Question: I am Gustavo Montana, a member of the ASTRO History Committee. I will be interviewing Dr. Rodney Million, ASTRO past president and Gold Medalist and also former chairman of the department of radiation oncology at the University of Florida in Gainesville, Fla. I'll be interviewing Rod with Bill Mendenhall, a member of the radiation oncology department at the University of Florida in Gainesville. Today is November 30, 2012.
Question: This is Bill Mendenhall. Gus, I'm going to give the phone to Rod for some of the stuff we'd like to start with. Rod, just say a little bit about where you're from, and your training and so forth and how you got interested in radiation oncology.
Dr. Million: I was born up in Idaville, Ind., a little tiny town. And then I went to school in Bloomington, Ind.. And then we stayed on in Bloomington, and I went to college there at the Indiana University. I was part of an old program they had that you could join the service and they would pay you at whatever level you were. So I was being paid lieutenant's pay for four years.
Question: Was that the Berry Plan?
Dr. Million: I can't remember that. It was some kind of plan like that. So then I ended up in Morocco for three years in the service as a flight surgeon. And then I didn't know what to do. I wanted to come back. I didn't know what to do. So I ended up in radiation -- in radiology.
Question: Radiology, right.
Dr. Million: I really wanted to be a surgeon but, I suppose, too much work. So I came back and went to Indiana and got started in radiology. And then, for some reason, I really liked the rotation of radiation oncology. And the guy got me interested in it and said, “Well, why don't you go down and talk to Gilbert Fletcher.” So I got on the train in Indianapolis and went down and talked to Gilbert. There wasn't a whole lot he said. I mean, I don't know if you know Gilbert Fletcher.
Question: Oh, I knew him, indeed. And he wasn't a man of too many words. And the few that he said you couldn't understand. They were half in French.
Dr. Million: Well, I had enough of French from my French Morocco experiences. So that wasn't a problem. It's just he was a man of few words. So I went home and tossed it around and I would have had to leave -- I was in residency at Indiana University Medical School. And so I thought about it and thought about it and everybody thought it was kind of stupid, nobody did that in those days. So I said, dang it, I'm going to do it. So we sold our house and went down to Houston and got started.
Question: Let me ask you, Rod, who was the chair of the department at Indiana, and who was the head of radiation oncology? I know that radiology and radiation therapy were one department. People were trained in both. But do you remember who the chair of the department was?
Dr. Million: Well, Jack Campbell was the chair for here, and then a guy came, by the name of Love -- L-O-V-E --, his initial experience in radiation treatment was that he'd been a dermatologist and he was treating for cancer with radiation and they hired him up there. And one year that he came over last was my year. And he was kind of a funny guy but, anyway, I really had kind of turned off it seeing the cancer patients. And so he sent me down to Texas and I talked to Fletcher and I didn't know what to do, so finally I said I'm going to do it. And...
Question: That was in the '60s, early '60s I take it, right?
Dr. Million: Yeah. So I got down there and started in residency, rented a house about three doors from Fletcher. I had saved a lot of money when I was in the service. I mean, when I came out of the service I had $70,000 or $80,000 in cash, just saving money.
Question: So you started your training with Fletcher. It must have been extraordinary because those were the years of development of radiotherapy in this country and Fletcher played a very significant role in this.
Dr. Million: Yes, but you've got to realize that -- I'm just thinking back, radiation oncology was on three floors. Herman Suit was first year there. He mostly was in the lab, and then Paul Chiao and Lowell Miller, and that's a lot of patients. We were treating 120 patients a day and seven or eight radiums a week, and so it was a pretty first-class crew back then. I didn't do any basic research. Eventually I did two clinical research projects.
This question is kind of important. It says should residents be involved in basic research or not? And I think they should be involved in research in some way, at least clinical research. When we hired a guy to be a resident, it was understood that he was going to do a research project every year, clinical research. And so one of them I did a project with Herman Suit. It was very much guided to doing some research. And should we be doing things differently in training and education.
Question: Let me hold you back for a little bit. Obviously you were very influenced by Fletcher. You developed an interest in head and neck and gynecologic tumors. It must have been a very important forming time for you, for your future career. Fletcher was dictatorial, to say the least, but very organized and an excellent clinician.
Dr. Million: Well, Fletcher was not easy, I mean, we got along. And the guys that were there doing patient care and so forth were people that you know: Lowell Miller and Paul Chiao. Do you remember him?
Dr. Million: And Luis Delclos.
Question: Oh, yes.
Dr. Million: So it was a pretty good thing.
So now the next question says, should we be doing things differently in training and education. Well, I don't know what's being done now. I think that residents should always be some kind of researcher or be doing something other than just patient care, but I don't know...
Question: Very good. Well, Fletcher was very interested in clinical research and documenting everything that happened to the patients, but at least in those times, when he did not appear to be interested in basic research, Herman Suit was there and Fletcher did support his basic sciences research.
Dr. Million: Yes.
Question: About the education of the residents. I’m sure that in your department they learned a lot from being in contact with the ENT surgeons. I’m sure they went often to the operating room with the surgeons. Do you know if we should go back to providing them with these experiences?
Dr. Million: Well, I really like the idea of going to the operating room. I thought that was important and the residents liked it, the surgeons liked it too. And you'd get in the operating room and it was all good and they pointed out things. I never even thought twice about it. I think it's important. I think it's very important.
Question: Oh, sure.
Dr. Million: One thing that every resident who came here understood was that they had to do a clinical research project every year.
Question: Every year?
Dr. Million: Yes, every year they had to do this. And we had a meeting and they had a guest speaker and I was very proud of that because it meant that everybody who came here to give a talk -- I'll get them mixed up here a little bit – but, anyway, it made sure that every one of our residents every year did a project, and wrote it up, and got up in front of the crowd there and gave us information. It was good and bad like you would guess, but still it served the point of what's important. I don't think you were ever here...
Question: I visited your institution a couple of times. I was very impressed with the caliber of the residents and the presentations that they made at ASTRO and other meetings.
Dr. Million: Well, they were -- they had to do it and they had to do it several times. And they were expected to go over several times with whomever was in charge of them and make sure it was good and wasn't full of bull and more bull than usual.
Question: Rod, of all of your accomplishments what are you most proud of? Needless to say, you have a lot of things to be proud of. But just give us an idea of what you consider to be your most important achievements.
Dr. Million: I can't remember when you started, but getting high-quality people into the residency program, because I remember when we actually decided that at Indiana, I guess, that you were either going to go into radiology or radiation oncology. It wasn't like there was an option.
Dr. Million: So the guys who came who were sort of interested in radiology; they spent six months with me and then six months in radiology. So what happened was they all liked radiation therapy and they drifted over into our program and the guy who ran the whole program, Williams, he said, “This is nonsense, and we're getting all these good residents for you, and they're drifting over to you.” So at some point we decided, well, they either go into radiology or they go into radiation oncology. And I thought, gee, how am I going to find guys to even get in the program? But, you know, it wasn't a problem. There are a lot of quality people.
Question: Now let's go on to the subject of your own publications and those from your department and your institution. Over the years you had a very large and excellent number of publications. With your work with the head and neck surgeons, you showed that you had a unique relationship with them. Was that relationship as good as it appeared to all of us outside of the institution?
Dr. Million: I developed -- I say I -- we developed a program early where once a week we met to see every new patient with the doctors and head and neck. We'd see head and neck patients and we'd decide on what treatment they were going to get individually, and then we met together. And then we extended that to lymphoma and then we extended it to God only knows what. And that was kind of good. It got the doctors together before the treatment and, in most cases. And that got us talking together and I kind of -- what do you think, Bill?
Question: We still do it.
Dr. Million: Do you?
Question: Oh, yeah. We've got multiple site specific-tumor boards and probably the best is head and neck. So we still do a lot of that.
Dr. Million: So that program is still going on. I think it's really important. It means that you sit down in a room and, I mean, there's a lot of jerks, as you know.
Dr. Million: But to get together and talk and find out that they weren't all jerks and that maybe you were the jerk. I just think that was -- I had forgotten about that, but Bill says they still do it.
Question: Dr. Cassisi, as I remember, was one of the head and neck surgeons you worked with very closely, is that not correct?
Dr. Million: Well, that's what happens. You start meeting and talking and some of that getting mad at each other that's usually involved goes away and it works. I mean, they're still doing it.
Question: Yes. You co-authored books, right?
Dr. Million: One book we did -- well, I did the head and neck book.
Dr. Million: And it went to a second edition. And I'm really proud of that because, as you know, you've written stuff and it just -- it's hard. I mean, writing is one of the most difficult things. But that's important to do, so -- and I don't have anything else to say about it.
Question: You also did a lot of work on breast cancer, is that not correct?
Dr. Million: I didn't.
Dr. Million: Nancy Mendenhall did the breast cancer stuff mostly and as I look back at it, it was so funny because she would write a breast cancer paper and she'd give it to Fletcher and he'd just tear it up, and it would go all over, and she stuck with it. She just stuck with it all her life and she's still working. And I thought -- I didn't think she'd go anywhere. My guess on how people are going to turn out 10 or 15 or 20 years later -- I do pretty good with the guys, but the women I do awful. She's really done well, exceptionally well.
Question: Yes, very well, she is very good. Well, there's no question that the academic clinical output of your institution has been exemplary. Understandably you are most proud of your trainees, but do you have any words of wisdom for the radiation oncology community at this point? Do you want to say anything about the direction we're going?
Dr. Million: You know, I've been away from it so long that I don't know. One thing that irritates me beyond belief is the cost to patients.
Question: Let's talk about this. The cost continues to escalate. If you wanted to change something big in our healthcare system, what do you think you would want to change?
Dr. Million: Change something?
Question: Yes. For instance, change the way we bill patients or the administrative system. Do you want to tackle this?
Dr. Million: Well, when I run for President I'll work on that.
Question: Well, good for you, then. I'll vote for you.
Dr. Million: What do you think the best system in the world that we have going today?
Question: Me? You're asking me? Well, I will volunteer an opinion, but that's not part of the interview because you are the person being interviewed. Several European health care systems are very good. I think that we ought to look at causes for the escalating cost in our country and address them. One of the factors that contribute significantly to the cost in this country is the administrative complexity of our system.
Dr. Million: Well, I don't know. It's obvious that the greed has not disappeared.
Question: Okay. Rod, let's talk about ASTRO -- the Society. I was looking at your CV and, in fact, I believe that you do not list having been president of ASTRO in 1991.. You probably haven't taken a look at your CV in a long, long time..
Dr. Million: Well, I think you're correct. I've got one.
Question: You've got one?
Dr. Million: Yes, someplace.
Question: Yeah, well, I see -- oh, no, I see American Society for Therapeutic Radiology and Oncology -- Chairman, Board of Directors and President. Yes, I missed it.
Dr. Million: I took the Gold Medal when I got the Gold Medal.
Dr. Million: And they had gotten a nice photograph of me, I guess. They made a big thing and hung it on the wall. So I insisted we take the Gold Medal and slip it into that big photograph so it would always be available for people to see.
Dr. Million: Bill came to me and said somebody is going to steal that. Well, if they steal it, we'll make another one.
Question: It's still there.
Dr. Million: It's still there? Nobody will think of that.
Question: Now I would like to talk about the Red Journal. You haven't been looking at the Red Journal, have you?
Dr. Million: No. I don't know where I've even seen one.
Question: Well, it's still being published. The Red Journal is receiving many more articles for publication than it can possibly handle. So they have to make the print smaller, the paper thinner, and the articles shorter to get more articles in the Journal.
Dr. Million: That's like the old British journals. Remember? They were so much fun to compare them because they were short and brief.
Question: I really want to thank you very much for giving us this interview. You are without a doubt a very prominent member of our Society and I’m very glad to have had the opportunity to interview you along with Bill Mendenhall, one of your highly accomplished trainees and member of the department you headed. I’m sorry that we had not gotten around to interview you until now.
Dr. Million: Who is chairman of the department up there now?
Question: At Duke it's Chris Willett. Chris came from MGH. He has been chair of the department for about six years or more. He's doing an excellent job and the department is doing real well. I know that Bill, Nancy and the rest of the staff are doing an excellent job with your former department in Gainesville.
Dr. Million: Well, it really is incredible what I've seen Bill do. I thought of all the things that you -- I think about what you really did -- if you get people who are going to carry on…Most departments have something they do pretty well, and if they can carry on and keep it going, keep their residency going, I don't know what it's like now, but I think about it a little bit, but . . .
Question: Yeah, you have good memories. That's very reassuring. Well, again, thank you very much Rod for the interview and thanks, Bill, for your help setting this up and for participating in the process. Thanks again.
Dr. Million: Say hello to everybody.
Question: All right, I will.
Dr. Million: All right. Bye now.