HPM542, Leadership interview Tamar Sofer (previously Tamar Tsivion).

The interviewee is Professor Stephen (Steve) Lagakos, the director of the Center of Biostatistics for AIDS Research (CBAR), a former chair of the Biostatistics department and my lecturer in the course “clinical trials”.

 At the beginning, he asked “I don't have to agree I'm a leader, do I?”. Throughout the interview he is very modest and very rarely say that he specifically has done things unless I pressure him to that. For example, I did not notice the size and the importance of the CBAR until I came home and listened to the recorded interview. Part of it because he used words like “we” mostly and barely “I”.

 When Lagakos entered Biostatistics in the 70th the field began to change. Prior to that Statistics departments did theoretical work and Biostatistics departments did an applied work. The change emerged when money started pouring out to cancer research. Number of key researcher started to change the texture of Biostatistics departments- for example Marvin Zelen, a senior faculty in the Harvard Biostatistics department. He (Zelen) arrived in 1977 and started a research Biostatistics department at the Dana-Farber Cancer Institute and convinced about 10 researchers to follow him from his previous position in New York. That is how Prof. Lagakos arrived to the Biostatistics department in HSPH.

 Lagakos was inspired by Professor Zelen and he (Lagakos) considers him to be a true leader. A few more examples of Zelen appear during the interview.

 Lagakos says he thinks what makes Zelen a leader is his vision, and his determination to do things that he believes at.

 When Lagakos entered the Biostatistics field, he did not know a thing about it. His training was in mathematical statistics, but he followed Dr. Zelen.

 Lagakos express appreciation to a few people he mentioned, like Zelen and his (Lagakos') father. He says that he notice behaviors and actions that he likes and feels that it effects him and his actions later, but not necessarily in an obvious way (it is not as if he is about to take decision and thinks “how this guy would have act?”).

 His being effected by other people is an example for his learning. I got the impression that he keeps learning all the time.

 After he has been in the department for a few years, AIDS broke out. He formed a group of people interested in HIV. The government decided to establish a thing called “the AIDS clinical trials group” because a new helpful drug, AZT, was discovered. They called it a cooperative group and it was formed in medical centers around the country. Lagakos and his group became the statistical center. At this point there was a “quantum jump” in the faculty. Part of the new HIV group was a data management center in Buffalo, and the statistical part was here at Harvard. Lagakos is still the director of CBAR (Center of Biostatistics Aids Research).

 CBAR has more then 100 people in Harvard and more then 80 in Buffalo.

 In addition to his leading role at the HIV research, he became a chairmen of the Biostatistics department in 1999. Aids was already strong back then. (Pretty established).

 A change he led as a chair of the department was changing the degree given to doctoral students from the not-so-familiar DSc (Doctor of Science) to the well known PhD. There were objections from the outside and fewer from the inside (most of the faculty agreed, part of them did not.). Some faculty that objected the change thought “that what makes us unique” (“DSc? oh you are from Harvard”), but it was more comfortable to change to PhD, mainly because it is more familiar and to some extent it was important for students, and also because DSc is something with different meaning in Switzerland. (Some degree after PhD).

 Another change he led was the recruitment of international graduate students. The Biostatistics department barely had international students, mainly because the way the funding goes (they are very expensive to the department, unlike to other department in the Graduate School of Arts and Sciences). He insisted to be creative and to find ways to bring international students. “Hopefully many of them will stay, but also part of them go back and promote Biostatistics in their countries”. He says that in many countries Biostatistics doesn't exists and it is important to spread it out.

 He thinks his interest in international student have to do with his dad. His dad is an immigrant from Greece. He feels that this is deep inside of him, the understanding that people who come from other countries don't have the same opportunities as there are here.

 When I asked him if he likes working with other people, he immediately answered “no”. (At this point I was smiling. Such an immediate answer- he must be so honest! Also, it seems to me that “yes” is a much more popular answer.) and I appreciate honesty.

 Following that, I asked about collaboration. He enjoys collaborating with people from other fields, especially if he respects what they do and vice versa. He also feels that in HIV it's important that everyone is immersed in the science. However, he doesn't like to give statistical consulting- I think the reason for that is that it is less interesting and from my impression what motivates him is mainly the intellectual stimulation.  He also like collaborating with faculty – a lot of it is brainstorming. But most of his collaboration inside the faculty is with students and post-docs.

 He feels that as he gets older, he grows a nice relationship with the younger people. For example, if they are students, they benefit from the interaction- they learn how to think more broadly, how to write... On the other side, they do more of the computing. He enjoyed this relationship with students. (He implement a coaching leadership style with students).

 Regarding thinking with other people- he likes to first think of things on his own, and then later he enjoys brainstorming, especially with people from other disciplines. (He works with MD doctors a lot).

 I think he is an introvert, and he said so as well. That is because he likes thinking first by himself and because he prefers working alone- unless there is a defined relationship between the collaborators. (Advisor – student, statistician – other).

 He is involved in clinical trials. The involvement is mainly at the beginning phase- at the design of the trial and sometimes in the intra-monitoring (when the trials get complicated). Usually it is not hard to work on clinical trials (even with large groups of 20 people) because of the authority and expertise of the statistician- the teams trust it.

 When he was young he loved mathematics- and fun. After graduate school, he wanted to do something socially relevant, but the connection between mathematics and “doing something to help society” was completely an unknown to him. He thought Statistics might do it, but he didn't really have a clue, since his training was very theoretical. Dr. Zelen offered him the job as a Biostatistician at the Dana Farber but all he knew was that “it is something with cancer”. It seems interesting, so he went for it.

 When he started to work at the Dana Farber's, it was enough for him to know that he does something important and uses mathematics.

 Usually when he takes decisions he does not considers them a lot, but rather plunge right in. He never thinks ahead and plans his life. (He feels that today people think more about implications).

 I think he is a perceiving type- doesn't like to plan ahead.

 I think he is a intuitive type – cares about principles more then details.

 He is definitely a thinking type (though I think he is quite emotional).

 Generally when he takes decisions he does not really care about having all the information possible.

 If the decision is important and he feels he doesn't have all of the information, he would usually set a date and by this time he would take the decision.  In the department (as a chair), when taking important decisions he says that he learned that it is important to try to engage the other faculty, especially the senior faculty. He feels that it's important to get everyone's point of view and try to convince them (even if he has the authority to take a decision and he knows what he wants). At the end he feels that most of the decision were eventually agreed upon.

 He is definitely using the 9/9 conflict management style.

 He still feels that he is not that good in talking to many people and hearing all of their opinions. He says that sometimes he becomes impatient and try to convince people too much to his view. “Try to twist their arms”.

 He feels that he needs to remind himself to listen to other people. He thinks it is easier now that he gets older and he is not as sure in himself as he used to be. Bottom line- he tries, but feels that he is still stubborn at times.

 I think that he keeps learning and trying to improve his leadership skills.

 He did a study a few years ago with a physician friend from San Francisco. A private company supported it. Lagakos and his friend did all the right things- the protocol, the analysis and they found that the company's product wasn't any good. It was a small company and that probably meant the end of the company. So naturally the company did not like the results. The company claimed it could found something good in the data in some respect. The situation became pretty tense and bitter. The company tried to sue Harvard but Lagakos had a well written agreement with them. It sued his friend for about 10 million dollars. The company also threatened them. Lagakos and his friend felt that they ethically had to do the right thing anyway. They published their results (and the journal was very enthusiastic to publish it because of the dirty situation going on around it).

 There were a few related incidents, to this company or one of its subsidiaries, in Thailand (there were various HIV clinical trials in Thailand). Lagakos and the same colleague saw that things are going on not right and could just not do anything or get involved somehow, and ethically they decided they have to do something. For example, the same company they worked with did a trial in Thailand that was somehow related to the trial Lagakos and his friend did with the company. Lagakos and his friend felt they have to share the results of their study with the people working for the study in Thailand (a remark: it is unethical to do a clinical trial- a trial that involved people- if one knows that what's being tested is not effective). Again the company threatened and said that Lagakos is not allowed to share information and said they would take all sorts of actions. But again even though they risked themselves they did what they felt is ethically right.  At the time, there were two young statisticians working for the company, and the company used somehow data that Lagakos and his friend worked on and published it. Lagakos took some action with the journal about the publication- also to protect his statistician colleagues in Thailand. (* I don't know what this action was).

 He says he would not have done anything differently in any of the above incidents- the right and wrong was clear.

 There were other cases where he didn't feel ethically convenient with a trial, though not enough to stop it, and in these cases he resigned the trial's committee.

 there were two times in which he resigned from a trial's committee. He thought the researchers are good people and did not want to really heart them by saying they are just not doing things the right way. So he politely resigned and explained why he feels he cannot be a part of it. He says that “maybe what they were doing is okay but it is not for me”. Therefore the actions he took were moderate. He also says he maintained collegial relationship with them researches who were the primary investigators in those trials.

 I think that might be an example of a 1/1 conflict management style- don't confront it, just avoid.

 He admires Marvin Zelen as a leader in the field. Lagakos recounts the Zelen came with a technical background (I think it means not from Biostatistics) and nevertheless dived into the matter and created the environment and supported the faculty for the group in Buffalo that he helped create. Lagakos says that Zelen likes to help and he does not care about the consequences for himself. In the times of the cancer, Zelen took untraditional decisions and manifested a vision led behavior.

 An example of a decision that Zelen took in order to help people even though there were many challenges and difficulties: Zelen and Lagakos worked on a case of contaminated water in a Massachusetts town on the suburbs of Boston named Woburn. Their study ultimately proved that a company contaminated two of the wells of the town and this contamination caused childhood leukemia; it was a very hard study (it is usually very hard to statistically prove that something causes cancer in small populations) so they expended the scope of the study, used more then 300 volunteers from the school of public health and from the town and initiated a large civic action, in order to help these people.

 Generally, Lagakos says he appreciates people who “go out and do stuff”.

 He seemed to me to be an appreciative person, so I asked him if he convey his appreciation to people. He said that sometimes he does, but he does not go out of his way doing so. Some people, he says, he admire from afar, but if he feels strongly about something he would say it.

 In the clinical trials course he talked about conflict of interests (with regard to ethical considerations in scientific publications). He showed us a part of a New England Journal of Medicine editorial about it. In the interview, he told me that he went to the journal's office and told the editor that he liked this editorial. He also told me that following this editorial he told the department chair to check and make sure that we don't have conflict of interests in the department, since some of our funding for students comes from private companies.

 This is another evidence to the fact that he learns all the time.