By Martin Colman, MD, Rodney Withers, MD, DSc, FASTRO, and Gustavo Montana, MD, FASTRO
In 2002, ASTRO established the History Committee for the purpose of documenting and recording the history of radiation oncology in the United States. This interview took place at the 44th Annual Meeting of the American Society for Radiation Oncology in New Orleans on October 7, 2002.
Question: ASTRO meeting in New Orleans as part of the Oral History Project for ASTRO, and we have the pleasure of interviewing today Dr. Hall from Columbia University, and we'll ask you to tell us a little bit more about yourself. But I just want to introduce Dr. Gus Montana from Duke and I'm Martin Colman from the University of Texas Medical Branch in Galveston.
Question: So, Eric, it's great to have this interview at long last and why don't you tell us a little bit as an intro to your current position and how you got into radiation biology at the beginning of your career.
Dr. Hall: Okay, well, I was an undergraduate in physics at University College, London, in 1950, and at that time, the glamour profession was high-energy physics. It was the exciting thing to do and the brightest kids went into that field. And that's what I wanted to do, but you had to be in the top 1 percent of the class to do that, which I was not, and so I had to look for a job and jobs were not easy to come by. So I ended up in medical physics . . . really by the back door because I just needed a job. I started in 1955 at The Churchill Hospital in Oxford. Ray Oliver was the chief of physics and Frank Ellis was the medical director. For the first couple of years I spent my time calibrating machines, treatment planning and that sort of thing. And the head of the research group there was Lazlo Lajtha, who in fact was an immigrant from Hungary. And he said, "You don't want to be doing this all your life, do you? You should be getting into research." So he started me doing radiation biology . . . at first in the evenings and weekends because I was by then in charge of the physics program. But gradually I spent more and more time on radiation biology, went back to graduate school at Oxford and did my doctorate there. And about that time Harald Rossi at Columbia University was trying to move the Center for Radiological Research more from physics into biology. I wasn't the first choice by any means. He tried Morton Elkind first, Warren Sinclair after, and I was the third choice. And so I moved in 1968 to Columbia for a full-time research position—no duties or responsibilities in the clinical department. So that's how I got to my present place where I've been for 33 years. And when Harald Rossi retired in 1984, I took over as director and the lab was made into a free-standing center at that point—a center for radiological research from 1984 on. So that's how I got into radiation biology . . . starting with physics and moving into radiation biology.
Question: We have a set of questions, really, that I'd like to sort of start with, but I think we can divert from these questions pretty readily. But what was your perspective on the role of radiation biology in the radiation oncology department when you first sort of got into radiation biology?
Dr. Hall: Well, there was great excitement at that time as a result of the work mainly that had been done at what became The Gray Lab., and the possibility that oxygen was a dominant factor in the response of cells. An enormous amount of effort has gone into that sort of research with not very great benefits or consequences except the intellectual challenge. This was one of the factors that led to a big interest in radiation biology and to the beginnings of the integration of radiation biology as well as radiation physics into the teaching programs. First in UK, it was through the Royal College of Radiology and then later in the United States.
Question: Well you've had a tremendous impact on the teaching of radiation biology and we have Dr. Rodney Withers joining us.
Question: Well, Rodney, we've just had a sort of an introduction. Eric has told us how he got into the field and I'd like to defer a lot of the questioning to you because this is your area and this is a set of questions. I've just asked Eric about . . . he's had a tremendous impact on the teaching of radiation biology to radiation oncology residents over the years and just talk a little bit about that and how it evolved and from your lectures to your book to the various editions.
Dr. Hall: Well, okay, let me start historically. I started teaching physics to registrars in radiotherapy while I was in Oxford. When I came to New York in 1968, physics was still being taught largely by Edith Quimby, although she was quite a memorable lady by then. And it was she who encouraged me to start a parallel biology course. At that stage it was possible to have a citywide course. If you advertised the course, people came from all around the city, which nowadays they won't do. We used to get about 50 residents and she taught the physics course and I had to put together the biology course. I had never taught a biology course before, so I had to put together a set of notes to start a course as soon as I got to Columbia. The idea was that we started the course with both the radiation oncology and the radiology residents and cover the ground that was common to both, and then the radiology residents didn't come to the rest of the course. So that's how it started, with encouragement from Edith Quimby. Having taught the course for two or three years, she introduced me to the publisher of her book because she had written the physics textbook and encouraged me to bring out a biology textbook. So that's how it started. And it was really, I think, the environment and the challenge of having 40 or 50 residents to teach that made the atmosphere different and made me spend much more time and effort than one would do now, with only four in the group. It's a different story when you've got a room full of people questioning after every session. So that's how it came about. And then soon after that, I think by 1974 or thereabouts, I was joined Don Pizzarello on the American Board of Radiology test-writing committee. So that was sort of both ends of the picture—writing the questions and writing the textbook. And then in the same year, I started giving two refresher courses at ASTRO. That was in Key Biscayne and it was 1972 or 1973. And this year it had been dropped so I gave it for almost 30 years. For all of that time, I gave refresher courses, wrote board questions and wrote various editions of my book. That's been the part of my life that's been the biggest interaction with ASTRO because, in fact, very little of my research support has ever involved radiation oncology. It's always been much more basic stuff.
Question: And I just made it because I had committees of oncology, but when did they allow you to become a member?
Dr. Hall: Well, it's quite interesting. At first, biologists could only be affiliate members of ASTRO, so I said "The hell with you. I won't become a member." [Laugh] Actually, then, it was Herman Suit who took me aside and said, "Look, you should be an affiliate" So I said, "Well why should I become an affiliate member and pay my way to the Annual Meeting of the Society when I cannot be a member and have my fare paid to teach a refresher course!" And so he said, "Yeah, well that's being silly." So I listened to him and I became a member, but I did hold up one year until nonphysicians were allowed to be full members.
Question: ASTRO began as a sort of rebellious breakaway from the RSNA. But you also taught at RSNA as well, did you not?
Dr. Hall: That is correct. I started a refresher for diagnostic radiology residents and it lasted for 25 years. I took over from Gordon Whitmore who had taught at RSNA for a number of years. I changed the course to make it suitable for residents in diagnostic radiology. Because I felt that there was a great need of something along these lines. ASTRO was providing courses for residents in radiation oncology, but there were no comparable courses in radiation biology for residents in diagnostic radiology. So it was repeated every year for 25 years and I told you the story of how it ended.
Question: We need to have that . . .
Dr. Hall: I gave the refresher course for the 25th time and a young lady came up to me afterward and said, "That was very useful. Thank you very much. I enjoyed that. You know, my dad took your course." [Laugh] I thought at that stage it was time to quit, so I quit.
Question: Actually, they gave you some award, too, didn't they?
Dr. Hall: Yes, they were unnecessarily generous. I got the Gold Medal. Not many nonphysicians have received the Gold Medal from RSNA. And then, the first year they had the Researcher of the Year Award, I got to share that with a diagnostic radiologist. And then this year, I competed for and got a grant from RSNA—a two-year grant to put the radiobiology course for diagnostic residents on the World Wide Web. The idea is you have, each month, a set of five questions, board-like questions. They're allowed to try the questions to see if they can get them right—multiple-choice questions—and then there's an essay explaining why the answer is correct and why the other answers are not correct. And then there's a link to appropriate literature so that if anybody is sufficiently interested and wants more information, there's a link to textbooks and to published papers. And that's free. People don't have to pay to take it. It's funded by RSNA and it's being used a lot by students from developing countries as well. A lot of hits coming from India, for example, and from Europe as well as from the United States. I think that might be the way to go in the teaching of radiobiology. If I'm allowed to put this plug in, when Bill McBride, Amato Giaccia and I met at Rod’s instigation at the ABR to talk about revising the radiobiology syllabus for the therapeutic radiology boards, we thought then that ASTRO repeatedly missed the boat by not having refresher courses that are suitable for residents in training. There's nothing being offered this year apart from J. Martin Brown’s course on molecular biology, which is only about one-tenth of the syllabus in cancer and radiation biology. But all of the basic stuff in the residents ABR exam, there are no refresher courses on that.
Question: Yes, that's been a recent development because they used to have quite a lot of radiobiology—your course, Jack Fowler gave one, I did one for a while.
Dr. Hall: It was a categorical course for a while. I gave the first two, Jack Fowler gave one and Joel Bedford gave one. The course went throughout the whole ASTRO meeting, but that got dropped bit by bit. And then you gave one for a while.
Question: I gave one on fractionation.
Question: Well, your mentioning this instruction on the Web raises a question. I know that at one point you were looking into the possibility of having your book published as a Web edition. Can you tell us a little bit about that? Is that going to happen?
Dr. Hall: No, the publishers wouldn't do it.
Question: Oh. They make too much money from the printed version.
Dr. Hall: Actually, it was a little more complicated than that. First of all I asked the publishers to put it online and they said, "No way." They wouldn't make any money doing that. And so then, as a result of the conversation with you, Martin, we got one of the big equipment manufacturers to say that they would finance putting the summaries of the chapters, which is all anybody needs to read, really, on the Web, and they would recompense the publishers for loss of sales and partly recompense me because I'd lose royalties. The bottom line was that the publishers were very greedy, I think, in what they asked. The amount of money that they asked for was too much, and the company that made the offer more or less told them to go take a hike. So that never happened. But it's quite interesting that when we came to do the Web-based course for RSNA, we collected all the questions by asking residents to try to remember what they were asked, so we got a lot of Board-like questions for the diagnostic residents, but then when it came to write the essays, the grant reviewers said, "Well, you need more diagrams and illustrations." So I thought to take the illustrations out of my book, but the publishers wouldn't allow that because of the copyright. And so, to cut a long story short, I went to the publishers and said, "I want to use diagrams out of the book," and they said, "Well, you can't do that." So I said, "Well, I'll color them all and when they're changed you can't stop me using them." And so that's what we did. We made Technicolor versions of all the diagrams relevant to diagnostic radiology and they are all a part of the Web course.
Question: And the copyright can't be challenged?
Dr. Hall: Well, if you change the diagrams, you don't have to ask permission.
Question: And changing colors is sufficient?
Dr. Hall: Well, we changed the figures a little bit too. It's very easy to do. Nearly all the diagrams now are computer-based, and if you make them color and you change one little line on them, they're different and you don't have to have permission.
Question: Can I just ask one question while we’re on the subject? Over all the editions of your book, how many copies have been sold?
Dr. Hall: I can't answer that exactly and it varies, but it's about 12,000 to 14,000 copies of each edition.
Question: Wow. And how many editions?
Dr. Hall: Five. But that's because it's not restricted to radiation oncology. It was Edith Quimby again who gave me advice. She said that if you sell a book to radiation oncology residents, you sell 3,000 per edition. Sell a book to include diagnostic radiology residents as well and you'll sell 14,000 per edition. So because I've always, in one way or another, designated parts of the book for diagnostic radiology and a portion for radiotherapy, it sells more copies than if directed solely at radiotherapy. Now, I did at one stage talk to the publisher in my naiveté saying, "Well, why don't we make a thinner book for the diagnostic residents and the full one for the therapy residents," But they said, "No, no, no, no. That's not the way to do it," because actually printing the book doesn't cost much. It's the production that costs money, so it's better to do it all in one. It's not commercially viable to separate the books. The paper's not worth very much.
Question: The book was such a success because it was simple and straightforward, and there was a big need for it at the time because there were no good books on radiobiology and it was just clearly and humorously written.
Question: With regard to equipment in radiation biology, how would you contrast the labs that you've worked in when you first got into the field with the sort of labs that you're working in now?
Dr. Hall: Well, I've never worked in a nice swish-new building, you know? My first lab was the wash-house of the Italian prisoner-of-war camp. The Italian prisoners used as labor to build the Churchill Hospital, which was built for the United States Army long before the United States was in the war. It was built to cater for the casualties that were expected in the invasion of Europe a year before Pearl Harbor, which is quite interesting. And they built it at Oxford because that was just out of range of bombers with fighter escorts, so it could never be bombed during the day. So the labs were tacky and crummy. They were Quonset huts and crummy old buildings that were meant to be only temporary. But the change in the equipment, of course, is the change from cellular to molecular. That's the big change. And then the other change is the computerization of everything. And the most exciting thing we've got is these single-particle machines where we can irradiate individual cells with an individual particle, so that's a highly computerized thing, too. So there has been a big change in equipment in the lab.
Question: The changes from cellular to molecular during your lifetime or just before you became a radiobiologist, I imagine the change was from tissue to cellular.
Dr. Hall: In my case, it was from bean roots to cellular. I followed Read and Gray. The first paper I wrote in the field of radiation biology described the first determination of the RBE of cobalt gamma rays compared with 250KV X-rays. And that was done with bean roots using the system that Gray and Read and Neary had used. I didn't use the bean root system for long because by then Puck came along in 1956, so I went and spent a year in Colorado on a Fulbright exchange scholarship to learn the technique of cell culture. And that was about the time that you, Rod, were coming to London, right? About 1962?
Dr. Hall: 1963? Oh, I was back by 1963. I went in 1962.
Question: Just getting back to the bean roots for a second, I remember an interesting story you told me about doing bean root experiments in New York and the problems you had.
Dr. Hall: Well . . . [laugh] you want that story? Well, it is quite interesting really that all of the biology of seedlings, not just Vicia, experiments done by Gray at *Hammersmith or by, Neary at Harwell used water that came ultimately from the River Thames. The River Thames rises in the Cotswolds, which are chalky hills and as it flows toward the sea each town takes the water out of the river and throws the sewage back in again. So there's a statistical probability that by the time the Thames reaches the sea at Greenwich that it may have been through twelve bladders on the way. [Laugh] So it's good for growing plants. When I came to New York, a student wanted a simple project and so we tried to grow bean roots, but they died in the New York City tap water. Of course, immediately people said, "Wow, it's polluted, it's New York." But it turned out that wasn't the case at all. The New York City water comes from the Catskill Mountains and there's nothing in it. It's pure. There are absolutely no dissolved minerals in it, and it won't sustain plant growth at all. For a long time we couldn't figure out why this was happening, but eventually I met up with a biologist down at Cornell University, a guy by the name of Hutner—I remembered his name. He was famous because he had invented a solution, the forerunner of what is now marketed as MiracleGrow. And it was called Hutner’s Solution. It was a complicated stuff to make with all sorts of minerals, and if you put a squirt of that in the New York tap water, plants grew fine. But it was quite interesting that all of the previous work that had been done with bean-roots used water from the Thames, which was chalky and had all sorts of nutrients in it.
Question: Just out of interest, Eric, what was the RBE between X-rays and cobalts?
Dr. Hall: Cobalt-60 was .85
Question: And when cobalt became extensively used instead of 250 KV, did any radiation oncologist ever take any notice of the RBE value?
Dr. Hall: Yeah, there was a committee who took some notice. Actually, it was a little bit more complicated than I told you. There was a paper in the literature from Jack Krohmer, who died recently, but who was in Dallas at that stage. They did some experiments and claimed that the biological effectiveness of cobalt varied with depth because while it started off as almost monoenergetic, well there are two peaks at 1.1 and 1.2 MeV but at a depth due to multiple scatter, the average energy will be lower and the biological effectiveness would vary. And so the project that I started to do was to see if that was true. We thought it was unlikely, and we couldn't see any change in RBE between a depth of 1 centimeter and 20 centimeter depth. The average came out to be .85. There was a committee set up I think by the British Institute of Radiology, but I'm not actually certain about that, and they summarized all of the experimental measurements that had been made and recognized that the RBE was probably between 0.8 and 0.85, But when they came to make the clinical recommendation, the suggestion, they used was 0.9. Their argument was strange. They knew that 0.9 wasn't the average of the experimental values but that when one goes from 250 KV X-rays to cobalt, the depth doses were much better. So were using a slightly wrong RBE to account for the fact that the depth doses were greatly improved with a megavoltage radiation.
Question: What year was that committee? Approximately?
Dr. Hall: About 1960 I would say.
Question: Because I can remember when I was a resident in 1968 and Lionel Cohen guiding me in doses, we used 10 percent more for cobalt.
Dr. Hall: Right.
Question: Now, with electrons relative to gamma rays, what's the RBE and has that ever been taken account of?
Dr. Hall: Well, there are some really wild values in the literature for the RBE of electrons and the reason is that people have made big mistakes in dose measurements of electrons. The dosimetry has been wrong in many, many cases.
Question: As far as I know, they've never made a correction for the RBE of electrons relative to X-rays.
Dr. Hall: No, you're right. But there have been some papers in the literature that suggested very different RBEs for electrons, which were corrected later when the dosimetry was looked at.
Question: So, the RBE may be one or is it also about .85?
Dr. Hall: No idea.
Question: One of our sort of set of questions relates to the most important developments in the field of radiation biology. What are your viewpoints over the years as being the three or four most important contributions of radiation biology research?
Dr. Hall: Well, I think that they fall into two categories. There are some developments in radiation biology that have been of importance to basic research, and there are other developments in radiation biology that have had a big clinical impact. Now I maintain that there haven't been many of the latter, very few really. I'm not saying this because Rod is here because I said the same thing in my keynote address last year. The only one that's had a big effect on practice was Rod’s observation of a difference in the shape of the dose-response relationships for early and late responding tissues. That is the only observation that had a big dramatic effect on the practice of radiation oncology. Otherwise, while radiation biology has affected the thinking of radiation oncologists a lot, it hasn’t really affected what we do very much, in my opinion, as far as I can see. But the milestones in radiation biology are interesting. When I started in radiobiology, before the advent of mammalian cell culture, it is amazing to recognize that we didn't even know that a daily dose fraction killed about half the cells. And, in fact, a lot of people didn't think that the effect of radiotherapy was anything to do with cell killing. So when Puck came along and produced the first mammalian single cell survival curve it became obvious that what radiation was doing mostly was removing reproductive integrity of cells. That was a big step forward in radiation biology and gave an immediate explanation into what was going on in radiotherapy. So that was the first big step, I would have thought. And then later steps included the understanding of how different radiations produce very different biological effects. In more recent eras, borrowing from the wider field of cancer biology, the understanding of oncogenes and suppressor genes have just revolutionized our understanding of the field, I think.
Question: Now, you mentioned earlier that all the research on oxygen had not led to any significant advances, but do you still think that oxygen and the observation of the oxygen effect is significant?
Dr. Hall: Well, don't put words in my mouth of what I said or didn't say or didn't even intend to say. [Laugh] I would say that the study of oxygen and the search for radiosensitizers that went on led to some really very clever science, but it never was translated into a big impact in radiation oncology.
Question: In human cure rates.
Dr. Hall: Hypoxia is a factor, but not the dominant factor, in why you have to fractionate, why a few large doses will not work, but there are other factors involved. But it did explain a lot. The existence of hypoxic cells in tumors and the whole idea of re-oxygenation are all very important to understanding basic radiation oncology, but it didn't lead to any big significant change as far as I can see. No magic substance that came along to offer a substantial advantage.
Question: We could take a contrarian view and say that all of the discoveries in radiobiology and biology have prevented radiation oncologists from doing silly things.
Dr. Hall: Yeah, yeah. But then, well, I think actually they didn't stop radiation oncologists doing silly things. A few radiation oncologists have done silly things and it's those crazy guys on the fringe that have kept everybody else on the straight and narrow road.
Question: And provided some of the information that is important in understanding what you should be doing.
Dr. Hall: That's right. The people who went and designed a treatment course for the convenience of the patients, so we thought, and gave a few big doses. This led to a lot of understanding, but it was a disaster for those patients, but it led to a lot of understanding.
Question: As you said, it was extraordinarily well motivated and was something to make it easier to deliver radiation oncology.
Dr. Hall: Well, actually the stimulus for the actual experiment at the time was that some of those patients were very successful businessmen who didn't want to waste their time five days a week coming in for radiotherapy treatments.
Question: Weren't there also some misinterpretations of things like NSD?
Dr. Hall: Well, that was all wrapped up in it, same story basically. But there's no question that when you go to countries that are less affluent and have less availability to get equipment, they have used fewer fractions and shorter treatment times for a long time and it's very difficult to show that their results in the end are all that much worse. And now we've come around full circle with the suggestion that has come out of the analysis of the beam therapy and brachytherapy results that, in the case of prostate cancer, hyperfractionation may in fact be a big waste of time, because the alpha/beta ratio may not be that different in prostate cancer than it is for late-responding normal tissues. What they've done, for example, in UK for the last 40 years, maybe is as good as anything else—giving fewer bigger fractions—saving enormous amounts of time and effort and money. I was in Ireland only last week at St. Luke's Hospital and with a staff and equipment much smaller than big departments here, they treat 4,000 new patients a year. Now, there's no way they could do that with the sort of protocols that are common in the United States.
Question: We've talked about radiation oncologists not making mistakes. Radiobiologists have also made many mistakes. One of them was probably regarding tumors as a generic big basket with high alpha/beta ratios.
Dr. Hall: Uh, did radiation biologists say that?
Dr. Hall: Well, of course the biggest mystery that clearly was a mistake, although who made the mistake I'm not quite sure, was the whole argument about whether the oxygen effect varied with dose, based on the data from Stockholm. But that was a controversy for many, many years and the main protagonists are passed on now, so I guess we'll never get to the bottom of that.
Question: Yes, they passed on almost simultaneously.
Question: Another one of our sort of standard questions in your opinion, what are some of the institutions that have had the most significant impact in the evolution of radiation biology in the last 70 years?
Dr. Hall: Well, I'm glad you phrased the question as you have most of the questions in the standard list here, end up within our country, and I think it's a great pity to limit the discussion of history, whether it's radiation oncology or whether it's radiation biology, to one country—our country or any other country—because I think you get a totally warped view of history if you do that. There's been a clear shift and “go West, young man” and there's been this westward movement in the field, I think. When I first came to the United States as a Fulbright exchange scholar in 1962, the stimulus 100 percent was to go where Puck was to learn first-hand what was known then about mammalian cell culture. But in order to earn my daily bread, I had to work in the radiation oncology department in Denver. Compared to England at that stage, it was primitive in this country. And you didn't ask me that, but I'll tell you anyway, that in the U.S. there was hardly any radiation biology in radiation oncology departments. Radiation biology in the United States, at that stage, was in the national labs.
Question: We had nuclear energy in bombs.
Dr. Hall: Well, not entirely. People like Cronkite at Brookhaven and, of course, Elkind in Brookhaven for a long time and then at Argonne National Lab, so in the early days, radiation research in the United States was almost all in the national labs—not particularly interested in radiation oncology. Whereas radiobiology grew up in radiation oncology in the UK and in France, for example. And you had good influence in those early days in Paris Hammersmith was also very influential, and then when Gray got ousted from Hammersmith and started the lab, what became the Gray Lab, much of the research from the start was more clinically oriented than was ever the case in the United States. And then the torch just sort of crossed the Atlantic at some stage, partly because people came here, like Rod and myself. But it's much more than that. The increased interest coincided nicely with the beginnings of ASTRO and departments of radiation oncology finally started to hire people and radiation biology became more oriented towards radiation oncology. While in the meantime, it had gone down the tubes in Britain and to some extent in France, too. In Britain there's hardly any radiation biology left.
Question: I think one of the big factors was that in France and Britain, radiation oncologists separated from diagnostic radiologists 20 or 30 years before they did so in this country. So there was a much better defined discipline in radiation oncology.
Dr. Hall: Yeah, that, that was a big factor. Well, in fact, to a large extent in Britain, it isn't that they separated earlier, they were never together in the first place. For example, you can think of a number of people, using Frank Ellis as a prototype, who were never trained in diagnostic radiology. He was appointed as a radium officer, as were many other people who became the early radiation oncologists. That's where they started. So it wasn't that radiation oncology was a side shoot of radiology, it was started as a separate thing. It was never together in the UK as far as I know. They only came together because of the political usefulness of the Royal College of Radiology.
Question: So, moving to this country, what would you say the influential institutions were in radiation biology? I know your group at Columbia was very influential.
Dr. Hall: Well, Columbia was very influential in radiation physics mainly and in microdosimetry. The biology, in fact, was not radiation oncology oriented. The best known biologist in those days at Columbia was Roberts Rugh, who did all the early work on the effects of radiation on the developing embryo and fetus. It was nothing to do with radiation therapy. So, I mean, the person who, despite the fact that he wasn't in a radiation oncology department, did the work that sparked so much interest in it, wasMortimer Elkind. He lectured the world on his experiments with this way out crazy cell system that was really not a model for radiation therapy at all, but he focused on the importance of fractionation. If he'd used a human cell line to start with, he probably never would never have seen this success. [Laugh] So he was so influential worldwide in those early days, even though he didn't really have much feel for radiation oncology.
Question: He developed that in later years.
Dr. Hall: Yes.
Question: But if I could just interrupt, when Harold Rossi recruited you to Columbia, he wanted you to work on biology associated with microdosimetry, did he not?
Dr. Hall: Yes, that is true. The biology staff he had were not interested in radiotherapy.
Question: But he as well was interested in radiation biology relevant to radiotherapy.
Dr. Hall: Yes. Rossi referred to the radiotherapists as the “clowns in the basement.” [Laugh] He had no time for them. He had no respect and no time for them. He wanted the basic radiation research to do with protection. That's what he was interested in. And to do with mechanisms. He also wanted biological data to support the notion of doing fractionation and that sort of thing. But he got a bit more than he bargained for because my intellectual roots have been in radiation oncology and I immediately got involved in low dose-rate work. That was the first work that had any clinical relevancy, if you could say it did have that. And so he got more than he bargained for. And before long, a lot of what we were doing had relevance to radiotherapy. But then, that's gone because it's very hard to get translational research in radiotherapy now. Most of the available grant money now is in basic research from NCI or from DOE or from NASA. The research oriented toward mutagenesis or carcinogenesis and has nothing to do with radiation therapy.
Question: But your laboratory had a big interest in those subjects anyway.
Dr. Hall: Yes, well that's true. I’d say we've had very little support for radiotherapy associated research except in those first early days, in the 1960s and 1970s when you could get a grant on almost anything. But not now.
Question: And the other institutions in the United States that have had an impact. Lets talk about them.
Dr. Hall: Well, Harvard and MD Anderson are the obvious ones.
Question: Now, you've mentioned many people already, but . . .
Dr. Hall: Oh, and Stanford. Yeah, Stanford.
Question: We're going to do an interview with you one of these days.
Question: How about Princess Margaret Hospital in Toronto? Would you say that the biology there has made a significant contribution?
Dr. Hall: Yeah, well that's not in the United States.
Question: I know, but I was thinking about in North America.
Dr. Hall: Uh, yes. I think less so than the ones that were mentioned.
Question: And you mentioned many of the people involved, but who are some of the other people that you haven't mentioned yet who have had a significant impact on the development of radiation biology in relation to radiation oncology?
Dr. Hall: I'm sorry you included the last phase because I was going to say a very important person, I think, is Warren Sinclair. He started in M. D. Anderson related to radiation oncology, but he moved out and went to Argonne and became a very dominant person in more basic radiation biology and in radiation protection. He was a member of both the NCRP and the ICRP for example. So I think he's been a very important person as much because he writes well and he's a very strong committee person, more from that than from the experimental work he actually did.
Question: He's very quick.
Dr. Hall: He writes well, he speaks well and he's persuasive on a committee. The other person who is, I think, a wonderful purveyor of ideas is Jack Fowler. Jack forgets where the ideas came from before long. [Laugh] Jack and Ged Adams did some good science themselves, but the biggest contribution that both of them made was as ambassadors for radiobiology and radiation research all around the world. And like bees going from one flower to another, taking ideas from one lab to another, and as you say, both of them tended to forget where the ideas came from very often, but that's okay. I think they were both important stimulators of research. That's important because some of the best scientists are not very good—what's the word I want—synthesizers, not good at making things easy to understand. And I think Jack and Ged were both superb at making things easy for people to understand. See, neither of them did basic work that holds a candle to what Rod did. Rod’s work is much more important. The experimental work was much more important, but they were the guys that went around talking and synthesizing and I would say that that's what they were good at. Do you think that's true?
Dr. Hall: Then, of course, there was Julie who always asked the most difficult questions—a very difficult woman—but she made a lot of contributions, too. And she did some good stuff in the lab, too, I would say. But she challenged everything and most of us had a sort of a love/hate relationship with Julie. Horrified when she'd get to her feet and first to the microphone after you've given a talk [laugh] because you knew that some barb was coming… but very good and very influential.
Question: Well, you know, I've heard wonderful anecdotes from you over the years, but one of the ones that I'd really like to have on the record is your first encounter with Juan del Regato. I believe it was your first encounter with him.
Dr. Hall: When I went to Denver as a Fulbright Exchange Scholar, I had to earn my keep, so I gave a course to the residents. From all around Colorado they came to this course that day. They would fly in from distant parts of the state for this course—it was in physics, not biology. And one day half a dozen residents appeared together with this funny little man who didn't speak very good English. When I started my lecture, I hadn't been going more than about 10 minutes when this little guy interrupts and asks a question. And I said, "Look, this lecture is really for residents. I don't mind you being here, but I insist that you keep quiet until I give you a chance at the end of the lecture." [Laugh] I was from Oxford, and people didn't interrupt to ask questions. Of course, I did not know that this funny little man who interrupted me was Del Regato. [Laugh] I have to say this—he never held it against me. At the end of the lecture, he came up and introduced himself and I was embarrassed to say that I didn't know who he was then. [Laugh] Juan Del Regato . . . but I found out later, and he was always very kind and very friendly and never held that against me, although I was a very rude brassy young man.
Question: And did you notice any reaction amongst the residents when you said that?
Dr. Hall: They were quiet. [Laugh] The same thing happened when I came to Columbia. I had a classroom full of 50 residents and this old man came in sat in the front row and was reading the New York Times. I told him to get out. "Get out." [Laugh] And it was Maurice Lenz, one of the pioneer radiation oncologists in the U.S., who had been chair of the department at Columbia.
Question: Must have caused a stir. [unclear]
Dr. Hall: He got out. He wanted to read the paper. He was being very disruptive.
Question: He did leave?
Dr. Hall: Yes. Oh, and the other thing, unlike Del Regato who was perfectly charming and never held it against me, I'm not sure Maurice Lenz was quite the same. Well, he later then corrected me when I was giving a talk on the pronunciation of Michigan. I pronounced it Mitch-i-gan and he said, "No, it's of French origin and it's Mish-i-gan." And I said, "I think it was decided on the Plains of Abraham that we’re going to speak English not French in North America!" [Laugh] So I didn't get along too well with him, but he was 80 years old and, in fact, a grumpy old man by then. I’m beginning to sympathize with him now!
Question: Talking about some of the other people that we would like to have interviewed, but we started this project very late and there are a lot of people we don't have around anymore, but you had contact with some of them. Can you tell us a little bit about Quimby.
Dr. Hall: Edith Quimby.
Question: Um hmm.
Question: Is there another one?
Dr. Hall: Yeah, and much more famous is her husband whose name was Shirley Quimby. Well, as I was just going to say, to understand Edith, you sort of have to recognize that she was married to Shirley Quimby, who was a very famous physicist. He was chairman of physics at Columbia, and if I remember correctly, he was also chairman of the U.S. Nobel Nominating Committee. He was also president of the Magicians Society and he was quite a remarkable man. He was quite happy, despite his elevated position in life, to be a spouse at all radiology meetings when he came with Edith. And there, of course, she was the one who was known. Edith was a very tough lady. She came to work until she was about 88 or 90 on the subway and rattled away on her typewriter. She typed everything herself. She would never have a secretary type anything, which was unusual in those days. She was a wonderful teacher, a wonderful lecturer and she treated the residents like naughty school boys. People came from huge distances to her course, not because they wanted her to teach them, but to make sure she couldn't examine them. [Laugh] It was worth commuting from a hundred miles away just to make sure that they didn't get her for the oral test because she was a very tough lady. She was not the first author of the textbook, but she was the one who wrote most of it and it was always called the “Quimby” book. It was the first book on the physics of radiology. She was not entirely in radiation therapy. She taught the diagnostic residents, too. In those days, the lab was a division of radiology and radiotherapy also was a division of radiology, so it was all part of radiology. So she taught both diagnostic and therapeutic residents. She was honored by all of the diagnostic and therapeutic radiology societies. She was, I think, the first woman president of the American Radium Society. In fact, they changed the rules of the Radium Society specifically to allow her as a non-M.D. to be president.
Question: Because she was a physicist, not because she was a woman.
Dr. Hall: Um . . . yes. They changed the rules because she was the first non-physician and they changed the rules for her to be president. And she was also the first woman to give the Janeway Lecture.
Question: Could you mention some other people of that era that you came into contact with, either in Britain or in the U.S.?
Dr. Hall: Well, there was Hal Gray. When I was getting my doctorate, I went up to what was then the British Empire Cancer campaign radiobiology unit. Lazlo Lajtha took me up to present my thesis work to Gray and to hear his criticisms before I wrote my thesis. And that was quite shortly before his death. It was in 1962.
Question: He died in 1965.
Dr. Hall: He was getting on. He wasn't all that old, but he wasn't in great health at that time. When did you get your PhD, Rod?
Question: He had a stroke in 1962 and he died in 1965.
Dr. Hall: Okay, so that was before 1965 because I finished my thesis in 1962, so he had not had a stroke then. He was an interesting guy, and then John Read was an ornery old guy from New Zealand. Did you meet him?
Question: Yeah. A wonderful man, I thought.
Dr. Hall: Yeah? I think he was an ornery guy.
Question: Was he also . . .
Dr. Hall: Well, he was a New Zealander and he came and worked with Hal Gray. And he had a bit of a bee in his bonnet that he'd never got the recognition he thought he deserved. [Laugh] He's not the only one who thinks that, but he expressed it more than we would. And then he went back to New Zealand, didn't he? And I corresponded with him. He was very helpful to me. So he was an interesting guy. I never met Douglas Lea, but the first eponymous lecture I ever gave was the Douglas Lea Memorial Lecture, I went to Cambridge and met and talked to his widow. And she told me a lot about Lea and I gather that Gray, for much of his early days, was very much overshadowed by Lea.
Question: He was.
Dr. Hall: . . . for Lea was a much smarter guy. It's incredible to read his book considering when it was written. There's hardly anything else [laugh] apart from re-oxygenation that he didn't think of. I think he was a giant in his field in those early days. And then the other guy who built out a huge lab and probably, in the early days, one of the biggest reservoirs of expertise was Harvey Patt. And he was one of the early presidents of The Radiation Research Society, and he built up a big DOE-funded lab at the University of California, San Francisco. Remember that?
Question: Um hmm.
Dr. Hall: Bob Painter did a lot of DNA repair work. Then there was Shelly Wolf and Jim Cleaver. Some of the best academic radiation biologists in the United States were in that lab, I would say. Bob Painter, Shelly Wolf and Jim Cleaver.
Question: Wasn't he a member of the Academy?
Dr. Hall: I think radiation biology and radiation oncology have not done well in terms of getting people into the Academy. There have been a few, but the ones who did get in didn't seem to exert themselves much to get anybody else in, which is what usually happens. You've got to have somebody in as an advocate. So that was one of the very dominant labs in the Radiation Research Society in the early days.
Question: There were four questions that sort of relate to the present and future and I don't know it there's anything else in the past you want to say now.
Question: I don't know . . .
Question:Let me ask you, then, how you think we can improve training programs from here on out in respect specifically to radiation biology?
Dr. Hall: I think that the notion of insisting that there be a radiobiologist, or at least a basic scientist, in every department has been very good for the employment of radiation biologists, but I'm not sure it's done as much for training and I'm not sure it's been as good for training as people thought it would be when it was set up. Because it has had one very negative impact, which is that is has discouraged to the point of elimination the more central courses. Now, this is very parochial for me to say this, but whereas in the days of yore, in Edith Quimby’s day, essentially all the residents in the New York were taught physics by her. And then for quite a few years all the radiobiology in the New York area was taught in the course at Columbia. Nowadays that can't happen because the chairman of each department can't send residents to another department because that implies that you don't have the facilities. So very often residents get much poorer teaching because they've got somebody at home. Very often that person hardly speaks English and doesn't know any biology anyway, but they have to give the course. So I think that's been, in many ways it's not worked out as well as it might have. And that takes me back to what I said earlier, that I think ASTRO has missed the boat in not providing better teaching in physics as well as in radiation biology. Well, physics is not so bad because you've got to have competent physicists for the treatment planning. But you don't have to have competent biologists. All he's got to be is a biologist and many are not very competent and many don't speak English very well.
Question: ASTRO has some good courses . . .
Dr. Hall: Yeah, I think that there appears to be no connection. For example, there's a radiobiology committee in ASTRO. I've never been on it, but there is a radiobiology committee and there's a refresher course committee, but there doesn't seem to be any connection between these. And this came up again at the ABR meeting that we had that the radiobiology committee got no input into the refresher courses. And while I don't think for a minute that that ought to be the central role in refresher courses, not at all, not at all, not at all. But, with the number of refresher courses there are, they could be sufficient for residents to get their course. Now, the residents from Mass General, residents from UCLA and Stanford get all their teaching perfectly adequately at home, but there are many residents from smaller programs around the country that could have a much better course at ASTRO than they get in their own institution.
Question: And there are two points that perhaps I'd like you to comment on. One, the wording for next year has been changed to read, “Cancer Biologist,” but they still are a requirement for every program. The other is that I heard from people who are behind this initiative that the reason for it was mostly motivated by, not the full employment of radiation biologists (laugh), but to try and encourage more participation by residents in research. And that by insisting that each program have a basic scientist, that there would be that opportunity. So maybe you could comment on those two things: the changing of the wording and maybe the origins of the initiative and why it arose and how you would deal with it.
Dr. Hall: Well, I don't think the initiative worked. Right from the start it didn't work because if you ask which residents have had a good experience and good introduction to research, they've almost all come from the big programs that had a radiation biology program anyway. And so their research experience did not result from this initiative. And this initiative only affected smaller departments and then, again, it is invidious to mention the individual places, but there are many instances where one single person has been hired to satisfy this requirement and they don't put on a good course and they don't really provide much of a research environment. I think isolating the individual is not the way to get any research done in my opinion. So I think that initiative never worked anyway.
Question: And changing the description of the person . . .
Dr. Hall: “A rose by any other name would smell as sweet.” I don't care what you call them because I don't think it was ever called a radiation biologist, was it? A basic scientist was the wording. It didn't have to be a biologist in the original initiative. I'm not arguing against the initiative, but I don't think it's really achieved very much.
Question:Well, I hope that some of the points that you've made relating to the role that ASTRO can play . . . I mean, we're going to make suggestions to the right people within ASTRO and I think they're all valid suggestions and should be followed. One of the things that we're doing right now in training that we shouldn't change, I mean in relation to radiation biology?
Dr. Hall: That's a funny one . . . I noticed that one. What shouldn't we change?
Question: What do you think are the strengths that we should maintain, then?
Dr. Hall: Well, I think . . . it's not the training. The strength in the United States is that the residents have got to learn a lot of basic science. Now, I don't know quite how to say this, but recently I was in the UK and talking to residents and I was asked to sign a copy of my book in the library. And in discussing the teaching, there's my book, which is geared to what the Board requires here for residents, which is “this thick,” and in the UK, residents read Gordon Steel’s book, which is about “this thick.” And it isn't a question of comparing books because the books only reflect what the exams ask, and so the registrars in the UK, I can't speak for the rest of Europe, don't learn anything like as much basic science as residents have to here to pass the Boards. And there are times when, I know Rod thinks, and I tend to share his view, that exams here are much too easy and they ought to know more, but it's a lot more basic science. So that's a strength the way things have developed here, I think radiation oncology residents are learning much more basic science. And we've also in this country, because of the combination of the Board and ASTRO, we've introduced far more of the new biology. I mean, if you ask does a resident need to know any molecular biology to practice, and the answer is he probably doesn't need to know very much. But the background information so that he can interact with his medical oncology colleagues is important, and we teach them much more here than they're being taught in Ireland or the UK. So that's a strength. I don't quite know how it's happened, but it's good.
Question: I think also the science of radiation oncology is much better taught than the science of say medical oncology. Later, all that transformations in science and even the understanding of exponential relationship between those things is not very basic in their training.
Dr. Hall: Well, I think there's an historical reason for that, and you may not like it if I say so, but I think the reason for that is that many of the radiation biologists started as physicists and they were brought up with a quantitative mathematical background—maybe too much. Whereas in the medical oncology field, that's not the case. It's not just the medical oncologists. The researchers in that field don't think quantitatively and in fact it's one of the clashes that's coming in as departments—and I know I'm as guilty as anybody—realizing how hard it is to teach old dogs new tricks. You realize that molecular biology was going to become important and we hired some card-carrying molecular biologists, and they do not think quantitatively. They simply do not think quantitatively. So that is certainly one of the hallmarks of people that are trained in the field is they think quantitatively, try to think quantitatively.
Question: I'm just scribbling. Do you have some questions you want to talk about?
Question: Just a very generic, very general question and that is what's been the most satisfying aspect of your career—your professional career? And I guess the second one is what would you say to you if you were 32 again and beginning your career? Impossible questions, perhaps.
Dr. Hall: No, they're very simple questions to answer. I think the most rewarding thing in my career has been, if I can make it number one, I love to teach and I get enormous pleasure out of my teaching. I forget who said it once that teachers get a quite nonrepresentative and inordinate satisfaction thinking that they have more to do with the success of their students than they really did. And so I think that's given me great pleasure. And then the other thing is that the recognition, recognition isn't quite the word I want, that I've had from the clinical societies, from ASTRO and from RSNA has been astonishing. I mean, I've been surprised and that has given me great satisfaction—far more than from the Basic Research Society.
Question: I'm surprised that you're surprised.
Dr. Hall: Oh, I was astonished. I mean, more than surprised—astonished. Years ago when Sarah called up and said I was going to get the ASTRO Gold Medal, I was absolutely astonished. I was completely astonished.
Question: That amazes me.
Dr. Hall: Well, I was astonished. So then you said what would I do if I was 32? I would go to medical school.
Question: And be a radiation oncologist?
Dr. Hall: No, but that's the biggest mistake I ever made and I could've remedied it even after I came here, after I came to Denver, I could have, but I didn't and that was a mistake.
Question: Well, your son . . .
Dr. Hall: Yeah, my son is a physician. He didn't go to medical school because I advised him because he never did anything I advised him. [Laugh] But what I kept telling my son, although I say he never took any notice, is regardless of whether you want to look after people or whether you want to do research, you're better off going to medical school than you are doing a Ph.D. in my opinion.
Question: Certainly science relates to clinical practice.
Question: Are there any other things you want to mention that are sort of relevant to the oral history project that we haven't touched on?
Dr. Hall: Perhaps as the chairman of the History Committee and I'll tell you what my son told me when I was doing one of the revisions of my book; he said we should leave out these historical introductions because a preoccupation with history is one of the earliest signs of senility. [Laugh] And I think he's probably right. Okay, so I'll say one more thing, which, again, you may not agree with because I know everybody won't. And I think I would be happier if ASTRO was a little more geared than they are, possibly following ESTRO, in taking more interest and responsibility for radiation oncology in the developing countries. I think we tend to be a little self-satisfied and introverted and that came out at one stage. I think they have got over it now, in the lack of support for the international meeting by ASTRO trustees. And I think, rather than be totally introverted, if we could recognize that there are ways in which we could help countries that are not as well developed in radiation oncology. I think that's something that ASTRO could do better than they do now.
Question: There is an initiative. Yes, I agree with you 100 percent and there is an initiative that Terry Wall is leading and they actually asked for volunteers from ASTRO who would be interested in getting involved in helping developing countries in all areas of including teaching and clinical care.
Dr. Hall: I think it's by and large the one area where ASTRO does not do as well as ESTRO; that's one area in which I think they need more response.
Question: Well, thank you very much for being here today.
Dr. Hall: My pleasure, Martin.
Question: You were great and thank you.