Page 1  2  3  4  5  6

Q: Was there a certain point at which you stopped pursuing animal experimentation as some kind of way of testing your medical ideas?

Finch: Quite the opposite. I think I did more later on. You have to be a bit of a detective. The issue is not that animal observations are not relevant to the mechanism involved. It's just that you have to know what the differences in the animal are. In that instance, I think it was a function of muscle mass. We worked out a mechanism, and that mechanism is a valid mechanism and does apply to man. But not enough. I think if we could get a really, extremely muscular man and have him do that-- and make him iron deficient, we could show it. But its clinical relevance isn't significant.

Q: Arnold Schwarzenegger special?

Finch: That is what we need.

Q: How particularly have animal studies been increasingly important in your work?

Finch: There are different components there. I grew up in the school where you did every experiment on yourself before you did it on anybody else. When it came to using radioactive isotopes, I couldn’t do that from the standpoint of the radioactive burden that I would collect eventually. Things like bleeding, and methernoglobin production in myself, these studies I always did in myself before I did anyone else. This seemed a good way to evaluate the appropriateness for another person. The attitude about clinical experimentation has changed so that there are many things that we did years ago, which won't be appropriate now. What I'm getting at is, of course, that there are now protocols and things that really make you feel that you must be very, very certain of safety before you go to a clinical study. And a way to be much more certain is to try it out in applicable animal models. For most research of the type that requires clinical trial, use of animals gives additional protection to what you may want to do. Some studies can only be tested in animals. For example studies in pregnant women, fetuses, you surely can't approach these days. You need to go to animal models. The example of that is: can a very iron-deficient woman hurt her child by making him iron deficient? There are clinical studies that tend to say that in man, in women this really doesn't seem to happen, although you get some evidence on the other side too. We worked on animals. We could produce fetal deaths, fetal reabsorption, and so forth. Then when we worked out the calculation of how much iron was going. Ten fetuses growing at a tremendous rate, the requirements of those fetuses were maybe ten or twenty times that of the requirements of man per day. We had a clear explanation of why, in fact, it wasn't valid to say that the mother can hurt the fetus, unless she herself has cardiac problems or some other complication affected by iron deficiency.

Q: I suppose that was the rationale behind of a lot of Dr. Thomas' early work?

Finch: Yes.

Q: So, what you're really saying is that--

Finch: I think there should be a balance. It may be true that we did too much in humans and not enough in animals before. Of course, there are people now who say you shouldn't even do it in animals. You should use a test tube. I think the whole chain is the important thing. That each situation provides certain opportunities at each level. Hopefully, you should be free to pursue a productive line of research in the most indicated way.

Q: When did you cease to implement the philosophy that you just articulated, which was that you would do something on yourself before you would attempt it on a patient?

Finch: I think that was the way it was done when I started. I know my mentor, Joe Ross, was of that philosophy. We did it also even before, when I was chief resident. We'd do things on ourselves before we would want to do it on a patient.

Q: For you, this was a way of ethically checking to make sure this was a reasonable course of action?

Finch: Yes. I can see the weakness of being overly motivated to find out something, but on the other hand, it may be better than nothing. I can say though, that in recent years, I've found myself psychologically reacting at times to experiments. I remember a time when we were studying the effect of removal of fairly large amounts of blood. I think I'd had 1500 cc [cubic centimeters] taken off. My cardiologist, whom I was working with, asked me if I was feeling any symptoms and I said, "I guess I am." He said, "Let me give you an injection that will level things off. You'll feel better." He gave me an injection and I felt better. Of course, it was a placebo. But you find yourself not always being the ideal subject. I think about then I stopped doing it because I felt I had invalidated myself as a subject. I don't think I had that trouble earlier, that I was aware of.

Q: Do you have any general reflections on clinical experimentation or the use of patients as subjects? How that's changed over--

Finch: It's certainly changed. I think anything I'd have to say would pretty much be standard. We relied an awful lot on the fact that the patient had confidence in us and would accept the fact that if we said, "I think this is no problem here and it would help research," that they would say, "Yes," without having me really go through every possible complication that might have occurred. Now, of course, one has to be so revealing of every possible adverse complication that patients are not really given a completely unbiased picture of the thing. I do think we probably took too much on our own shoulders before. Now patients are much more qualified to make assessments themselves. They could probably be given in a little bit better perspective in some of the ways, but the possibilities of appropriate clinical experimentation have been improved by an informed population.

Q: Speaking of patient populations, when I was talking to Dr. [Helen] Ranney, she made the interesting observation that in moving from New York to San Diego, she had a completely different sort of patient population, and thus a difference in the sorts of research that she could pursue. I was wondering if you had some similar impressions, moving out from Boston to Seattle?

Finch: The Peter Bent Brigham largely had indigent people. It's a poor part of Boston. The county hospital here was similar. We did many of our studies on medical students, several hundred medical students. I think the racial derivation is not too different. They're both from northern Europe. If you have had little or no previous contact with the patient, the hard thing is if you just come in and say, "We’re going to do this. Let me do this on you." I would be uncomfortable if I were the patient, too.

Q: Did you say that you thought patient's these days were a little better informed?

Finch: Certainly the more educated people are. Often ahead of you. What they've read or heard over the television set. What was very interesting to me--one time the army sent three or four of us over to ~Rssia to evaluate blood preservation? They were concerned because the Russians had reported keeping blood a hundred days, which turned out just to be in vitro observations. On the hospital wards, to the patients there, the doctor was practically a god. The doctor would say, "This is my friend from the United States, " and I would get the same respect. At that time, you asked a doctor, ''What do you tell the patient if he has an incurable disease?" And he'd say, "That he's going to get well. We wouldn't tell anybody he’s going to die.'' I realized that the dependency of the patient on the doctor was based on his inability to participate. Whereas in this country now, patients think for themselves and are much more willing to take some responsibility for themselves. It makes a much more effective patient, in treating his illness.

Q: How do you think it compares to some of the other countries that you've seen?

Finch: I think that the attitude of people in terms of taking responsibility medically is almost unique in this country. What's your feeling?

Q: I think so too. In fact, I just came from a talk at Berkeley on patient activism. I sat in on a lecture by a very outspoken activist--

Finch: It's a double-edged sword, but in the long run I think it's better.

Q: I guess my next question--is there anything that you feel that I've left out or that you'd like to talk about? Concerning your career?

Finch: No. I find it's a little awkward to talk about yourself. I have such a very positive attitude towards almost everything that's happened medically. It has been an unusual period in medicine, where a clinician could do research and teaching and not have to be highly focused on a very narrow area. It was a time when resources were available, all we could use and maybe more. I think probably, the good fortune that I had was to come to a medical school which within twenty years was in the forefront of the medical schools of the country. Also the countryside was attractive. Any accomplishments we did have were primarily due to the research fellows, the graduate-level people who came and spent a few years with us. The school itself is an in-house affair, where there are a few people, you see them a lot over the years. But when you have a stream of people coming in from all over the country and abroad, the stimulation that they provide is enormous. I think too little emphasis may be spent now in teaching, for providing an environment where people can learn. If there are good facilities, a flexibility, and people who are highly motivated, anything can happen. People go out and do important things. I think there is too little emphasis on teaching. One of the things that I thought was important was that our teaching program of the medical students in hematology be one of the best teaching programs in the school.

Q: Actually, I have a question: what is your evaluation of the other medical centers on the West Coast and how Seattle relates to that?

Finch: There are some wonderful schools, each with its own flavor. I forget how long ago, twenty years ago, I went down to San Diego. I thought I might go down there. I thought I’d leave here just because there was such a wonderful group of young people, and I thought, "It's not right for an old person to stay on when he's probably over the peak," which was, I'm sure, true. But they said they'd all leave if I left, so I didn't leave. I looked at San Diego. Marvelous opportunities there. They were different in that everyone was independent. We worked to get a cohesive unit, interdependent. I went down there and I said, "How can I fit in to this," and the answer, paraphrased, would be, "Well, just do what you want to do. We'll do what we want to do.'' In fact, they were awfully bright people, but with a different philosophy. I think that's a good school. My son is in Revelle, at UCSD, the state school, college, and wants to go there. I have encouraged him. Stanford is an excellent school, and it is unfortunate that its cost to the medical student is so great. Los Angeles is a very good school, but a very adverse environment. Yet very heavily supported. Much better than we are. We're the poorest school on the coast, as far as the state legislature is concerned, but well financed by grants. University of California at San Francisco is a first-rate school. I think all of these schools on the West Coast are very strong schools. You couldn't do better if you're a student.

Q: I couldn't help being struck by the fact that three of the former presidents that I interviewed on this trip are in the Sand Diego area. I was wondering why that is?

Finch: I almost went down there, too.

Q: Is it because of Scripps? The sort of the wealth of the local economy and their ability to support these kinds of institutions?

Finch: I think it's probably a matter of timing. San Diego's the most recent school. They've picked people who are outstanding, such as the two presidents of ASH.

[END OF TAPE 3, SIDE 2; BEGINNING OF TAPE 4, SIDE 1]

Finch: The University of Washington Medical School was the first school in the Flexner mold since 1910 on the West Coast. Stanford was before then. Then there was a big gap. Then UCLA, then San Diego. I don't know where San Francisco came in. The California schools have all been supported well. It's rich state, heavily populated and they've had an opportunity to take in highly qualified people who were acknowledged to be good. I would say that the success of these schools at the present time is that they're new. That is really appealing: when you can come in and set up something. Looking back at the early days of this school, it was really remarkable how people were working seven days a week. Everyone was so excited at the beginning.

Q: You said that you had done a history of the university, the medical school. What was the motivation for that?

Finch: The older founders were dying off or leaving. It was over 40 years. I thought if a first hand--the opportunity of talking to people, trying to get their input--was going to happen at all, it had to begin right away. I spent about three and a half years talking with people and searching the archives. It was great fun. I had been working in an area and had my own objectives and so forth, but to look back at the school and its objectives. See how the early faculty was able to do what it did. The state gave so little money. Fortunately, the NIH came along. The timing was such that the NIH wanted to set up forward-looking committees to plan research. This school had picked young, promising people from all over the country. So it ended up that all of the committees seemed to have a lot of people from our school. Which meant that the ideas that the NIH would develop would be partly their ideas. They would also be impressed with what the NIH wished to develop and were in a favorable position to compete for grants. Everything went very well with the school. It was perfect timing. But to hear about the administrative problems and how various activities were funded. The book was written primarily for the alumni, who now amount to over 4,000. I thought they'd be interested in seeing the whole picture.

Q: Do many of them, your graduates, settle in this area?

Finch: This school has the unique program of training family doctors. It's a coalition between Alaska, Montana, Idaho and Washington. About a third to a half of the class want to go in family medicine. About half of those take family medicine residencies. Most of those stay in the northwest. Concerning our own fellowship program, we had over two hundred fellows over the years. About two-thirds of them have gone into academic medicine. Of the other third, I guess it must be maybe 30 or 35 are in hematology/oncology in the northwest. I think, again, the strength of the school has been derived from the very extensive post-graduate training program. There are so many people going through the fellowship program that you can pick some really good people to stay around for awhile. That's different from going out and hunting. You know the people well enough to know you can get along with them. It was a lot of fun to do the history. In the process, I became aware that people in the northwest have little interest in what's happened. They're much more interested in what's going to happen. The documents that you would expect to find back east, about what has gone on with the school, you don't find around here.

Q: No archiving?

Finch: Perhaps we are too young to be interested in history. Of course, when you go to Europe and see all of these wonderful pictures of past scholars on the walls of the lecture halls. Even in Boston and at [Johns] Hopkins you can see that. I asked the University if they didn't want to consider selecting an outstanding teacher and placing a picture in the library or some other appropriate places. But no interest in that. The Northwest is a very vigorous part of the world. Most of the people are still people who came from the East rather than were born here. That does make a different person. A little more hospitable to strangers. I think a lot more flexibility. I'm sure glad I had the opportunity to come out here. Just far enough away so that you don't get too many visitors but you enjoy them once you have.

Q: Thank you very much for your time.

Page 1  2  3  4  5  6

©2008 Columbia University

back to Dr. Finch's profile

back to top