By Theodore Phillips & Eric Gressen
The following interview of J. Frank Wilson, MD, FASTRO, was conducted on October 17, 2014 by Theodore Phillips, MD, FASTRO and Eric Gressen, MD.
Question: Where were you born Frank?
Dr. Wilson: I was born in Huntsville, Missouri. It is a small town in North Central Missouri. There were about 1,200 souls living there and it’s gotten smaller every year since I left.
Question: What were your parents? What did they do?
Dr. Wilson: My father was a dentist and my mother had been a legal secretary until she married my father and became a housewife after that. After he passed away, she returned to work as secretary to the school principal.
Question: Did your father die while you were still at home in high school or later?
Dr. Wilson: He died while I was working in the NCI Radiation Branch in 1970. He died at an age I’ve considered to be young, of myocardial infarction. I believe he was 57.
Question: Did you go through all of your schooling in that same town?
Dr. Wilson: I graduated from our consolidated school district in 1958. We had fewer than 20 students in the graduating class. I think there were only 18. My father strongly encouraged education. Nothing was more paramount than that. I actually started school in a one room country school house at age five, instead of six, because he could get the schoolmaster to accept me there.
After graduating from high school in 1958, at which time I was barely 17, a few weeks later I enrolled in and started undergraduate studies at the University of Missouri, in Columbia, which was about 35 miles away.
Question: Did you finish up and graduate from the University of Missouri?
Dr. Wilson: I did. I finished in three years, majoring in zoology and chemistry.
Question: During your high school and college years, were you active in any particular activities or sports?
Dr. Wilson: Well, practically everything there was. But in a small community like that, there wasn’t much to participate in. We had basketball and few clubs, but they were not as it is today. There was little to really participate in.
Question: What was your major at the university?
Dr. Wilson: Zoology and chemistry was my secondary major. I could’ve graduated with either, but the way the hours worked out best, I declared zoology as the major.
Question: For college, where there any honors you had in particular?
Dr. Wilson: No, not in college. I was Salutatorian in my high school graduation.
Dr. Wilson: I arrived at the University not well prepared, but I had very strong language skills. Because of that, I tested into the Honors College, upon entry. That proved difficult for me at first, because most of the other students had come from college prep schools in either Kansas City or Saint Louis. They were much more advanced in their overall educational levels than I was. So I had some catching up to do within the first couple of years. It required a lot of effort on my part.
Question: I see. And you stayed in Missouri for a fair amount of time, because I know you went to medical school at the University of Missouri, School of Medicine.
Dr. Wilson: Right. It was predetermined that I should be a doctor, basically, from my childhood.-There was a group mindset of the whole community where I was from expecting that after I went to medical school I would come back and be the family doctor in our town. I probably thought that myself, initially.
Question: Was that your decision or something your parents made you do?
Dr. Wilson: Well, if it had been entirely up to me, I probably would’ve been an archeologist. I like digging into historical things. However, the family influence was so strong that I felt that becoming a physician was the thing that I was destined for. It became incontrovertible and actually, they were correct. That’s what I should’ve done and did, and I’ve been totally satisfied with that.
Question: It’s interesting that they particularly chose that you should be a doctor. I don’t know if there was like a grandparent that was a physician and then they said, “Okay, you have to be a doctor.” It’s interesting that they predetermined you for that, at such a young age.
Dr. Wilson: Well, my father was a dentist. He shared an office building with a primary care physician who was like an uncle to me, so they were my role models. They were the only health professionals in our small town and among the few in our rural community. My being associated with them in that way, there was a natural inclination.
Question: During medical school, at some point, did you decide what you wanted to specialize in? Or did that come later during your internship?
Dr. Wilson: It came later. As I went through medical school, I did all of the standard rotations, and graduated from medical school in 1965. As I went through the rotations, I didn’t really experience anything that I thought I was terribly interested in as a career. The only field that really captured my imagination was psychiatry. I had very hands-on experiences during that rotation that led me to do some psychiatry electives. I thought at one point that maybe I would go into psychiatry. But the decision to go into radiation oncology instead was made inadvertently. If you want me to just talk about it, I'll go ahead and do that.
Question: That’s really important. Yes. Please.
Dr. Wilson: The Vietnam War was raging when I graduated. Unless you knew what you were going to do, you were certain to be drafted and sent overseas. I had been accepted into an internship in the U.S. Public Health Service. I selected New Orleans and was chosen to go to the U.S. Public Health Service Hospital in New Orleans, which provided the medical care to the Coast Guard, the International Geophysical Year, Merchant Marine fleet, et cetera. And those are very good experiences. It was a rotating internship, and some of the rotations were at LSU at Charity Hospital which was also a great experience. One thing that happened during internship is that I became turned off to psychiatry. I realized that what had been most fascinating to me was treating psychotics and being able to help them recover quickly from psychosis. What I realized about psychiatric practice was that it mostly dealt with psychoneurosis. I couldn’t see myself doing that long term, but I did find out during the internship that I had good manual dexterity and so became interested in surgery. I had some very good mentors there and they let me do surgery almost independently in minor cases and I became interested in that.
At the end of my internship, I applied for and was accepted into a service sponsored surgery residency in the U.S. Public Health Service. I had actually started that residency, but about the third day into it, I got a call from the Office of the Surgeon General. They told me that I was not eligible for the residency because upon reviewing my record, they realized that I had a history of childhood allergies and asthma. Even though I was not asthmatic at that time, they said they couldn’t offer a long term role in the U.S. Public Health Service to anyone who might become a pulmonary cripple later. They told me I had to either leave the service and be subject to the draft or go to the Indian Health Service, to a VD control center in Tijuana, or to an IGY ship above the Arctic Circle for two years. These options were not good. None of them were anything that I wanted to do or was prepared for. I was pretty despondent and went to the chair of radiology who had become a friend at the hospital where I was serving. He was a very good guy. He asked, “Why did you want to be a surgeon?” I answered, “Because I like to do things that are definitive. I like to see the outcome of what I do. I don’t think I can be involved in something that is repetitive and I don’t think I could be involved in something where you never actually get an outcome that you can see.” Then he asked, “Well, do you care about cancer?” and I said, “Of course, that’s part of surgery and that’s one of the reasons I was interested in it.” He said, “Well, have you considered radiation oncology?” I responded, “Well, Joe, I wouldn’t want to be a diagnostic radiologist, you know, sit in the shadows like you do in order to become one.” He said, “Oh, you don’t have to do that anymore. There is this man, Dr. del Regato, out in Colorado Springs, who just started the first NCI sponsored straight radiation oncology residency. Why don’t you give him a call?” I said, “Well, yeah, why don’t I give him a call. I don’t have any other options right now.” So I called Dr. del Regato. We had a brief conversation on the phone. I really liked what he told me. In fact, I was very attracted to it. I didn’t really know anything about the field of radiation oncology, but did not have a negative opinion about it either. As we’re going to touch on later, he mentioned that he had been at the Ellis Fischel State Cancer Hospital, the public hospital in the Missouri, which is about 30 miles from where I was born. I vaguely knew of him and didn’t have a negative opinion about their work. He said, “Why don’t you meet me at NIH in a couple of weeks. I'm going to introduce you to some of my trainees there and you can talk to them. And you and I can talk some more.”
Question: What was the name of the radiologist who pointed in his direction?
Dr. Wilson: I can’t remember his last name. All I remember is Joe, possibly, Levin. I wasn’t in touch with him after I left the USPHS. But he was a great adviser and very kind man. At that particular time, it was not as it is today. One didn’t just stop what you were doing and fly off to Washington and have a meeting. That was a big thing, but I did it. I showed up at NIH in the Radiation Branch there where I was introduced to Ralph Johnson.
Question: Johnson was in Missouri, right?
Dr. Wilson: Johnson was the director of Radiation Branch. He had trained at Penrose Hospital. As were a couple of other people I met there. As I recall, Juan Fayos and maybe Jose Campos were among the people I met. I basically spent the morning there in the Branch and others talked to me about radiation oncology and what they were doing. I met later with Dr. del Regato, and knew absolutely by the end of that visit that radiation oncology was what I wanted to do, and that I had found what had been missing in my education.
Question: I'm glad you did. I think it’s interesting that being an asthmatic and a possible pulmonary cripple, you’re not able to care for patients in the U.S. Public Health but you are able to go into the jungle with all those allergies and fight. I don’t exactly see how you’re capable of doing that if you can’t even perform as a physician.
Dr. Wilson: I made all of those arguments that I wasn’t asthmatic at that time, that I was in the asthma capital of the world and not symptomatic, and that I had grown out of it in my late teens, but there was no persuasive argument that I could make. It was all by the book. They gave me a very limited amount of time to figure out what I was going to do. Very quickly, one thing led to another, and I remained in the U.S. Public Health Service and entered the radiation oncology residency with del Regato in Colorado Springs on July 1, 1966.
Question: Okay. So Public Health Service then sent you to residency?
Dr. Wilson: They did, and the payback to the U.S. Public Health Service was, the Clinical Associate period to be paid back at NIH. However, I went to NIH thinking that I was going to stay a longer time, but it didn’t turn out that way.
Question: How long did you spend at the Penrose and how long at NIH?
Dr. Wilson: I was at Penrose from July ’66 through July ’69. And in ’69, I went to NIH. Ralph was still the Head of the Radiation Branch. For the most part, our work was focused on Hodgkin’s disease and Ewing’s Sarcoma as the only two diseases that we dealt with and lots of both. Tom Pomeroy joined the staff later and we added head and neck cancer. Vince DaVita Chief was then the lead medical oncologist along with George Cannellos. Paul Carbone was the head of the medical oncology division. I walked in soon after Bill Shipley walked out. We sort of met in the hallway and have been friends ever since. Bob Kagan also preceded me to NIH.
Question: Who was at Penrose while you were in residency? Who were the other residents?
Dr. Wilson: On day one of residency, I met Jim Cox for the first time. He and I have been close friends and associates ever since. Steve Brown was chief resident. He is unfortunately deceased. The other residents were Alfonzo Arenas who, sadly, is also gone. There were about six or seven residents there at the time including Charles Taggart, James Dolan, and Vinicio Perez from Costa Rica. A lot of medical students passed through Penrose as well and some of them later became leaders of our profession. Sara Donaldson and Larry Kun come to mind, in particular, in this regard.
Question: Who were the other faculty members at Penrose you’ve met besides Dr. Del Regato?
Dr. Wilson: There were two. There was Dr. Chahin Chahbazian who was clinical director as well as program director. He essentially is the clinical mentor of everybody that passed through there over a long time period between 1950 and 1974. The second person was Augusto Gutierrez who, after he left Penrose, spent the remainder of his career at St Joseph’s Hospital, I believe, with colleagues from the MD Anderson faculty that rotated there as part of their practice. Don Herbert was the Physics Director at Penrose.
Question: In Houston?
Dr. Wilson: In Houston, yes. Before I got to Colorado Springs, another of Dr. del Regato’s associates had been Ruhieri Perez- Tamayo, the Mexican-born radiation oncologist, also deceased.
Question: What happened after you finished your stint at the NIH?
Dr. Wilson: When I went to NIH, I thought that I would be there for a long time. I found however that I didn’t like the work environment very well. It was very intensely competitive and collaboration was difficult. I met my wife during that period. As luck would have it, Dr. Chahbazian came to Washington D.C. in the spring of 1971 and told me that he and Dr. del Regato wanted to recruit me back to Colorado as their associate, because Gutierrez, whom I just mentioned, had left for Houston. They needed somebody new and they wanted that to be me. It was my dream job. So, my wife and I got married and one week later, we showed up in the Colorado Springs with me in the role of Dr del Regato’s junior associate. That was in early July of 1971.
Question: I see you climbed the ranks, maybe a little bit while you were there and I believe in ‘74, you took a trip to France. Was that arranged through Colorado as kind of an international experience?
Dr. Wilson: Indirectly. Because of del Regato’s international prominence and because Penrose was the premiere training center for radiation oncology in the U.S., many European visitors would go out of their way to come to Colorado Springs to meet him and have conversations. As residents and staff, we were given the opportunity to meet a lot of famous people. Franz Buschke was one of the main people because Buschke and del Regato were dear friends and he would come almost every summer for a couple of weeks respite at the Broadmoor Hotel, and spend part of every week in informal discussions with residents. Marvin Williams, the physicist, was also a frequent visitor. Residents had a chance to meet and interact directly with a lot of important people. I was particularly impressed by the French that came through including Jean Dutreix, Bernard Pierquin and Daniel Chassagne.
Question: Did Tubiana visit as well?
Dr. Wilson: I don’t recall that Maurice Tubiana visited; but he may have. I think he was very preoccupied with his responsibilities in France, at that time. But there were many others. Julian Bloom from Royal Marsden, Van der Verf-Messing of Rotterdam, lots of people of that caliber who were basically defining our field at that time. Sim Cantril Sr., before he passed away. Fernando Bloedorn, Simon Kramer, Milford Schulz and so on. It was a long list. It seemed there was somebody coming pretty much all the time and we were always given full access to them in a social context as well. Many of my peers went on to fellowships that were made possible through those contacts. For example, Jim Cox went to Gustave Roussy, and Don Eisert went to Hammersmith and to the Rotterdam Radiotherapy Institute. Larry Kun went to Marsden and Rotterdam. It was very strongly encouraged as part of our education to have such experiences. I personally wanted to go with Pierquin who was beginning to attract a lot of attention because of breast conservation therapy. That’s what I was most interested in.
As it turned out, after being recruited into what was my dream job at Penrose, in 1973 Dr. del Regato decided to retire and became a Distinguished Physician of the Veterans Administration in Tampa. There were some political problems at the hospital such that neither Dr. Chahbazian nor I wanted to remain there any longer. That’s when he went to Orange County and when I tried to make arrangements to go to France with Pierquin. In fact, that’s what I ultimately did in the fall of 1974. However, there was a stopping off point before it happened. My wife and I were about ready to leave for France when I got a call from Jim Cox. Jim told me that he had been recruited as the chair at the Medical College of Wisconsin. He wanted to know if I would be able to join him there and get things going, and said it was an opportunity that I should be interested in. I said I normally would be, but I was on my way to France. He said, well, here’s the deal, I’ve been recruited, but when I told Georgetown that I was leaving, they wouldn’t let me out of my contract. I need you to go there and get things going in the model that we were used to, which will involve collaborations with community hospitals that are associated with the academic medical center. He said, I would be perfect for that task and if I could do that until he got out of his contract, I’d be free to leave. I was recruited to the Medical College of Wisconsin in December of 1973 by the MCW chair of radiology at RSNA. Radiation Oncology was a still a division of Radiology at that time.
Question: Jim Youker, right?
Dr. Wilson: Yes, Jim Youker. The only thing I negotiated, and I was certainly naïve at that early juncture, was that I didn’t have to remain at the Medical College of Wisconsin any longer than six months. I just spent my 41st year here, so, I advise, “Never, say never”.
Question: So longer than you expected.
Dr. Wilson: Yes. When Jim got out of his contract and was able to arrive in Milwaukee by midyear 1974, I did leave. We left for France in August of ‘74 and remained there working with Pierquin until late 1975. By then, I had realized that the Medical College of Wisconsin was a pretty good place. In April of 1974, Jim came to Paris and recruited me back on a full time basis and that’s where I’ve been ever since. I only resigned once. I actually did resign, but was reinstated.
Question: Did you speak French when you were in France?
Dr. Wilson: I was supposed to, but I didn’t. I attended to Berlitz for about six weeks and I could count to 10 and say hello, goodbye, and please and sometimes understood what people were saying, when asked my name etc. When I checked in at the University of Paris, the registrar at the desk was asking me questions while I was filling out the papers and not getting answers. My wife spoke French, so the clerk called her over to the counter and said, you know, it’s obvious that your husband doesn’t speak French and he’s supposed to be fluent if he’s going to occupy this position. My wife said, “Well, he studied French. He is just a shy speaker”. It didn’t matter to Pierquin. I had two fantastic mentors, del Regato and Pierquin, they were both consummate mentors and like second fathers to me. Pierquin had told everybody at the hospital that I was coming and that I didn’t speak French and that if anybody spoke English to me during the year I was there, they would lose their jobs. He felt learning French was one of the main things I would gain from the year and he was right. On my final day at Creteil, by which time I was fluent in French, I went around to tell people goodbye. Almost everyone spoke to me in perfect English. I said well, my God. You let me break my head open here for all those months and you’re able to speak English? I formed many great friendships there and I'm glad that I did learn French. It was of huge value to me as it turned out.
Question: I assumed you came back a great radiotherapist.
Dr. Wilson: I did and I'll tell two stories about what a great person Pierquin was and an example for all of us to follow. After we arrived, the Pierquin’s gave a party in their apartment in Paris. They invited a lot of sophisticated Parisians to dinner to welcome us. They were not from the medical community; they were from different walks of life, military service and business. There was a fairly big gathering. After dinner, we’re sitting around the table. I knew they were talking about race relations in the United States. All of the sudden, Pierquin turned to me and said, well, I don’t know why we are talking about this. We have someone here from the United States. Why don’t we ask Dr. Wilson to explain what the situation is around this issue? I could understand what he was saying in French but I couldn’t say a word and so, I stammered and slowly constructed a response and with everybody looking at me I said,” I am sorry that I cannot respond. I understand what you’re asking but I can’t say anything”. There was a dead silence in the room. Pierquin said, well, that is wonderful, absolutely wonderful! He said, Dr. Wilson will work with me for a year and it’s just going to be a great year. He said that was because most of the people he worked with “understand nothing and talk all the time and Dr. Wilson is the exact opposite. He understands everything, but he can’t say a word”. We got on famously.
Question: I think Dr. Joe Castro has spent a year with him.
Dr. Wilson: He did, yes. While Pierquin was at Institut Gustave-Roussy. Bernard loved Americans. He was also welcoming to people from all over the world. He was a fantastic mentor and warm human being. He was just great in every dimension.
Question His father was instrumental in the beginning of radiotherapy, as I remember reading about his father.
Dr. Wilson: Yes. His father, Jean Pierquin, and his godfather, Georges Richard, did the early empirical work with radium to determine what filtration gave the optimal clinical result. Unfortunately, all of that history is not well documented. Pierquin wrote about it in his autobiography and I read that. Jesse Aronson in Boston has been working on an article that will include some of that information, maybe for the first time. But Pierquin’s father and godfather were pioneers in the field.
Question: What happened after you finished a year in France?
Dr. Wilson: By then, I had been recruited back to the Medical College of Wisconsin and initially, my focus was based on what I’d learned during the fellowship. As you know, back then, we were all more or less generalists and were just beginning to sub-specialize. Breast cancer and brachytherapy became big parts of what I did. When Jim left for Columbia University in the mid-80s, after a search, I became chair. I just spent my 29th year as chair of the department. Actually, only two weeks ago, I asked our Dean to allow me to step down as chair. So they’re about to organize the search for my successor.
Question: Do you have any idea if you’re the longest acting radiation oncology chair right now?
Dr. Wilson: I think I might be. I know that most of my age peers are not still in that role. I probably am the longest serving chair.
Question: Yeah. I think you set the record, Frank. I served 27 years this year. But 29, that’s the longest I’ve ever hear of.
Dr. Wilson: The years went by in a flash. We’ve had so much fun and it’s been so gratifying to see what we’ve been able to accomplish in our departments. In my case, with the situation that Jim and I walked into in 1974, I would have to say now that it was not promising that we could’ve developed anything close to what we have here now. We worked initially in a county hospital where the academic program was based. It was a time when local government was getting out of health care and we missed three budget cycles and the capital budgets. I knew that was not consistent with being able to move forward in radiation oncology. Lauren Ackerman, the dean of anatomical pathology in the United States, had retired to emeritus status at Stony Brook in New York. They had a new department that had already been built, but it was not functional. It was just a shell. There was no equipment. There were no people. There were no patients and it was a fantastic opportunity as they described it. Lauren and the search committee said that they really wanted me. I found it a very interesting opportunity, so I resigned at the Medical College of Wisconsin. Before I actually got gone from here, I realized that the administrative model within SUNY was far different than what I’d been used too. Here at the Medical College, I report directly to the Dean and to the President of the hospital and we make decisions together. What I came to realize was that all decisions ultimately had to track back for approval to Albany within the State University of New York system. It was going to take 15 years to get anything done - So I didn’t go. They had even given a going away party for me here. I sheepishly went back to the Dean of the medical school here, who had become a good friend, and asked him if I could be reinstated. He said I never left. They never processed the papers. He told me to never think about leaving here again. So I didn’t.
Question: You kept your promise.
Question: Over the years while you were chair, what was your major focus in terms of research and publication?
Dr. Wilson: My main focus became what I would term health services research serving as PI of the Patterns of Care Study which evolved into QRRO. I was its third PI. There have only been three, Simon Kramer started it, Gerry Hanks was the second PI and I was the third. That project unfortunately came to an end several years ago because it was no longer fundable after having functioned for almost 40 years, either as an RO1 or as a U01 with only a few short funding lapses. We could no longer renew it because of the limits placed on the size of RO1 awards. It was impossible to continue with no more than $500,000 allowed and there were no UO1’s being offered that we could find. It’s unfortunate for radiation oncology that it could not be continued. As is clear now, it was a process that was 30 years ahead of its time. The Patterns of Care and QRRO through reporting the results of onsite surveys of national practice helped to significantly transform and elevate American radiotherapy practice.
Question: So it was very forward looking.
Dr. Wilson: In fact, I remember at the NCI site visit when the grant was renewed for the last time I made the comment to the site visitors that if it didn’t continue to exist, it would ultimately have to be reinvented. I still believe that, however the concept has now segued somewhat into the registry function of the NROR. I’m on the Board of the ROI. The NROR in some ways is a continuation of that interest. We badly need health services research of this type and better evidence to continuously improve care and protect radiation oncology specialty interests in the coming future.
Question: When was that finally closed your quality research organization?
Dr. Wilson: Funding ended about three years ago. It’s hard to remember because we’ve continued publishing results. People who were in charge of designing the studies and the analyses that were done within the disease site committees have continued to publish the results. The data collected is still valid and useful as benchmark data to measure against with regard to the penetration of evidence into practice. That probably will not continue much longer. As of the last ASTRO meeting, we still had papers on the podium that derived from the POCS/QRRO work.
Question: Is the College still supporting the QRRO operations?
Dr. Wilson: It couldn’t because of the large infrastructure costs that are involved. Without external funding there’s no way of sustaining it. We tried many different avenues, many different collaborative models and couldn’t find any funding opportunities. It would be difficult to revive at this point.
Question: So where does the data reside now?
Dr. Wilson: It still exists. Under the rules of the federal game, the data must remain available. So it is available.
Question: To the College?
Dr. Wilson: Yes. It would be quite a challenge to extract it because the statisticians who managed the database are no longer available.
Question: I noticed you’ve been a Cancer Center Director in Milwaukee for several terms. Why did you get involved in that? Do you think it was useful and rewarding to do that?
Dr. Wilson: In 1982, we began to see the possibility of an important cancer program here in Milwaukee. Radiation oncology was the focal point for its development. There was nothing else really. While Jim was still here, there was a planning grant application, but it was quite obvious that it was not going to go anywhere at that time. But it was a start and that planted the seed. There’s been steady growth in our oncology program here to the extent that probably within the next few years it will be competitive for NCI designation. When we recruited the first full time Director, it was unfortunate that he was not successful. You know how it is when a point person at that level leaves and the resources that had been made available to him are again up for grabs. All the old rivalries of others that didn’t get those resources come out.
So, I volunteered to be the acting cancer center director rather than see all that we had worked hard to put together potentially dissipate. Because I was effective as the acting director, I was later asked to become the full time director, so for some period of time I was not only chair of the department of radiation oncology but also director of the cancer center. I was able to do that because of the strength of our department and the wonderful support of my senior associates. I didn’t have to give that intimate attention to operations that was required during the early phases of departmental development. I think I was in that dual role for nine years during which we made steady progress. I was successful in fund raising. I felt that as director and as the fund raiser, I should be able to carry out independent recruitment of individuals that would occupy the chair positions that I had secured funding for. But our Dean didn’t see it that way. That’s when I stepped down as center director. It was time for me to do so anyway, so I don’t make a big deal out of it, but that was definitely a factor in my decision to step down at that time.
Question: I do understand.
Dr. Wilson: I preferred to step down as Center Director rather than step down as Chair of Radiation Oncology, which was and is still my preferred. I was then asked to chair the planning committee for our new clinical cancer center, which is a patient centered care facility second to none. It took five years to conceive, design and build it. It’s been tremendously successful. When I was asked by the Dean at that time to be the first Cancer Service Line Director I said yes, because I was in many ways already functioning as such. I don’t know exactly when I gave up that particular position but served for several years before stepping down. It’s not my kind of role. It involves a job description suitable for only a few, I think.
Question: Well, Frank, you’ve had an extremely important role in many national organizations. Could you tell us about what you remember most about your interaction and your really great accomplishments in the various societies?
Dr. Wilson: Yes, I have a lot of priceless memories. Let me talk about RTOG, to begin with because I never played a very prominent role in it although I have been one of its very strong supporters. The reason was because while I was either the chair or co-chair of the GYN committee, we designed a study to examine the validity of post-operative radiotherapy for endometrial cancer. One-hundred percent of people around the committee table said they thought it was the best study that had ever been designed to answer the outstanding questions. When we asked how many of the participating intuitions represented around the table were going to enroll patients in the study, nobody said they could because of their local politics, so we’d done all of that work and there was not going to be any enrollment. That was frustrating. There was also at a later time, under Jim Cox’s direction, an interest in starting a brachytherapy subcommittee. I became the brachytherapy subcommittee co-chair. Around the same time, under Phil Rubin and Pierquin’s leadership, an interest in creating an international brachytherapy clinical trials group arose but that didn’t get off the ground. There were a lot of brachytherapy questions that needed to be asked at the time but no funding source could be identified. We designed studies and there was interest in them, but unfortunately, the way the RTOG approval process worked, they never received priority. The research process was just too contentious and too laborious for me. I minimized my personal role in RTOG but have been totally supportive of the many people around me that have had very major roles in RTOG for long periods of time. In fact, we’ve been one of the top ten accruing institutions and our administrative contribution to RTOG has been very significant for well over 25 years.
My leadership role in ASTRO came at the time of major evolution of the Society. I have to go back to the beginning and tell you I had attended some of the original meetings of the American Club of Radiotherapy that were held in association with the RSNA meetings in Chicago. During that period of time, ASTRO was trying to emerge and become independent, and del Regato was instrumental in that effort. I became educated about our history, where the profession wished to head and the delicacy of the diplomatic negotiations that were involved in becoming independent. Thus I’d been involved in the evolution of ASTRO since its beginning and attended the first independent ASTRO meetings. I recall many of my peers who were then residents or fellows presenting at those first meeting. The thing I best remember about ASTRO was that when I was president and then chair, in response to the membership ASTRO began to actively expand its scope of activities beyond the annual scientific program into government relations and socio economics. That is a process that is still continuing with ever greater independence from other organizations that formerly shared responsibility for that important work. It hasn’t seemed to me, because radiation oncology is still such a small specialty, that becoming too isolated in those political arenas without strong collaborations with other larger, more powerful societies would be wise. But that’s how it evolved over time.
Question: You’ve obviously done major things for the College, RSNA, and the Radium Society because you got their gold medals. Can you say a few words about your participation in those groups?
Dr. Wilson: The American Radium Society is something that I was involved in from an early part in my career. There I also got to know a lot of the seminal figures in our field. Through those contacts I benefited greatly from being the young guy that was mingling with the dinosaurs, getting to know them and learn from them. Because of my interest in history that was a logical lead in. I always found the Radium Society extremely attractive because it had such a great provenance and was truly multidisciplinary. And all of its scientific sessions are plenary, which I like. Even though it became dominated by radiation oncology, it still strives to be multidisciplinary. I eventually became president. At the time, I think there was a possibility of me joining the ABR but that didn’t occur. I believe the thinking was that I was probably too busy with all the other things I was doing at the time I became President of the Radium Society. During my long involvement in the Society, I planned three annual meetings to be held in Paris. And only one of those actually occurred. The second of these in 1995 was the meeting I organized for Marv Rodman that did actually occur. It was a great success. The first one was when Bob Parker was President of the ARS in 1990 and asked me to organize his meeting in Paris. That didn’t work out because of the outbreak of the first Gulf War.
At that time we told the Intercontinental Hotel, we were cancelling because people were afraid to travel. And they threw a fit and said that we must meet there again, some other time. Bob’s meeting transferred to Montreal at the last minute and was very successful. A key feature that I was able to arrange was that Madame Eve Curie Labouisse, the younger daughter of Marie Curie, agreed to give the keynote address. That was an unforgettable evening. Finally, when it was to be my meeting in 2003, I decided, we needed to go back to Paris and fulfill on our promises. But that time it coincided with the US invasion of Iraq. This time, the hotel told us, please don’t come! They didn’t want anything that said “American “associated with their hotel because of the risk of becoming a terrorist target. So, although I’ve developed a lot of good plans for meetings in Paris, I'm only batting 33% on execution.
In the American College of Radiology, I got my start there again through an interest in history. There used to be a special Commission on the Institute of the History of Radiology made up of many of the most notorious living radiologists that were made part of the Commission. Harold Jacobson, Benjamin Felson, Juan del Regato, people of that caliber. The charge to the Commission was to preserve the history of the radiological sciences and they were nominally in charge of the archival holdings of the American College of Radiology.
Question: Is that how you got involved in the Radiology Centennial and your book of the history?
Dr. Wilson: Yes, but much later on. It was a partial lead into it. The Institute didn’t actually do a great deal for years, but it was a very interesting forum to be part of. I don’t know if you would’ve known Dr. Jacobsen or Dr. Felson, but there was some interesting chemistry between these and the other legends involved. They never stopped being competitive with each other and were highly political. There was a lot to learn watching them in operation. So that association was a background, as it turned out, to activities that I have had both with RSNA and ACR. When the Radiology Centennial rolled around, in part because of my interests, I had a significant role in several aspects of the celebration planning including the three volume history book series and the Smithsonian exhibit. Even later on, I was also involved in the planning of the Centennial celebration of the RSNA.
However, my first real work in the ACR was when Bill Moss recruited me to organize and conduct the first in-training examination in radiation oncology. That was a very enjoyable and gratifying task that let to other ACR involvements.
Question: There is a co-author on that series. There’s a co-author with you and the others and who was that person?
Dr. Wilson: Ray Gagliardi. Ray was a diagnostic radiologist and journal editor. Now, retired, still living, I believe, in Florida.
Question: Could you say a little bit more about the ROI? You’ve mentioned it before but it’s been a major project of yours. I know you were in on it at the very beginning. Could you clearly point to us why that was done and what is it doing now?
Dr. Wilson: The Radiation Oncology Institute is a place where industry and the profession can come together in a way that isn’t inappropriate. The common interest is in advancing radiation oncology through research. One reason I’m involved is because when Dr. del Regato retired, there was a residual of funds made up of small residual amounts of money left over from grants or from philanthropy. When he left Penrose, that account was used to create the Juan A. del Regato Foundation. Former trainees of his were members of Foundation board, Victor Marcial, Jim Cox, Ritsuko Komaki, Chahin Chahbazian, Jerry Vaeth and several others, including some members of the del Regato family. We administered that Foundation sponsoring research activities that advanced radiation oncology interests. As time went on, it was difficult to sustain and so we transferred our assets to help sponsor the initiation of ROI. We converted all our foundation resources to the ROI. Among the first projects that were seen to be essential to advancement of radiation oncology efforts in the future is the outcomes research that would be convincing to payers and to funding agencies. Unfortunately, the evidence base that supports radiation oncology is not regarded as very persuasive while some other medical specialties have accomplished a great deal through the maintenance of very elaborate registries that justify payment for what they do. I'll just say briefly that the cardiologists have done that well. . Both are great success stories and their registries are multimillion dollar operations. So the first thing ROI felt was a priority was something similar. And that was the NROR, the National Radiation Oncology Registry concept. After the initial planning work was accomplished it became obvious that it was a large operation and it was recently signed over to ASTRO management. The first pilot project is underway right now, collecting real time data from about 30 different volunteer sites related to prostate cancer treatment. But this is only a model for something that we need to have happen more broadly. The ROI will be going on to fund other projects that advance the specialty and several research RFPs have already been responded to and the work nearly completed.
Question: It sounds like ASTRO will sponsor the Registry that eventually will cover all sites. Is that correct?
Dr. Wilson: Correct. That is my understanding as well.
Question: Now, Frank, I think you were probably the main mover behind the FASTRO program. Could you tell us something about that why it evolved and where it’s heading?
Dr. Wilson: I was asked to lead a task force and to serve as founding chair of the Fellowship Committee in ASTRO. -- Within ACR, I served a couple of terms on the Board and had been very involved at the Fellowship program of ACR. Officers of ASTRO, when the notion of something similar within ASTRO begin to take hold , asked me if I would chair a committee and organize a framework for the award of FASTRO. It’s become a highly sought after professional recognition and credential. But the process is still in evolution.
Question: Do you think that it was necessary when we already had it at the ACR?
Dr. Wilson: I think it was necessary in that some people who’ve made significant contributions to radiation oncology advancement never had a professional profile within ACR that would get them to the level of Fellowship. I think there’s also a distinction and it’s debatable whether it’s the right position or not. In the ACR it’s possible through longevity of membership to become FACR.
Question: Right. Almost anyone who has 25 years can get in.
Dr. Wilson: In ASTRO, it’s become an even tighter meritocracy than FASTRO was at the beginning. I think, ideally, one would be both FACR and FASTRO, but both distinctions have their place. I know there are senior members of ASTRO who are troubled by the fact that they have not been considered for FASTRO. This came up during the business meeting at the last ASTRO meeting when a gentleman stood up at the end as an item of new business and expressed frustration. He had been a longtime member and said that people like him were not being recognized. I don’t know how the committee is going to deal with that concern.
Question: I think it’s probably heading in the right direction. So you have probably more gold medals than anyone I know, which I think shows how important you’ve been to our specialty? Just enumerate what societies they’re in and how do you feel about it.
Dr. Wilson: I received the ASTRO gold Medal, the ACR gold medal, the gold medal of the del Regato Foundation and I received the gold medal of RSNA last year. I feel extremely fortunate. I never thought or planned that I would receive these distinctions. As I reflect on it, I feel very grateful that I was put in positions where I could do meaningful things; things that seemed important to others. I have known almost all of the living Gold Medalists and I wouldn’t want to measure my contributions against those of others. I know that everyone contributes in their own particular way. In many respects, any contributions I’ve made have been a little unique and different than the contributions others have made and were recognized. I feel extremely honored that my contributions were valued in the way they that were. I’m very humbled to feel that I made a difference.
Question: Back in the day, mastectomy was the way to go and you’ve got involved with breast conservation. I'm kind of curious, have your take on the battles you had to try to make that are more common treatment.
Dr. Wilson: Let me just hit some high points. When I came to Milwaukee in 1974, 99% of all women with breast cancer, regardless of age, stage, or anything else, got radical mastectomy. When I returned from France in 1975 and began to offer the option, implementation of breast conservation therapy was very dependent on two things. First of all, there had to be patient interested in that approach, and secondly, the identification of a few surgeons who felt that the radical surgery they had been doing was not warranted. They were somewhat influenced by the work of early trials being reported around that time. With the patients who were seeking alternatives to mutilating surgery and a few surgeons who were willing to debunk convention, we were able to make progress. We completely turned the treatment paradigm around within a matter of a few years. I am still clinically active and one of my greatest frustrations is to see the unwarranted decline in the utilization of breast conservation therapy. I'm not being sanguine about this when I say that it’s a battle that I'm fighting every day. I think that we haven’t done enough as a profession to continue our patient education efforts about breast conservation therapy. We’re so focused on technique rather than on the patient. Somehow we’re going to have to figure that out because breast surgeons and the plastic surgeons are under the same economic and other pressures we’re under. And they usually control the patient. We have got to talk more deliberately and convincingly to patients. How many redundant publications do we have to read in lay and throw-away medical journals that come along? America is rediscovered every month in articles from someone who concludes anew that breast conservation therapy works. Why is this message not sticking? I have thoughts about this, obviously and think it’s reaching a crisis stage in the United States.
Question: Could you tell us a little bit about your wife and your family Frank? And the children and grandchildren, and what they’re doing?
Dr. Wilson: My wife, Vera, when we met, was working for the cultural attaché of the Embassy of Kuwait in Washington D.C. We’ve been frankly inseparable since the day we met. She’s a professional volunteer and spends about 60 hours a week raising money for medical education and for breast cancer research. She does that by running a café and gift shop at the medical school for the last 16 years. She’s chief cook, bottle washer, manager, you name it, and she does everything. Vera also runs a boutique in what is called the Wisconsin Breast Cancer Show House. Her organization has raised about $5 million for breast cancer research. Our daughter, Julie, is a defense attorney and she’s in the Office of Corporate Council for Milwaukee. Our son, Frank, works in compliance in a financial firm here in Milwaukee. Neither of them is married. So I can’t talk about our grandchildren.
Question: Are there any unusual treatments you did in the past that aren’t done now?
Dr. Wilson: Well in the early days we used to give chemotherapy because there were no medical oncologists. I remember a VIP Saint Bernard that we treated one night at Penrose that for an osteogenic sarcoma of the fore paw. I didn’t make a profession out of that.
Question: Do you have any favorite sayings that you like to say to your residents or people you’re educating?
Dr. Wilson: I always say, “You have to stay until the end of the movie to know how it ends.” And that’s applicable both clinically and generally in life. Because of my longevity in our profession, I’ve witnessed a lot of stories that end in unexpected ways, it’s really quite remarkable. I'm currently seeing patients that I’ve cared for decades, the oldest one for 38 years. When you follow a patient for that long of a time, seeing them once a year, twice a year, the patient-physician relationship becomes something completely different than most people have the opportunity to experience. You have a chance to see the outcome of what you did, both positive and negative. And it is sometimes not the outcome that is generally anticipated. It’s a life-altering experience. It’s a privilege to be able to do that.
Question: Anything else you’d like to add?
Dr. Wilson: I thought you were going to ask me about my hobbies, which is mostly painting. I'm actually increasingly active in that. I’ve been a painter since childhood. One of the greatest things that ever happened to me was when Anthony Zietman asked me to do a cover of the Red Journal. It was one of the first pictorial covers that came out under his Editorship. Once I'm not doing what I'm doing, currently I plan to spend a lot of time painting.
Question: What kind of painting do you do? Oils? Watercolors?
Dr. Wilson: I do everything. Most recently, I'm working in acrylics and in a lot of different styles and with a lot of different media. They’re very creative works. When I go to my basement “studio”, I’m never quite sure what I'm going to come back up with. Sometimes, it’s a Monet-like thing and sometimes, I come back out with a de Kooning. Lately, I come back up with Kandinsky. Currently, I'm coming up with early Kandinsky’s.
Question: Did you have some art training while you were in the school?
Dr. Wilson: I was interested in art, even as a child and my parents encouraged it. Anything we were interested in, they encouraged. They hired one of the art teachers to tutor me after school when I was in fifth or sixth grade, which only increased my interest. Later, I would occasionally take classes. I don’t sell my paintings, but donate them to the Wisconsin Breast Cancer Show House. I have a following there, and they sell about 15 of my pictures at their annual event , which has raised a fair amount of money for breast cancer research.
Question: I'm glad you didn’t become a starving artist while you were in France.
Question: You’ve had an extremely interesting career, and it has been a pleasure to hear about the major impact you’ve had on our specialty.
Dr. Wilson: I'm very flattered to hear what you said and thank you for your comments.