The Clinical CancerProgram at YALE by david s. fischer, md THE SMILOW CANCER HOSPITAL AT YALE-NEW HAVEN sterling hall of medicine on 200th anniversary of yale school of medicine david s. fischer, md david the smilow cancer hospital at yale-new haven 2009 Notice: Every effort has been made to ensure that the facts in this publication are correct, but since some of this is oral history, errors will occur in spite of attempts to verify the facts in published accounts. In a few instances, published accounts were apparently in error according to reports of multiple individuals who had contemporary personal knowledge of the events. The interpretation of events is subjective and individuals may view them differently. The opinions and interpretations herein are the responsibility of the author and not of the individuals consulted or those who reviewed all or portions of the manuscript. Y printing and publishing services Frank Savino, Publication Operations Andrea Porto, Graphic Designer, Prepress Operator John Heine, Design and Prepress Copyright 2012 by David S. Fischer, MD ISBN 978-0-9797398-6-6 The Clinical Cancer Program at Yale Table of Contents Introduction 1 Founding of Yale College 2 The Medical Community in Colonial Times 5 Yale School of Medicine (YSM) 6 Abraham Flexner 9 Dean Milton C. Winternitz, MD 11 Deans of the Yale School of Medicine 13 Rectors of the Collegiate School 13 Presidents of Yale College (after 1887, University) 14 World War II and Nitrogen Mustard 14 Yale’s Contributions to the War Effort 16 Financial Problems at the Medical School 17 Yale New-Haven Hospital (YNHH) 19 Other Hospitals 21 Beginning Interest in Cancer 23 The Cancer Committee 24 Members of the Cancer Committee in 2008 26 Department of Pharmacology 27 Chairs of the Department of Pharmacology 28 Arnold D. Welch, PhD, MD, Chair Pharmacology 1953-1967 28 Paul B. Beeson, MD, Chair Department of Internal Medicine 1952-1965 31 Paul Calabresi, MD, Chief Clinical Pharmacology & Chemotherapy 1963-1966 33 Philip K. Bondy, Chair Department of Internal Medicine 1965-1972 39 The National Cancer Act of 1971 & Comprehensive Cancer Centers 41 Joseph Bertino, MD, First Director, Yale Comprehensive Cancer Center (YCCC) 44 Alan C. Sartorelli, PhD, Third Director YCCC & Scientist 47 William N. Hait, MD, PhD, Acting Section Chief Medical Oncology 48 Chairmen of the Department of Internal Medicine 49 “Follow the Money” 50 Dean Gerald Noel Burrow, MD 56 Vincent T. DeVita, Jr., MD, Fourth Director YCCC 57 Directors of the Yale Comprehensive Cancer Center 58 My return to YSM after 25 Years of Community Practice 61 Albert B. Deisseroth, MD, PhD, Section Chief Medical Oncology 62 YCCC Grant Renewal Threatened & 1999 Letter to Dean David Kessler 66 YCCC Support Grant Renewal & 2001 Letter to President Richard Levin 69 Richard L. Edelson, MD, Fifth Director YCCC, “Holding the Fort” 71 Edward Chu, MD, Section Chief, Medical Oncology 73 i Section Chiefs of Medical Oncology 73 YCCC Research Units in 2008 76 Section of Adult Hematology 77 Chiefs of the Section of Adult Hematology 77 Chairs of the Department of Pediatrics since 1921 80 Howard A. Pearson, MD, Chief Pediatric Hematology , later Chief Pediatrics 81 Chiefs of Section of Pediatric Hematology 82 Chairmen of the Department of Surgery 83 Section of Surgical Oncology 84 Section of Neurosurgery 85 Section of Gynecologic-Oncology (Gyn-Onc) 85 Peter E. Schwartz, MD, Section Chief Gyn-Onc 86 Department of Therapeutic Radiology 88 Leonard R. Prosnitz, MD and Adjuvant Radiation in Hodgkin Disease (HD) 89 Role of randomized Clinical Trials in HD & BMT for Metastatic Breast Cancer 92 Yale New-Haven Hospital Tumor Registry, Manager, Teresita Vega, CTR 94 Department of Pathology 95 Chairs of the modern Department of Pathology 100 Department of Dermatology 100 Yale School of Nursing, (YSN) 101 Deans of the Yale School of Nursing 102 Mary Katherine “Tish” Knobf, RN, MSN, PhD 104 Florence Schorske Wald, RN, MN, MS, Fourth Dean YSN 107 The New Haven Hospice (TNHH) 108 The Connecticut Hospice (TCH) 109 Medical Ethics 109 Robert J. Levine, MD, Ethicist, Chair Human Investigation Committee 111 Howard M. Spiro, MD & Program for Humanities in Medicine (PHIM) 112 Thomas P. Duffy, MD, Hematologist, Ethicist, 2nd Chair PHIM 113 Summing Up 113 Appendices: 1A Compilation of Medical Oncology Fellows, 1964-2010, Alphabetical 115 1B Compilation of Medical Oncology Fellows, 1964-2010, Chronological 121 2A Compilation of Hematology Fellows, 1955-2010, Alphabetical 127 2B Compilation of Hematology Fellows, 1955-2010, Chronolgical 131 3 Disclaimers and Additional Faculty 2008-early 2012 135 4 A Photographic Display of Some of the Individuals Mentioned 137 5 Medical Oncology & Hematology Faculty 2011-July 2012 161 6 Photographs of the Melanoma Unit in 2012 165 ii a history of the clinical cancer program at yale-new haven hospital and yale comprehensive care center: one man’s view and a personal memoir by david s. fischer, md, facp, Clinical Professor of Medicine (Oncology) In 2010-2011, the Yale School of Medicine (YSM) will celebrate 200 years since it was chartered by the Connecticut Legislature as the Medical Institution of Yale College, and thereby became the sixth medical school in the United States. It was preceded by the Medical Department of the University of Pennsyl- vania in 1765, the College of Physicians and Surgeons in New York in 1807 (originally in 1768 as King’s College), and the Medical Departments of Harvard in 1783, Dartmouth in 1797 and the University of Maryland in 1807. To celebrate this occasion, a well illustrated series of chronologic vignettes has been compiled (Falvey, KL, Medicine at Yale: the First 200 Years, Yale University Press, 2010) and published. Several departments have been asked to write histories of their department and some that had written his- tories in the past were asked to bring them up-to-date. So far, the only one that I have seen is the excel- lent review on Pediatrics by Dr. Howard Pearson. I am aware that Dr. John Fenn is doing one on Surgery for which I have provided him with some information on the first use of cancer chemotherapy at Yale for which he has done much additional research. Some colleagues have asked me to review the clinical cancer program at Yale since I have been involved in it for more than 48 years. This is an attempt to do that based on what I have read of the early years and what I know from personal experience. The first five years of that experience was in the department of pharmacology where I observed and participated in both basic science and clinical studies. The remain- ing experience has been in the clinical practice of oncology and hematology, most of it in the community but interacting with the full-time faculty, and since 1993 as a volunteer, consultant and as an administrator with an office (starting in 1995) in the Yale Cancer Center (YCC). I have limited knowledge of the ex- tensive and impressive basic science studies done here, which are documented in the thousands of pub- lications available in the literature but I will refer to them when they interact with the story that I know from some personal experience. It is therefore both a history and (after 1962) a personal memoir, subject to my bias and an overemphasis on events in which I participated and to the neglect of important events of which I have no personal knowledge. In the course of writing what I had originally hoped would be a brief history, many interesting events came to my attention that I thought might be of interest to readers. This includes some observations on the founding of the Collegiate School that later became Yale Univer- sity. It also includes some observations on how economic problems impacted its development and almost resulted in the dissolution of the medical school in the 1910-1913 period, after World War I and again after World War II, and the near loss of the National Cancer Institute (NCI) designation as a NCI affiliated Comprehensive Cancer Center (CCC) around the turn of the 21st century. This is one man’s view and a personal memoir. 1 The history prior to 1962 (the year that I came to Yale) is gleaned from published reports (Gerard N. Burrow, A History of Yale’s School of Medicine, Yale University Press, 2002; Brooks Mather Kelley, Yale: A History, Yale University Press, 1974; George Wilson Pierson, The Founding of Yale: The Legend of the Forty Folios, Yale University Press, 1988; Howard H. Spiro and Priscilla Waters Norton, Dean Milton C. Winternitz at Yale, Perspectives Biol & Med, 46:403-412, 2003; Dan Oren, Joining the Club: A History of Jews at Yale, Yale University Press, 1974; Toby Appel, Lilli Sentz, Medicine at Yale, 1901-1951, accessed at http://info.med.yale.edu/library/exhibits/yalemed2/1901-1911.html), and 1951-2001 at same URL but / yalemed3/1951-2001, and unpublished documents made available to me. The Historical Register of Yale University Online (HRO) 1701-1968 was a great help in checking dates, but after 1968, there are only some spotty additions to individual records up to the early 1980s and then none—a great historical loss. I have been unable to find much published material on the cancer program at YSM and Yale-New Haven Hospital (YNHH) prior to 1962 except for scattered reports. Some valuable faculty information for the period after the HRO discontinued adding new faculty data was provided by Julia Buchanan of the Fac- ulty Affairs Office. I can fill in some information from that time forward with my own records, observa- tions and information (memory permitting, because I had to discard many records in 1993 when I moved to a smaller office with less storage space).