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0:00 - Segment 00A: Interview Identifer

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Partial Transcript: "The time is about 9:16 on the 13th of October, 2016. And today I am at the Baylor College of Medicine in the Department of Epidemiology, is that correct?"

Segment Synopsis:

Keywords:

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2:04 - Segment 01: Family and Educational Path in South Africa

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Partial Transcript: "Wow, that’s a wonderful statement to make. I usually start these interviews kind of in the traditional oral history place, which was, tell me where you were born, and when. And tell me a little bit about your family background.'

Segment Synopsis: Dr. Spitz begins this chapter by sketching her family background, her original dream of becoming a nuclear scientist, and her transition to medicine because her father thought the field was “transportable.”

She talks about her experiences as a woman in medical school in South Africa, where she was told she was “taking the place of a man” and where even nurses were unsupportive of women students and physicians. She explains that she and her husband, Lewis Berman, left South Africa because of their opposition to Apartheid. Dr. Spitz also notes that, at the time, she didn’t realize how submissive and deferential she was.

Next, Dr. Spitz sketches her educational background, noting stark differences between education for boys and the curriculum she followed at an all-girls high school, where no physics or chemistry was taught. She also notes the lack of mentoring she received, which has motivated her to serve as a mentor in her own professional life.

Turning to her medical education, Dr. Spitz notes that her clinical training in South Africa was “exceptional” (1966 Medicine, MB, BCh, University of Witwatersrand, Medical School, Johannesburg, South Africa). She tells an anecdote from her internship at the same University, where she turned down an internship with an anti-female surgeon and was blackballed.

Dr. Spitz then explains that she took a hiatus from work for a time after her daughter was born in 1968; she began to do research out of convenience and discovered she really liked it.

Keywords:

Subjects: 1. Segment Codes - A: Educational Path 2. Story Codes - A: Personal Background A: Character, Values, Beliefs, Talents A: Experiences Related to Gender, Race, Ethnicity C: Mentoring D: On Mentoring

18:32 - Segment 02: Leaving South Africa and A Focus on Oncology and Epidemiology

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Partial Transcript: "So tell me about the decision to leave South Africa. And this was in what year?'

Segment Synopsis: Dr. Spitz begins this chapter by explaining that she and her family left South Africa in 1978. She notes that “emigration isn’t for sissies,” talks about the decision to come to Houston and then sketches the process of settling in. Dr. Spitz explains that she worked as a physician at an old age home and then decided to do a master’s in public health. Her interest in cancer evolved during this time; she also talks about how family issues influenced her career’s evolution. She notes that she always make family her priority.

Keywords:

Subjects: 1. Segment Codes - A: Professional Path 2. Story Codes -A: Professional Path A: Experiences Related to Gender, Race, Ethnicity A: Personal Background A: Professional Values, Ethics, Purpose

28:10 - Segment 03: A Job in a New Department and Research Successes

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Partial Transcript: "Now tell me, so you got your master’s, and I’m just quickly checking—"

Segment Synopsis: Dr. Spitz begins by noting that she received her MPH from the University of Texas School of Public Health in 1981 and began to look at job offers. This was when Guy Newell offered her an assistant professorship in the new Department of Cancer Prevention and Control. She briefly sketches Dr. Charles LeMaistre’s vision of cancer prevention.

Next, Dr. Spitz tells the story of discovering salivary gland cancer, which led to several publications, then her work linking parental occupations and pediatric neuroblastoma. The latter work gave her exposure. She then discusses her study of lung cancer and mutations to the p53 gene in Mexican Americans and African-Americans. She notes that this study marked the beginning of her real success.

Keywords:

Subjects: 1. Segment Codes - A: The Researcher 2. Story Codes -B: MD Anderson History A: Educational Path A: Joining MD Anderson B: Building the Institution C: Discovery and Success C: Discovery, Creativity and Innovation

40:09 - Segment 04: Epidemiology in the Eighties

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Partial Transcript: "Now tell me a little bit about the state of the field at the time. You know, what—"

Segment Synopsis: In this chapter, Dr. Spitz talks about the state of the field of epidemiology in the Eighties. She notes that it was generally regarded as a “second-class science.” She quotes a colleague who made dismissive comments about the field. This situation began to change when the NCI required SPORE programs to have a population science component. At that point, Dr. Spitz explains, epidemiologists became very much in demand at MD Anderson. MD Anderson’s growing focus on prevention under Charles LeMaistre also created demand, as “epidemiology was the basic science of cancer prevention.”

Keywords:

Subjects: 1. Segment Codes - A: Overview 2. Story Codes - A: Overview A: Definitions, Explanations, Translations D: Politics and Cancer/Science/Care D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

43:42 - Segment 05: The New Division of Cancer Prevention and Department of Epidemiology

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Partial Transcript: "So tell me those stories that you wanted, the lab?"

Segment Synopsis: In this chapter, Dr. Spitz talks about the creation of the new Division of Cancer Prevention and Population Science under Dr. Charles LeMaistre and her role heading the new Department of Epidemiology. She notes that she suggested Dr. Bernard Levin [oral history interview] to head the Division. She also notes that MD Anderson had three population sciences programs at the time, which was “unheard of” in a cancer center.

Dr. Spitz then talks about why the Department of Epidemiology was formed at this time she then talks about her activities as Acting Chair and then Chair of the Department (1992 – 1995; 1995 – 2008). She lists her recruits and tells an anecdote about securing laboratory space for them.

Dr. Spitz notes that the Department was “my baby.” She talks about intentionally creating an environment to provide a good quality of life. She notes that many of the supports for staff and faculty that she instituted are no longer in existence.

Next, Dr. Spitz notes some particular achievements in the Department. Lung cancer research became a focus and the Department created a Lung Cancer Database that continues to serve as a great resource. She lists several activities that focus on lung cancer.

Dr. Spitz next explains why she stepped down as Chair in 2008.

Keywords:

Subjects: 1. Segment Codes - B: Building the Institution 2. Story Codes - C: Leadership A: The Researcher B: MD Anderson Culture B: MD Anderson Impact B: Research B: Working Environment C: MD Anderson Impact C: Mentoring C: The Professional at Work D: On Leadership D: On Mentoring

61:05 - Segment 06: A Research Focus on Lung Cancer and Views on Evolution of the Field

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Partial Transcript: "And what did you do when you—and actually, now that we’re at this place, I wanted to make sure that we picked up all of the evolutions of your own research during this time. I don’t think we completed that story."

Segment Synopsis: Dr. Spitz talks about her research interests in lung cancer in this chapter, beginning with the idea that captured her intellectual interest: only a small percentage of people who smoke develop lung cancer. This led to her major contribution to the field: creation of a lung cancer prediction model that was used for many years (she notes that another, better one is now in use). She then talks about her other roles as a consultant and as a recently appointed member of the National Cancer Advisory Board.

Dr. Spitz then gives an overview of the evolution of the field since the eighties. She notes that in the nineties, the concept of molecular epidemiology furthered the understanding of carcinogenesis. (MD Anderson was one of the first places to operationalize this research.) She then cites technology as an important factor in conducting genome-wide association studies. Now, she says, basic science functional studies are advancing the field and creates the need for epidemiologists to work with basic science colleagues, creating “team science at its best.”

Keywords:

Subjects: 1. Segment Codes - A: The Researcher 2. Story Codes -C: Discovery and Success A: The Researcher B: Education B: MD Anderson Impact B: Research C: MD Anderson Impact 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

71:28 - Segment 07: Founding Integrative Epidemiology and New Training for the New Era of Team Science

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Segment Synopsis: Dr. Spitz next observes that this has created the need for training programs to provide researchers with the necessary skills to work on teams. She also states that the culture of institutions needs to change to adequately recognize team science. Dr. Spitz talks about her pride in having developed the Integrative Epidemiology Workshop, an outgrowth of her innovative concept of integrative epidemiology. She explains this concept and talks about the mindset, skills, and temperament that researchers need to bring to work in this area. She explains how academic science needs to change to foster more team science. She reflects on the legacy she has left in MD Anderson’s research culture.

Keywords:

Subjects: 1. Segment Codes - B: Building the Institution 2. Story Codes -A: The Researcher A: Definitions, Explanations, Translations A: Overview B: MD Anderson Culture B: Multi-disciplinary Approaches C: Discovery and Success C: Education at MD Anderson D: On Research and Researchers D: Understanding Cancer, the History of Science, Cancer Research

0:00

ROSOLOWSKI:

The time is about 9:16 on the 13th of October, 2016. And today I am at the Baylor College of Medicine in the Department of Epidemiology, is that correct?

SPITZ:

No.

ROSOLOWSKI:

I’m sorry.

SPITZ:

At the moment it’s Molecular and Cellular Biology [Department of].

ROSOLOWSKI:

And Cellular Biology.

SPITZ:

But we’re moving to the Department of Medicine.

T. A. Rosolowski, PhD

Oh, excellent.

SPITZ:

And we’ve actually already moved there as a section.

T. A. Rosolowski, PhD

Oh, interesting. Okay.

SPITZ:

And it’s to be called the Section of Epidemiology and Population Sciences.

T. A. Rosolowski, PhD

Okay. So that’s your current position, since 2010? Is that correct?

SPITZ:

Yes. About there, yes.

T. A. Rosolowski, PhD

Okay.

Female Voice

Okay, well, I didn’t want to bother you.

T. A. Rosolowski, PhD

Oops, we have—let me just put this on pause.

(The recorder is paused.)

All right. And we are recording again, after coffee was brought in and water, and we’re both grateful for that. So I wanted to just resume the identifier, and say I’m Tacey Ann Rosolowski. And today I’m interviewing Dr. Margaret R. Spitz for the Making Cancer History Voices Oral History Project, run by the Historical Resources Center at MD Anderson Cancer Center in Houston, Texas. Dr. Spitz came to MD Anderson in 1981 as an assistant professor in the newly created Department of Cancer Prevention and Control in the Division of Cancer Medicine. Between 1995 and 2008, Dr. Spitz served as chair of the Department of Epidemiology. When she left the institution in 2010, she was a full professor in the Department of Epidemiology, in the Division of Cancer Prevention and Population Sciences. So I wanted to thank you for—

SPITZ:

It’s my pleasure.

ROSOLOWSKI:

—yeah, joining me today, or allowing me to join you today.

SPITZ:

Sure. I’m happy to do this. MD Anderson was my home away from home. I spent the happiest years of my career there.

ROSOLOWSKI:

Really?

SPITZ:

Absolutely no doubt about it.

ROSOLOWSKI:

Oh, that’s a wonderful statement to make.

SPITZ:

It’s a wonderful, nurturing environment.

ROSOLOWSKI:

Wow, that’s a wonderful statement to make. I usually start these interviews kind of in the traditional oral history place, which was, tell me where you were born, and when. And tell me a little bit about your family background.

SPITZ:

Sure. Well, I—

ROSOLOWSKI:

And do feel like you can make yourself comfortable. This is an extremely sensitive audio recorder, so you can lean back, and no worries about pickup.

SPITZ:

Okay. Well, I was born in Johannesburg, South Africa. My father was a physician, my brother is a physician. And I married in South Africa. My husband is also a physician, he’s a rheumatologist.

ROSOLOWSKI:

And your husband’s name?

SPITZ:

Louis Berman. And we—

ROSOLOWSKI:

Can I interrupt you just for a minute, and ask you your father’s name?

SPITZ:

Harry Spitz.

ROSOLOWSKI:

Spitz. And your mom?

SPITZ:

Sheila Spitz.

ROSOLOWSKI:

And your brothers?

SPITZ:

Well, I have one brother, Irving Spitz, who now lives in Israel, Jerusalem, Israel. And I have a sister, Shirley Gamsu, and she lives in London, England. So we’re spread all over.

ROSOLOWSKI:

Gosh, you certainly are. Right. Now, obviously you grew up in kind of a medical family. How did that influence you?

SPITZ:

Well, it’s interesting. I wanted to become a nuclear scientist. I don’t think I really knew what it was.

ROSOLOWSKI:

Why did that capture your imagination?

SPITZ:

It just sounded so exciting, the whole concept of nuclear medicine, nuclear science, nuclear physics. My father, who had been born in Lithuania and had to flee the country and went to Germany to study medicine, he felt that I should study medicine, because one never knew about the future. He felt very insecure for many reasons. And he thought that medicine was a great, transportable profession. And he proved to be quite prophetic about that.

ROSOLOWSKI:

Now, was it unusual at the time for a father to be so supportive of a daughter who wanted to go into the sciences?

SPITZ:

Well, this was in the 1960s, and yes, in my medical school class of about 200, maybe there were seven [ ] women. And for the full six years, we went straight from high school to medical school. Sad to say we never had a traditional broad college education, which I think is a mistake. But for the six years, I was told very often that I was taking the place of a man, and I shouldn’t be there because the men needed the slot so that they could graduate and become physicians and support their families. And some women did drop out. It was certainly not a nurturing environment for women in those days. And the strangest part of all is that even the nurses were not supportive of the women medical students. For example, when we did our rotation in the Obstetrics hospital, the nurses used to help the men set up their trays, and so on. But they were very resistant to helping the women. It was a strange setup. But of course, the way they treated women paled in significance compared with the way the black people were treated in South Africa. And that was the reason, eventually, we left. We felt that in the apartheid system, there was very little future for us and our family.

ROSOLOWSKI:

You are not the first person who was originally from South Africa who has told me that was the reason for leaving.

SPITZ:

Yes. When we left South Africa in 1978, we came to America. It was at the height of the apartheid system still. We were fortunate, my husband was offered a job at the UT Health Science Center. And I just came along for the ride.

ROSOLOWSKI:

Can I interrupt you just in kind of moving forward with that story, and go back a little bit? Because I wanted to get a picture—first of all, I wanted to ask you, what were some of your reactions as a girl and young woman when people said that to you? About you taking a place of a man, or kind of being discouraging?

SPITZ:

Well, I kept very quiet about it. And I didn’t realize how submissive I was until I watched my own daughter, who went to medical school. And by the time she went to medical school, I think the class was 50 percent women. But she would not tolerate any thoughts of discrimination against women. And she was very vocal about it. And I thought, how different she was to my generation. We didn’t—we didn’t speak up. And sad to say, we didn’t speak up against the anti—or the apartheid system, either. For example, when we did pathology in our maybe third year of medical school, the black students—and there were only a handful in our class—they were not allowed to attend the post mortems of white patients. When I think about it now, I’m outraged. But we never said or did anything. And that is, I think, to some extent shameful. But we didn’t.

ROSOLOWSKI:

How were your interests evolving? You said that you originally wanted to be a nuclear scientist, nuclear physicist.

SPITZ:

Well, it’s another interesting story. I went to an all-girls’ high school, and we were not offered Physics and Chemistry as classes. We were only—we could study Biology and French. And the boys’ schools were not offered French. They did Physics and Chemistry. And I often wondered, what did the South African authorities think that men in France spoke? (laughter) It made no sense at all. So there I was a very good student in high school. When I arrived at medical school, I was so behind the ball, because I had never studied Physics and Chemistry. And it was an incredible struggle just to keep up. And I actually did consider dropping out. But I didn’t, and—

ROSOLOWSKI:

What made you stay?

SPITZ:

I’m not sure. Maybe just I didn’t want to admit defeat. And I weathered my way through it, and after the first year in the Physics and Chemistry, it was much easier.

ROSOLOWSKI:

Were there certain people that you found were kind of role models or inspirations for you at the time?

SPITZ:

I’ve never—you know, I tell students all the time that it’s so important to have role models and mentors. And I know it is important. But I’m afraid I never had such luck. Maybe I didn’t look hard enough to find a mentor, but I never really had outstanding role models. And I think that’s a deficit.

ROSOLOWSKI:

You had to kind of go it alone.

SPITZ:

Yes, I did.

ROSOLOWSKI:

Self-formation, you know.

SPITZ:

Yes.

ROSOLOWSKI:

Which, I think, it happens to people. It really does.

SPITZ:

Oh, but less so now.

ROSOLOWSKI:

Yeah.

SPITZ:

It was more the era that I grew up in.

ROSOLOWSKI:

Did that lack when you were in your formative time?

SPITZ:

It made me much more focused on helping junior people now. And in fact, now, my research career has ended. I only now spend my time helping the junior faculty, helping them with their grants. And I am the PI of a CPRIT training program in integrative epidemiology. And I’m recruiting post-docs, epidemiology post-docs, and helping train them to become state of the art, twenty-first century epidemiologists. And that’s exciting to me.

ROSOLOWSKI:

It’s amazing how often people are inspired by negative models. (laughter)

SPITZ:

That’s right. Interesting, yes.

ROSOLOWSKI:

It is, yes. So in medical school, then, why don’t we turn a little bit to that. In medical school, you talked about some of the—you know, your more or less pleasant memories about the situation there. How did you feel you were growing as a mind, as a physician, during that time?

SPITZ:

Well, the clinical training in South Africa was exceptional. We were actually taught to be hands-on physicians. Of course, there were no computers in those days, so we actually examined the patients carefully. We took a detailed history and were taught the importance of clinical signs and symptoms. So I think most of the physicians that came out of the medical school were extremely well-trained clinically. Maybe in terms of basic sciences, we weren’t as well-trained. And of course, the extent of the knowledge was not there at the time. This was in the 1960s, when you think how science has escalated since then. But certainly we were trained as great diagnosticians.

ROSOLOWSKI:

Interesting. I’m just checking a few dates here. Let’s see, you graduated—you got your medical degree in ’66?

SPITZ:

Yeah, so actually, we just are celebrating our fiftieth reunion. The [ ] reunion is in February, I was unable to go. But from all accounts, it was a great success. People came from all over the world. I would say more physicians have left the country than are still there, which is very sad for South Africa.

ROSOLOWSKI:

Has that created a kind of crisis? A shortage of physicians, or—?

SPITZ:

Well, there’s certainly a crisis in education in South Africa now, because there’s a lot of revolt and unrest in the universities, because many of the students are demanding free education. And the University of Cape Town has closed for the academic year. And at my university, which is the University of Witwatersrand, it is closed now, although they’re going to be reopening, I think, next week, or this week. So there’s certainly a lot of turmoil, and it can only have an adverse influence on training of academics.

ROSOLOWSKI:

Now tell me about after medical school. Residency, internship? Or internship, residency? And your choice of specialty at that time?

SPITZ:

Well, interesting. There was a—we had a professor of surgery who was very against women. He felt that the only women—he was a wonderful surgeon and a wonderful teacher, but he thought that the place of any women in the OR was as a nurse, not as a medical student. And his internship was really highly sought-after, and he usually took the top candidates. People vied to become appointed to his program. My brother had done it, and many others I knew had done it. They’d all tell me what a difficult experience it was, long hours, and a lot of excessive rules, and very little experience, on-the-job training. So a really unusual thing happened. I was contacted and offered, and asked to apply for his internship. And I decided not to do it, because I felt that I didn’t want to do it, A, and I wasn’t that interested in surgery, anyway. And I didn’t want to be exposed to such a brutal regimen. I hadn’t given thought to the fact that I was probably setting women’s issues back even further. I wasn’t mature enough to think broadly. And as a result, I was pretty much blackballed—is that the expression?

ROSOLOWSKI:

Yeah.

SPITZ:

It was very difficult for me to get another internship. But I managed to get one, and I did Obstetrics and Gynecology. And then I did one in Internal Medicine.

ROSOLOWSKI:

Wow. Do you think that if you’d been in a place where you were looking more broadly at women’s issues, that you might have taken it? Or how would you have weighed that in that situation?

SPITZ:

Well, I suppose I still probably wouldn’t have taken it, because I probably wouldn’t have been very good at it. And it would have still set women’s issues back. So either way, it was a non-winning situation.

ROSOLOWSKI:

Yeah, and a wise decision.

SPITZ:

Probably. In retrospect, I have no regrets.

ROSOLOWSKI:

Yeah.

SPITZ:

But the interesting part is that many years later, I did some research on salivary gland cancers, and this was his area of expertise and interest. And I sent him some of my papers, and we had a very nice communication. So I felt that I had closed that circle.

ROSOLOWSKI:

Yeah. God, what a strange interaction. And you still remember it so well.

SPITZ:

Yes. Oh, it’s a long—50 years ago.

ROSOLOWSKI:

Now how did you feel your interests were evolving during that time? I mean, you know, did you have a sense that the entire world of medicine was open to you, except for surgery, which you didn’t want—

SPITZ:

No. What happened was, I got married and I had my daughter. I think she—in ’68, she was born. I actually didn’t work for a while, and then I only went back part-time to do some research. And then we moved to America. So when I came to America—

ROSOLOWSKI:

Oh, but let me—

SPITZ:

Okay.

ROSOLOWSKI:

—before you start that, let me ask you about the research piece. So when did your interest in research take place? I mean, I have to pick up that piece, because research has been so important to you.

SPITZ:

Yes. Well, that was the only thing I could sort of do part-time, which is all I wanted to work, because I had little children at home. So it was more a matter of convenience than anything else.

ROSOLOWSKI:

Interesting.

SPITZ:

And in those days, there was a new type of microscope [electron microscope] I’m blocking on, and that’s what I was focusing on. I’ve always—I’m actually a frustrated pathologist. I would have loved to have done pathology.

ROSOLOWSKI:

Huh. Interesting. Why were you drawn to that area?

SPITZ:

I’ve always liked pathology. In fact, I tried to specialize in pathology when I came here, but I was told I couldn’t do it part-time. So I didn’t.

ROSOLOWSKI:

Interesting. A lot of pathologists I’ve interviewed have talked about their visual acuity. I guess, did you feel you had that too? That sort of ability to read slides? The “pathologist’s eye,” as they call it?

SPITZ:

I don’t know. I hadn’t thought of it that way. But I just loved looking at the cellular level. You know, we didn’t have such sophisticated microscopes. We had one eye microscopes in those days. And when I see the fantastic sophistication of the microscopes now, where you can train students, it’s just amazing and exciting.

ROSOLOWSKI:

Yeah. It is amazing.

SPITZ:

And exciting.

ROSOLOWSKI:

So what was it that you were doing research on during this time?

SPITZ:

It was at the—you know that I never published anything. It was only part-time. It was looking at—

ROSOLOWSKI:

It doesn’t matter. I guess a more important question would be, you know, what did you take away from that experience?

SPITZ:

Well, I enjoyed research. I really did enjoy it. It was something—I found it exciting. It’s interesting to delve deeply and to tell a story, to go from one finding to the next finding. Although I got no formal training in research there in South Africa at all. Nor did any of us, really, get training in how to conduct research. That only I learned later when I came to America.

ROSOLOWSKI:

But you got the bug.

SPITZ:

I got the bug. That’s the way to put it, yes.

ROSOLOWSKI:

So tell me about the decision to leave South Africa. And this was in what year?

SPITZ:

Well, it took a long time. We moved in 1978. But we started in, I would say, at least two years earlier. It was a long, involved process. You know, we had to go to the American Embassy and apply, and my husband had to get a job, so he came several times to America. And he was offered a job at the University of Texas Health Science Center. He was offered several other jobs, which I’m very happy he didn’t take, like one in Wisconsin. I don’t think I would have done well there.

ROSOLOWSKI:

It’s cold there.

SPITZ:

It’s pretty cold. And one in Philadelphia, which might have been great. But we settled on this one in Houston. And my favorite story is, I didn’t even know, I’d heard of Dallas, obviously, because President Kennedy was assassinated there. I hadn’t even heard of Houston. I had to look it up in a map. And my favorite story is when—as we were about to leave, my daughter, who was maybe in first or second grade, wrote a little note in her class, and she wrote, “We are leaving South Africa. We are going to live in Texas, which is in Houston.” (laughter) And the teacher gave her a star, and 10 out of 10. I don’t even think the teacher knew how crazy that was. It’s my favorite story.

ROSOLOWSKI:

That’s a good one. Even people within the U.S. tell stories about how when they were contemplating coming to Houston, there was a lot of ignorance and assumptions and all of that. So was it difficult to leave South Africa? What was that emigration process like?

SPITZ:

Well, there’s leaving the family, although most of my family were also thinking of leaving. That’s the one aspect. It’s moving to the unknown, which is another aspect. And then from the medical point of view we had all these exams to pass. There was a visa qualifying exam. There was the FLEX, which you had to write in America. We came—my husband had passed a long time before, but we especially flew to Austin for me to write it, and that’s a story unto itself.

ROSOLOWSKI:

I’m sorry, I don’t know what you’re referring to.

SPITZ:

It’s FLEX, F-L-E-X, it’s called the—I don’t know what it stands—it’s a licensing exam.

ROSOLOWSKI:

0:20:56 Oh, okay.

SPITZ:

It’s probably a federal, but I’m not sure.

ROSOLOWSKI:

Okay.

SPITZ:

I can’t remember. But it was a very difficult exam. It was an almost all day, multiple choice exam. And then there was the whole political upheavals that were going on in South Africa. And people didn’t talk about leaving. And you went to the American Embassy, and there you met your relatives, who were also lining up to leave. It was quite a strange situation.

ROSOLOWSKI:

Now, why didn’t anyone talk about it?

SPITZ:

I’m not sure, because it was a lot of competition to get in.

ROSOLOWSKI:

Oh, I see.

SPITZ:

So what happened was, there was apparently a shortage of physicians in Houston, and somebody advertised in the South African Medical Journal that they needed physicians in Houston. And that is why there’s a large group of South African physicians who moved to Houston. And you know, there’s quite a large South African Houston community here now.

ROSOLOWSKI:

Interesting. No one had ever mentioned that to me before. Huh. Interesting. So did you bring—you came over on a boat, by plane?

SPITZ:

Oh, we came by [plane], and we had our green cards already, but we only received them at the airport in New York. I can’t remember if it was LaGuardia or JFK. I can’t even remember. I remember thinking, it’s called a green card, but it was blue. (laughter) And we moved into Houston. We moved to Houston. We came straight to Houston. And it took us five years, and then we became citizens.

ROSOLOWSKI:

Oh, wow. So tell me about the work you were doing, and settling in during that time.

SPITZ:

Well, of course it was very difficult, because the way of life was so different. And we came and we lived in a rented little house, and it was so tiny. We’d come from a beautiful home on an acre, with a built-in trampoline and a tennis court. And we came to this awful home that somebody had rented for us. And it had no garden, and there was rented furniture. And the dining room table was unstable, and we had to put newspaper under one leg. And it was—you know, my husband said, “What have we done?” I was far more positive than him. And he had to start work almost immediately, and I had to get the children into school. It was very difficult. I wouldn’t say that immigration is for sissies, but I think if you’re young, you don’t think of all the adverse consequences. You don’t think, what happens if we become ill, or what happens if we lose a job. Fortunately, I was too naïve, and maybe even stupid, to think of all these dire things that could happen. But fortunately, my children settled into school very nicely. And I actually started working as a physician at an old aged home near where we lived. And my husband was full-time at the medical school. And I didn’t enjoy clinical medicine. And somebody told me that I should go and do a degree in public health. And the public health in South Africa was all focused on infectious diseases, sanitation. Very different from the public health I was fortunate enough to learn at the school. So I enrolled in the School of Public Health in about maybe ’79 or ’80. And I got my master’s in Public Health.

ROSOLOWSKI:

What was your focus during that? Or, how did your focus evolve during that time?

SPITZ:

Well, I did—my thesis was on pancreatic cancer in the Golden Triangle, that’s Beaumont, around Beaumont, Texas. And actually, those data were never published. They’re lying in a blue folder, gathering dust somewhere on my bookshelf. It’s quite sad. But fortunately, that didn’t put me off. I became very interested in cancer and I wanted to pursue a career in cancer epidemiology.

ROSOLOWSKI:

Why cancer?

SPITZ:

I just was very interested. I can’t explain why. And maybe that’s because it is the subject of my thesis.

ROSOLOWSKI:

Why—were you advised? Did your advisor suggest you work on that topic?

SPITZ:

Yes. I think they did, yes. My training was not outstanding, and that was partly my own fault, because I had three children at school. I had very little social network. And before I selected the classes, I looked at what time they were offered. And if they were morning classes, I could take them. If they were afternoon, I couldn’t, because I had to pick up the children and be with them. So I had not the best education, and I learned most of my epidemiology on the job.

ROSOLOWSKI:

I want to kind of interrupt just for a moment here, because we’ve got a lot of construction noise, which I’m sure is being picked up here. So I will say that for the record. Maybe the next time we get together we can choose a little bit—

SPITZ:

Okay.

ROSOLOWSKI:

Something on the other side, or—

SPITZ:

Sure. Or, I can come to you.

ROSOLOWSKI:

Oh no, I wouldn’t want you to have to inconvenience yourself. I’m happy to come here if there is another place we can do it.

SPITZ:

I’m sure we can find, excellent.

ROSOLOWSKI:

Yeah. Yeah, okay. I kind of lost my place in my mind—

SPITZ:

Well, we were just saying—

ROSOLOWSKI:

Oh, I know what I was going to say. That often, because women have those other responsibilities to family, I mean, those are just practical, logistical aspects of making career choices.

SPITZ:

Yes, well, I tell women now that you have to prioritize, and that your priorities change at different phases of your life. You can have it all, but just not at the same time. That’s what I tell them. And I always made my family my priority, and I actually—I know a lot of women might have guilt at the end of their careers. But I feel that I didn’t deprive my children, nor do I think they suffered from my working. I always put their needs over and above my own.

ROSOLOWSKI:

That’s a nice place to be.

SPITZ:

Yes.

ROSOLOWSKI:

Look back and not have regrets.

SPITZ:

Because most people, at the end of their lives say, “I wish I had worked less.” I don’t say that, but I also don’t say I wish I would have worked more. I did work very hard, and I have no regrets about that, either.

ROSOLOWSKI:

Yeah, I know that with some interview subjects I’ve interviewed, it’s almost as if they have no life outside the walls of the institution.

SPITZ:

It’s difficult to balance the two, but I think it is possible.

ROSOLOWSKI:

Now tell me, so you got your master’s, and I’m just quickly checking—

SPITZ:

In 1981.

ROSOLOWSKI:

Nineteen eighty-one. Okay.

SPITZ:

Then what did I do?

ROSOLOWSKI:

What did you do at that point?

SPITZ:

Well, I had two job offers straight away. One was with Texaco as an occupational physician. And I even went to interview in White Plains, New York, and I was offered the job.

ROSOLOWSKI:

Oh, interesting.

SPITZ:

And I was thinking of taking it, but they refused to give me any flexibility in hours. So I didn’t take it. Then I was offered a job by Guy Newell, who was chairman of—I think it was called the Department of Cancer Prevention and Control. It was in the division of, I think, Medicine, I don’t know what it was called. Maybe Cancer Medicine in those days.

ROSOLOWSKI:

I actually have it on the—let’s see. It was—yes. In the Department of Cancer Prevention and Control—

SPITZ:

Control.

ROSOLOWSKI:

Division of Medicine—

SPITZ:

Medicine.

ROSOLOWSKI:

—at that time.

SPITZ:

Yes.

ROSOLOWSKI:

And it’s just—for the record, there have been so many name changes—

SPITZ:

Yes.

ROSOLOWSKI:

—at MD Anderson.

SPITZ:

That’s right. And so I took that. And he took me on faith, because my resume was like one page, double-spaced. I always tell people I had no publications. And I’m quite amazed that he even hired me. And I was given the position of assistant professor, non-tenure track, part-time.

ROSOLOWSKI:

Now you’ve mentioned, you know, a few times people offering you these jobs. I’m thinking of the surgeon who offered—who wanted you to apply. And now Guy Newell kind of taking you on faith. When you look back and kind of see that young woman, what do you think they saw that made them want to take a chance, or thought, yeah, this is a caring person?

SPITZ:

I’m not sure, because I don’t think in those days I had much to offer. I’m often quite astounded by it. And I wonder if I would have hired me. Something I’ve thought about.

ROSOLOWSKI:

Yeah, interesting. Now tell me about this department that you were stepping into.

SPITZ:

Okay. Well, Guy had come from the NCI, where he had been, I think, deputy director. And there was at that time only one other faculty in the department, and that was Barbara Tilley. I think she’s a biostatistician. I think she’s currently at the School of Public Health.

ROSOLOWSKI:

When was the department actually founded?

SPITZ:

I think shortly, it may be in ’80 or ’81, I don’t know, they didn’t tell us.

ROSOLOWSKI:

Because it was shortly after Charles LeMaistre began.

SPITZ:

Yes. Yes.

ROSOLOWSKI:

Okay?

SPITZ:

Yes, I—and I have to tell you that Charles LeMaistre had this wonderful vision about cancer prevention. And I think all the success in the current division is owed to the vision of Charles LeMaistre. So but when I started, we were physically located in what’s now, I think, is it still called the Smith Building—

ROSOLOWSKI:

Yes.

SPITZ:

—on Knight Road? At that time it was just being converted from the food facility for the Texas Medical Center.

ROSOLOWSKI:

That’s right.

SPITZ:

And I remember, I had a cubicle right next to a giant washing station, where they must have washed dishes, or something. And when I think about now how when faculty come in and they want offices, administrative support, and it’s quite amazing. I just took it and I was happy with it. And I didn’t care.

ROSOLOWSKI:

Yeah. Let me ask you another question. I mean, how quickly did you kind of understand what Charles LeMaistre’s vision was? What did Guy Newell feel was really his mission as being the person who was going to implement part of this?

SPITZ:

Well, I was really far removed. I was multiple layers away from Charles LeMaistre—

ROSOLOWSKI:

Oh, sure.

SPITZ:

—for many years. So I had no idea what his vision was. And Guy really wanted to build a very strong program. And he did bring in Peter Mansell. I don’t know if you’ve heard of him?

ROSOLOWSKI:

No. Who was Peter Mansell?

SPITZ:

He was, I think, an immunologist. What happened was, at that time, the AIDS epidemic started. And they both became very involved in the AIDS epidemic. And it was a very difficult time. They had many patients here, and I’m not sure that everybody in the institution felt totally positive about building a big AIDS program. Of course, I was at such a junior level, I wasn’t privy to all the discussions. And that—

ROSOLOWSKI:

It was highly controversial everywhere.

SPITZ:

Yes. Yes, it was controversial. And unfortunately, they had a large case control study, but never made the mark, so to speak. That was left to other programs like in California, San Francisco and so on. So it wasn’t as successful as it might have been. And I started off, we had no research support at all. And there was a patient with salivary gland cancer. And he reported that another coworker also had salivary gland cancer, which is relatively rare. And he wondered if it was a potential occupational exposure. So I decided to conduct a case control study doing chart reviews. And I was fortunate to get two wonderful women who were research volunteers.

ROSOLOWSKI:

Oh. I didn’t even know they had research volunteers.

SPITZ:

Yes. They still do.

ROSOLOWSKI:

Interesting.

SPITZ:

And these women helped me abstract over 300 charts of patients with salivary gland cancer, and an equal number of controls without salivary gland cancer. And we did this very interesting study. Maybe it wouldn’t have gone anywhere, but I was fortunate that at that time, a new head of the Division of Pathology was hired, Dr. John Batsakis. And his focus of interest was salivary gland cancer. So I met with him several times. He was very excited about the data. He helped me. And the first three papers, we sent to journals. And they were all accepted. And I never realized that this was actually not the norm. I thought, you know, it sounds simple. And in fact, he also arranged for me to give a presentation—this was the first scientific presentation I had ever given, but sad to say it wasn’t to a community of epidemiologists, but to an International Association of Pathologists in Boston. And I had a hard time answering the questions, because they were all related to pathology, and of course I’m not a pathologist, although I wanted to be one. (laughter) So that was the first. And that got me going.

So that was the first successful study I did. And then we did a study looking at parental occupations and a childhood cancer called neuroblastoma. And we showed that fathers who were exposed to electromagnetic radiation had a higher risk of their children developing neuroblastoma. And this was looking—it was a birth certificate study looking at the occupation of the fathers, as recorded on the birth certificates. And this caused a lot of public health interest, and a lot of blowback from electrical industries, and so on. And it was very controversial. And I found myself being requested to do a lot of legal cases. And people used to call me up and say they want to buy a house, but it’s near some electrical power plants. Should they buy the house? It was very difficult for me to answer those questions, because the science hadn’t been validated. So I ended up saying, well, it’s not a very attractive view, and maybe you should consider the resale value of the house. I’m giving them financial advice but not scientific advice.

ROSOLOWSKI:

Yeah, yeah, very interesting. Well, and sort of unexpected role for you to serve.

SPITZ:

Yes, of course. And I only once gave expert testimony to a lawyer, and I’ve never done it again. It’s not something I ever wanted to participate in.

ROSOLOWSKI:

Now, during these years, how did you feel you were evolving as a professional, you know, a member of the faculty here—

SPITZ:

Well, it took me a long time to get integrated, because of course, eventually I moved full-time and into the tenure track, and from assistant to associate professor. And I became more integrated. But only when I—the National Cancer Institute put out an RFA, which is a Request For Applications, for studying cancer in minority populations. And I decided to look at lung cancer in African Americans and Mexican Americans. And the reason was, African Americans had higher incidence rates and poorer outcomes. And Mexican Americans had lower incidence rates, and also poorer outcome. So I thought that would be a good contrast. So I wrote a grant. And this was the first grant I’d ever written. No one told me how important it was to even write grants. So I wrote this grant, and I actually met Jack Roth, Dr. Jack Roth, who was chairman of Thoracic Surgery at the time. He’s stepped on since.

ROSOLOWSKI:

What year was this now?

SPITZ:

Maybe it was—I think it was maybe ’91, 1991. And I met him when we were both in line to have some vaccination at Employee Health, and I told him about my grant. And he was interested. And he proposed a molecular add-on which I thought was fascinating.

ROSOLOWSKI:

What was that?

SPITZ:

To look at P53 germline mutations. And in those days, epidemiology was still fairly classical. It only came later that they added molecular components to the study. So it was quite new. I wrote this grant. And actually, I’d had a grant before, a small grant [ ]. And it came quite easily. And it was a small grant. [I did not realize how difficult it was to get funding.] Anyway, so I wrote this R01, which you’ve heard of R01s. And I was getting on a plane to go somewhere, and the program officer called me up and congratulated me, told me my grant was funded. And there were several other grants from this institution going out, and I always assumed they’d have a much better chance than me. And I said, “Really?” And I was so amazed. And the whole way on the plane, I kept thinking, how could I have got this grant? So to my embarrassment, when I got off the plane, I called the program officer back, and I said, “Are you sure you didn’t make a mistake?” I sort of remember, it was Dr. Joe Patel. And he thought I was crazy. And he said, “No, I didn’t make a mistake. It is your grant.” So that was the beginning of real success for me.

ROSOLOWSKI:

Yeah.

SPITZ:

And that program really helped my career, and that of many others as well, because many others built their careers on lung cancer after that, which is exactly what I had wanted and hoped for.

ROSOLOWSKI:

Now tell me a little bit about the state of the field at the time. You know, what—

SPITZ:

Well, interesting. Epidemiology, to be quite truthful, was regarded as a second-class science. And the chairman of medicine once said that epidemiologic research, and mine in particular, was phenomenologic. I actually hadn’t heard the word, and I briefly wondered whether he meant phenomenal. But I had caught the disparaging tone in the voice, so I realized it wasn’t a good compliment.

ROSOLOWSKI:

I wonder if it means “subjective” in this case?

SPITZ:

Well, I think he meant—I understood afterwards what he meant, that we did little bits of work here, there, and never joined it together, and never went in depth and pursued each topic. So I spent the rest of my career trying to show him that epidemiologic research was not phenomenologic. And then what happened was, the NCI started the SPORE program. And initially, each SPORE program had to have a population science project. And most of these, our colleagues were very interested in epidemiologic projects. So all of a sudden, we were in such great demand to provide epidemiologic projects for each of these new SPOREs that were going out. And at one stage, we had projects in six or seven SPOREs, and that really made our name and solidified the success of the epidemiology department. Of course, I’ve neglected to say how hard we worked at recruiting good faculty. And we can go into that, and I think we should.

ROSOLOWSKI:

Yes, absolutely. But first, I did want to ask you a little bit more about just creating this presence of epidemiology at MD Anderson. Was that controversial? Was it difficult?

SPITZ:

Well, it was disinterest. People were not probably really interested in epidemiology. But gradually, I think they saw that we were doing good studies. And certainly, when the discipline of molecular epidemiology emerged, and we actually were one of the first epidemiology programs to have our own lab, and that’s an interesting story in its own right, which I will tell you the whole story.

ROSOLOWSKI:

Now one other question, just to sort of context in background. Was the inclusion of epidemiology in this original vision of cancer prevention and control, was that, at the time, an understanding how prevention should operate? Was epidemiology considered an absolutely critical facet?

SPITZ:

In fact, some people said it was the basic science of cancer prevention.

ROSOLOWSKI:

Oh wow, okay. Okay.

SPITZ:

And Dr. LeMaistre, of course, knew all this. And you know that Dr. LeMaistre was part of the 1964 Surgeon General’s report on smoking.

ROSOLOWSKI:

Yes.

SPITZ:

And lung cancer. I mean, he was right up there. He recognized the importance of prevention.

ROSOLOWSKI:

Okay. Terrific. No, that’s really, really helpful. Yeah, it’s amazing as I interview people how so many individuals who came to the institution in the ’60s and ’70s were really very busy establishing new fields.

SPITZ:

Yes. Absolutely.

ROSOLOWSKI:

So tell me those stories that you wanted, the lab?

SPITZ:

Well, I don’t know the exact years, but the Division of Prevention was established in—you’ll know when, I think in—

ROSOLOWSKI:

I don’t have the date in my brain, but—

SPITZ:

And actually, Dr. LeMaistre spoke to me about heading the division, but I suggested that he recruit Bernard Levin [oral history interview]. And that was a wonderful [choice]—Bernard did a fabulous job. He was kind and generous, and supportive, mostly. And he created the Department of Behavioral Science. And Ellen Gritz [oral history interview] came as the first chair. Then there was the Department of Epidemiology, and I was acting chair for, I think, two years, before I became a chair. And then there was the Department of Clinical Cancer Prevention. And this was unique among cancer centers, you have to realize. And towards the end, he also established the Department of Health Disparities. Now there’s a fifth department, Health Services Research. And then I was obviously given some positions to recruit. And Melissa Bondy, whom you met, came. She was one of the first recruits. And then we brought in Chris Amos who was, at the time, at the National Cancer Institute. He was perhaps one of the best recruits I could possibly have brought in.

ROSOLOWSKI:

Why was that?

SPITZ:

Well, he was a brilliant scientist. He’s a statistical geneticist. He was the first one not only at MD Anderson, but in the State of Texas. So he developed—we gave him the freedom to develop his own section within epidemiology, which we called CGE, Computational Genetic Epidemiology. And he recruited his own faculty and staff. In fact, he was in such demand that not only did he do cancer, but he developed research programs on rheumatoid arthritis, on dermatologic diseases. He was in great demand. And then I recruited Michele Forman from the NCI, who was in nutritional epidemiology. We had really a fantastic department.

ROSOLOWSKI:

Now can I ask you, someplace in my background research I read that you are listed as founding chair.

SPITZ:

I was the first chair, yes.

ROSOLOWSKI:

Okay, you were the first chair.

SPITZ:

Absolutely. I was the first acting chair, and then founding chair.

ROSOLOWSKI:

And then the founding chair. So why was it actually formed as a department at that time?

SPITZ:

Well, because we already had a nucleus. It was clearly such an important topic. In fact, it became its own program within the Cancer Center, so that there were three programs, which is actually unheard of in Cancer Centers, three [population] science programs. There was Epidemiology, Behavioral Science and Clinical Cancer Prevention. And, in fact, epidemiology was twenty-seventh program out of twenty-seven programs. It’s probably changed now, but [it was so] when I was there.

ROSOLOWSKI:

So I hadn’t realized the degree to which all of this activity really was unique in the country.

SPITZ:

Oh, it certainly was. But I want to go back and talk about getting a lab for epidemiology.

ROSOLOWSKI:

Yeah. Absolutely.

SPITZ:

I recruited Qingyi Wei from—he was at Johns Hopkins. And he was truly a molecular epidemiologist. He did epidemiology studies, but he also—he worked in the lab, and he had assays to measure DNA repair capacity. And he agreed to come, but he said he needed his own lab. And how naïve I was, I can’t believe. I called up Fred Becker, who was then the—

ROSOLOWSKI:

VP of Research?

SPITZ:

VP of Research. And I said, “Dr. Becker, good morning.” I said, “I’m calling you because I need a laboratory for epidemiology. And he was a very dominant person, shall we say. And he said to me, “What? A laboratory for epidemiology? Never heard of it. You can’t have it.” And he put the phone down. And I was fortunate that Margaret Kripke [oral history interview] had been recruited at the time to the Smith Building. She and Josh Fidler [oral history interview], her husband. And she was given more lab space than she needed, and I can’t remember how it turned out, but I did approach her, and she offered lab space. And that was how our laboratory, our epidemiology laboratory started, on the good will of someone else.

ROSOLOWSKI:

That’s an amazing story.

SPITZ:

Oh, there are plenty of stories. And then eventually, after a lot of fighting and scars, to tell the tale, we did get our own lab. But it was moved more than once. We were in Naomi Street, we were in the Main Building, then eventually we ended up in the Mitchell Building. But we were never—if a department had to be moved, it was always thought this was the department that could move. And then they wanted to put us very far [out from the main campus]. And I tried to explain that our research, we contacted patients, we collected blood from patients, we got data from patients. And the blood had to be delivered to the lab. If all the time we were so far removed from our lab, this would never be successful. And it was very difficult. But I had some support of colleagues, and eventually we did get our own beautiful lab space.

ROSOLOWSKI:

And where was that located?

SPITZ:

In the Mitchell Building.

ROSOLOWSKI:

In the Mitchell Building. Okay.

SPITZ:

And that’s where I understand it still is.

ROSOLOWSKI:

Okay.

SPITZ:

But when they used to do reviews of lab space, which I think was a very good idea, and we always got an outstanding score, certainly when I was chair. I can’t say anything about now. I don’t know.

ROSOLOWSKI:

What did these reviews involve?

SPITZ:

Well, they used to review—they actually to decipher it to see how well you utilized the space. And then they reviewed each of the faculty, the grant dollars, the number of positions that they had, and dollars per square foot, and so on. And we always came out very well.

ROSOLOWSKI:

Which, of course, encouraged people to keep supporting [that dimension?] of it.

SPITZ:

That’s right, yes.

ROSOLOWSKI:

So you were [ ], acting chair and then chair until 2008. [ ].

SPITZ:

Yes, it was my baby. And I constantly thought about how can I improve and build the department. And I have to say this, you can only be a successful leader when you feel that your own career, you’ve done everything that you wanted to do. And now you’re thinking only of the good of the department and the good of others. And sad to say, this is not the case with all leaders. Certainly not at the time I was there, and probably currently, too. But we had a wonderfully happy, cohesive department. We developed a lot of very nice traditions. One was we had a lot of foreign students and foreign faculty in our department, so that every year in February, we used to have an international lunch. And everybody was asked to bring a dish from their home country and a flag, and we used to describe what the dish was. And we had this wonderful lunch. And then we used to select somebody to talk about their home country. And that was every single year. And I’m told now they no longer do it, and that saddens me.

ROSOLOWSKI:

I was going to ask if the inclusion of this international component went over into research, was the research globally focused as well?

SPITZ:

No, most of our research was local.

ROSOLOWSKI:

Okay.

SPITZ:

And then I did another wonderful tradition, and that was a 9-11 commemoration every year. It’s no longer done. And every year, we used to have a meeting, and we read the Gettysburg Address. And I chose that because it was relatively short. And we had it read by three people; one was an American citizen, one was a naturalized, and one was somebody on a foreign visa. And these three people would read the Gettysburg Address. And then some of us spoke about what our thoughts about 9-11, because we had a very diverse department. And we even had a map showing where all people came from. And then we used to also select somebody to tell us about their home country. So this was a wonderful tradition that we had. That, too, no longer is in existence.

ROSOLOWSKI:

What do you think is the impact of establishing those kinds of traditions in a department?

SPITZ:

I think it’s quality of life. I did a lot for improving quality of life. We had a care team. And this was a group of faculty and staff who were there only to be sure to make the lives of everybody better. And if there was somebody who was ill or needed help the care team was there. Somebody had a fire, they were there to help raise money. And they also organized—every year, we used to have a holiday party. And although I knew what I would have liked as a party, I didn’t interfere. I gave them a budget, and they decided where they wanted the party, what was the menu for the party, and what was the entertainment. And they were generally lovely parties. And I don’t know whether that’s still in existence. I’ve heard that the care team is no longer in existence, and all these things saddened me because I spent so much time building things up, and I don’t want them to be lost.

ROSOLOWSKI:

Right. I mean, I can imagine that it would do a lot for retention and attracting faculty to know that there was—

SPITZ:

All these—yeah, absolutely. You know, in fact I used to—I was a firm believer in feedback from the faculty and staff. And some of my colleagues told me I needed anti-depressant medication, because I was wanting to hear the bad news, and you know, to improve. And they thought I was crazy, you know.

ROSOLOWSKI:

But you took it really not as a downer, but as a—

SPITZ:

No, it’s to make myself better.

ROSOLOWSKI:

Inspiration.

SPITZ:

Yes. That’s right.

ROSOLOWSKI:

Yeah. I can understand that.

SPITZ:

And most of the faculty were really very happy.

ROSOLOWSKI:

Now, I mean, you’ve told some individual stories about what went on during your period of leadership during this time. But when you came in, did you have a vision of what you wanted to accomplish?

SPITZ:

I don’t think I did. I think it developed over time.

ROSOLOWSKI:

Interesting. And what were some of the milestones in the evolution of that?

SPITZ:

I think one was the lung cancer research, because I started a database of lung cancer cases. And these were African Americans, whites and Mexican Americans, and matched controls with samples. We collected well-annotated information. And I knew this would be a great resource. And in fact, we had post-docs who worked on it and eventually became faculty. And Chris Amos built on it, and he published in Nature, Genetics, one of the first genome-wide association studies of lung cancer.

ROSOLOWSKI:

Wow.

SPITZ:

And that really solidified his reputation. And many other faculty worked on lung cancer as well. And that was the dominant part of the department. But then Melissa Bondy, for example, built a fantastic program in brain tumors. She created a Brain Cancer International Consortium, first focusing on familial gliomas and then on sporadic gliomas as well. We developed programs in prostate cancer, and a wide variety of other cancers; bladder cancer, head and neck cancers, and so on. And we worked very closely with Waun Ki Hong [oral history interview], who was a great supporter. I helped him with his former smokers, he had a chemo prevention in former smokers. In fact, it was our observation that over 50 percent of lung cancers were occurring in former smokers, of whom about 30 percent had quit smoking maybe 30 years before their diagnosis.

So we realized that we needed to focus on former smokers. Even if you were to stop everybody from smoking on day one, we’d still have an epidemic of lung cancer for a long time. So that was the—and then also, we were given money by the State tobacco settlement fund. And this was the vision of the institution, I believe it was already in John Mendelsohn’s time [oral history interview]. He gave substantial money to cancer prevention, and Bernard divided it out among the departments. And I decided that I didn’t want to fund merely incremental research. I wanted something transformative. So what I did was, instead of funding research, which I felt should be funded by people’s grants, I wanted to create research infrastructure. So we started a Mexican American cohort, which Melissa Bondy spearheaded. And that’s still in existence today.

ROSOLOWSKI:

What does that mean?

SPITZ:

Well, we enrolled Mexican American households using a variety of different techniques in the Houston Metropolitan area. And it’s a very important program, because they’re understudied.

ROSOLOWSKI:

Now are you studying this population from the perspective of only brain cancer? Or is this all—

SPITZ:

No, all cancers.

ROSOLOWSKI:

All cancers, okay.

SPITZ:

Yes. And I wrote a grant looking at initiation of smoking cessation in Mexican American youth, building on that cohort, which was a very successful study.

ROSOLOWSKI:

And that was established in the ’90s sometime?

SPITZ:

Yes. Maybe even later. We’d have to look that up. And the other—the rest of the money I used to create the patient history database, which is ongoing now. And that was, we wanted a set of core epidemiologic data on every new patient who walks into the institution. And this would include family history, smoking history, alcohol abuse, previous medications, and so on. And originally, it was a paper form. And then it became electronic. Now I’m told it’s part of the EPIC database. And this is an extremely valuable resource, because if you can link it with the tissue banks [ ], it enriches the tissue banks. And I’m hoping, although I don’t know, that this is widely advertised and used.

ROSOLOWSKI:

Yeah, it’s always key to make sure people know about these resources.

SPITZ:

And it probably should not belong in the Department of Epidemiology, but should be somewhere where it’s accessible to everybody. But I don’t know the status now. I can’t say.

ROSOLOWSKI:

Now when you—why did you step down as chair of the department?

SPITZ:

Two reasons, maybe more. One was, I had spent a year, I had been three times to Israel to visit my mother, who was in late stage Alzheimer’s. It was a very painful and difficult time. That was one reason. And on the plane coming home after her funeral, I thought there are more important things to life than just working nonstop. And number two, there were one or two very challenging faculty in the department, that I’m not going to go into any further, and that had made my life much more difficult. And I thought, number three, that it was time to turn the reins over to someone else who could take the vision and move along with it, and that I thought that I could carry on in a part-time capacity. I’d been longest in the division than anyone else. In those days, Bernard had left, and there was a new leader, Ernie Hawk. And I thought that I could provide the background and advice, and strategic direction for the division in a part-time capacity. And of course, there were financial reasons. I was on the old retirement plan, which was excellent. So those were the main reasons why I stepped down.

ROSOLOWSKI:

And what did you do when you—and actually, now that we’re at this place, I wanted to make sure that we picked up all of the evolutions of your own research during this time. I don’t think we completed that story.

SPITZ:

No, we didn’t, probably.

ROSOLOWSKI:

Yeah. So there are a couple of directions we can go, it’s just sort of what next after you stepped down, in terms of administration—

SPITZ:

Well that—

ROSOLOWSKI:

Or would you like to talk about research? It’s your choice.

SPITZ:

I think we should go back and finish that first.

ROSOLOWSKI:

Okay.

SPITZ:

So I focused almost exclusively on lung cancer. I did do head and neck cancer, because I was working with Ki Hong, but eventually I turned that over to others. And I was really interested in lung cancer because I realized that only a fraction of smokers developed lung cancer. And how did you identify that fraction of smokers who were at risk for lung cancer? And that was very important. And then the subject of lung cancer screening came up that showed that—there was a program that showed that lung cancer CT screening reduced mortality from lung cancer by 20 percent.

ROSOLOWSKI:

Wow.

SPITZ:

But the question was, there were about seven million eligible people to screen, and we couldn’t afford that. How do we [identify] the highest risk smokers? I worked, and we developed a lung cancer risk prediction model, which has been changed. Now it’s evolved into better models. But certainly, ours was one of the first to be published.

ROSOLOWSKI:

Now tell me about that. Because that just seems like an amazing tool to have created.

SPITZ:

Yes, but there are better ones. But we were the ones that showed that the family history was important, that a history of allergies—although that’s not included in the model anymore, but we did show that people who had chronic obstructive pulmonary disease were at substantially higher risk for lung cancer. And that’s now included in a model as well. So certainly we helped push the science forward, and that I’m proud of that.

ROSOLOWSKI:

So how would this actually be used? I mean, did you put it in the hands of—

SPITZ:

Well, actually, it’s on the website.

ROSOLOWSKI:

Oh!

SPITZ:

One of our younger faculty, Carol Etzel, helped to automate that model. And it’s got a name. I think it’s called CLEAR, C-L-E-A-R.

ROSOLOWSKI:

So someone can go on the website and kind of tip boxes and figure out, wow, this is my risk?

SPITZ:

Yes. They can.

ROSOLOWSKI:

That’s incredible!

SPITZ:

Well, there are better models now.

ROSOLOWSKI:

Right.

SPITZ:

But certainly we were a little bit ahead of the game, which was great. And I also neglected to say that I had a—I was quite involved with the National Cancer Institute. I had a part-time role there. And Dr. von Eschenbach appointed me to co-chair the Lung Cancer Progress Review Group. And that was a very tough task. I did that with a clinician.

ROSOLOWSKI:

Why was it difficult?

SPITZ:

Jack Ruckdeschel—well, it was because our task was very difficult, A, and B, while we were writing our report and recommendations, the NCI leadership was changed. And the new leader, who was—I’m blocking on his name—he was not very supportive of our recommendations, and most of which weren’t followed. So it was not the brightest. But since then, I’ve had many other roles at NCI, including I worked as a consultant for the extramural program, which is the Division of Cancer, DCCPS, Cancer Control and Population Sciences. But more importantly, I’ve worked with the Division of Cancer Epidemiology and Genetics, which is the intramural program, both when Dr. Fraumeni was in charge, and more recently with Dr. Chanock in charge. I’ve done a lot of work in helping to give strategic advice and direction, and reviewing tenure track faculty and non-tenure track faculty, and mentoring post-docs, and so on. So it’s been a very enjoyable part of my career. I’ve loved it. Now I can’t do any of that, because I’ve just been appointed to the National Cancer Advisory Board.

ROSOLOWSKI:

Congratulations!

SPITZ:

Thank you.

ROSOLOWSKI:

Now, in those positions, you’ve also had the opportunity to watch the growth of the field.

SPITZ:

Oh, absolutely. And we all—we know all the epidemiologists. And they know who the good players are and who the bad players are. I tell all my faculty that you have to do your best science. You have to behave collaboratively. You have to treat everybody with respect, because it’s a closed, small community, and people know what’s going on.

ROSOLOWSKI:

How has the field evolved since?

SPITZ:

Oh, dramatically, because in the beginning, we had just classical epidemiology. When I was hired in the 1980s, it was epidemiology required a pen and paper. All you had was questionnaires. And in the 1990s, the concept of molecular epidemiology evolved, and we were among the first to do it. And that was including biomarkers of risk, biomarkers of susceptibility and biomarkers of exposure, in order that you could understand a little bit about the underpinnings of the process of carcinogenesis. And then in the more recently [still?] with the evolution of technology platforms, we had the ability to do genome-wide association studies. First we did candidate genes, because the technology wasn’t there, so we studied small numbers of genes in small studies. And using PCR-based approaches.

ROSOLOWSKI:

What would be an example of some of those studies?

SPITZ:

Well, we looked at, for example, one or two genes and lung cancer risk. And most of these studies were underpowered. And we selected the wrong candidates. And they were never replicated, so people call this the “lost decade,” when we were publishing these candidate gene studies. But with the development of high throughput technologies, it was possible to do genome-wide studies. And that really propelled the field forward. And as I said—and Melissa Bondy published a GWAS on brain tumors. I told you about Chris Amos and the lung. We published a head and neck cancer GWAS. We had never smokers lung cancer GWAS. And prostate [ ] and these are all large-scale collaborative studies. No one institution could do it on their own.

ROSOLOWSKI:

When you’re talking large-scale, how many—

SPITZ:

Oh, thousands.

ROSOLOWSKI:

Thousands of patients involved.

SPITZ:

And then, Chris Amos, there was an announcement, it was a U19 program for post-GWAS to begin to look at what in the era of post-GWAS, what are the next steps needed in epidemiology? And he did the lung cancer one, and I’m happy to say it was funded. And so we’ve had a prominent role in lung cancer since then, looking at functional studies. And now it’s moved onto much more basic science functional studies, looking at gene expression, protein expression. And a lot of other interesting approaches, such as imputation of genes, and so on.

ROSOLOWSKI:

What does that mean, “imputation?”

SPITZ:

Well, because when you do GWAS, you identify a locus of interest. And this locus might contain several genes. And the locus might not be in a functional part of the gene. So we have to look and see, what is the gene involved? And what is the functional relevance of the locus? And that’s the way the science is moving now. So it’s very much more basic science than it’s ever been before. And you have to now work with basic science colleagues. You have to work with people who would know genomics, and bioinformatics and statistical genetics. So it’s team science at its best. And that is why we developed this new training program to train twenty-first century epidemiologists, because very few of them are being trained with the skills needed to conduct these very complex, high-dimensional-driven data and collaborative programs. And also, we have to change the culture at academic institutions, where they have to recognize the value of team science, because you might not—you have to be a team player, and you can’t lead all the teams. So they have to recognize someone who’s in the middle of a team science paper that’s published.

ROSOLOWSKI:

Interesting. Now when you say, “we,” are you talking about Baylor? Or are you talking in general about the field?

SPITZ:

Well, the “we,” the Baylor has developed the training program. But “we” is much more in the general epidemiologic sense.

ROSOLOWSKI:

Right.

SPITZ:

And the other thing I did, which I’m very proud of, is I helped—I worked with Tom Sellers from Moffitt and others, and with AACR, to develop an integrative epidemiology training workshop, which is now in its third year. It was funded by NCI, and it’s very successful, highly competitive program. It’s a week-long program, training epidemiologists in integrative epidemiology. And I should have said that’s something I’m also very proud of. I developed the concept of integrative epidemiology.

ROSOLOWSKI:

Yeah, I had that in my notes to ask you about. So maybe you can talk to me about, what is that concept that you developed?

SPITZ:

Well, we believe—it’s part of the fact that the technologies have changed so dramatically, and there is need to integrate all these omics data. And this is not only genomics, it’s proteomics and metabolomics, microbiomics into epidemiologic research. And while we can’t know all these omics approaches, we need to understand the language so that we can communicate with others. And we can—and this is the way epidemiology is moving. And we need to equip our epidemiologists with the skills and the tools to do this. So, for example, we’ve recruited three post-docs. And the one is focusing on integrating genomics into brain tumor research. One will be doing microbiomics of the developing gut and looking at risk of acute lymphocytic leukemia in children. And the third one will be looking at mitochondrial DNA and prostate cancer. So we have these very highly-sophisticated approaches. And each faculty, each trainee, will have a multi-disciplinary mentoring team with an epidemiologist, with one or two basic scientists with a statistician. And this is a whole new way of mentoring our [fellows]—there’s no longer the one-on-one approach.

ROSOLOWSKI:

Tell me what you believe are the skillsets that are needed, I mean beyond kind of the expertise in individual research areas. But what does this new team focused person need to have?

SPITZ:

Well, I think they need to develop, to understand the lab skills in any particular area that they’re interested in. So we’re hoping that for a few months, they’ll immerse themselves in a lab. They don’t need to be doing lab research, but they need to understand it. And then they will do a project on their own, in which they will integrate data with epidemiologic data, with the help of their lab people, bioinformaticians, biostatistics and epidemiologists.

ROSOLOWSKI:

It seems like that requires an unusual, really an unprecedented degree of mental flexibility.

SPITZ:

Yes, absolutely.

ROSOLOWSKI:

Yeah. And are there some people that are more suited to that kind of work?

SPITZ:

Yes. We’ve had many more candidates who’ve applied that we’ve rejected, because we didn’t see a focus or an interest in working with omics, or whose entire career until now had been purely classical epidemiology. We thought there would be too much of a learning curve. So we’ve been very restrictive in who we’re inviting to participate.

ROSOLOWSKI:

Is there certain facets of culture in which team science can evolve? You know, do you—and I’m talking here not just people’s technical or information-base areas, but you know, is there a certain personality type or a person who has certain kinds of interpersonal skills that you are—

SPITZ:

Oh, absolutely, because people have to be willing to share their data and specimens, and to lose a little bit of control. And not everybody is willing to do that. Although now, the [genomic] data have to be published in dbGaP. Once the funding period is over and the first paper’s published, then there’s a mandate to make the data publicly available. But even then, the best way of doing research is in team science, where people understand the data and know the intricacies of the data, because some of the epidemiologic data, not only to talk about the omics data, but the epidemiology data are very complex.

ROSOLOWSKI:

Now you mentioned earlier, that you said academic medicine needs to change in certain ways, to support team science.

SPITZ:

Yes, or to recognize team science as one of the—you know, we look at papers, published grants funded, how much your educational role. But we don’t give enough weight to participation in team science.

ROSOLOWSKI:

What’s the obstacle for doing that?

SPITZ:

I think it’s tradition. It just has to be changed.

ROSOLOWSKI:

But what do those traditional academic science look at that makes team science fall through the tracks?

SPITZ:

Well, they look at first-authored or last-authored publications. And that doesn’t always happen with team science. That’s the issue.

ROSOLOWSKI:

So what is—how are you thinking differently about how credit is given, or how credits should be evaluated in this kind of scenario, when multiple people are contributing?

SPITZ:

I think there needs to be a—when I look at somebody’s CV, there needs to be a good mix of first-authored, last-authored to show that they’re mentoring others, and collaborative publications. There needs to be a mix and a balance. And I can’t give you statistics, how much of each, it’s just an impression.

ROSOLOWSKI:

Yeah. No, I mean, that’s kind of what I was asking. You know, what do these different mixes communicate to you about this individual’s research values? So when you left MD Anderson and kind of had your track record there, what did you see in terms of the culture of team science that you were leaving behind there?

SPITZ:

Well, I’ll only speak about epidemiology. We had a lot of success in working with other programs and institutions, and forming collaborations and consortia. Not everybody in the department was on the same page, but most were.

ROSOLOWSKI:

Were there training programs, or—?

SPITZ:

Oh, yes. The training program was started by Robert Chamberlain, who you might consider interviewing as well.

ROSOLOWSKI:

Okay.

SPITZ:

He would have a very interesting perspective. He became my deputy department chair. And he had the largest and longest standing training program in cancer prevention. And it’s still ongoing now. But I think they’re looking to refund it. I think they’re resubmitting it.

ROSOLOWSKI:

And he shared your vision for team science?

SPITZ:

Well, it was different, because his was not only epidemiology, it was behavioral science, clinical cancer prevention. And so it was a different approach. Totally different approach. But he certainly shared my vision of where the department should be going. But his training program was different.

ROSOLOWSKI:

Interesting. And this was for fellows?

SPITZ:

Pre and post-docs.

ROSOLOWSKI:

Pre and post-docs. Okay. Did we finish up the story of your research?

SPITZ:

I think we covered enough.

ROSOLOWSKI:

We did? Okay. I noticed you looking at your watch. Do you kind of want to—do you have things you need to turn to today?

SPITZ:

No, but I’m quite tired, actually.

ROSOLOWSKI:

Oh, okay. Then that’s a good reason to say let’s stop for today.

SPITZ:

Okay. I think I wouldn’t—

ROSOLOWSKI:

That’s fine.

SPITZ:

Because we’ve done one and a half hours.

ROSOLOWSKI:

We have, yes.

SPITZ:

And it went very quickly.

ROSOLOWSKI:

It did. Well, good. Well, let me just close off for today. I just want to say for the record that the time is 10:37. And I wanted to thank you for your time today.

SPITZ:

It’s a pleasure. I actually enjoyed going back in time.

ROSOLOWSKI:

Yeah? Good. Good. Well, I look forward to our next conversation.

SPITZ:

Absolutely.