||American Society of Hematology President - 2000
President and CEO, Dana-Farber Cancer Institute
Director of Dana-Farber Harvard Cancer Center, CEO, Dana-Farber/Partner CancerCare
Richard and Susan Smith Professor of Medicine, Professor of Pediatrics, Professor of Pathology,
Harvard Medical School, Boston, MA
Q: How did you become interested in the field of hematology? Academia in particular?
A: I became interested in academic medicine before becoming interested in hematology. It started in high school when I got in an argument with a nun about how many chromosomes man has. That got me interested in DNA and then molecular biology (MB). I was very interested in MB research in college and wanted to pursue patient research in MB, which was very new in the 70s. I became interested in hematology because of a presentation by David Nathan (a past president of the American Society of Hematology). I realized hematology was the only field that would allow me to use MB research to study human disease. It was virtually impossible in other areas, except in hematology because you can work directly with patient blood cells.
Q: Why do you think it is important for people to get involved in this field?
A: Because hematologists are responsible for treating patients with many major conditions that cause illness and death. For example, one third of patients with cancer actually die of blood-clotting related to their cancer. Also, it is still the specialty of medicine where the newest discoveries in science first get applied to human disease.
Q: In your experience, what is the most difficult or challenging aspect of becoming a hematologist in the United States?
A: It's not that challenging to become one - you have to go to medical school, get into a good residency program, then be accepted into a fellowship - those hurdles are true for every specialty in medicine. The challenge in being a hematologist, unless you're also an oncologist, is the reimbursement scheme, which makes it difficult to be in private practice in hematology. If you're interested in working purely in hematology, you will find yourself working at an academic center. If you want to work in private practice by being a hematologist/oncologist, the oncology part of your practice will overwhelm hematology and make it hard for you to focus on hematology and keep up with the research.
Hematology is a broad discipline so you have to master many different subtopics of hematology - for example, in leukemia, bone marrow failure, transfusion medicine, etc. So, you have to be able to think broadly as well as deeply.
Q: How do you feel advances in technology (recent or past) have helped you along the way, be it in your studies or in general practice?
A: Advances in scientific technology have been incredibly helpful for diagnosis and treatment of hematologic disorders. We can now give growth factors to help patients replace the loss of red and white blood cells who used to need transfusion. We can replace clotting factors in hemophilia. We can diagnose leukemia to a level of precision that we can customize therapies in a more advanced way than most other areas of medicine.
Q: What do you find to be most rewarding about a career in hematology?
A: You can do good because you're taking care of patients and helping them with conditions that really require specialized knowledge. And you can do research that is still on the very cutting edge of science but still very relevant to the needs of your patients. Hematologists are the nicest docs out there.
Q: Finally, what advice might you have for a younger person who will be pursuing a career in this field?
A: You want to be sure that you're achieving academically. You need a very strong background in science, and be sure that you're learning great communication skills so you can be both a physician and a scientist. Hematologists must be adept at all of the things that make you a caring physician but also very well prepared scientifically because it is a science-driven discipline.
The beautiful thing about hematology is that there are so many ways where you can be of use to patients and study something truly fascinating. If you're a good hematologist, you'll have unique knowledge and the ability to help patients that no one else can help, and you can still be a very accomplished researcher.
After my second year of medical school I took a year off to try to apply the brand new techniques of MB to study a form of inherited anemia called thalassemia. I was trying to do something that no one has ever tried to do before. At 49 weeks out of my 52 weeks in the lab, I had nothing - nothing worked. I paid a visit to a professor at the Massachusetts Institute of Technology (across the river), and during the course of that conversation we realized I had the right question to answer, and he had the right system to answer it. In the next three weeks we were able to generate data that really launched my career and today remains one of my most important research contributions. Lesson: You can feel like you're beating your head against the wall, but you're only one conversation away from something really special. I had been contemplating quitting, but my mentor wouldn't let me do it. Find people you feel you can really trust with your future.
Thalassemia patients don't make hemoglogbin. In those days we knew genetic diseases could result in making abnormal proteins that functioned in the wrong way. No one had a way of understanding diseases in which you failed to regulate the protein.
We were the first at the National Institutes of Health to isolate and express human messenger RNA (ribonucleic acid) and show that it was a defect in that messenger RNA in these patients that explained why they had the disease. It was among the first applications of MB to explain human disease. The other lab that deserves credit is the lab of Art Nienhuis who worked with French Anderson. I worked with Bernie Forget - they were our senior mentors.
Research is a long run for a short slide.
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