By Luther Brady, MD, and David Hussey, MD
On December 1, 2004, Luther Brady, MD, and David Hussey, MD, interviewed Robert Parker, MD, professor and former chairman of the Department of Radiation Oncology at the University of California in Los Angeles. The interview took place in Chicago during RSNA’s annual meeting.
Question: Tell us a little bit about the basic demographics—where you were born and where you went to school?
Dr. Parker: I was born in Detroit in January 1925. My parents were Canadians and came to Detroit so my dad could find a job in the automobile industry. My mother was a housewife. And because there was a scandalous mix-up at the Harper Hospital, they decided that they were going to have my birth at home. Unfortunately, there was a blizzard and no medical people showed up, so I was born to a mother in the presence of three aunts, none of whom had any medical training. I think that in itself was a miracle. It was a big house and I spent my first three years there. It belonged to my uncle who was working for the Grand Western Railroad, which was the Canadian Pacific Railroad in the United States and his job was to move cars out of Detroit. We then moved to a town called Clifton Ridge where I grew up until I went to college. In high school, I was a typical hyperactive young person who for some reason or other ended up no. 1 in my class while still finding time to play on the basketball team, run track and do a few other odd things. My father never went to college and, in fact, he never graduated from high school. He decided he was a quasi University of Michigan alumnus and so I was going to go to the University of Michigan.
I entered the School of Engineering. I had no thought of being able to afford being a physician, although I had some interest in it. Our family physician, Dr. William Shields, was a close friend of my father and was always a part of my life. After one year of engineering, I realized that’s not how I wanted to spend the rest of my life. Fortuitously, a Navy support program came along called V12. I had previously, on December the 8th after Pearl Harbor, raced down and volunteered for the Marine Corps. What I didn’t realize was you had to have permission of your father and he refused to give it. He said, ‘Some day when you get old enough, I’ll permit you to join the Navy.’ So when the V12 program came up, I held him to his word and he did allow me to join the Navy. This turned out to be very fortuitous because they picked up my tuition and my room and board while I studied mathematics and physics at the University of Michigan. I got as far as differential equations when they determined it was time for me to go to Great Lakes Naval Training Center where I became a hospital corpsman on the neurosurgical service, a 75-bed ward of fresh paraplegics flown in from the South Pacific. Another young man and I had the job for some six months of doing 75 enemas and back rubs daily on fresh paraplegics, none of whom had been told that they were going to remain paralyzed for the rest of their lives. That became our unofficial duty, to break the rather sad news. Rather than ruin my interest in medicine, it actually increased it for some reason.
One day we went down and saw that we were on the list to go abroad to a place which had a 50 percent death rate for the corpsmen. When I went in to interview, I met a man by the name of Lieutenant Thomas Meany, a two-stripe medical officer who said, ‘Mr. Parker, I notice that you were a pre-med. You know this is going to be a long war. You know the Navy is going to need doctors. How would you like to go to medical school?’ So after thinking that opportunity over for about three seconds, I said, ‘I’d be glad to go to medical school rather than go abroad and get shot.’
Question: Not the Thomas Meany we know?
Dr. Parker: No, not the radiologist. I have spent much time trying to find that Lieutenant Thomas Meany and what I found out is that the Navy does not keep track of reserve officers very well, and they get lost. If he would’ve been a regular officer, I could have found him to thank him for what he did for me.
I was sent to the University of Wisconsin where I showed up on January 1, 1945, to start medical school at 8:00 a.m. New Year’s morning. At that time, I planned to go to the University of Michigan which was a pyramid system, but what it meant was about half the class was eliminated by trying to study clinical medicine. The dean at the University of Wisconsin announced that morning that they had spent a lot of time recruiting and that if anybody failed, they considered it their own failure as much as ours and that everybody would pass if they worked hard. I thought I must have landed in heaven after missing the pyramid at the University of Michigan. We went through medical school in three years. I graduated, I finished my training in March of 1948, a little more than three years since starting, which meant there were no vacations including Christmas, New Year’s and everything else. It turned out to be a very good medical school, at least for my purposes. Because of the intensity of the program, it had no interest in research, there was simply no time. At that time, everybody had to get their own postgraduate training program. Because of my dad’s contacts through the Chrysler Corporation where he worked, I was already accepted as an intern at the Henry Ford Hospital and accepted as a surgical resident in a Henry Ford program; I had already met the chief of surgery and everything was all set. What I hadn’t counted on was the dean of the school, William Middleton, had picked me out as one of 10 out of the class he was going to send to places of his choice to further their training. There was a rule of thumb that you did not cross Dr. Middleton, so when I went in, I was told, ‘Congratulations, Mr. Parker. If you pass your doctorate exam, you are Dean Middleton’s assignee to the University of Nebraska.’ I knew nothing about Nebraska except they had a good football team. When I got there, I found out that there was no full-time staff there. Everything was done by the house staff in the County Hospital. I also found out they cut their budget and the house staff had been reduced to one-half of its previous level. So I was the only house staff person on OB and GYN for three months, which meant I delivered babies all night and worked in the operating room all morning.
Question: How long did you stay at the University of Nebraska?
Dr. Parker: One year as a general intern. I caught the eye of a man by the name of R. Alan Mosher who was the dean and a friend of Dean Middleton. He reported to Dean Middleton that, rightly or wrongly, I was the best house officer he had sent out there. That sort of eased my path with Dean Middleton. I’m sorry that nowadays deans really don’t have much time to deal with students. I don’t think our students at UCLA know who the dean is. On my wall in my office is a signed photograph from Dean Middleton, ‘To Bob Parker, My good friend and good student.’ That man intervened in every step of my career.
I had a little interruption in the Korean War for two years, and I wanted to train in radiology and I wanted to come back to the University of Michigan. It turned out that Dr. Fred Hodges, who was chief of radiology there, had already filled his five spots, one of which was his son, Fred Hodges Jr., who was from Wisconsin. It was against his rules to appoint two from any one school. However, Dean Middleton stepped in and told Dr. Hodges, who was a Wisconsin graduate, that he was to accept me as a resident, so Dr. Hodges added a sixth resident to his roster on the word of Dr. Middleton. I got a little note from Dr. Hodges on Christmas morning, ‘Please join our program.’ I found out later it was Dr. Middleton that did that. I started with the group that included Fred Hodges, the chief’s son, Owen Doyle, and a few others, and came back two years later and joined a group that included Phil Rubin and Mal Bagshaw.
At that time, we all rotated through nine months with Dr. Lampe, which was a bright light in my career. While I was at Nebraska, I developed an interest in tumors. I spent a year doing tumor pathology at Cleveland and so I had in the back of my mind that I wanted to do something, probably cancer surgery. When I was out in Nebraska, Howard Hunt was doing the therapy with an old 200 kV machine and what caught my eye was that we’d go to tumor boards. After the chief of surgery would huff and puff at the tumor boards, they’d all turn to this little man who was sitting there smoking his pipe and say, ‘Well, Dr. Hunt, what do you think?’ and he’d say something and all of a sudden all the others would say, ‘That’s exactly what I think.’ I got interested in this man and I think he lit the spark that Dr. Lampe eventually picked up.
Question: So how was it that you decided to accept the position in Seattle, there being no medical school in Seattle?
Dr. Parker: When I was finishing my year with Dr. Lampe, he called me in the presence of Howard LaTourette and said, ‘I want to keep you on the faculty.’ I ran home and told my wife and we celebrated. I came in the next day and his secretary said, ‘Dr. Lampe wants to talk to you,’ and he said, ‘I changed my mind. I want you to go elsewhere.’ I was crestfallen. He said, ‘But I want you to go to either a place where there’s Dr. del Regato or Dr. Garcia or Dr. Maurice Lenz or two people out in Seattle, Simeon Cantril and Franz Buschke. If you want my advice, I would go to Seattle because there are two of them there and one of them is always likely to be in town, and if you go to any of the other places, you’re very likely to not see the man you’re there to train with.’ So I went to Seattle. Both Cantril and Buschke were extremely important people to me. Simeon Cantril was, by acclamation, the first president of the American Club of Therapeutic Radiologists. I intended to go back to Ann Arbor but Dr. Cantril asked me to stay there and the medical school was opening up. So I had to call Dr. Lampe and tell him that Dr. Cantril had asked me to stay and that was my choice. Dr. Lampe’s answer was, ‘I am extremely proud that they think enough of you to want to keep you.’ And this is a man that had kept a faculty position open for one year for me and that was his response and I can’t imagine being more graceful. I was going to stay there for a while because I could see that we were the teaching component for the new medical school. But what happened was Mel Figley, who was one of the residents in Ann Arbor, took the job as chairman of radiology, and so he asked me if I would come out and discuss organizing the oncology section. I told him as a courtesy, I would do that, but actually my ultimate plan would be I would be going back to Ann Arbor. I went out there one morning and the first man I interviewed with was Dr. Robert Williams who was the kingpin, he was the chairman of medicine, wrote the standard textbook on endocrinology and actually had selected Mel Figley for the chairmanship.
Question: This is the beginning of medical school at the University of Washington?
Dr. Parker: Yes, and he told me they were about to open up a new hospital that was in the design phase, that Bill Middleton had called him and told him to hire me and that the job was mine, ‘Now let’s spend the next hour deciding how we,’ namely Dr. Williams and I ‘are going to do this job.’ I had gone up there with no interest whatsoever and for some reason I thought that sounded sort of interesting because I got to design a department in a brand new hospital and so I stayed for 17 years.
Question: What do you think are the most important things you accomplished at the University of Washington?
Dr. Parker: I had the good luck to hire for the first time a physicist, Peter Wooten, who became extremely important to me as not only a physicist, but as an adviser. Peter and I would bounce ideas off each other. For instance, we got the first national grant to test hyperbaric oxygen, as crazy as that sounds in retrospect, we had an ACS program going there for several years with an old Vickers tank. Then we got the idea of neutrons. Dr. Lampe had gone out and spent some time with Robert Stone and he had a whole bunch of pictures of post-neutron treatment patients. They were actually disasters, and all this was in my mind that Dr. Stone actually was re-treating everybody and his reactions may have been, in effect because he was re-irradiating and it had nothing to do with neutrons. So Peter and I found a physics department cyclotron that was unused and decided to see if we could convert that into a neutron generator, which we did. We then got the first grant to clinically test neutrons. We actually got the grant before Dr. Fletcher did, but Dr. Fletcher treated patients before we did because we were so conscious in trying to get this old cyclotron working.
I think the most important thing at Washington was building a program that trained a lot of young people. When I was first in the Northwest, Dr. Buschke left for San Francisco to found a radiation oncology section at UCSF and Cantril died prematurely of a coronary; so I looked around and I was the only trained radiation oncologist in Washington, Alaska, Montana and Idaho. Now there are, I think, fourteen radiation oncologists at Swedish Hospital alone. That’s sort of an interesting thing to happen during your lifetime, to see oncology develop in a part of the country where it didn’t exist.
Question: So you, after 17 or 18 years at the University of Washington, elected to be the chairman of radiation oncology at the University of California, Los Angeles.
Dr. Parker: The University of California at Los Angeles wanted to build an NCI-sponsored dedicated cancer center and the NCI looked at them and said, ‘Not until you develop a radiation program will we give you any money,’ in probably better terms than that. So, Dr. Malakoff said, ‘Let’s do that,’ and he picked as his envoy Rick Stekel, who was the designate to develop this center, he happened to be a diagnostic radiologist who worked at NCI with one of my trainees, Mark Hoffman. The other designee was Fred Rasmussen who had been on the faculty at the University of Wisconsin. They came up with the proposal, asked if I would please come down and tell them what they needed to develop a department. After about three or four trips to Los Angeles, I was telling Dr. Malakoff that he had a program that was a disaster — they had no clinic, old equipment, inadequate space, no physics department, no research, no biology and on and on. He looked me in the eye and said, ‘If I give you my word that we will do all of that, would you like to be the captain of the team?’ And so my ego got in the way and I said, ‘Yes.’
I went down there in 1977 and his promises were that he would create a department, that he would give me five positions to recruit faculty and he would raise money to build a new clinic. It took 14 years, but he did it.
Question: When did you develop the neutron program at the University of California?
Dr. Parker: I applied for the grant within a year of getting there. We didn’t treat patients for several years because we had to build a cyclotron because the one we bought was from the Cyclotron Corporation, which went out of business. Jim Smathers and his team went up there with three trucks, put all the parts on the truck, and came back and built this thing on site. So it took us almost four years to build the cyclotron. It is still there and they use it to make isotopes.
Question: Tell us a little bit about your activities on the national level like in ASTRO and RSNA.
Dr. Parker: I was president of this organization in 1976 and it was called ASTR. There was no O in it. Our Society got off to a fairly slow start. Dr. del Regato was the president the year before I was and Frank Hendrickson was the president the year after I was.
The year after I was president was the first year we awarded the Gold Medal. During my year as president, we thought that we were becoming mature enough to start giving recognition to those who have made major contributions to the field. Somehow the word leaked out that we were thinking about gold medals, and then the phone calls started. The Fletcher Society called and said Fletcher should be the first medalist and the del Regato Society said del Regato should be the first medalist. The Kaplan Society called and said Kaplan should be the first medalist. So we decided to postpone it for a year. Frank Hendrickson being reasonably clever said, ‘Well, you can postpone it, but you’re in charge of it when I’m president.’ So the next year when he was president, I still had to take on the Gold Medal.
I just arbitrarily, maybe with the help of Sheila Abban, decided that we would make all three of them Gold Medalists, and then the question was what order would they come in, because now they wanted to argue about who was first of the three, so then I arbitrarily decided that we do it alphabetically — del Regato, Fletcher and Kaplan. So I phoned Dr. del Regato and said we were instituting this and we would like to give him a Gold Medal, and he said, ‘I am very, very honored.’ So then I called Dr. Fletcher and he said, ‘That’s nice. Give my third of a medal to Dr. del Regato.’ Then I called Dr. Kaplan and he said, ‘I’m too busy to do that kind of stuff,’ and he hung up. Within half an hour, I got a call from Dr. Fletcher saying, ‘I’m coming to the meeting and I’ll be glad to accept the medal,’ and I got a call from Dr. Kaplan within the hour saying, ‘I’ve looked at my schedule and I can make it.’ So they all came. I have a picture of these guys standing shoulder-to-shoulder. I have it in my office and the quip is, ‘That’s the closest those guys ever were to each other in their life.’
Question: You also received the Gold Medal from ASTRO in 2001. When did you become involved with RSNA?
Dr. Parker: The first time I ever went was 1950. I heard Dr. Buschke give a talk on cancer of the esophagus, but I think I joined in 1955 or somewhere around there.
Question: Tell us a little about your family. Your wife, Diana, was involved in cancer activities with the National Cancer Institute.
Dr. Parker: I met my wife when she worked with the National Cancer Institute. I met her at M.D. Anderson at a visit and I quipped that it was the single biggest accomplishment of the neutron program. I have two great sons and six grandkids.
Question: What do you think are the most important contributions that you’ve made in your career?
Dr. Parker: Despite my abortive attempts at being a scientist, I really think training young people to be very good young doctors. Now, a lot of them are very good old doctors. In fact, I have many trainees that are retired and some of them have died, but there are hundreds of them out there and they have completely converted the landscape of the Northwest in radiation oncology. They’re all over the place — either those trainees or their trainees, they’ve made radiation oncology, at least in the Northwest United States, a substantial venture.
Question: What’s your assessment of the way the direction of the field is going?
Dr. Parker: I have some worries which I think some people probably know they’re maybe a little bit similar to Dr. Levitt’s. Although early in my career I got involved in the mechanics, namely super voltage equipment, I think we’re going to have to spend a lot more time on basic biology of cancer and how that applies. We have to know the method and we have to understand how to use radiation, but I think it’s much more important we know cancer biology. We have to learn that stuff. We can’t give it all to the medical oncologists or the Mike Phelps programs. We have to be there or we’re going to be shut out. I don’t think you can rely on technical innovations like IMRT very long because they’re going to be superseded by something else.
Question: But I think some of the things that have come out at this particular meeting represent unique opportunities to regain that position for the radiation oncologist with targeted radiotherapy and molecular emphasis.
Dr. Parker: We’d better get at it. Historically in my lifetime, we were the cancer doctors and we somehow let that get past us. I think we were too busy doing other things and not paying attention, not handling bed services, for example. At the University of Washington, we had a bed service which for several years was awarded the best hospital bed service. We took care of cancer patients from start to finish. Now we delegate that to some other person and we hide in the basement and I think we’ve suffered because of that. I think a lot of people on my faculty would not be anxious to have a bed service.
Question: I think part of the problem in radiation oncology is an unwillingness to take on the responsibility to care for the patient at all levels of their care.
Dr. Parker: It’s taking a call on Christmas morning or on your birthday.
Question: Or coming in at nighttime to see someone in an emergency room or on the weekend to see someone.
Dr. Parker: Taking care of the complications.
Question: What do you think of the relationship between radiation oncology and diagnostic radiology?
Dr. Parker: I think we have to sustain it if we can. I think it’s very important. That’s our heritage. There have been some rough spots. One time we were hell bent on claiming our independence and staying as far away from them as we could, but I don’t think we should do that. I think they play a more and more important part. We send our residents, and I’m sure you do, back for rotations through the imaging services, the head and neck imaging services so that we know what we’re looking at when we’re setting up patients. Unfortunately, I don’t see the reciprocal. I don’t see them coming to us and seeing what we look at. For example, at my place, young diagnostic radiologists are sometimes surprised when I say we treat prostate cancer for cure. They don’t really know that. Or when I tell them that we can treat acoustic neuromas with radiosurgery with less damage to the auditory nerve than the surgeon, they don’t know that. They’re not seeing what we do as much as we’re seeing what they do. I would like to see us hang together.
Question: What do you see or think of the relationship between medical oncology and radiation oncology?
Dr. Parker: I think we’d better work very closely with them. Sometimes I think we’d better work harder at gaining their respect. Sometimes they look at us as technical help. There are medical oncologists who treat you as equals when they find out you know something also and we’re perfectly good people. Some of them are and some aren’t. I enjoy more working with cancer-related surgeons, I guess, because of my personality; they get things done. They don’t spend half of the time thinking about it.
Question: What else would you like to pass on to us?
Dr. Parker: One of the most encouraging things to me, toward the end of my career, is to see the enthusiasm of young medical students for our specialty. We are just bombarded with candidates. Every student at UCLA comes through our service — every one of them. We get them in class, but a large number of them want to come back for electives. We don’t have room for them all. And almost everybody that has come back for electives immediately signs up for residency. Last year, we could only select two. We had 75 finalists when the applications were filled out. When we reviewed them, many of them had written papers, spent time at NCI, on and on and on. We had to pick two out of 75. How in the world can you pick the best two? I mean, they were just enthusiastic about what we do and so they’re seeing something that maybe we ought to be seeing.
Question: What did they do when they finished their training?
Dr. Parker: Well, unfortunately they flee into the private sector. I’m not against having good quality work in the private sector, but I wish that some of them would find what we do more interesting.
Question: Thanks very much, Bob.