wth ot Sotrervtoery

A CONVERSATION WITH HENRY S. KAPLAN
Interviews conducted December 7, 9 and 14, 1983 CSpyres
pudneopsutes)
Q: Let's begin with the history and see where it takes us.

Then I'll pose some specific questions.

A: I can't recall anymore all the dates with precision,
except that I arrived at Stanford on September 1, 1948. I have
been here a little over 35 years. Wally Sterling was appointed
President of Stanford the following year. By 1952, if my memory
is correct, Sterling had heard arguments on both sides of the
issue of moving the medical school trom San Francisco to the
main campus. He decided to form a committee, but instead of
picking its membership from among the old guard--which at the
time included people like Arthur Bloomfield in medicine, Harold
Faber in pediatrics and Emile Holman in surgery~~he reached out
for some of the younger faculty of whom I was one. Indeed, I
was the youngest, because when I accepted the job at Stanford I
wasn't quite 30 years old. Incidentally, Bloomfield, Faber and
Holman had served on a committee which a year earlier had
rejected the idea of moving the school.

We (the Sterling-appointed committee) met many times in
the evening, I remember, at very attractive places like the
Bohemian Club-~places I had no knowledge of, and was quite

N

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xsl
overwrought especially when I looked at the prices on the menu.
Lloyd Dinkelspiel who was then chairman of the board of
trustees was a committee member.

We reviewed demographic charts with projections for
Santa Clara and San Mateo Counties and it was perfectly clear
that although we might initially have some paucity of patients
ultimately we would have more patients than we could ever have
in the city. That was, incidentally, the basis upon which the
Faber committee had rejected the idea of the move--that there
weren't going to be enough patients. But it was a very static
view of things. The Faber committee didn't project forward into
the next decade or two. In addition, the old guard in the
medical school really were a bunch of pure clinicians, all very
good in their fields, but with essentially zero track record in
research or anything that could be remotely considered

research. To them, therefore, it meant nothing that the medical

school would be located on the main campus working side by side.

with chemistry, biology, physiology, physics etc. Moreover, the
medical school was already a divided school; all the clinical
departments were at the hospital in the city, but there was a
small unit on campus that included anatomy, physiology,
pharmacology, and a so-called division of biochemistry in the
department of chemistry which was manned by two people, Hubert

Loring and Murray Luck. Their general attitude was that they
condescended to teach medical students--it was a painful duty
for them. This was not a very satisfactory arrangement. Our
committee (which Sterling really ran, because he knew where he
was going) built a very strong case for the move and one of my
assignments was to build the general argument about the
increasing interdependence of the sciences and the increasing
scientific basis of medicine, and the fact the medical school
could not flourish unless it was located in proximity to the
scientific departments of the main university.

I might say parenthetically that all of this happened
in a way that was most painful for me, because we had a
stunning house high up on a hill in Sausalito, about a thousand
feet above the water, designed by Mario Corbett. It was like a
piece of sculpture. And I had labored long to develop the
landscape and so on. And I absolutely loved the place. But I
saw no alternative to the answer that the school must move down
if it were to try to become anything but a third rate clinical
medical school. It was sort of second rate clinically then and
it would have slipped backward in time.

So that is one set of memories and that decision was
firmly taken, and of course almost immediately there were howls
of outrage from people like Holman, Bloomfield and Faber. To a
degree they were all gentlemen and their howls were rather
restrained, but they were forceful. They kept after Wally,
through the alumni, saying this was the worst decision

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imaginable, it would mean the death of the medical school, and
so on. And I'd say Wally deserves a medal for the courage that

he showed in sticking with that decision.

Q: Was there any indication at the time that the proposed

move of the medical school might not go through?

A: There were circumstances that made the move happen,
which were ironic and ludicrous. For example, Yank Chandler,
who was a fine dean, could not live with this decision. So he
resigned. I thought this was all right. It's an honorable way
to behave. His successor, Windsor Cutting, a professor of
pharmacology, was chosen. That was a very bad choice, however.
Cutting wanted to build mediocrity. He wanted to build in the
absence of argument and debate. Those things were anathema to
him. In 1954 I went off on sabbatical and meanwhile I heard
that he had concluded this crazy deal with ‘the Veterans
Administration to construct a hospital near the campus. I also
heard they were going to woo the Palo Alto City Council that
planned to expand the Palo Alto Hospital (Hoover Pavillion).
Somebody had gotten the brilliant idea of building two
hospitals belonging to two different owners under one roof! And
this was Windsor, the great compromiser. And I think you know

the trouble that decision has given us and continues to do so
to this present day.

When I heard about it I was in Bethesda, Maryland. That
made me so upset that I sat down and wrote Windsor a long
letter explaining what I thought was wrong about the two
hospitals under one roof, and also about that separate deal
with the Veterans Administration Hospital five miles away on
campus. My tone must have been very rough. As you know I am not
noted for being a diplomat. And in time I got back a letter
from Windsor at the National Cancer Institute where I was doing
my sabbatical, which in essence said, "Perhaps it's not
possible for you to be happy at Stanford and you should think
about going somewhere else." I was hurt by that but then I
considered the source and I decided that this man was so stupid
he couldn't understand my arguments.

There was an intervening period, which seemed to last
forever, during which the medical school project was going
nowhere. While Cutting was down on the campus wheeling and
dealing, committing the faculty in ways that would pose great
difficulty, I got a call from Wally Sterling asking if he could
see me privately. Much to my amazement he asked me what I
thought of Cutting as dean. I said he was an embarrassment and
a catastrophy. And Wally said it had taken him much too long to
come around to the same point of view. But he now felt that way

and he was going to ask Windsor Cutting to step down. He asked
who did I think among the existing faculty would make a good
dean. I paused briefly and I said I thought it would be very
tough on him, because he didn't make decisions easily, but in
terms of having integrity and the respect of the faculty and
some dynamism, Robert Alway would be my choice. So Alway was
appointed acting dean initially for six months, and then Wally
decided he liked the way he worked with him, and made Alway
permanent dean.

That was in 1957. Meanwhile, I had served as chairman
of the committee to find an architect. I had visited Eero
Saarinen in his offices in Bloomfield Hills and the
Owens~Skidmore-Merrill architectural firm and been taken to
lunch by an executive vice president and I knew immediately
that if we had signed up with Owens-Skidmore-Merrill, a huge
firm, there'd be some nameless, faceless person in the back
room doing our work while we would be dined and wined by the
brass out in front. That was not what we wanted.

We also interviewed local architects, one of whom tried
to use political influence to get the job. It was a difficult
business. In the end we had several groups of architects to
choose from. There were local architects who had built
buildings of distinction but had never done a hospital or a
medical school, there were the hospital architects as such, and
we ruled them out because we knew their imaginations were very

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limited. They worked from old formulas. That left us with a
group we called the great solo architects and that included
Saarinen, Edward Stone, and a man in Boston whose name I seem
to have obliterated but who was in that category.

I was sent on a trip to interview these three gentlemen
and also to see the Owens-Skidmore-Merrill people, and I
started with Bloomfield Hills where Saarinen lived. He was a
wonderful man, very kindly, soft-spoken, and he took me on a
personally escorted tour of the new General Motors technical
center which at that time was considered one of the wonders of
the architectural world, and yet had been designed essentially
by one man's firm--not a big outfit. I was deeply impressed
with Saarinen. When we got back to his office, he said, "I'm
very interested in your project. I have never designed a
hospital. There are of course guidebooks and brochures from the
Public Health Service--every architect has access to those. It
would be a great challenge to design a truly beautiful hospital |
and medical school. But there is a problem.”

The problem, Saarinen said, was that his firm was busy
designing a complete campus for some small university,
renovating the harbor of New Orleans and he went on describing
one project after another. The consequence of this is that he
could not leave his office. "If you decide that you want me to

work with you," he said, "then delegations of your faculty
would have to fly to Bloomfield Hills every two or three weeks
to review progress and help refine our thinking."

My heart sank on hearing this news. I knew his proposal
would be quite unacceptable to the faculty and it wouldn't
work. But I must tell you, Eero Saarinen was a fantastically
impressive figure. Unfortunately, he died of a heart attack
sometime thereafter. After this I went on to see the architect
in Boston. I wasn't impressed with him and that's maybe why his
name doesn't register with me anymore. In successive days I
flew to New York and visited Owens-Skidmore-Merrill, and the
latter was exactly what I had expected. Some smooth-talking
vice president immediately was available to take me to lunch
and tell me all about their vast design, engineering resources
and so on. But it was really not what we wanted because we
would have gotten a carbon copy in slightly different size of
some of the other hospitals they had done and they had done
plenty. ,
Next I went to see Edward Stone. When I arrived the
Chancellor of Vanderbilt University was there, finishing up a
visit. Stone had been doing some new large hall for Vanderbilt
and I looked at the design and it was just beautiful. When he
left, Stone and I sat down. I told him about the scope of our
project. I asked him whether he had ever done a hospital. He
had done two, one in Lima, Peru--a huge obstetrical hospital
which is still there and looks quite good-- and the University

- 8 -
of Arkansas Hospital and Medical School which, he said, we were
welcome to visit. He had developed a very novel arrangement of
beds in relation to nursing units, which worked out quite well
and lent itself to a beautiful looking building. While we
talked, I told him we were interested in building about a
400-bed hospital, a complete set of clinics, classrooms and
research laboratories for students and faculty. He said, "If I
were offered this job, it would be the biggest single design
job that I have every undertaken in my life. I will put my New
York office on a skeleton force and I will move my family out
with me and I will guarantee to stay in the Palo Alto area for
no less than 18 months until the project is well off the
ground. After that I will make arrangements for continuing
supervision by one of my staff."

The difference was so night and day that when I
returned I reported all this to the committee and they voted
unanimously to select Edward Stone. Then Wally and the trustees
said the Palo Alto City Council members needed convincing and a
junket was arranged to Arkansas. I went along and saw the
building. We were all most impressed and it was clear the
councilmen and the university were ready to give the job to Ed
Stone. It was at this point that he approached me and said
there was something he had to tell me. He said he was a member

of Alcoholics Anonymous, but that he had not had a drink in
several years. He said he didn't think he'd fall off the wagon
on this job, but he would not accept the offer unless Wally
Sterling knew this and was willing to make the offer in spite
of it. Here was a man, staring at more than $22 million worth
of buildings and willing to lay it all on the line because of
this question, which I thought showed great courage and

integrity.

Q: What difficulties did Stone face in this project? I saw
some blueprints that looked different from what we now have.

Who changed his plans?

A: I'm glad you asked that. It brings up a very important
and absolutely true episode. Stone's Original design for the
medical center included a vertical, high-rise hospital,
intersecting with a clinic building of four stories, and then
the medical school at the other end. It would have taken a
totally different shape, saved miles of walking, and most of
all it would have cut down about 10 percent in personnel costs.
He took the plan to the board of trustees at the time David
Packard was head of the board. And so help me God, Stone was
voted down on the grounds that no building on campus could be

taller than the Hoover Tower. That was it.

-10 -
We
and he was
that issue

He

time there

went to the Stones' house that evening for dinner
in despair. He had fought hard with the board on
and he had lost.

said, "Henry, you watch and see. In the course of

will be thousands of people who will say this

goddamned thing is so spread out, and I have to walk my leg off

in it, and

board of trustees." It is also not widely known that when the
hospital building committee wanted to save costs by deleting
the beautiful hanging gardens, Ed Stone shamed them out of it
by offering to pay for them out of his own pocket.

I'd like to have that put straight.

There's another item I must mention related to that

particular

Stanford trustees in their wisdom--and of course they always do

things in their wisdom--and the Palo Alto city fathers had

everyone of them will blame Ed Stone and not the

era. One problem, as I mentioned, was that the

 

decided to build a hospital, owned by two djfferent owners,

under one roof. This led to a curious kind of struggle. It was

Clear that if there was to be a Palo Alto wing, there would be

a Palo Alto medical staff and a Stanford medical staff. That

was no problem, except when you got to Pathology and Radiology,

two services seldom duplicated in hospitals. There was an

agreement to unify Pathology because the doctor who ran the

pathology labs for the community was then retiring and it was

simple to ease him out and build a single, unified department.

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But in the case of Radiology there was Howard Jones and Robert
Brown aS one group. They were already the established
diagnostic radiology people for the Palo Alto crowd, and there
were other demands beginning to surface from the Palo Alto
Medical Clinic radiologists for access to machines and space
and time. I was called to a hearing of the Palo Alto City
Council with a couple of the university trustees of whom
Packard was one.

The council asked me, "Does it make sense to have two
departments of Diagnostic Radiology?" Apparently, nobody cared
about radiotherapy and nuclear medicine because they lost
money; at least in the way they were beina practiced in Palo
Alto at that time. So the only issue that was a matter of
principle--money being a matter of principle--was diagnostic
radiology.

They asked me, "Do you believe that there should be two
departments under one roof in this hospital or do you feel they.
should be amalgamated into a larger, stronger department?"

I knew what they were fishing for. They wanted me to be
the fall guy who would vote to throw Howard Jones and Robert
Brown into the street. Then I would have inherited 30 years of
hatred from the Palo Alto staff. And I said just as much.

"Pirst," I said, "I don't believe in two departments of

diagnostic radiology under one roof in one hospital. But this

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isn't one hospital. This is two hospitals owned by two. owners.
If you can put up with anything as Silly as that, then you
ought to be able to put up with something as Silly as two
departments of diagnostic radiology."

I knew some university people were very unhappy with me
for saying this, but certainly the Palo Alto medical staff were
relieved although none of them came up and thanked me. I might
say even to the present day, not a single one of them has
thanked me.

Things became more complicated four weeks later. I got
a phone call from Windsor Cutting who was still a dean, so the
date of this episode must have been early 1957. He said David
Packard wanted to come up to San Francisco and have dinner with
the two of us. I accepted, went along to dinner and argued the
same thing all over again and I thought I had made my point
convincingly and clearly and the whole matter was resolved. We
parted company very amicably. Then about two days later I get a
call from Cutting saying, "Henry, it's been decided to unify
diagnostic radiology into one department after all."

I said that was interesting and asked who decided that.
"Did you decide that?"

Cutting replied the matter had been decided at the
trustee level and specifically by David Packard.

I said, "Would you mind giving me his phone number, I'd
like to call him up." I was in the middle of a busy clinic full

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of patients when this happened.

He said, "That's not necessary because David Packard is
right here in my office."

Minutes later I marched into Cutting's office, still in
my white coat, and said to Packard, "Hello, David, I understand
you decided to unify the department of radiology after all."

And he started out to explain and to apologize, and I
cut him off saying that he didn't have to explain all that to
me. I said you are the president of the board of trustees of
Stanford University. It's entirely within your power to make
that decision." And I added, "But there are other decisions
that need making." I then took off my white coat, handed it to
him and said, "For instance, there are a lot of patients down
in the radiology clinic in need of care. And you've just become
the chairman of the department of radiology by default. So you
better get on down there and start taking care of them."

Packard was dumbstruck. He said "What is all this?”

I said, "It's very simple. In any of these situations
there can be only one president of the board of trustees, there
can be only one chairman of radiology. Who is it, you or me?"

He took a long look at me, I am sure he wanted to kill
me, but he handed me my white coat and said, "You are the

chairman and we'll do it your way."

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PART II

Q: It has been my impression since I came to Stanford
twenty years ago that the medical center is operating under
very restrictive financial conditions. The arguments being made
against building the hospital modernization program today, for
example, are the same made against constructing the Stone

building in the fifties. Do you share that impression?

A: I don't know if this is well-known fact. But the
trustees of Stanford University had originally budgeted the
total sum of $6 million for the entire medical center
project--a project that included a library, a medical school
building, a hospital and clinics. (The figure excluded the
budget committed by the city of Palo Alto for its hospital
wing). The budget incidentally was supplied to them by Windsor
Cutting and they accepted it! The final figure, of course,
turned out to be $22 million and that was accomplished by
leaving out one of the important buildings for the clinical
sciences which was eventually constructed four years later.
It might be of interest to point out that in contrast
to these early years and based on my recent contacts, our
trustees today are very much more on the ball. In those days

there was a lot of nepotism, family connections and other

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factors that got you on the board. So there were some people
who could be tycoons of industry, but who did not have the
brains to check a figure of $6 million to build such a large
enterprise. Moreover, it's clear they would not have approved a
bigger budget. In a sense, therefore, this medical center and
school were built by mistake or by a ludicrous misunderstanding

of anticipated costs. This is an intriguing historical fact.

Q: During your years as chairman you built a department of
radiology noted internationally. What was the secret behind

this development?

A: When I became department chairman in 1948 there was
not a single department of radiology in the world in which
there was any scientific research. The only thing being called
research for diagnostic radiologists was to sit on their butts
in front of a viewing box and look at films and perhaps collect
one or two cases of some rare malformation. That was the only
notion of research.

I felt it was very important for therapeutic radiology
to have an experimental as well as a clinical research base. I
insisted on laboratory space from the start. We were housed in
a little corner of the old Lucy Stern Building in San
Francisco. We had very little space and at one time I made a
desperate attempt to persuade Dean Yank Chandler to give me

-~ 16 -
additional space. I pointed out that in the small Space we had
there were 28,000 mice and three technicians and two
physicians, which added up to 28,005 breathing, living
Organisms in a space of about 700 square feet. I made it clear
that this was not feasible. He laughed so hard that he gave me
the space I had asked for.

In those days I had a mouse colony. I had inherited it
when I was at Yale from Lionel Strong. He was an anatomist and
geneticist who spent his entire time in his mouse laboratory.
He had hundreds of thousands of pure-bred mice that he used for
various kinds of research. When I was recruited I had asked if
I could have a couple of shelves where I could keep my mice.
When I arrived at New Haven I was given a budget of $300 a year
to take care of my animals, which meant taking care of them
personally. I cleaned the cages, replacing the dirty with clean
Sawdust, and put in fresh food and water. This mouse colony was
the original C-57 black strain developed by a colleague of
Strong's named Clarence C. Little, the founder of the Jackson
Bal Harbor Laboratories. These mice turned out to be
extraordinarily useful in our research and we have used them
ever since.

I had taken this mouse colony to Bethesda during the
year I had spent there. And then, after I had joined Stanford,

they arrived one night at the San Francisco airport from

-~17 -
Bethesda, and my assistant Mary Brown and I were there at three
o'clock in the morning to receive them and see that they got
put to bed.

In a sense, I had a laboratory from the start. I felt
intuitively that it was no good having a department chairman
make big speeches about how important research is and himself
do no research whatever. I felt on the contrary that in
radiology which was then so backward with respect to research,
the only way it would work was for me to see just as many
films, just as many patients as anybody else, and to be
chairman on top of that and do research. That would shame my
faculty into feeling that they too could and should do
research. Obviously, not everyone I selected turned out to be a
red-hot research man. But in the course of time I weeded out
most of the ones that were not productive in both areas--the
laboratory and the bedside.

Simultaneously, I took steps designed to advance our
field in a broader sense. In those days, Russell Morgan at
Johns Hopkins was an active researcher in the field, although
his specific work was in imaging and electronics. We got
together and invited my former chief at Yale, Hugh Wilson, and
the radiology departments from the University of Chicago,
University of Rochester and University of Michigan. Our six
departments founded the Association of University Radiologists.
We met once a year by rotating the sessions at different

- 18 -
institutions for two or three days. Papers presented at these
meetings had to be strictly on research and little by little
that organization grew to more than 100 departments and several
hundred radiologists. Russell Morgan was the first president
Since he was senior to me, and I was the second.

If I had to focus on some central theme in my
endeavors, you might say that I created the idea of doing
laboratory research in an academic department of radiology, and
I insisted on doing it myself, partly because I was interested
and because it closed off an escape hatch for other faculty

members who could have found excuses for not doing research.

Q: What were the conditions in which you worked in those

early years?

A: They were godawful. Our physical plant was
indescribably bad. There had been a famous engineer at General
Electric named Snook. He had designed X-ray machines in the
1920s, and Stanford had bought some of them. On the day I
arrived I observed that his machines had an extraordinary
feature--bare wires, carrying up to 200,000 volts, dangling
above the patient. We had three non-shock proof machines for
radiography and one other for fluoroscopy. I insisted that

money be provided to change all that, and the dean was as good

- 19 -
as his word and it was changed. But it took several months to
do it, and I had more nightmares than in all the rest of my
life put together, and every single one of those nightmares, no
matter what form they took, always ended in a brilliant
blue-white flash! Until we moved these machines out of the
department I just couldn't rest.

In those days Henry Jones, now professor of radiology
in our department, and I were the entire faculty. He was loyal
enough to be willing to stick around on an instructor's salary
and work like a dog on Saturdays and Sundays to help get the
job done. And I did the same. I was finally able to recruit
somebody a year later and begin the process of bringing more
people in and weeding out those that lacked research
orientation.

Meanwhile, by sheer luck, among three young residents
that I had inherited when I arrived was a young man named
Herbert Abrams. The other two residents were good, hard-working
but not outstanding. But Herb was Clearly special. Moreover, I
had the feeling that radiotherapy was such a shambles, a
disgrace physically, that I had to do something about it. So
when Herb finished his residency, I appointed him to an
assistant professorship and gave him more responsibility over
the diagnostic division which up to that time I ran also. The

only specialty we didn't have was nuclear medicine. This was

- 20 -
later created by Robert Newell, my predecessor who had resigned
the radiology chairmanship in order to do this. He was a very
sweet man who never interfered in what I was doing.

When I think of the young faculty we recruit today--for
instance, those we have attracted to staff the Structural
Biology program in the Fairchild Building--they were given
everything on a silver platter. We had to struggle for years
with an inadequate physical plant, even after those old
machines were replaced.

Meanwhile, in the early fifties another development
became of overriding importance. I began to hear cocktail party
conversations about an interesting new atom smasher being
developed on the campus by Bill Hansen and Edward Ginzton and
their colleagues. I became increasingly interested because of
the properties of this machine. In the fall of 1951 I asked
Yank Chandler to introduce me at a luncheon to Fred Terman who
was then head of the School of Electrical Engineering, Leonard
Schiff who was chairman of physics, and Edward Ginzton who in
the meantime had replaced Hansen who unfortunately had died of
pneumonia at an early age. I met Ed for the first time at that
luncheon and, as you know, we have become lifelong friends.

He and I spent our time at that luncheon talking about
the properties of the linear accelerator, and what we could do.
One of the nicest things about it was that you could get very
high energies out of it for a very low energy input. You

- 21 -
accelerated electrons with these high energies, and you could
hit a heavy metal target and make them into xX rays. I explained
to Ed that's what radiotherapists were for years dreaming
about. We needed much higher energies than we could possibly
get from the crude devices then available.

Here was a microwave device which by the clever
positioning of the electron pulse--just ahead of each microwave
peak--could force that pulse to ride along the microwave at
almost the speed of light. The farther it went the greater
energy it got. This sounded miraculous and I became convinced
that this was to become the radiotherapy machine of the future.
Nat only had I convinced myself, but by the end of that
luncheon I had convinced all of them. And so a committee of Ed
Ginzton and myself was formed to look into the possible
applications of the linear accelerator in radiotherapy. But
then sadly we ran into problems.

There was an MIT professor whose name is no longer
important but who was a stockholder in the company that made
Van de Graaff machines. Every time we submitted a grant
application to the government he knocked it down. It took us
more than two years in the richest country on earth to raise
$150,000. Hard to believe. Of course, in those days I had no
wealthy contacts. It was strictly dealing with the American

Cancer Society and the National Institutes of Health. But with

-~ 22 -
some additional help from the Office of Naval Research, we got
started. Ginzton was in charge of the design and construction
of the machine. I used to come to the campus from San Francisco
as often as I could, to meet with him and members of his staff
to see where things were. I participated, of course, most
actively in the clinical design because I was interested in
having a machine that was functional therapeutically, not just
a gadget.

By 1955 we had our first linear accelerator for
radiation treatment finished. We were about six months behind
the British who had built a machine totally different from
ours. The delay was, of course, because of the time it took us
to raise the money. We began steps to have our machine
assembled in the department in San Francisco. But there was a
new problem. Before we could assemble the six-million volt
machine, it was clear we had to have protection from its beam.

Wally Sterling again came to our aid. He went to the
Irvine Foundation and they met with us. He made an impassioned ©
speech and I made an ordinary technical speech. At that time it
was publicly known that the medical school was preparing to
move to Palo Alto within four years. But I said to the Irvine
Foundation people that if they helped us, we could learn a
great deal in four years of work in San Francisco, because the
techniques of treatment with this machine were different. "This
is like a rifle," I said. "Whereas the past machines had been

-~ 23 -
like shotguns. And we're going to have to learn our profession
all over again. We're going to have to work out technical
procedures that have never been done before. The opportunity to
have four years to do that before moving the machine was to us
crucial."

The Irvine Foundation made a one-time gift of $75,000.
We built a tiny concrete pillbox into the hillside. It was
well-protected and had a hatch on top because we knew that
someday we would have to bring a crane along to pick that
machine right up through the ceiling and move it to Palo Alto.

In January 1956 the installation of the machine was
completed and a team of physicists calibrated it. I should
mention here that all this time, if I hadn't given free rein to
Herb Abrams and Henry Jones to run diagnostic radiology, I
would not have been able to do all this. I was devoting my
efforts to patients, to the work on the linear accelerator, and
to keeping my lab running. .

The great day finally came and we were ready to turn on
the machine for a patient. The true story of what happened is
somewhat stranger than anything I could have made up. It was
quite unbelievable. We had had many bull sessions of what kind
of cancer patient would be our first referral. The very first
patient was a seven-month-old baby with retinoblastoma of the

only remaining eye, because surgeons had already removed the

- 24 -
tumor in the other eye. This was one of those genetically
determined tumors since his father had had it. I don't think I
will ever forget the puzzled look on the face of the garage
owner down on Fillmore Street when I asked him to borrow a
heavy duty automobile jack, and then explained that it was to
carry a huge block of lead with a pinhole in it, to enable us
to position that pinhole day-after-day for six weeks directly
opposite the tumor in the baby's eye while missing the lens and
the cornea. That boy is now in his twenties and doing very

well, with his vision in the treated eye intact.

Q: Wasn't there some controversy generated by some San
Francisco doctors who had questioned the use ot the machine in

patients?

A: That came mostly from a dirty bastard named Henry
Garland. He didn't believe in high énergy X rays. He was so
cynical that he was once heard to say that the only reason he
would like to have a cobalt machine was not to use it in order
to prove to everybody that it wasn't essential. He was just a
private entrepreneur but he hated me because he had the feeling
that if I had not accepted the job at Stanford, he might have
been selected instead. He had demanded at one time that he not

only be the chairman of radiology at Stanford, but be permitted

- 25 -
to continue with his private practice at 450 Sutter Street. And
the university would not agree to that. And he felt that I had
pre-empted that possibility by accepting the chairmanship. So
he hated me with a passion. And he had a scurrilous tongue
which he used very freely. I dealt with him mostly by ignoring

him. It worked.

Q: What do you think were the major milestones in your

work, not only in radiotherapy but also the biology of cancer?

A: The fact that I was carrying a major laboratory program
made matters difficult, because it did not directly parallel
and support the clinical program. There was no easy way to do
that anyhow at the time. But I did begin to build up a group of
radiobiologists who could- try to understand the fundamental
mechanisms of radiation on patients. And we did develop an
unusually strong program of radiobiology at Stanford.

However, my own research started off with those mice.
I could induce lymphomas of the thymus in them with radiation.
At that time the absolute gospel was that this happened because
of mutation. We proved little by little that the mechanism
couldn't be mutation. And we succeeded in isolating a virus
from these mouse tumors which would induce exactly the same
lymphoma in unirradiated baby mice of the same strain. I called
that the radiation leukemia virus. We spent probably the better

- 26 -
part of the last 30 years trying to understand how that initial
exposure to radiation results in activation of such a virus.
Only just now do we have some extremely exciting leads. It's
Curious that this work has gone from one end of my professional
life to the other, and is still very active and in an extremely
fascinating state.

Without going into major technicalities, there are two
broad classes of these so-called retroviruses. There are the
ecotropic viruses which grow in the species of Origin. If you
get a virus out of a mouse it will grow in mouse cells. If you
get a virus from human cells it will grow in human cells. Then,
some vears ago, it was discovered that there is a very strange
class of a virus known as xenotropic, which comes out of a
mouse or other species, but the only strain on which it will
not grow is its own. Yet it is clearly present in the genome
of the cells--you can prove that beyond any question.

We have recently generated some strong evidence showing
that in all of the virus-induced lymphomas a complete
infectious virus is present from day one when you first harvest
the tumor. That virus is ecotropic. However, when you take
succesSive radiation-induced lymphomas, you'll find some of
them will also produce virus which is ecotropic, will grow in
mouse cells and cause lymphomas in mice. But the great majority

of the radiation-induced thymic lymphomas seem to be devoid of

~ 27 -
any sign of virus even though we know a virus is present. They
Present no viral antigens, nothing that grows when there's
passage from cell to cell, and here is the great mystery.

I should explain that when xenotropic viruses were
discovered, an all out effort was made to find what they do.
People thought maybe they induce certain types of tumors, but
nobody has ever induced a tumor with a complete infectious

xenotropic virus.
Q: Did you find this discouraging?

A: Marty Scott, one of Kirk Fry's students, has now shown
in about 15 consecutive radiation-induced lymphomas that a
radioactive probe, prepared from a specific region of the
envelope gene of a xenotropic virus, will detect in every
Single one of them, without exception, an altered size of
messenger RNA. So far we have not found any, tumor that lacks
this messenger RNA. Currently, he is studying those messages
through cloning techniques. Since we have a tumor already in
existence by the time the message is detected, we suspect the
xenotropic message for just this short region of the viral
genome, the envelope gene, to be sufficient by itself to switch
on or induce the tumor. Then, by happenstance, there may be a
secondary event in which an ecotropic virus comes along in the
Same mouse or the same tumor cells grown in culture, undergoes

- 28 -
recombination with this little bit of xenotropic virus and
rescues it, so what comes out is a recombinant virus with a
small patch of xenotropic virus envelope gene in it, which
carries the message for tumor induction.

If that secondary event happens, then you see virus. If
it doesn't happen, then you're looking at apparently virus-free
tumors. So we are dealing with a remarkable phenomenon which
appears to be an alternative to mutation. We know that it
applies not only to radiation but to certain chemical
carcinogens or leukemogens as well. I think our lab has been
the only one in the world to have been stubborn or foolish
enough to have stuck with this. I don't know how globally
Significant it's going to turn out to be, but I think we really
are now on the threshhold of breaking open this very

long-standing mystery.

Q: Some years ago when we talked about this, you mentioned
how difficult it was to actually prove the existence of a human
cancer virus. But you said your gut feeling was that in fact

many lymphomas were induced by viruses. Can you comment?

A: The implications here are very straight forward. You
don't have to have a virus in order to have a virus-induced

lymphoma. If you have that little bit of genetic information of

- 29 -
the specific type, that may be all that's needed. Humans have
few or no ecotropic viruses that could possibly come along and
rescue that bit so that you could fish it out and detect it.
Our discovery will lend force to that notion and open ways of
looking now for such subviral entities. Until recently I think
we've been looking at the wrong level. People were looking for
typical mouselike viruses and that just didn't work. It's much

more subtle than that.

Q: Besides developing successful treatments for Hodgkin's
disease and the cancer virus work, what other milestones would

you include in your career?

A: We made important contributions in several areas. One
point perhaps I should make in connection with your earlier
question of what makes for a good or great department is a
point I frequently stressed to our facultysa It was that no
matter what they were doing in their research, no matter what
else was going on, it was a given that the quality of patient
care in the department had to be absolutely first class. We
would not undercut the quality of patient care just to find
more time for our research. You may remember I had some
memorable fights with Halsted Holman on issues relating to

that. That's a point worth stressing.

~ 30 -
In 1956, shortly after we treated the infant with the
retinoblastoma, a urologist on our staff named James Ownby came
by. He was like a little boy with an electric train. He saw all
the red and green lights on our control panel and he was
fascinated. And he became eager to have one of his patients
treated on our machine.

One day he asked if I'd be willing to treat a patient
with a large cancer of the prostate but with no known
metastasis. The man was unable to urinate and Ownby was
managing him with estrogens, an acceptable treatment at the
time.

I told Ownby that I really didn't know whether we could
safely irradiate the prostantic tumor in such close proximity
to the urinary bladder and rectum. Nevertheless, he pleaded and
I started this patient on treatment. Within a couple of weeks
he no longer needed his estrogen. He could urinate all right,
his prostate was down and was softer. We went on treating him
for several weeks and that patient lived for years. So Jim
Ownby began going up and down the area attending urological
meetings, and drumming up business for us and we treated large
numbers of patients with locally inoperable cancer of the
prostate. Malcolm Bagshaw arrived shortly after I treated the
first patient. As I got busier with Hodgkin's disease patients
I asked him to take over the prostate work which was growing in
volume.

-~31-
We also evolved new techniques for treating cancer of
the nasopharynx, many of them with lymph node involvement.
These have resulted in survival data reported by Rich Hoppe
several years ago which, as far as I know, are still
unparalleled. We have, of course, done a great deal with cancer
of the larynx of different stages, and the overall result has
been very successful. In cancer of the Ovary our former
colleagues, Zvi Fuks and Eli Glatstein, had devised a
completely new, rather aggresSive treatment that covers
essentially the entire abdominal surface. Their work has
resulted in improved survival in ovarian cancer. Similar data
were developed hy John Farle for testicular tumors, with cure
rates for some of these of 100 percent.

I would have to say in fairness that the recent
introduction of chemotherapy regimens, including cis platinum,
have made an even greater impact on advanced testicular

a

cancers. Those are a few examples.

PART III

Q: How do you wish your research to evolve by those who

succeed you in the years ahead?

A: That would depend on who is actually recruited, and

-~ 32 -
what his interests are. But there is a case to be made for the
generation of human monoclonal antibodies to cancer-related
antigens. If I were well, our program would be oriented in a
strong way toward trying to develop such antibodies. I know
this is exceedingly difficult. But antigens capable of
stimulating human lymphocytes do exist in many cancers, and
that would be the direction I would like to see followed. I
know some of my young people want to continue with this
research as long as they can, and certainly for the next six
months or so. I see no reason why anything should interrupt
them. But after that a lot would depend on the status of our
laboratory funding and on the recruitment of a new endowed
professor who will presumably take over the lab. His interests,
I would presume, might be different. I would expect a lot of
new, quite unrelated kinds. of things would come to the lab over
which I have no control. That's all I can say about the future

of our program.
Q: Where do you see radiotherapy going as a specialty?

A: It's a tough situation. Many of the newer
radiobiological approaches have been tried. It's true some have
not been tried well and our own Norman Coleman and Martin Brown
want to do them really carefully. Nonetheless, there is a good
chance that the so-called radiosensitizers may not pan out as

- 33 -
an effective treatment. If they do their work well, Coleman and
Brown will prove this point more conclusively than other people
have done already. There is a second area of hyperthermia
interacting with radiation, and Malcolm Bagshaw is very
interested. The underlying mechanisms of hyperthermia are not
well understood. They are being worked on carefully by people
like George Hahn and others. They are making progress but they
do not know why hyperthermia works when it does and why it
fails. Nonetheless, Bagshaw and others have acquired machines
that permit the introduction of heat deep within the body ina
more directed way. To the extent they can do that now will take
avay one of the arguments that one conldn't focus these beams
and get the heat directed to the tumor. It could be an enormous
success if this were true, but it could also fail. It's a
gamble.

Another area in which people are putting a lot of
effort now concerns radiosensitizers. I had been pushing this
idea for years, but no one has been listening.

Let me explain. There are three classes of
radiosensitizers. One uses the oxygen effect, but I don't think
it will be very important. A second category uses
bromo-deoxyuridine, a drug that has to be introduced into the
DNA of tumor cells in advance of radiation and must get in

quite uniformly. The radiosensitization is very powerful. But

- 34 -
the usefulness of this approach is seriously limited by the
consideration that not every tumor cell makes DNA at the same
time.

There's a third approach that doesn't depend on either
of these. That's the one that shows promise. It can best be
called radiosensitization through inhibition of enzymatic
repair. Radiation produces injury to tissues. A lot of that
injury is repaired almost instantaneously by enzymes. People
now finally are just beginning to look at the metabolic
pathways of the repair system and to consider the use of drugs
which can be introduced through a catheter during and after
radiotherapy. The drugs would block the repair in irradiated
tissues, but would have no effect at all on unirradiated
tissues. I see that as being a valid area for exploration in
radiotherapy.

There's also renewed interest in the combined use of
external beam radiation and interstitial radiation. This
approach does less overall damage to the tissues while still
affording the same probability of eradicating the tumor. The
technique is used with the greatest effect in early breast
cancer. In that I think there will be a big development. We and
Harvard have been using it. The method makes it unnecessary to
remove all the breast. All one has to do is remove the small

lump. It's most appropriate for patients with very small lumps.

- 35 -
If one removes the lump surgically and then does external beam
radiotherapy and performs an interstitial implant, the
long-term cosmetic result on the breast is nearly
indistinguishable from that of the opposite unirradiated
breast.

A more important consideration is that today many women
are so fearful of a lump when they discover it in their breasts
that they refuse to go to their doctors until the lump has
grown much bigger and their chances of a cure have been
seriously reduced. If they knew they did not have to lose a
breast, that merely removal of this little lump followed by the
radiation procedure would offer them exactly the same long-term
survival, many more of them would come forward early. That
would change survival. I see this development gradually pushing
radical surgery for breast cancer into a much more restricted
frame. And that's good.

Beyond that there are people talking about new machines
and types of beams--neutron beam machines and negative pi
mesons-~but frankly at the moment I don't see any good
arguments in their favor. There is a trial going on in
Switzerland using a Stanford design for a negative pi meson
machine that we would have liked to have here. If there is
anything to it, they will come up with the hard data because
they are doing the work carefully and objectively.

I don't appreciate any other major new thrusts in

- 36 -
radiotherapy that I can see, just as I see none in chemotherapy
except with the advent of new drugs that are really effective
and not too toxic. The last really good drug was cis platinum,
introduced 12 or 15 years ago. That says to me that it isn't so
easy to find new drugs that really have a different mode of
action and are free of toxic effects.

Vince de Vita, the director of the National Cancer
Institute, is and has to be, because of the nature of his job,
very optimistic that we will continue to push the frontiers of
cancer prognosis forward. I looked at this as dispassionately
as I could before I got sick, not just now when I could take an
unduly pessimistic view. But even before that time I felt I
could really not see any major directions from which big
increments in the results in cancer therapy were going to come.

Today there is a lot of excitement in oncogenes. It may
be that some brilliant molecular biologist will be smart enough
to figure out a way, not to put them back where they belong,
because I don't think that would be feasible, but maybe to
neutralize the effects of their abnormal expression and "put
the cancer to sleep" so to speak. That I believe is a
possibility but it's obviously a very speculative one. And it's
going to take a long time.

My overall perspective on the cancer problem, however,

is not very favorable except for those tumors that are due to

- 37 -
viruses where I think we can have a handle on the disease. It
could be possible to work through the virus to get at the viral
oncogene and hopefully to eliminate the virus from the tissue.
That would be a way of achieving cure. But we are only
beginning. We know very little so far about viruses in human
cancers. As I mentioned Bob Gallo has succeeded in identifying
a so-called HTLV human T-cell leukemia-lymphoma virus. This
virus occurs in a selected group of T-cell leukemias and
lymphomas in Southern Japan, the Caribbean basin, and adjacent
shores of North and South America. That's fascinating and
important, but it accounts for a very tiny amount of the total
problem. It certainly has nothing to do with cancer of the lung
or of the pancreas, for example.

In the last 40 years the cure rate of cancer of the
pancreas has remained at 1- percent. It has not even increased
to 2 percent. There, we see a measure of the challenge that
still exists. I, for one, am not smart enough to see where to
go to conquer cancer of the lung or pancreas or the esophagus,
some of the major killers. Overall, I come down on a somewhat

pessimistic side.

Q: Why is it so difficult to develop effective treatments

against these particular cancers?

A: The main answer is early metastasis. We know very

- 38 -
little about how metastasis really occurs within the human
body, except for general patterns of distribution. There are
researchers doing all sorts of fancy and elaborate research on
metastasis with mouse and rat tumors. They can isolate in
substrains of tumor cells certain genetic markers or other
traits and they know those cells will not metastasize at all.
In other tumors they find different genetic markers or traits
and they know they will metastasize very quickly. Every tumor,
however, is a mixture of all of these things, and so it's
likely to contain some cells that will metastasize.

The rate of metastasis in a cancer of the skin is known
to be extremely slow. It's for that reason that we achieve very
high cure rates. We remove the tumor and it doesn't come back
anywhere else. In lung cancer, instead of something close to a
100 percent cure rate, the best that de Vita can report in his
newest data is 12 percent survival, and the best he can report
for pancreatic cancer is 1 percent. For cancer of the esophagus
the survival rate is somewhere between 5 and 10 percent. And
the answer is metastasis. These are silent areas, the tumors
tend to get rather large before they can be detected, and the
chance of metastasis is linked to the size and type of the
tumor and to its location. One reason that lung cancer is so
bad is that we are breathing 20 times a minute, and so we are

massaging the tumor as often.

- 39 -

 
Q: Are you concerned about the level of cancer research
funding? Are there areas of cancer research for which you'd

like to see more money spent?

A: For some years viral oncology was underfunded after a
brief period of generous support. But then the environmental
carcinogenesis people jumped into the act and made big noises.
These are people like Bruce Ames of the University of
California, who argued that we must identify every mutagen in
the environment. Today we know that most mutagens are not
cancer inducing so that a lot of that thrust was false and
unwarranted. Agents that can break chromosomes or aiter
chromosomal structure are much more dangerous. I suppose you
can refer to them as mutagens, but that definition to me is
outside the general meaning of the term, mutation. So
structural rearrangements of chromosomes are meaningful in
cancer and what brings them about is an important area of
future research.

As to funding, the biggest problem I see is the
politicization of the boards that are called upon to make final
decisions, at least at the federal level. Today, the National
Cancer Advisory Board is a heavily politicized body with

relatively little scientific competence. That was not true 15

- 40 -
or 20 years ago. I think each president in recent years has
carried this one step further, and Mr. Reagan has really done
it much more than before. Now, we have Republican businessmen
and Republican writers and conservative right-wing thinkers,
all of them pronouncing judgments on how funds for cancer
research should be allocated, while a tiny handful of very
frustrated, competent scientists on the board cannot get their
opinions through. I think that's the most dangerous thing. It
has not yet happened at the lower echelons of the National
Cancer Institute. The boards of scientific counselors of the
different branches of the Institute are still made up entirely
of scientists and physicians, and they really function very
well. How iong this will last I don't know. But I know that de

Vita is much aware and concerned about this problem.

Q: You mentioned recently that you have some yet to be

published important research. Can you tell me about it?

A: We have developed two new sets of human monoclonal

antibodies. One of them protects against endotoxin, and thus
Should contribute to a decreased mortality in gram-negative
sepsis, which is a major problem throughout the world. It's
estimated that in this country alone there are about 100,000
cases a year, with about 35,000 deaths. In many instances

antibiotics not only don't help, but their use makes things

- 41 -
worse by causing the release of endotoxin from the bacteria as
they are killed. That in turn causes circulatory collapse and
shock.

We have developed a highly potent broad spectrum
anti-endotoxin. Stanford has applied for patents, and we are
currently negotiating with some companies to select one or
more. We want to have this scaled up first and carry out
clinical trials, then hopefully market it with the usual
royalty agreement with Stanford. So that development will
generate royalty income to support research in the lab in the
future.

The other set of antibodies we have developed are
directed against the blood group antigen Rh Type D, the major
Rh antigen. About 15 percent of people are Rh negative and 85
percent are Rh positive. Lf an Rh negative woman is married to
an Rh positive man, there is a very strong chance that the
first Progeny will be Rh positive. Some of the blood of that
baby during birth, through the force of the delivery, somehow
finds its way into the maternal circulation so that now Rh
positive cells, which are foreign to the mother, are residing
in her circulation. And obviously it doesn't take long until
her immune system will make antibody to this antigen.

During subsequent pregnancies with Rh-positive

children, the process is repeated, stimulating an increasingly

- 42 -
strong response, with more antibodies formed. These antibodies
move across the placenta into the fetal circulation now
destroying the red cells of the baby. The baby will develop
jaundice and be mentally retarded. Often the baby is born dead.
If the baby is born alive a technique of exchange transfusion
has been developed to save his life. Another way to prevent
this from happening though is to give the Rh-negative mother an
injection of serum containing powerful anti-Rh antibodies,
which sweeps the baby's red cells out of her system.

Today in some countries there are extreme shortages of
immune serum. In this country there are about two of three
companies supplying immune serum, but their supplies are also
dwindling. ‘‘nese companies often nave to procure some of their
blood products from people who may have hepatitis or AIDS,
whereaS a monoclonal antibody is a pure substance.

We are sending manuscripts of this work to the
Proceedings of the National Academy of Sciences very shortly.
Dr. Abe Braude at UC, San Diego, the chief of infectious

diseases, has worked with me on the anti-endotoxin project.

Q: Let's go back to the question we left unanswered last
time. What role did you play in the recruitment of faculty

before the medical school moved to the campus?

A: My role had to do mainly with two faculty

- 43 -
members--Arthur Kornberg and Joshua Lederberg.

With Arthur, his entire team of what was then the
department of medical microbiology at Washington University in
St. Louis came right along with him. I Suppose I can take some
of the credit for that. It happened this way. I had been
invited to Harvard to become the Cook Professor and Chairman of
Radiology of all the Harvard-affiliated hospitals. It was a
tempting offer and it came at a time when I was losing my
conviction that the new school when it moved down really would
become a first-class scientific school. I felt that way because
I saw no action on the part of anybody in the recruitment of a
new chairman for the department of biochemistry, which did not
exist except as a small division in the department of
chemistry, with a very limited research base.

Fred Terman, who a then university provost, became
chairman of a search committee to recruit the biochemistry
chairman. I was beginning to lean more toward accepting the
position at Harvard. Leonard Schiff, who was a very dear
personal friend, was then on sabbatical leave in Paris. He had
sent a very anguished telegram to Wally Sterling saying, "For
Christ's sake, do something, don't let this happen." In time I
was asked to come to the Campus and see Terman. As we talked, I
was amazed by his negative attitude, because it was clear he

didn't think he could compete with Harvard. But I made it clear

~ 44 -
I really didn't want anything for myself. I was already well on
the way to building a fine department. I didn't need anything
that I couldn't get in the normal course of events.

I told him what I wanted--literally the word was
"playmates," intellectual playmates. I said the medical school
had been so strongly clinically oriented--and I have no quarrel
with strong clinical care because I believe in it and I
practice it--but I also believed in fundamental basic research
in order to make future care better than what we can do today.
I said, for example, there's biochemistry. We've talked about
it now for two years, but there has been no action that I know
of.

On the contrary, Terman said, I am the chairman of the

search committee. He reached in the drawer and he fished out

@

list, and there was Arthur Kornberg's name at the top of the

list.

I said that's wonderful, because Arthur is a dear
friend and one of the greatest biochemists in the world. But I:
added that having him on the top of the list and getting him to
come to Stanford are two different things. I said I hope you'll
pardon my being cynical, but I've watched how Stanford does
some of its recruiting. Typically, from what I've been able to

observe in some other recent episodes, you wait until you hear

that the guy has been invited out to give a seminar at Berkeley

- 45 -
so that you won't have to pay his plane fare, and then you'll
invite him across the bay to the Farm and you'll talk to him
about the sunshine, the climate, and the bay and you won't
offer him any budget or any space, and then you won't
understand why he won't come.

Terman turned kind of green, because this was a rough
way to talk to a provost and especially one as tight-laced as
Fred Terman. But I didn't give a damn, I had nothing to lose.
He said, "What would you like us to do?"

I said, "I'd like you to invite Mrs. Kornberg with
Arthur on the first visit. I'd like them to come first class.
I'd like to have a car waiting for them at the airport,
preterabDly a convertible. I'd like them to have a suite at
Rickey's. All these are just creature comforts, but they make a
difference because they indicate the level of your interest.
Beyond that, I want you to promise him every square inch of
space and every dollar of budget that he asks for, because I
know Arthur well enough to know that he won't ask for more than
he can use."

As I got up to leave I said to Terman, "I'll make it
very simple for you. If you recruit Kornberg successfully, I'll
Stay. If you fail, I'm going to Harvard." It was just as simple
as that.

Terman's jaw, of course, by this time was hanging kind
of slack. But he was as good as his word. A few days later

- 46 -
Arthur and Sylvie came out, and before he returned he had
accepted the Stanford job.

A few months after that I was returning to Stanford
from Bethesda by way of St. Louis to offer whatever help I
could to Arthur in getting his department ready for the move to
Stanford. There was a party that evening at Paul Berg's to
celebrate this great new venture. Just as we walked in the
door, the phone rang. It was Lederberg wanting to speak to
Arthur.

Lederberg simply wanted to know what was going on at
Stanford. "I was out there last year looking at a job in
biological sciences," he said. "It seemed like the same old
Sleepy place as ever, and I turned them down. But now I hear
that Henry is staying and you are going. I want to find out
what's happening to inject this degree of excitement."

We took turns on the phone and talked about the new and
improved curriculum, outstanding students and so on, and Josh
said, "Gee, that sounds wonderful! I'd be very interested."

I flew back to Stanford that night and the next morning
I went in to see Bob Alway. This time I didn't request, I
demanded that he forthwith create a new department of genetics,
which didn't exist in the medical school, with Josh as
chairman. Alway had to dig down into some temporary dean's

funds in order to get it off the ground. Alway, to his

~ 47 -
ever-~lasting credit, was never afraid of people who were
smarter than he was. And he was not afraid to do battle with
the university administration if the issue seemed important
enough. That's how it happened. And, of course, the two Nobel
prizes came a year apart at just about that time. Because of
that, suddenly Stanford was catapulted literally from a second
or third rate clinical school into some kind of mysterious but
very exciting place that students thought of in the context of
Harvard.

Subsequently, more faculty were recruited, some good,
some not so good. We had, of course, Avram Goldstein who was as
good as gold, a very strong effective leader. Alway was dean
and was doing a good job. But one of our most terribie mistakes
that started us on the road to losing our momentum was the
Selection of David Hamburg as professor and chairman of
psychiatry. I take personal responsibility, because I was
chairman of the selection committee. It took me three more
years to realize that he was the Original three dollar bill.
The second bad mistake was the selection of Halsted Holman as

chairman of medicine.

Q: Do you think the school today offers the same
excitement as it did when it was first started--especially in
its ability to attract topnotch faculty, or has it lost its
momentum?

- 48 -
A: Losing momentum is a very real threat. Another threat
is that over the years quite a number of people have been
brought in for not absolutely first rate work. They are better
than mediocre certainly but not great. Our ratio of Paul Bergs
to other types of people is gradually changing. Another aspect
that's important is perhaps inevitable. When we were a little
group, even though there were 16 departments, only seven
departments were calling the shots on everything. We would meet
evenings and weekends to try to keep up with our own work as
well as the planning for the school. We'd meet with Alway and
try to function as a very active and dynamic kind of
sub-executive committee. There was tremendous idealism and a
willingness among us to give up things for the greater good of
the school. The school improved dramatically because of that. I
don't see that anymore. Perhaps this is a function of size, but
it seems there are an awful lot of people more concerned about
maintaining their own territory and don't want anything that
would expose them to possible discomfort or loss of power or
anything that might help the school, but not directly help
them. The dean has a tremendous problem in that whole area of

motivation and I don't know how he's going to get around it.

Q: The same question comes to mind when you consider what

-~ 49 -
happened with the faculty practice plan. Why after 20 years of

debate about it, we still have no plan that satisfies everyone?

A: It's too painful for me to talk about it. The major
reason is simple. We have never been a true faculty practice
except for a brief period before Bob Glaser's arrival as dean.
We used to have a faculty practice plan run by the chairmen of
the clinical departments. They arrived at 7:15 a.m. every
Wednesday morning and met with the lady who was doing all the
accounting and bookkeeping for the practice. After a year or so
we got her an assistant. But we were making money. We were |
willing to distribute some of that money to the dean as long as
the earning faculty got their share. When Glaser came he made
it an absolute issue that he take over that program. That very
nearly destroyed the school, and it almost led to my departure.
What we have had since then has not been a faculty practice
Pplan--it has been a dean-run practice Supposed to be carried
out by the faculty as hired hands. It's not our own practice
plan. And even now, in my view, we have to ask only one
question. It's the acid test. That is, who appointed and who
can fire Don Tower. You know damn well it's not the faculty.
With each of the respective deans, every single one of them
after Alway, the faculty was given no incentive to give a damn.

They were helpless. They had no control over how these pieces

-~ 50 -
of paper were shuffled. And this has led to losses of millions

of dollars of faculty hard-earned income.

Qs: This is my final question. It's a difficult one to ask,
but it would be important to do so. The question is how would

Dr. Kaplan like to be remembered?

A: That's a tough one. Well, I guess I'd say, on the one
hand, I'd like to be remembered for those of my accomplishments
that stand the test of time such as Hodgkin's disease and
malignant lymphomas. That is an area where there will be
continued further improvement, but I think we contributed a
foundation stone which today 1S leading to the cure woridwide
of hundreds of thousands of patients.

It's hard for me to know whether my work on mouse virus
or radiation-induced lymphomas will be remembered or not. I
happen to think it's very interesting, but I have the feeling
people tend to gloss over it.

I'd like to be remembered as the co-developer of the
medical linear accelerator for cancer treatment, which today is
a standard of excellence throughout the world, and has
dramatically improved cure rates for many types of cancer
despite of what I said about cancer of the lung and pancreas
which are among the areas of failure. There are many other
cancers in which radiotherapy is extremely effective and has

- 51 -
changed prognosis significantly. That's another area I'd like
to be remembered for. And not just for developing the machine,
but the standards for its use. We had to learn to think
differently since we were working with a rifle and not with a
shotgun. We had to develop techniques of precision that were
utterly new. Those are part and parcel of that development.

I'd like to be remembered for my service on the
National Cancer Advisory Council in 1960 at a time when the
total number of radiotherapists in the United States was about
120 and the number of physicians in radiotherapy training was
18, of whom 6 were from other countries and scheduled to go
hack to their native lands. In other words we were not training
enough people to take care of our own natural attrition. I was
asked to give a lecture on radiation therapy to the Cancer
Council, one of several such invited lectures at a time when
that body wanted to educate itself. I decided not to fear
washing dirty linen in public. So I brought out these numbers.
I pointed out that radiotherapy was dying of attrition. The
presentation must have been compelling, because the council
voted to have the National Cancer Institute director, Kenneth
Endicott, create a committee to look into this. Six weeks later
Endicott came into my office at Stanford, sat down, and in his
typical, and distinguished gravelly voice, he announced that he

had been asked to form the committee, and he added, "Henry, you

- 52 -
and I both know that the optimal size of any committee is one.
I'd like you to be the committee. You're free to consult anyone
you want to, but you call the shots on what you recommend.”

I talked to other leaders in the field extensively. I
finally put in a program both for research training and
clinical training with decent stipends, and it was accepted
with enthusiasm. Today there are close to 2,000 board-certified
radiation therapists.

I was also instrumental in fighting a battle with the
American Board of Radiology to certify specialists in
radiotherapy alone. At one time you were forced to do both
diagnostic radiology and therapy, and I won that battle too.
Today, there are departments of radiotherapy of good quality in
a high proportion in all the medical schools in the country,
and some of the major community hospitals. That went
hand-in-hand with the linear accelerator. There was no point
having an expensive gadget, which was superior to all other
known gadgets, without enough people around who knew how to use
it. I believe I'm generally credited as the person who created
that.

Those are just accomplishments. As for the rest, I
guess I'd like to be remembered as somebody who has been
basically kind and deeply concerned about his patients, and
very humane in dealing with them. At the same time I want to be
remembered as somebody who was tough enough to be willing to

~ 53 -
fight the battles with a number of deans--battles that were
needed to create and maintain high standards not just for our
department but for the school. I fought more battles that had
nothing to do with radiology than almost anybody in the school
except Avram Goldstein. And he'll Probably back that up.

So viewed from one side I think I was a kindly
physician, a role model. Viewed from another side Iwas a
malignant son-of-a-bitch that drove deans to despair and was
known as a dean killer. These two kinds of things were sort of
hard to reconcile. I must say I never enjoyed fighting with
deans, I never enjoyed it for one minute. It took an awful lot
out of me. But if I believed in what I was fighting for, I
didn't care how hard I fought.

I guess I'd also like to be remembered as somebody with
a reasonably good sense of humor, with a love of art and music
and literature, and hopefully as a good husband and a good

father and a loyal friend. That's about all I can say.

end

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