement. And the way it occurred to identify the more malignant tumors within the brain, if you can't reach the tumor, or take it out, and you want to know its activity, it's at least the site for the--best site to do a stereoscopic biopsy to find out what you're dealing with. And dynamic contrast enhancement has become a significant factor in advanced brain tumor imaging, which I'm still doing at MD Anderson. And this we started in 1998, and it is getting better and better, and also has been published.

ROSOLOWSKI:

So I'm assuming that this is all very reliant on evolving technology.

LEEDS:

Yes.

ROSOLOWSKI:

So can you sketch a little bit about what those advances are that enabled this kind of imaging?

LEEDS:

Well, it's--what it was is we were able to take multiple images in a shorter series of time. In fact, the physicist who worked with me on the project came to us from General Electric, where he had worked on their advanced imaging techniques, so he was really able to optimize these, and he also was able to help and design the diffusion imaging. In addition, to help one of our neurosurgeon researchers, who is now the Head of Research at the Fred Hutchinson Cancer Center, Eric Holland, [MD], who left MD Anderson to go to Memorial, and then to the Hutchinson Cancer Center, he developed--we developed a small [bore magnet with GE], a means to image the mouse. He had developed a mouse tumor [after] he injected a virus [into the brain], and then got, first mouse tumor. We designed a--with General Electric--a small tube, which I demonstrated first with plastic that the mouse would fit in. And so it was made to put the mouse in closer proximity to the MR. And we used that, and that, too, was later published. We also demonstrated that these tumors, for the first time, showed what the human tumor does. It was infiltrating. So we demonstrated this with Eric, and this, too, was published.

ROSOLOWSKI:

Now, just to make sure I'm clear, is Eric Holland the person from General Electric, or is...?

LEEDS:

No, Eric Holland is the neurosurgeon who was at the Fred Hutchinson Cancer Institute. I think he's the head of the Fred Hutchinson, but he was here. He came here, and he and I worked together, and he was really a PhD neurosurgeon, an excellent neurosurgeon, as well as being a top researcher. And he wrote an excellent paper in which he published that whatever you see in the mouse, you know, and think you've got is really not the human. And it's important to know [this]. But this was the first time, I believe, that we're able to show not a localized tumor as it metastasized, but an actual infiltrating neoplasm.

ROSOLOWSKI:

Wow. Do you recall the name of the man from General Electric who helped design this?

LEEDS:

Oh, the... No, the... Yes, the one who worked here, that worked with me on several of--on all--almost all these projects, he and I, and I supported his graduate student with my research funds from the Kennedy Chair was Joseph Zhou, Z-H-O-U, PhD, who moved from here to Illinois, University of Illinois. I tried to recruit him at Mount Sinai but wasn't able to [come].

ROSOLOWSKI:

OK. I mean, it sounds like you had a really, you know, tremendous group of people to work with. You were underscoring that last time, too.

LEEDS:

Well, I think the important thing--and I think what makes us unique--is the team. I mean, I think we approach brain tumors with a team. It--you know, you need excellent people, but if you don't have the group doing their function jointly, or responsibly, together, you don't accomplish. And I think that was one of the reasons we grew. Dr. Sawaya [oral history interview], who is--was and is still--the Chair of Neurosurgery and I worked very closely together. We are very good friends now, as a consequence, and we came together. We both were within two weeks. I came two weeks later than he did.

ROSOLOWSKI:

You know, I was going to ask you about that, because I happened to be reviewing his transcript just yesterday, and I noticed the date when he came to the institution. And I thought, oh, yeah, that's really around the same time.

LEEDS:

We came together, yes. And we worked [together]. And we still do. We still work together. So we built that relationship, and it became a friendship.

ROSOLOWSKI:

And he had a very clear vision, because when I was interviewing he said--he pointed behind him to that picture of the tree in his office that showed all of the elements of treatment of brain tumors that went beyond neurosurgery itself to all the other specialties.

LEEDS:

Well, you need... Well, that's--what we're saying is the--to improve the care--and I think... This is the particular advantage of MD Anderson: everything is centered on cancer. So we have experts in neuropathology, like Dr. Fuller, who's another friend of mine, and I helped bring Dr. Fuller here. Because I was recruiting someone from Duke, and he said to me they have an excellent fellow in neuropathology, in brain tumors, who's from Texas and really wanted to go back. So we got Dr. Fuller here, and [he's great].

ROSOLOWSKI:

His first name?

LEEDS:

Gregory Fuller [MD]. I think--he said to me he recommended that you interview me early, but he said it must--it took them a while more. But it's--the team is only as good as the whole. It's the gestalt: you need all the parts. And we were very fortunate. I think Greg was the last piece to fill the hole. I mean, there were good neuropathologists, but there is no one quite like Greg Fuller.

ROSOLOWSKI:

What makes him so good?

LEEDS:

Well, he's interested in the whole area. He's got interested in neuroradiology, and he will, you know, say that you need both to accomplish things, so...

ROSOLOWSKI:

So I'm kind of getting the impression as you're talking--and you use the word "unique" and "advantage"--that this team approach you don't find so strongly expressed at other institutions.

LEEDS:

Not at every institution. No, we were very lucky. We all came together. But that's the advantage of the institution: the neuropathologists... Really, it's the material. I've come to the conclusion that this place is unique because it has a breadth of experience, not just in brain tumors, which--but in other tumors. I mean, I've helped two people, including a family member, with breast cancer, which was seen at other--which, unnamed--leading institutions, some of which were misdiagnosed, or not understood. And the interpretations of these clinicians, including breast cancer, were far superior to... Very good. And so we're not talking about Podunk. We're talking about elegant institutions. So I think that showed, to me, the advantage of seeing so much.

I mean, we have really such a good team, and such a volume of material, that you learn. You learn from your errors. They are not truly errors, but, you know, it's lack of knowledge. And we've built our knowledge base on many, many, many cases. I don't think there's another institution that has the number of cases, the number of neurosurgeons, just devoted to brain and spine tumors. So that our group is very experienced, but not just--I mean, when I say this--I just wanted to bring this up--it's not just that we are leaders in brain tumor, but in all other things, as well. I mean, I was very impressed with the breast [oncologists]. I had nothing to do, I just called on the right clinical people here. And again, like in the neuro field, they are--and we're talking about outstanding institutions--making significantly different diagnoses, and leading to... Now, are results always good? No. Cancer is a bad thing, and I experienced it. I lost my wife from ovarian cancer. So I am... And this is despite all we know, and she got the best of care here and at Memorial Sloan Kettering. It didn't help. But I think there are things we can accomplish, and that is because of the team effort.

ROSOLOWSKI:

Well, let me ask you. I mean, we--I'd like to talk more about the evolution of that team in the department, but I don't want to derail you from talking about your research. Which would you like to continue with right now?

LEEDS:

Well, I've literally... (laughs) The only thing we've done is, you know, we've also written, and one of the things that we've really contributed is on necrosis of the brain from treatment, whether it's chemotherapy or radiation. And I think we have probably one of the best articles, by the number of citations, on that subject. So that I accomplished because I was here, and we had all that material, and we utilized it.

ROSOLOWSKI:

So this was something--were you using samples from the tumor bank, and--or...?

LEEDS:

No, no, from our--you know, from the clinical experience. We had, you know--we had an excellent neurooncology team, and in the radiation, and working together with Victor Levin [MD] and the radiotherapist, Moshe Maor [MD], we were able to better evaluate the treatment effects on tumor.

ROSOLOWSKI:

So this--so the necrosis was something that had been observed for quite a while, or you had observed it?

LEEDS:

Quite a while. But no one realized that necrosis kills.

ROSOLOWSKI:

Oh. Oh, you mean it has an effect on surrounding tissue.

LEEDS:

Yes, it has a... Well, it destroys the brain. And we actually had an autopsy on one of our tumor cases, a 22-year-old, and there was--his brain was damaged diffusely, and there was no, N-O, no tumor at autopsy. It was all treatment effect. So we pointed out tumors kill, which everyone knows, but that sometimes treatment is an offender. So I think--I would say, you know, I didn't--that was probably one of the significant things, because we have the [material]. Again, that didn't come because we're smart, but because we had the volume of material, and putting everything together, and having that team. And I underlined that. I think that's what reinforces the value of places like MD Anderson, specialty hospitals, which are devoted, in which the pathologists are devoted to cancer, and have seen all variants. And that's what I think, and why I believe our breast cancer did those great results on patients from elsewhere, that had been at outstanding places that were unable to act as well...

So we have the advantage of not only the people but the team and the material. I think you--you know, no matter how good you are, it's the material. And Dr. Sawaya is obviously one of the neurooncological [neurosurgeons]--and developed--helped develop with us--you know, neurooncological neurosurgery is now a big fellowship here. I mean, it used to be where the neurosurgeons would allow the juniors to do the brain tumors, because they were going to die anyway. Well, you know, if you can't do anything, it's a way to train people, but now we can do something. I mean, the quality of life is improving. The--I mean, yeah, glioblastoma is still the smartest brain tumor, and probably the smartest tumor. It understands the treatments, and avoids them. And--

ROSOLOWSKI:

So how--what does that mean? You know, tell me, how does it avoid them?

LEEDS:

I don't know how it--but it develops defenses against [therapies]. That's why they have checkpoint inhibitors, and other activities to try to change this with the new immune therapies. But so far we have not--I must tell you, I think we've improved the length of life. They used to live six months to a year. Now, patients live two to three years. But we used to have a tumor conference, which we shared with UCSF, which the patients came back--it was just for the patients to understand brain tumors and therapy. And one patient asked, "Why don't we live longer than three years?" Well, three years is a long time in glioblastoma, because I remember when I was a resident at the neurological institute, which was one of the best places in the world at that time, you know, it was six months to a year, a year and a half. Now it's up to three to four years in cases, because of improved neurosurgery, improved chemotherapy, and improved radiation, the combinations have... But still, that's why they now have a Moon Shot Program on glioblastoma, because over the years the length of survival has not really, looking at the curves, the Kaplan-Meier survival curves have not significantly changed. They are living longer, but it's not... So that's why it was put forth was to see if we could improve the results. Yeah, things--I mean, if you look to what it was when I got here, survival has increased, I mean, because of all the efforts, but it still, when it comes to glioblastoma, is dismal.

ROSOLOWSKI:

What was the time period in which you were doing the work on the necrosis?

LEEDS:

That we... I think I started that in... Let's see, I got here in '91. We published the paper in 2000. I think by 1994, 1995 we started to really work on this, and accumulate the cases, and evaluate the findings. And with the help of Dr. Fuller, the neurooncologist, we were able to do the--put the materials together.

ROSOLOWSKI:

Now, I wanted to ask you: last time we spoke you mentioned that you were the first pediatric neuroradiologist.

LEEDS:

Well, yeah.

ROSOLOWSKI:

Tell me about that. (laughter)

LEEDS:

Well, that was easy, because I trained at the Neurological Institute, and I was actually the first NIH fellow in neuroradiology, which started under Dr. Juan Taveras, who was my--the head of neuroradiology at Columbia Presbyterian. And we had an outstanding pediatric neurology program at the Neurological Institute. And I left Columbia and took my first position as the Head of Neuroradiology at the University of Southern California, and I was at the Los Angeles County General Hospital, which was a major teaching hospital for that hospital, and was an outstanding place. The only problem was it was too nice. People used to escape. You know, there was sunshine and the sea.

And so I moved east, because it wasn't as academic as, I guess, I was at that time. And I went to the Graduate Hospital of the University of Pennsylvania, which wasn't as busy but was right next door to the Children's Hospital of Philadelphia. So I always had an interest in pediatrics because of my experience at the Pediatric Hospital connected to Columbia, and my colleague, Dr. Kenneth Shulman, who I had been a co-resident with, who in--he was in neurosurgery; I was in neuroradiology--came to Philadelphia, and he asked me if I would come to Children's to help with the neuroradiology. Up until that time, I don't believe there were any neuroradiologists in pediatrics. Yes, we did it at Columbia, but we--you know. And so I learned a great deal, because we had a very large neurosurgical program, and it was outstanding, so I was lucky. And--

ROSOLOWSKI:

Let me ask you--I mean, this is obviously a very naïve question, but why were children of such a special interest? What are the particular challenges that they present? How is it different?

LEEDS:

It's... (laughs) That's easy: because, one, you know, one doesn't like to see children suffer. Children's tumors are definitely different than adult. They are very different. And in evaluating a patient, the age is critical. And some pediatric tumors--and we've written on this--disappear. If you... I mean, you just take a piece out, and even if you leave it sometimes they go away. They just, you know... Children, you know, no one wants to see suffer. So pediatrics is very interesting. And, again, I was helped, because not only did I have Ken Shulman [MD], but we got one of the outstanding pediatric neuropathologists, who is still alive in Philadelphia, named Lucy Rorke [MD; Lucy B. Rorke-Adams], and she's still at the Children's Hospital--

ROSOLOWSKI:

I'm sorry, her last name?

LEEDS:

Rorke, R-O-A-R-K [sic], I believe. Lucy Rorke. She's one of the outstanding pediatric neuropathologists. So I was lucky. We had Ken Shulman. We had Lucy Rorke. And we actually had good pediatric neurology at the Children's Hospital. So I had a wonderful five years there, and helped build the program, and start, and today it's one of the leading centers, and I'm very proud of being at CHOP [ ]. Children's Hospital of Philadelphia is one of the [best]. And I see all the wonderful things they're still doing that are just tremendous. It was always... I had the privilege of working there, and consider myself lucky. You know, it's good to be at the beginning, when there are [many] opportunities, and I guess I seized that one at Children's, and really learned pediatric neuroradiology.

ROSOLOWSKI:

And obviously, you know, brought that knowledge to MD Anderson. What was the situation with pediatric neuroradiology when you came here?

LEEDS:

I don't know. It was OK. But I guess we improved on it, and worked on it. And I--we got good pediatric neurosurgery going, and it's a love of mine, because it was--I was there at the beginning of it. Well, most of it. So I was, you know, fortunate to have gone into the specialty before it was a specialty. It was while I was a fellow that the Society was formed, the American Society of Neuroradiology. And having been there at the beginning, and worked with Dr. Taveras, I was fortunate enough to be selected as one of the founding members of the Society, and am now getting to the end, and I'm the last working, living neuroradiologist and [founding member]. But it's interesting: I told you I had two others who shared an office at the Neurological Institute. They were my teachers, Norman Chase [MD], who later became the Chair of Radiology at NYU, and Gordon Potts [MD], who came over from New Zealand. I told him his English was quite [good]--and he laughed. He said, "No, they think I'm a foreigner. I'm from New Zealand." And he came from Queens Square to the Neuro Institute. So he was one of my teachers. And he and Norman Chase and I shared an office at the Neuro Institute, and we were all founding members. And Gordon Potts is still alive, but he's retired. And Norman Chase is still alive, but he's retired. So I'm the only one [working. The others have died.]

ROSOLOWSKI:

Late-working member.

LEEDS:

--working. And I'm getting close. (laughter)

ROSOLOWSKI:

So tell me about how your research evolved after the necrosis project.

LEEDS:

Hmm?

ROSOLOWSKI:

After you did the work on necrosis, how did your research evolve from there?

LEEDS:

Then I did all that other physiological studies. I was always--I was always interested in the physiological factors of blood flow and changes, and actually wrote a seminal book, which came out at the wrong time, because it came out when CT [started], so it got lost. But it was written with Dr. Taveras on dynamic changes with cerebral angiography, in which we foresaw most of the current changes that are really being seen better, obviously, with CT, and then with MR. But we did come up with circulatory changes, and I guess that was the title of the book: Circulatory Changes in Neuroradiology.

ROSOLOWSKI:

So am I understanding correctly that the fact of doing the imaging changes circulation patterns in the brain, or that you were using imaging to--

LEEDS:

No, no, no. No, we're using the... No. (laughs) No, it doesn't change. It gives physiological information. It's a physiological feature. The circulation in the brain, understanding the normal, and then the abnormal, I mean, you know, many things came from that. We wrote about when just angiography, the shaggy vessel brought into focus. But that came from my understanding of that dynamics. We talked about all the circulatory changes, which helped us. What--we learned that the flow in children, the circulatory time in children is obviously shorter, and then reaches a normal, about 4.2 seconds, and then goes to six seconds. Anything over six seconds was pathological.

That came out of our circulatory dynamic research. But we also pointed out the importance of the veins. I mean, I pointed out to the neurosurgeons prior to our work all they were interested in was shifts, midline shifts of veins and arteries, and stains, tumor stains. But we pointed out that the veins were critical because the veins around the lesion identified the exact location of the tumor, and was extremely helpful. So we identified many important things on physiological change. I wrote a paper subsequently based on that, on simulating brain tumors, circulatory changes. We had stains in infarcts, and we distinguished those stains from tumors, which I wrote. And then that was what we see in then CT and then MR. So it was an evolving. But it was the knowledge that learned from... I mean, angiography has never left. It was a lot of the knowledge of the flow that I learned that enabled me [to] call a meningioma [ ] a mother-in-law lesion. She came early and stayed late. (laughter) And that was the stain of a meningioma. Came early and stayed late. So we used those stains, which we still use to identify tumors. So we had done a lot of this early work, you know, with the angiography. And I think that gave me an advantage. We also did air studies, which were terrible, and I was happy to see them disappear.

ROSOLOWSKI:

Yeah, you were mentioning those last time, they didn't like them.

LEEDS:

Patients did not like them.

ROSOLOWSKI:

Yeah. Now, how did--you said that you returned to more physiologically-based work after you looked at the necrosis, so how did your focus shift in physiology? Because a lot of years had passed. What were you doing then?

LEEDS:

Nothing. No, it's just using the material to redefine the brain tumors to understand the various patterns, to be able to figure out what was what. To tell what the stain meant, to identify the various patterns to separate gliomas from meningiomas, and from other lesions. Also, it's amazing how vascular lesions, meaning infarcts in the brain, can look like tumors. I said I wrote that paper that turned out to be mostly strokes that gave these unusual stains in the brain, which we identified and wrote about, which helped me to analyze. And it's knowledge. You build up a knowledge base. And it's critical that you understand stroke, because to separate a brain tumor, it is not always so easy. I mean, we've gotten cases referred both here and in New York that were called brain tumors that we're able to analyze and say, "No, no, these are not brain tumors. These are strokes. Leave them alone, leave-me-alone lesions," like an infarct.

When we established the fellowship program in neurooncological neuroradiology, we wanted it to be someone who had had a neuroradiology training so that they would understand brain tumors, because if you don't know about infarcts, and you don't know about trauma, and these other things, you're going to make significant errors. So we want people to have a knowledge base of neuroradiology so tumors can become more meaningful to them. So it all builds, and if I look at my material, it's all there now. But understand--knowing the angio--we had the advantage of having looked at the early vein, and the significance of the early vein. How does it become an early vein? Which is seen in stroke and in tumors. But how to identify it, how to know it, how to avoid making those errors. You don't want to treat a stroke as a tumor and a tumor--

ROSOLOWSKI:

And vice versa.

LEEDS:

--as a stroke, which happens in a lot of places. So knowledge is critical. And basic knowledge is more so. So I had the advantage of starting with very little and growing it. And, you know, I tried to do that to teach others, because I'm not going to be here forever, and I'm trying to instill the search, the interest, and the knowledge in those that follow.

ROSOLOWSKI:

Yeah, I was just going to ask you how you communicate that depth of knowledge to trainees.

LEEDS:

By training the residents, pointing out the various changes that will enable them to be better than I am. The more I can teach, the next generation will get better and better. Hopefully they will continue to improve. And there are always new things coming. I mean, I will not--we are not at the end. I mean, we are at the beginning. I mean, I think--you know, who would have--I mean, we just got CT, and we're beginning to understand that, and along came MR, and changed the whole approach and visualization. I mean, looking--for the first time, we could look inside the brain, I mean, with CT, but really now with MR, you know, with the different pulse sequences, looking at the different changes, look at the dynamism and the contrast. And I think we'll get different contrast, which we got. Look, myelography was terrible with the oil contrast. It became--then we had the nonionic contrast, which is safer, and we didn't have to take out. We had to take out the oily contrast, which was painful to the patient, which led to a lot of problems. But it was the best we had.

LEEDS:

And, you know, I worry about the lawsuits. I mean, they come up with these things. They want to sue doctors for drugs that do... But, you know, until they--they've done some good, and, you know, this is the risk. There's always a risk--benefit. A patient takes a risk. When you're on a drug, you never know what can happen. And when I see these--I watch these programs, "If you have this, and if you've taken this drug, we're going to sue them." I mean, this is terrible. This stops advances, because people say, "We don't want to..." And I think they've got to stop. There is no malpractice. You've used it because it's the best you've got at the time. These same lawyers who are making all this money don't care. It's just how much money do they earn, I mean, on this, and that bothers me. And it also obstructs. People are afraid to do certain things because there is risk. But everything is risk. If you do nothing, there's a risk. If you do something there's... I mean, this hasn't been pointed out, but I think if I were a lawyer I--on the other side you'd point out if you didn't do this, if these things weren't available, many patients would have died. And new drugs come along that are better, but that's the same in everything we have. Nothing lasts--penicillin was great, and then it caused problems, you know, and allergies and so forth. And, you know, that's the same with everything. Nothing la... And the infections and the tumors learn how to deal with the therapy.

ROSOLOWSKI:

Do you feel that the informed consent processes in institutions, and the IRBs, help protect researchers against those lawsuits?

LEEDS:

No.

ROSOLOWSKI:

No, you don't.

LEEDS:

No. No. I think--I saw a classic TV program on suits, and actually they were--it was Denton Cooley, the famous Texas [heart surgeon]. Probably one of the great heart surgeons of all time, Denton Cooley. And he talked about having this patient, including the patient's rabbi, and they prepared this huge list of problems that if you operate on the heart these things can happen. Everything conceivable was in that risk essential, right? The patient signed. Something went wrong. They sued [anyway]. So no matter what, you know... People will sue. If you can, you will. Do you always collect? No. In fact, those were the only cases I really tried to help. I did not like malpractice, but if a doctor was being sued and I thought it was wrong, I would take [the case]. I didn't like dealing with lawyers, because they're not really considering the outcome--the true outcome, which is the risk. It's risk and reward. You don't know what the risk is.

ROSOLOWSKI:

What was the first occasion when you were called to testify at one of these lawsuits?

LEEDS:

I guess the first time was when I was a fellow, and just--and... And a neurosurgeon called me about a stroke case, and asked if I could represent him. And I said--I talked to him, look--I said yes. And they brought a--you know, and I had done thousands of angiograms. And they brought a neurosurgeon, the other side, who was close to 90, and I guess I was 39. And, you know, and he's talking about a hundred cases. I sat there, and when the judge--when they asked me, I had done, you know, almost a thousand. I didn't--you know, he was a man that was three times my age, and supposedly trained with Cushing, which I doubted, and I said--and I had to say how many cases, you know. And I felt embarrassed, because, you know... And then his lawyer asked me, he said, "Dr. Leeds, do you ever make a mistake?" And I knew that was a double-edged sword. If I said "No, I never make a mistake"--you know, I thought this all over very quickly--the lawyer would say "Ladies and gentlemen, this doctor thinks he's God. He never makes a mistake." That was not the answer.

If I said I make a mistake, then "Why isn't he wrong in this case?" So I said, "The answer is yes and no." He didn't want that. You know, lawyers only--always want a [yes or no]. I said, "I can't give you a yes or a no. I mean, a yes or a no, it is a yes-slash-no." The judge figured it out, what I had figured out, and he looked at me and he said, "Doctor, do judges ever make mistakes?" And I looked at him and I said, "When I'm in your court, sir, no." (laughter) The judge laughed. The jury laughed. The lawyer stopped. Because there was no answer to that question is what I'm saying. You have to know... It's like people say--they ask you about a book, and if you say you believe in that Dr. Smith is a world authority, and they say, "Here, he disagrees with you on this," so what I usually say is "Dr. Smith is a great authority, but do I agree with everything he writes? No. Do I disagree with everything? No. But he is one of the authorities." And no one is always right or always wrong. There's a mixed opinion on things. You know, you look at things, there are two answers on many things, both of which could be right. So I know I don't know everything, and I don't know what's coming. But I don't like lawyers.

I'll tell you the best case I had. I had a case where they called me in to look at a cervical spine. It was said she had a fracture of the spine, and her head would fall off. She happened to be a Rockefeller relative in an automobile accident. Well, the--I was working for the defense, and the lawyer brought me the films. I looked at the films, and I said, "No, no, this is not a fracture. This is a congenital anomaly, well-known." And I brought the research books to show the picture that was identical to this. And I said, "This is not a fracture. This is an anomaly of the cervical spine that this patient has." Well, you know, and that was that. So the other side says, "How do you know that, doctor? How can we prove that?" I said, "I wouldn't want to prove it, because we're only going to do harm by operating. This is a normal... And I've brought the example from the literature to show--just to verify what I'm saying." The lawyer almost kissed me, you know, before, because now he had a defense. Well, they did pay off, because she had an accident, but it wasn't the payment that lawyer was expecting, because, yes, she suffered an injury, but not with her head falling off. And he... (laughs) It was only funny in that when the case was, you know--when the jury stepped out, and I was leaving with the lawyer, the lawyer for the other side came up to me and congratulated me, because it was obvious--he said, "You did a won..." But boy, I mean, he made me sweat. But that's a good lawyer. So I--you know, there--it's not easy, and it's, you know... And there is never always yes and no. There are always two sides, and you have to amplify that for the jury to benefit the patient.

ROSOLOWSKI:

How many cases have you testified on?

LEEDS:

I don't know.

ROSOLOWSKI:

A lot of 'em?

LEEDS:

But many. But mostly because I thought the--I testified--I didn't have to testify, but they asked me to consult. The lawyer actually called me here for Dr. DeBakey. And I wouldn't have done it, but since it was Dr. DeBakey I couldn't say no, so I did look at the case. But fortunately they didn't need me, so I didn't have to go any further.

ROSOLOWSKI:

Yeah, it's interesting experience. I've never talked to somebody who has--or at least the conversation has never, you know, touched on any kind of testifying in legal cases before. I'm sure I've interviewed people who have, but it's not come up.

LEEDS:

No, it's just something--you know, I don't like doing it because lawyers are just trying to... And good lawyers win bad cases, and good lawyers lose good cases. I mean, you know, the jury hears, the jury doesn't hear. You do the best you can.

Chapter 10 Educating the Next Generation and Concerns about the Future of Healthcare A: Overview;

Codes A: Overview; A: Definitions, Explanations, Translations; B: Education; D: On Education; B: Research; D: Technology and R&D; D: Understanding Cancer, the History of Science, Cancer Research; D: The History of Health Care, Patient Care; A: Career and Accomplishments; A: Post Retirement Activities; C: Dedication to MD Anderson, to Patients, to Faculty/Staff; B: The Business of MD Anderson; C: The Institution and Finances;

ROSOLOWSKI:

Sure, sure, yeah. Would you like to talk more about your research, so we can bring that part of the story to a close?

LEEDS:

I'm done.

ROSOLOWSKI:

You're done?

LEEDS:

Yes. I've told you all the things... I can't--didn't...

ROSOLOWSKI:

No more research? What--you aren't working on anything right now?

LEEDS:

I'm right now--right now I'm just working on advanced brain tumor imaging, so, you know--

ROSOLOWSKI:

And what does that mean, exactly?

LEEDS:

That means using the advanced techniques, physiologic techniques, to better define tumor grade and tumor location and kind of tumor, why do we suspect it is. And learning more and more.

ROSOLOWSKI:

What do you think is sort of the next big phase for neuroradiology?

LEEDS:

I don't know.

ROSOLOWSKI:

Yeah, really?

LEEDS:

No, it's going to be some development in equipment, in either MR or... You know, there are several new techniques that are sitting there, waiting.

ROSOLOWSKI:

What are those techniques?

LEEDS:

Well, they're using temperature, and using other means with MR, and possibly even newer magnets, just like newer computers are possible. Advanced computing. Who knows? I am not going to be part of that, because I'm just now--my main goal right now is education. I'm working to educate the newer generation to be as good as they can be, to advance diagnosis, and education, and stimulate them to do work on research. But I've done my fill. But I'm enjoying it, so I think this is the other benefit, I think, is that I've enjoyed it so much that I like passing on the knowledge to the next generation, hopefully to make it better, smarter, and more advantageous to the patient.

ROSOLOWSKI:

What do you think of the--how has the quality of students or fellows shifted? Or what's--how are they different?

LEEDS:

I don't think they are. I think people are people. I mean, I think the people I trained with are very good, and through the years I think they're smarter, kids are smarter now. I mean, I see what they learn in school. My daughter was learning things, you know, about drugs and the brain in high school that I didn't learn until medical school. So the kids are really smarter, and, I expect, better trained, because of us and all the... You know, knowledge builds. Hopefully bad knowledge gets discarded, but there are occasionally bad things. But I think children are smarter, and they're growing smarter. And I think that's the advantage. So I think it will get better, because...

The only thing I worry about is the single-party payer and the cost of medicine. I mean, to go to medical school is very expensive. If there's a single-party payer, the salaries will decrease, the number interested will decrease, and eventually the thing that's going to be sold is nobody's going to want to go into medicine. Look, in Europe they do what they--they don't pay to go to medical school. Nobody pays. Do you realize what we earned? I earned $80 a month as an intern and didn't get food. Eighty dollars a month. And I worked long hours. I'm really glad that they cut the hours. I once worked Friday, Saturday, till Sunday--I mean, no, I should say Saturday, Sunday, and Monday morning. I didn't get home until five o'clock.

ROSOLOWSKI:

Is this as a resident or intern?

LEEDS:

As an intern.

ROSOLOWSKI:

As an intern.

LEEDS:

Five o'clock. So I had worked 48, almost 53 hours. And I didn't think that was right. But, you know, you're an intern. No one pays any attention. So I think... But it worries me, because I think if medicine comes like the traffic, like getting a license, which is what... You're talking about the VA system, where--right? What's going to--what is the VA system? A one-payer system. What's going to happen when the government... And I think eventually it's going to happen, because--I don't care whether it's Republican--because people think everybody deserves medical care. So once you come to that conclusion, which is correct, there's only one fallacy: if you don't have enough to eat, that's a significant... Nobody believes in free food, but they believe in free medical care. Well, you know, there is no free lunch. You know it as well as I know it, and if... Somebody has to pay. And if you make the physician pay, which means he makes less, then what's going to happen to medicine? I mean, it's not that MD Anderson or any of these places are going to disappear; it's that the quality will diminish. A lot of people go into medicine, as my son said when he was at Columbia College--the kids were going, he said, because they earn--they expected to earn more money. But it's going to come that that's not going to happen. Then they're not going to come running. And then the quality will go down, because the top people are going to go where the dollar is.

ROSOLOWSKI:

Where the dollar is, sure, sure.

LEEDS:

You know that. I mean, that's... I mean, you--I mean, no, people are--good people are going to go into things. They still do. I mean, the social studies would have disappeared if we went on just dollar. But, again, it's an inhibition. And I think one of the qualities in medicine has been the number of people and the quality of the people. You know, it's not easy to get into college, good colleges now, and it's harder to get into medical school. Well, what's going to happen...? I told you that when I went, we were inundated, because I had the people going, plus the people who had been delayed because of the being in the war and so forth. So there were so many... They're still hard to get into medical school. So I don't know what's... But when they do this, and--which is what is happening--I think then the quality will change.

ROSOLOWSKI:

Let me ask you--I mean, you've talked about these kind of big changes, you know, in the marketplace, and in kind of attitudes about medicine. What are some changes that you've seen at MD Anderson since the early '90s, when you arrived? How would you comment on that?

LEEDS:

I... Just that it keeps getting better, I think. Unfortunately, some good people leave, which you feel their absence. And the leadership is critical. They need a healing for the faculty. I never had that problem because I was always happy with what I did, but it did impact me--and I will tell you this--I told my kids not to go to medical school.

ROSOLOWSKI:

Really?

LEEDS:

Well, because I saw the beginnings of this happening, and I wondered when we would get socialized, or one-party medicine. And I felt it would be--I didn't know--actually, from what I see, it wouldn't have impacted them. But I didn't know. I just saw it happening with the cost of medicine going up, and I thought with the thinking that medicine is for everybody, and there is no free lunch. I mean, Bernie Sanders said, yeah, it could start as a free lunch, but eventually somebody has to pay for it. And who's going to go into medicine?

ROSOLOWSKI:

Now, you mentioned that you thought the leadership at MD Anderson was really critical. So you came in at the end of Charles LeMaistre's tenure, and then through--

LEEDS:

It didn't... For me, it had no significant impact. The significant impact for me was when Bill Murphy was--left the department. You know, I--

ROSOLOWSKI:

How did that change things?

LEEDS:

Well, I think Bill built--laid the foundation for a strong department, and I thought he did great work for Doctor... I mean, he did the finance, the tough stuff, and was a great leader. And I felt the loss when he stepped... But, you see, at my level, it didn't impact me.

ROSOLOWSKI:

Well, it--well, we're talking, too, about leadership of a department. So what was it that Bill brought to the department that was so key?

LEEDS:

He brought in a knowledge base and a brain that functioned at a higher level. He really started the new department, the growth, the building of the department, and he did bring a new life to MD Anderson. And I respected Bill very much. Well, he was very good to me. We got along very well. Our goals were similar, and--

ROSOLOWSKI:

How would you describe those goals?

LEEDS:

To build and make a better quality of department, to strengthen the department--

ROSOLOWSKI:

Now, did he--

LEEDS:

--to get new equipment. So he was really--he could--he was a seer and a doer. I really respect Bill.

ROSOLOWSKI:

And did he also share the kind of team focus that--

LEEDS:

Yes, I thought so. And he built a strong department, and he encouraged younger people, and he helped us build. And I really miss Bill. We became very good friends, and he was very good to me, so I couldn't complain.

ROSOLOWSKI:

Now, who replaced him?

LEEDS:

Don Podoloff [oral history interview].

ROSOLOWSKI:

OK. And how did kind of the focus shift when Dr. Podoloff came in?

LEEDS:

Well, Podoloff--Dr. Podoloff is more of a people person. Bill--the problem Bill had was really not a people person. He had a vision, but he was not... Dr. Podoloff was really more of a diplomat, more of getting together, but he really, I don't think, understood a lot of the complexity. So...

ROSOLOWSKI:

So you're saying there was maybe more of an intellectual kind of focus with Dr. Murphy, and more of a collaborative people focus.

LEEDS:

Yes.

ROSOLOWSKI:

OK, that's interesting.

LEEDS:

He knew how to build--Podoloff... That was Bill's weakness, if anything, was that he was not a people person. But he was good.

ROSOLOWSKI:

What do you think--I mean, when you and Dr. Murphy were working together, what were you kind of hoping for as a next step, you know, that kind of got cut short when...? You know, where might the department have gone if Dr. Murphy had stayed on?

LEEDS:

Oh, I think it would've gone further, and the hires would've been important, because Bill was really... I admired Bill, because even though he was a musculoskeletal radiologist, he had great comprehension in most of the specialties. He really... And, you know, when he was at a conference, he would ask very excellent questions, you know, if someone was asking a question. He had great perception. And he's... I think it's great that he's here, but--and I understand he's partially responsible for this project.

ROSOLOWSKI:

Yeah, he's on the Steering Committee, yeah. Yeah.

LEEDS:

Well, he's a wonderful guy, and I... I liked him and his wife, Virginia.

ROSOLOWSKI:

Yeah, I'm not asking you to talk out of turn or anything, just, you know...

LEEDS:

No, I... By the time Bill... You know, I was getting very senior, so it impacted me, and then it went well.

ROSOLOWSKI:

Now, tell me about--you talked a little bit about your decision to kind of split your time between New York and MD Anderson, and now you're here full-time, though.

LEEDS:

Yes.

ROSOLOWSKI:

Yes, OK. And what are your next plans?

LEEDS:

Well, (laughs) now I'm planning for what my grandchildren are going to do. So no, I'm reaching the end of the road, shall we say, and so my main goal is what I told you, is I'm going to help the new faculty--I mean, young faculty--try to make them better, and leave them with my knowledge, and articles to write, and working with Ray Sawaya to talk about things. And I work with Greg Fuller. So I am working with the neuropathologists. I go to their conference now regularly on Thursday morning. And talking to Ray about neurosurgery.

ROSOLOWSKI:

Yeah, what are the big ideas that you and Ray Sawaya are kicking around? Because I bet you two big thinkers are talking about some interesting things.

LEEDS:

Well, we're... Yeah, a neuro institute.

ROSOLOWSKI:

Oh, OK. So tell me about that.

LEEDS:

Well, to bring together all the forces in the same building, to be together, to think together, and I think if we're in the same building and we work together as closely, ideas will percolate. And by putting all of us in proximity, and to bring the sciences, the basic science, the neuroscience, all the activities in one place will stimulate the whole group. And it's just--we've lost that, I think. We used to have that, but it's gone.

ROSOLOWSKI:

Is that a factor of the growth of the institution?

LEEDS:

The growth, and... Well, everybody used to have lunch on the 11th floor, and there was the center table. And even doctor--the president sat at that table, the CFO, you know. And there was a communication. And many faculty sat, and we communicated. We knew each... I mean, I knew the chest surgeons very well, and liked them, and met--you know, talked to people I didn't know, that I wouldn't run into on a daily basis. So it was great. And then that disappeared. There's no single place where people meet anymore, so there's a lot of diversity, and not communication. So I think if we had that Neuro Institute, and if it had a dining room, like, that we would get to... I don't know any of the radiologists any... I used to know all the section heads--you know, the musculoskeletal, the chest, the... We don't know then anymore. You don't see them.

Each group is by--neuro, with its 20 people, doesn't communicate. Neurosurgeons, you know--it's... So I think if we were all together and had a place to congregate, they would probably put in, because you don't know--you have doctors, you have nurses, you have technicians, and scientists. So we think that putting everybody in one place would mean--you know, meetings will be held jointly when new things happen. So there will be an intermingling. Right now that's missing here. There is not a comingling. I mean, I don't know most of the people, but--and if I took the--they know less. I at least know many of the people that were here before, but we're all over the place now. The place is too big. That's... You know, bigness is not always... It's like any corporation: it gets so big you lose--OK--you lose this--how shall we say--communication.

ROSOLOWSKI:

Do you think that's had an impact on the institution as a whole, beyond neuro?

LEEDS:

I think it may have a... I said that, that, you know, we used to have that center table, and we all knew what was happening before it happened. I mean, people talked. I knew someone was leaving or coming long before it happened, because people would talk. That's how we got that CFO who I said, you know, "We need more MRs." And when I explained it to him he looked me in the eye and he said, "Norm, you're right. It generates income. I'm going to work on it." And he did.

ROSOLOWSKI:

So that was a conversation over lunch.

LEEDS:

Over lunch. But they were here. You could talk to people, and communicate. And I think that is missing now. I mean, everybody eats someplace else. You know, you either bring your lunch... There's no purpose. There's no group. We used to look forward--it was a social get- together, and to say hello, and you met people from various disciplines.

ROSOLOWSKI:

I mean, I've talked to a number of people who've tried to figure out how within their own department to create a sense of community, and it's a struggle. It's really a struggle.

LEEDS:

It--right now... Well, because you just--you hinted. Think about it: anything that gets too big becomes a pro... The advantage in bigness is having more people. The disadvantage is the communication levels drop. And I think that's another advan... The Neurological Institute will bring together all disciplines, and bring head and neck, which works with us very well, as well as neurosurgeons, neurologists, oncologists, together, neurooncologists, head and neck oncologists, radiation oncologists, to discuss things and problems more easily.

ROSOLOWSKI:

So are you kicking around concrete plans to raise funds to create this, or get this...?

LEEDS:

No, we're just talking about...

ROSOLOWSKI:

Just talking, yeah, yeah. I mean, it's a wonderful idea. It's very exciting.

LEEDS:

Well, he brought--Ray brought it up to Dr. Mendelsohn about the need, and also to Dr. DePinho. But they have to be responsive. I mean, these things don't happen in a vacuum, and we're not important enough... I mean, it really comes--certain things come from the top, and there has to be thinking on how to improve the communications between departments and in departments that is missing. Size is an advantage and a disadvantage, and you have to think about--that would be the first priority would be how to bring people together to realize that together there is strength. Separation is only weakness. So yes, I think a discussion of what can be done, what can't be done, what's possible, what could be possible with the proper resources, and how to bring them all together is what is necessary. So it's building. I believe that's critical for the institution.

ROSOLOWSKI:

Is there anything else you would like to add this morning?

LEEDS:

No, I can't think of anything else to add to this. I'll be interested to see what you've summarized.

ROSOLOWSKI:

Well, I won't summarize. These are your words, and I will leave them as is, and I will send you a copy of your transcript to have a look, and make sure you're OK with everything. But no, I don't--

LEEDS:

What do you mean? What...? But...

ROSOLOWSKI:

Oh, oh, kind of--

LEEDS:

Yeah, but you... Yeah, but still, you're writing things, comm... When I said "summarize," I mean I'll see what... That's fine. I want to see what you say.

ROSOLOWSKI:

Yeah. Well, I create materials so that people can find their way around your interview, so that--in that sense I do summarize.

LEEDS:

That's good.

ROSOLOWSKI:

Yes, yes, absolutely. So it'll get read and used.

LEEDS:

That's what I said, huh?

ROSOLOWSKI:

Yeah. Yeah, yeah, yeah.

LEEDS:

No, that's why I was happy to do this. No, I'm--look, I was smart enough to recognize the opportunity when it came, and realize it. And I had to sell it to my wife. And I had to live through... And--but on the other hand, I lived through it. I knew she was good at what she did. She actually came here, and she was a... She was at St. Thomas. She taught at the... Bette was always interested. She got her EdD. You know what an EdD is.

ROSOLOWSKI:

That's--no, education... The education PhD.

LEEDS:

That's a doctorate... Yeah, an educational... She just didn't take a language. Her work was excellent. And she was always interested in reading, and reading development. And she worked--she was a reading teacher in New York City, and she was the one who developed programs for improving reading for people. In fact, the best story about her is she took--she's constantly--I mean, she had her EDD, but in the New York City school system you get paid, you know, for how much--

ROSOLOWSKI:

Right, by level.

LEEDS:

And so--levels--and she was at too high a level. But she was taking this graduate course at New Rochelle College, and the child she got in this evening course wasn't reading. So she sat down. She diagnosed the process, because that--she was really a good diagnostician, you know, having had that PhD, and was very good at it, and outstanding. And she figured out a program for him. And the professor cited her for having, you know... When they asked, she said what she had done in the program. The professor was very impressed, because this child who couldn't read was now reading, and she had developed the program.

ROSOLOWSKI:

Customized for that person, yeah.

LEEDS:

And she was--she was really good at what she did. She was one of the few people who could test almost any child. She made them feel comfortable, and, well, she always made me feel comfortable, so I was lucky. So I understood she didn't want to give it up, and I figured out after a short time that I had the ability to leave early on Friday and... Because I put in ex... She wasn't here, so during the week I worked--and the week she... We met every other week, because that way it gave me time to build up... And no one--I didn't recall, but, you know, I put in probably more hours than I took.

ROSOLOWSKI:

So she taught for a couple semesters or so at St. Thomas, and then went back to New York?

LEEDS:

She did, and then went back, and then came--and then when she came back here she did that. And she taught courses on teaching at St. Thomas with the lady who ran the graduate program and then became the dean. You know, first was the professor of remedial reading, and then she ran the school, which Bette taught at. But Bette also taught at St. Thomas a couple of courses, and they made her--I forget what; they gave her a special... And I came to that program to--when she got her award. And Bette was special. I knew that. I knew that from the minute I saw her, or spoke to her.

ROSOLOWSKI:

What do you think Bette loved about you?

LEEDS:

I don't know, but I know that when I got through my first phone call with Bette... And by the way, that's why I'm very friendly with my sister, and travel... She introduced me to Bette. She gave me her phone number, because she thought she was pretty, and she was popular. And I called her. When I got through with that phone call--two hours, not knowing her--I said to my mother, "I just spoke to the girl I'm going to marry." How's that? And it happened. Then I finally got a date I had to talk myself into, because she was too popular. But I figured that that two hours I must have made an indent. And once we started going out we were immediately almost going steady, and I think we were going steady until the summer, and then I proposed. And she was a junior in college, and I was a senior in medical school. So we went through--she went through the whole thing with me.

ROSOLOWSKI:

Yeah, she did. Yeah.

LEEDS:

And she was great. We--

ROSOLOWSKI:

Well, it sounds there--like there was a lot of respect on both sides, and--

LEEDS:

We--well, we loved each other, but she had her own mind, which is what I wanted. I didn't want a... (laughs) I didn't want a dummy, or someone who followed everything. And I respected her wanting to stay, because she loved being a reading teacher.

ROSOLOWSKI:

What are your kids' names?

LEEDS:

Frederick, and Frederick is a federal judge, and Patrice G., and she has two kids which are--she's raising. And she broke a glass ceiling: she became a vice president of a conglomerate that included that company that treats the bugs in... The big company. It was one of the conglomerate, the one... No, you know it. The one that adver--it takes care of termites.

ROSOLOWSKI:

The Terminex?

LEEDS:

Terminex. I think it was one of the companies in her group, until she got married. But believe it or not, both my kids married doctors.

ROSOLOWSKI:

Oh, really? (laughter)

LEEDS:

Despite my... My son's wife is a doctor, and my daughter's husband is a doctor.

ROSOLOWSKI:

So how many grandchildren do you have now?

LEEDS:

Four grandchildren.

Two twins with my son, who speak four languages, because his wife is Bulgarian, so they speak Bulgarian, Russian, they speak Armenian, and I don't know what the--and English. And they're the cutest things alive. They're only--they're going to be six. And my daughter has two, one of whom is going to be--is really bright. He gave one of the best speeches I have ever heard, sixteen years old, at his confirmation. And the speech was outstanding. We had breakfast, brunch together that morning, and I said, "How's your speech going, Hagen?" And he said, "I've got to finish the ending. I don't like the ending." So he got up and gave it, and it was a... Do I remember what...? No, I just remember I was just brought in, and it was just wonderful. He expressed himself beautifully. When he got through I said to him, I said, "Hagen, I've been around a long time, and that was one of the best..." He said, "Grandpa, this is something I hope to do in the future." So he's very... And, in fact, I thought about bringing him down here for a few--a month, because he's interested in something... I told him--he's interested in--what is it? He wants to do--be an oceanographer, and work on speaking to dolphins.

ROSOLOWSKI:

Oh, how cool!

LEEDS:

Yes, but I said to him, "Yeah, it's cool, but it's..." I said, "Hagen, this is a materialistic world. You have to think about what you can do that you will generate the income to support what you want to do." So I said, "You may want to think about science, communication." So he--so I got him thinking, and he said, "You know, maybe I would be a bioengineer." I said, "That sounds interesting. And I think communication would be helpful." But I said, "Maybe you ought to come down to MD Anderson for a month, and I'll talk to Sawaya, after this year, between your junior and your senior years, when you're better able to make a decision. And if Ray is still around, I will see if... And I already mentioned it to Ray, as I did to him, that--

ROSOLOWSKI:

That'd be a great opportunity.

LEEDS:

He's such a... He's a great kid, and he's a leader, and he's an organizer, he's smart, and he's very active. But--

ROSOLOWSKI:

You're looking out for the next generation.

LEEDS:

Yes, and he... No, he's really... Well, he's going to a science and math school, and he's the president as a sophomore of the robotic club--

ROSOLOWSKI:

Oh, wow. (laughs)

LEEDS:

--which he hopes to build. And he's done some wonderful things. So I'm very proud of him.

ROSOLOWSKI:

Well, is there anything else you would like to add this morning?

LEEDS:

No, I've given you, I think, above and beyond, (laughter) to give you a full picture. And I agreed with my wife. That's why I said I traveled back and forth. In some ways it strengthened our relationship. Sometimes a little absence makes the heart grow fonder.

ROSOLOWSKI:

It can, indeed. It can, indeed.

LEEDS:

Huh?

ROSOLOWSKI:

It can.

LEEDS:

I said, yes. And we, you know, we had a wonderful life together. I still miss her, and that's the way life is. I mean, I'm grateful for the time I had. So I was lucky.

ROSOLOWSKI:

Well, let me thank you for talking to me this morning.

LEEDS:

OK. When can I expect to see what you're...?

ROSOLOWSKI:

Well, I'll send--

LEEDS:

I'm not put--I am not... You have a lot to do.

ROSOLOWSKI:

No, no, I'm... Why don't we let me kind of tie up the loose end here with the recorder, and then I can tell you what the next phase of the process is, so...

LEEDS:

OK.

ROSOLOWSKI:

So let me just say for the record that I'm turning off the recorder at about five minutes after 11:00.