An Interview with Richard Hoppe, MD, FASTRO
This is Dave Larsen and Ted Phillips, and the date is March 28th, 2008, interviewing Rich Hoppe. So the way we'll start, I guess, is just asking where you were born, where you grew up, that sort of thing.
DL: Good. That's the most enjoyable thing in these interviews.
RH: Okay, I'll give it a try. There was a woman on her way from Israel to California with her husband, a physician, who was also Israeli. They stopped over in New York, in Forest Hills specifically, because they had some friends who lived there. The woman was in a shop, and she heard some other women speaking Polish. The Israeli woman was born in Poland and emigrated to Israel after the war, so she understood their conversation. She also recalled that she has an aunt, also born in Poland, with whom she had lost contact, and who was living somewhere in Forest Hills. So, the Israeli woman approached the women who were speaking Polish, and asked, "Do you know Rega Hanna?" and the woman said, "Oh, yes. I know Rega. She lives on Yellowstone Boulevard, and I'll give you her phone number." So the woman from Israel called her aunt, Rega, who said, '"Oh, that's wonderful that you're here. Why don't you come to dinner and I will invite my daughter and son-in-law to come to dinner as well. He's in medical school and he can talk with your husband."
It turned out that the Israeli woman was Miriam Fuks, married to Zvi Fuks, and Rega Hanna was my mother-in-law! Bebe and I took the subway out from Manhattan to Forest Hills and had dinner. I was on a pediatric rotation at the time, somewhat exhausted, but we made the trip and met the entire Fuks family – Zvi and Miriam and their kids Yaron and Tamar. We went back to Manhattan that night, not knowing how this would play out in later years.
DL: I believe he was on his way out to Stanford.
RH: That’s right. Henry Kaplan had arranged an appointment for him in the Radiology Department at Stanford.
DL: That was in 1969?
RH: No, the fall of 1968. Anyway, I forgot all about that evening. Then fast forward a couple of years. I was in my last year of medical school and thinking about where to go for internship and what to do for residency. I still hadn’t defined an area that I was interested in as a specialty. I just assumed neurology or GI or one of those medical subspecialties that I found interesting. At that time, everyone on the East coast wanted to go to the West Coast for internship or residency. I was no different, and it just so happened that the medical intern who was on the medical service where I was doing a subinternship had been a medical student at Stanford. He told me, "Well, if you want to go out to the West Coast and look around at internships and residencies, you can travel up and down the coast, take an elective in radiology at Stanford and you'll have plenty of free time." So that sounded good and a good friend of mine from med school had gone out to Stanford for most of the year taking different electives. I told Bebe about this, and she was supportive. She thought it would be great to try a new place, and so I called up Les Zatz in Radiology at Stanford, the person who this medical intern had suggested, asking about doing a visiting clerkship. Les said, "Sure, fine. When do you want to come?" We had two-month electives at that time and I said, well, I can come on such-and-such a date, and he said, "Fine." And that was that.
The next issue to resolve was where I would stay once I got to Stanford. I mentioned I had this friend who was out here somewhere, and I tried to contact him. I don't know if I sent him a letter or whatever, and I asked him to find me a place to stay and he said he would, but then I never heard back from him. And the time was getting closer and closer to when I was going to be coming out to Stanford, and I mentioned this to my mother-in-law and she said, "Oh, well, you know, Zvi is somewhere in California. I'll try to find out where." So, she called her cousin in Israel, Miriam's mother, Zvi's mother-in-law, to find out where Zvi and Miriam were. She found out that he was at Stanford. We got the contact information and got a hold of Zvi. So, it turned out that not only was he in California, but he was at Stanford, and not only was he at Stanford, but he was in the Department of Radiology!
So, Zvi picked me up at the airport and brought me back to his house, and I stayed on a couch in his living room for a few days until I found a room to rent in someone’s house. But on the first Monday I was there I came into the Radiology Department and was informed that the clerkship rotation didn’t start for another two weeks. I told this to Zvi, who said, "Oh, well, why don't you just spend the time with me in radiation therapy?" And that’s what I did. I spent a brief two weeks in radiation therapy. But that was enough. I spent the time with Zvi and he turned me on to the specialty. And that was a very special time because Henry Kaplan was there, also Mal Bagshaw and Bob Stewart, and Joe Kriss in Nuclear Medicine, Ron Castellino and other notables in diagnostic radiology. Ron was the preceptor for my radiology clerkship. And since I knew Zvi, we sometimes had lunch together with Mal and some of the other faculty in radiation therapy or would go to the Stanford football games together (that was one of the years that Stanford went to the Rose Bowl – and won). Also, I vividly recall the Monday afternoon lymphoma clinic with Saul Rosenberg. Toward the end of those two months at Stanford, I came down with a bad pneumonia and was admitted as an in-patient to the student health center. I was hospitalized for a couple of days, but by that time I realized that radiation therapy was the field for me. I was interested in it, not simply because of the technology, but for the cancer care part of it, oncology was a fascinating discipline, and radiation was such an effective modality.
I went back to Cornell, and decided I should make sure that this is what I really wanted to do. I took a clerkship at Memorial Hospital, where Giulio D'Angio was the Chair at the time. This confirmed for me that radiation therapy was the correct choice. It was now the spring of my senior year, and I started to apply for radiation therapy residency programs. I sent an application to Stanford and fortunately they didn't require I come out for an interview. But I did fly down to MD Anderson where I remember meeting Gilbert Fletcher and Joe Castro. I also met Herman Suit, who was still there, and Herman said, "Would you be interested in going to Boston?" I interviewed at a couple of other places around New York, but Stanford continued to hold a special attraction.
Then, as I recall, it was on Father's Day, and Bebe and I were driving through New England on the weekend. I called my father to wish him Happy Father’s Day and he told me that Dr. Bagshaw had called and left a message that I should contact him. I did, and Mal offered me a residency position at Stanford. I accepted on the spot.
DL: Given your choices and possibilities, was it clear at the time?
RH: No question in my mind from that two-month experience that I had that Stanford was just a fabulous place.
DL: So, who was in your residency class?
RH: There were five in our class. Mike Chen, who joined the faculty at Yale, later the Mayo Clinic, and is now retired. The other three went into private practice – Rich Carmel, Ed Gilbert, and Steve Weller.
DL: Was it clear from the outset that some were destined for private practice and others for academics?
RH: It was a time of fabulous opportunity for young people in the specialty. There was such demand for graduates of good programs you could almost write your ticket. I think any of us could have differentiated in any direction. I think our choices were largely based on geographical preferences.
DL: When did you start your residency?
RH: In '72.
DL: The same year as Steve Leibel?
RH: Yes, I think we were in the same year.
DL: What happened between medical school and residency?
RH: Well, for starters, Bebe and I were married between first and second year of medical school. Then I decided I wanted to go to Stanford for my residency. Knowing we would likely move west, we decided we may as well stay in New York for one more year, so I matched with an internship program at North Shore Hospital and Memorial. It was a combined program where we spent nine months at North Shore Hospital in Manhasset and three months at Memorial Hospital. At the time they were both Cornell-cooperating hospitals.
DL: Was it straight medicine?
RH: Yes, it was. And in fact, it was for the full residency, so at some point I had to tell them that I was only going to be staying for that internship year.
DL: They put you in the ER for the rest of the year?
RH: Not quite, but after that I felt somewhat persona non grata. The Memorial part of the experience was great because, again, there were fabulous people there at the time, Jerry Posner in neurology - he's still there - Paul Sherlock and Sidney Winawer, as well as a number of notable oncologists and surgeons including ** It was the beginning of cis-platinum and bleomycin. I remember particularly the patients who had been on the early trials of cis-platinum - they all developed serious hearing defects. Dan Ihde was there as a resident and a number of other people who subsequently had important careers in oncology. The types of patients we were taking care of were truly fascinating - interesting physical findings and X-ray findings. Actually, I enjoyed that three months at Memorial much more than the nine months I had on the medical service at North Shore.
DL: You've written hundreds of papers. What was the first radiation oncology paper that had your name on it?
RH: The first radiation oncology paper that had my name on it was on nasopharynx cancer. Like all residents at that time during residency, I was looking for a project and the one that I settled on was the Stanford experience treating nasopharynx cancer. It must have been because I saw a patient with nasopharynx cancer and thought we must have hundreds of cases since the last Stanford review. So that's the project I settled on. I had all the charts pulled, I abstracted all the data, analyzed it by hand, including the Berkson-Gage actuarial curves, and I presented it at the ASTRO meeting in 1975, at the Hyatt Regency in San Francisco. That was the first paper I published.
DL: So, you started in nasopharynx, but what led to your interest in lymphoma?
RH: Another long story. I finished my residency, and I was looking around at jobs. At first it didn't seem like there was going to be a job available at Stanford, so I checked out other opportunities. I recall going back to Yale to look at an opportunity there. Then, sometime in May, Mal Bagshaw said, "Oh, I think we will have a job for you at Stanford, but I'm not sure what you'll to be doing other than taking care of patients with mycosis fungoides." This was because Zvi had run the MF program, and when he left, John Earle took it over, but now John was leaving to become Chair at Mayo clinic, in Rochester. Mal said, "We don't have anybody to do MF, so you must do MF if you want this job. Other than that, I don't know what." So, I said okay!
So, at first, I took care of all the patients with MF and beyond that it was just miscellaneous, helping out where needed. Don Goffinet was involved in the non-Hodgkin lymphoma program, but he was getting busier and busier with head and neck, so I started doing some non-Hodgkin lymphoma. Don had given a refresher course on non-Hodgkin’s lymphoma at the RSNA each year, and the ASTR (now ASTRO) decided to have refresher courses at their meeting. Don decided to focus his activity on head and neck cancer and offered me the non-Hodgkin opportunity, which I enthusiastically accepted, taking responsibility for the refresher course at ASTR for several years beginning in **.
At that point, I became the third person in line for lymphoma patients in the Department at Stanford. There was Henry Kaplan, Eli Glatstein and me. I was third man up to see patients with lymphoma, mostly when both Kaplan and Glatstein were out of town! But after a couple of years, Eli was recruited to go to the NCI. Just before this, at a time when there was heated controversy regarding the classification systems being used world-wide for the non-Hodgkin lymphomas, Eli had been awarded a contract from the NCI to evaluate the different classifications. This was to include having expert pathologists from around the world look at consecutive slides from biopsies of patients with lymphoma at major clinical centers, use their own systems to classify the material, and correlate it with clinical outcomes. There were to be six expert pathologists and six panel pathologists, all reviewing the same slides at each clinical center. The experts classified slides according to their own system and the panel pathologists used all classification systems. A random group of slides were reviewed twice, which would enable also both intra- and inter-pathologist agreement on interpretation.
So, there were Bob Lukes, Henry Rappaport, Karl Lennert, Ron Dorfman, Kristin Henry, Greg O’Conor as the expert pathologists. The clinical centers abstracted all the clinical information, treatment and outcome data for the same patients. Eli was to be the PI for this project and Stanford was to be the data center. The other clinical centers were Tufts University, the Tumor Institute in Milan and the University of Minnesota. But Eli decided to go to the NCI and he couldn’t take the project with him. Saul Rosenberg took over as PI, but he needed someone who could make a major investment of time on the program. That opportunity came my way. I was heavily involved in all aspects of the project – data review, analysis, meeting planning, manuscript preparation, etc. This was my true entrée to the lymphoma world. I met innumerable other “lymphomaniacs” and began to develop my own reputation by publication, presentation at meetings, and clinical practice. That project eventuated in what we called ”The Working Formulation of Non-Hodgkin’s Lymphoma for Clinical Usage.” Of course, the working formulation is now in the garbage can, it has been replaced, by a more scientifically valid classification scheme, but it served oncology well for quite some time.
DL: It was a salient piece of work.
RH: Thanks. So, I began to establish a reputation of my own, and then there was the unfortunate circumstance of Henry Kaplan getting ill and dying, which left me at the head of the table for lymphoma patients at Stanford, working closely with Saul Rosenberg, and helping to develop the new generations of clinical trials for lymphoma. Then, for a period of several years, together with the residents I mined our database. Virtually every resident who came through the program wrote a paper with me related to some aspect of lymphoma. We looked at a host of issues, usually sparked by a patient we saw and wondering, well, what has our experience really been with that?
DL: You've had leadership positions. Tell us about some of your honors.
RH: It was an honor to be in all those leadership positions. You both share those same experiences. First there was ASTRO. I was elected President early during the years of contested elections. That was nerve-racking, to say the least.
DL: What year were you President . . . in '97?
RH: Yes, in '97.
DL: And who was president before you?
RH: Steve Leibel. Steve was president the year before me and Jay Harris the year before that.
DL: Were those all contested?
RH: Yes. I think the first contested election was won by Frank Wilson. Or maybe it was Jay Harris, who was next. He ran against Allan Lichter but Jay won. Then Steve and then me.
DL: Who did you run against?
RH: I ran against Dave Hussey. I was calculating in my mind that M. D. Anderson was Dave’s alma mater, and they had a lot more people, so I was surprised to win the election.
DL: Did any loser ever come back to win?
RH: Yes, Dave Hussey.
DL: Oh, Dave did. Okay. And Tim Williams, the current incoming President. He had lost a few years ago. So those two, I think.
RH: Yes, I don't know of any others. Some people have lost twice, unfortunately, Paul Wallner lost twice.
DL: What were the important things that happened during your reign as head of ASTRO?
RH: Just after my election, when I came on the Board, as President-Elect, with Steve as President and Jay as Chairman of the Board, was the point where we had the sudden break-up with ACR. ACR had been providing all the administrative services for ASTRO and Nick Croce, who was the person handling ASTRO for the ACR was booted out, so we were left without administrative leadership. Also, at about that time, the ACR contract to manage ASTRO was about to expire. So, I was coming in as President, ACR still had another year or so in its contract to manage us, and Steve Leibel initiated a strategic planning process, to decide where ASTRO would be going as an organization. So, for some period, it was the elected officers of the Board, Steve and myself, Jay as ex-president, later Larry Kun and then Chris Rose who were trying to run the show in every respect, until we could reorganize and arrange for administrative support. It was a tough time until we could get that all settled. In fact, it took a good few years. It wasn't until I was halfway through my term as Chair of the Board when we finally hired Frank Malouff to come on as the Executive Director.
DL: It was a necessary step, in retrospect, essential to allow ASTRO to truly flourish.
RH: Yes. It was a major step. And a major responsibility for all of us who were involved.
DL: During those years, didn't ACR provide you with any support?
RH: Yes, they did. Greg Robinson was an ACR employee and provided us with some interim support, but this clearly wasn’t his forte. He may even have had the title of Acting Executive Director, I’m not sure. But he did provide some continuity. We also had some help from the meeting planning staff at ACR.
DL: Did you have to spend a lot of time back in Washington getting things organized?
RH: By that time, a lot of the activity was by email. It was difficult for me to spend a lot of time on the East Coast because of my responsibilities at Stanford. I had been Chair for only five years as and we were deep into the process of planning a new building and department.
DL: That was also the year of the UCSF-Stanford merger, wasn't it?
RH: No, that was a little bit later. Nevertheless, there was so much going on here that I couldn't be traveling across the country all the time. I was completing my first term as Chair at Stanford and preparing for an external review of our Department, so I needed to ensure that things were running well here. Also, Steve Leibel was still in New York. It was easier for him to travel to Virginia, so he could handle a lot of the responsibilities in the office, and certainly he did so while he was Chairman of the Board.
DL: You were mentored by some well-known people. You probably mentored a whole bunch of people yourself. Who were some of the people you've mentored and gone on to great things?
RH: Mentorship is often informal. Zvi was one of my important mentors, but there were others who were important to specific activities. I remember, for example, the first paper I wrote, that one on nasopharynx cancer. Mal was the senior author on that paper, but he would give his manuscripts for editing to his wife, Muriel, who was also a physician, because she was an excellent medical writer. And Kaplan’s detailed comments on my drafts were also fantastically helpful. He would go through generously with a red pen. I learned immensely from all the papers I wrote with him.
DL: When one of your residents writes a paper, do you use a red pen?
RH: I did. Now I use track changes! I like to think that I have mentored many of them with respect to their clinical writing skills.
DL: There's probably a whole lot that have gone on to successful careers.
RH: Yes, some have become Chairs of departments or program directors. But the person whom I have mentored most closely and for the longest time is not a radiation oncologist. It's Dr. Youn Kim, who is a professor of dermatology. In fact, she has endowed professorship, the Peter and Joanne Haas Professorship in Cutaneous Lymphoma Research. I have worked with her in our cutaneous lymphoma program since 1992, when she was an assistant professor.
DL: That must relate to your interest in mycosis fungoides.
RH: That’s right. Mycosis fungoides is what helped start my academic career. In 1976, when I joined the faculty, I was the designated radiation oncologist to oversee the MF program. Eugene Farber was the dermatologist of record, but there was a succession of young dermatologists who came to the program, and every few years there was somebody new. It was a revolving door of dermatologists and I was the clinician providing the continuity in the program. Finally, in '92, Gene Bauer, who was chair of dermatology at the time and would later become Dean of the School of Medicine, identified Youn Kim as a potential person to work with me. In the preceding two years, there was no full-time faculty dermatologist working in the program, but rather three community dermatologists who were rotating on the service. That was not acceptable. Anyway, Gene identified Youn Kim, early during her initial appointment as an Assistant Professor, as a potential partner. Youn came onboard and quickly educated herself on cutaneous lymphoma, and together we've had a quite productive collaboration. But writing papers was something she hadn't a lot of experience with. I remember giving her drafts back with the red ink in a similar fashion to the ones I had received from Kaplan. She talks about it still. But after a while there was less and less red ink on those papers, and now they’re nearly perfect! As time went on it became a true partnership, and ultimately, she was responsible for notable growth of the program, both in academic and clinical terms. We even have been successful with philanthropy, including funding for an endowed professorship, that she holds, and significant research support.
DL: With your visiting professorships, are there any memorable experiences?
RH: They've always been fun. I've loved to do it, but I haven't done as many in the last several years just because of so many service obligations in the institution and to national organizations.
DL: Tell us about teaching people, teaching residents and students and those kinds of interactions, pleasures and satisfaction of that kind of thing.
RH: That's one of the reasons I'm here. I enjoy immensely the interaction. I became residency program director after the departure of Dave Pistenmaa from our faculty, which was when I was still an Assistant Professor. I continued in that position after I became Chair, until I realized I couldn't do both, and Sarah Donaldson then took over as program director. I enjoyed it tremendously, and I enjoyed working with the residents. I've written a lot of papers with them. I've also enjoyed working with the medical students who have come through on our elective. We have a popular clerkship.
DL: At your graduation ceremony each year for the residents, do they tend to skewer the faculty?
RH: That hasn't happened in recent years. It was a tradition when I was still a resident, but that tradition has passed.
DL: Have you taken any Sabbaticals?
RH: I did. I've taken one Sabbatical and I'm long overdue for the second. In 1986, I took a six-month Sabbatical. Four months of it was at Stanford. What I did was to set up our clinical database for mycosis fungoides. I retrieved all the old records and, in those pre-HIPAA days, I contacted patients and referring doctors and everybody possible whom I could identify from the old records to track down patients and get their follow up information. I set up what has become an important database for our program because we have mined that database for numerous studies, just as we previously mined the Hodgkin and non-Hodgkin databases, and we've expanded it over the years. I spent four months doing that and then our entire family went for two months to Europe. We spent a month in Paris and a month in London and what I did there was to spend some time at different hospitals and cancer centers where people were active in clinical trials for the lymphomas. Most of these visits were arranged through contacts I had made when people visited Stanford. At the same time, my family had the opportunity to sample life in a couple of major European capitals. It was great.
DL: You've had, I think, some important roles here at the campus in administrative jobs outside of the department. Could you tell us a little bit about that?
RH: Well, beyond being the chair, for a period of time I was essentially the acting medical director for the cancer center, although I did not take that title. That was before Steve Leibel was recruited to the position. This was around the time of the merger with UCSF. We had worked carefully with an architect to design an out-patient cancer center, which was under construction. There was renewed momentum for the cancer program at Stanford, with Charlotte Jacobs and Sarah Donaldson leading the way. In fact, Charlotte served as director of the cancer program for the merged UCSF-Stanford entity.
DL: The cancer director for both places?
RH: That's right. And then there was the de-merger. As a result of all the funds flow from south to north (Stanford to UCSF), we came out of the merger significantly disadvantaged financially. The administration decided a number of cuts were necessary and notable among those cuts was support for the cancer program director. The building was being built and there was a vacuum of leadership, so the dean said, "Rich, your department is intimately involved in the cancer program, you're going to be moving into this building. You should take on this responsibility." What was I going to say? So, I did it. I oversaw the transition to a new building as well as coordinating the whole spectrum of cancer center activities. This continued for about two years. I didn’t accept the title as “acting” because I didn't want them to think they had an excuse not to go ahead and recruit someone. Ultimately, Steve Leibel was the successful recruit for that position, but until he arrived, I had to deal with all the issues, trying to get people to work together, trying to figure out where they were going to fit in this building and get all of the programs running. Another significant administrative appointment I have had is to the Board of Directors of Stanford Hospital and Clinics, although my term is expiring this year.
DL: Weren't you also active on the UCSF-Stanford Board?
RH: No, but there were plenty of activities to keep me busy during the merger. We had meetings every Tuesday afternoon in the offices at Candlestick, the contracts committee, which I co-chaired, the operations committee, etc. You were part of that too, weren’t you, Ted?
TP: Yes, I was. I think they were weekly meetings.
RH: Right. Every week.
TP: That's why I retired as chairman. Can you tell us something about your hobbies? I know you love baseball.
RH: Well, I wish I had more time for hobbies. We do enjoy baseball and going to see the Giants play – we have season tickets, but usually only go to games on the weekends. We also have a season subscription for the San Francisco opera. We like San Francisco, we have a condo there, we can walk to the ferry building, the ballpark, and Union square.
TP: So how many children do you have?
RH: Two. Our daughter, Kristin, was born about ten days after my internship began, nine days to be exact. Bebe was pregnant during my internship and her due date was, we thought, some time in mid to late June. The plan was to have the baby and then I would travel to the West Coast for my internship, find a place for her to live, and then she would come out and join me. That wasn’t a great plan, and it didn't work out, anyway. What happened was that we got to the last week of June and she still hadn't delivered and the gynecologist said, "Oh, you've still got at least another week. Why don't you go with your husband to California?" So that’s what we did. Within 48 hours we were on a plane going to California with Bebe nine months' pregnant. We didn't have a place to stay once we got there, so we called up Zvi and Miriam and they loaned us an apartment to stay in until we found a place to live. Kristin was born on July 9. Of course, at that time I no longer had any medical insurance from New York and there were no COBRA plans, and we didn't have any insurance for a pre-existing condition in California, so we had no insurance coverage whatsoever for Bebe delivering a baby. But at that time doctors gave professional courtesy and the hospital wrote off its portion since I was on the house staff. Our son Brad was born four years later, days just before the end of my residency, on June 14. I started my job on the faculty two weeks later. So, our two children’s births marked the beginning and end of my residency.
TP: And what is Kristin doing?
RH: Kristin is a teacher. She teaches middle school in San Jose, math for the most part, but she's taught history, leadership, and computers as well. She's currently in the eighth month of her second pregnancy.
TP: So, you're a grandfather.
RH: Yes, I have a granddaughter, Carmen, who turns three in February, and we'll have another granddaughter in May.
DL: And Brad, for the record?
RH: Brad is finishing up his residency in radiation oncology at Sloan-Kettering. He's engaged to be married in August to Sonia Coto, who is a therapist at Sloan-Kettering. They're getting married in Portugal in Arcos de Valdevez, which is an hour or so outside of Porto. Brad’s first job is at the proton therapy center in Jacksonville, University of Florida.
DL: That should be fun.
RH: Yeah, he can teach me a few things.
DL: Do you have any favorite sayings? It's part of our routine.
RH: Oh, favorite sayings? Yes. This relates to radiation oncology, and I use this in different contexts depending on whom I'm talking to, and I even sneak it into publications, whenever possible, namely, that “radiation therapy is the most effective single agent for the treatment of cancer.” I especially like to use that when I'm talking to the medical oncologists. I even included it as a multiple-choice question on a radiation oncology in-service exam many years ago – hopefully all the residents got that one right!
TP: That's good. Anything else that you want to add? We didn't get to honors.
RH: I’ve been privileged to have a number of leadership opportunities in ASTRO, and I consider those to have been an honor - to have been President and Board Chair. Being nominated to be a Trustee of the ABR was an honor. A great honor at Stanford, in addition to being Chair of the Department, was being awarded the Henry Kaplan professorship, technically the Henry S. Kaplan - Harry Lebeson Professorship in Cancer Biology. Harry Lebeson was Henry Kaplan's father-in-law, and he funded a large portion of the professorship. So that's a really important honor. And then beyond that, certainly the key ones would have to be the ASTRO Gold Medal and the Janeway Award from the Radium Society. But I'd say honors that are attached to people's names have special significance. I was invited to give the Vera Peters lecture several years ago at the Princess Margaret Hospital, which was very special, since Vera was a pioneer in the treatment of Hodgkin lymphoma. I received the Robert Reid Newell Award from the Department of Radiology at Stanford while I was a resident. I shared the award with Reed Dunnick who is currently the Chair of Radiology at the University of Michigan. Robert Reid Newell directed the Radiology service at Stanford before Henry Kaplan was recruited to become Chair. I gave the John Ultmann lecture at the International Hodgkin’s disease symposium; I delivered the Richard King lecture at the Medical College of Virginia. You probably knew Richard King.
TP: Oh, yeah.
RH: Actually, the only time that I met Richard King was when he was one of my three examiners for the oral exam of the ABR. Fortunately, I passed! And I was honored just two days ago to get a call from Mack Roach, inviting me to give the Franz Buschke lecture this year. I remember being at one of the first Buschke lectures, when Henry Kaplan was the awardee. As I recall it was not linked to a meeting, so the lecture was in a small classroom, not a large lecture hall. But Dr. Bushke was there.
TP: When we first started having them on the campus, the first few were held in one of the pie-shaped rooms. Then it moved to a hotel there.
RH: Right, right. So, I can say that I have a connection there since I did meet Dr. Buschke on that occasion and I was at that first Buschke lecture, and I had the pleasure of meeting Vera Peters before she died, that was also special. All of these honors are doubly special when it's named after someone you know!
RH: I was born in Brooklyn, at least that’s where the hospital was located, but my parents actually lived in Astoria, Queens. Our family physician was in Brooklyn, so that’s the explanation for the hospital location. I spent the first six years of my life in Astoria, and then my parents moved to Seaford, Long Island, which is on the south shore, not far from Jones Beach. That’s where I lived growing up until I graduated from high school. My father still lives there, in the same house.
DL: Were you a good student in grade school or junior high school, high school? Was it obvious that you were going to go on to college?
RH: Yes, I was academically oriented throughout. I was always in the honors class and all that stuff, but I didn’t wear a pocket protector!
DL: Was it a public high school?
RH: Yes, Douglas MacArthur High School, in Levittown.
DL: Did you have an interest in medicine at that time?
RH: I had it from some early time, so long ago that I can't remember exactly when. I can only guess that it must have had something to do with influence of the family doctor, experience in a hospital for an appendectomy when I was in third grade, or something like that. There were no physicians in my family. In fact, although my mother graduated from high school no one in my family had graduated from high school until my older brother did, a couple of years before I did.
DL: But your parents wanted you to get more education.
RH: Oh, absolutely. It was expected.
DL: When was the last time you looked at a picture of yourself in your high school yearbook?
RH: Many years.
DL: Does it have anything like destined for or whatever?
RH: No, we didn't do that. But I was the editor of the yearbook!
DL: You must have had a couple of pictures of yourself.
RH: Yes, I did. One was the usual mug shot. It listed our activities, but we didn’t have “most likely to succeed” or “best dressed” or things like that.
DL: So you finished high school and you applied for college.
RH: Right.
DL: Where did you go?
RH: Cornell, in Ithaca, New York.
DL: Why Cornell?
RH: Again, I can't remember exactly what, but something turned me on about it - it was a popular place to apply to from people growing up on Long Island because it wasn't too far away, but it was still far enough away. Also, it had an excellent reputation, especially in the sciences, which by then I realized was my strong suit. I remember driving up there to visit with my parents. We drove up and back in the same day, about ten hours in the car and a few hours on the campus! I liked the place, and decided to apply there with early decision, and I got in. So, it was the only college I applied to. It was great because I found out where I was going to be going before my other classmates in high school.
DL: Were you in a fraternity?
RH: At Cornell? Yes. Phi Sigma Kappa.
DL: Where are they located?
RH: On University Avenue, corner of Stewart, not far from where the men’s dorms were then located. It's a big white house with tall columns out front.
DL: Do you still maintain relations with some of your fraternity brothers?
RH: Yes, mainly Christmas cards. Sometimes I’ll be contacted around the time of a reunion.
DL: You were a declared premed major at Cornell?
RH: Well, premed was not a major there. Most premeds majored in a biology-related field. You just had to make sure you fulfilled all the premed requirements.
DL: So, what was your major?
RH: My major started out as zoology and then it became biological sciences.
DL: You had to take chemistry as well.
RH: Oh, sure. I took all the courses that were required for premeds, as well as those that were required for my major. I took the entire chemistry sequence through organic chemistry, and physics for a couple of years etc.
DL: Did you have to get a scholarship to go to Cornell?
RH: It wasn’t required, but I did have several.
DL: Did your family have enough money for you to go?
RH: Well, they would have done it, even if they had to go into debt, but I was fortunate, I did get a New York State Reagents scholarship, another Cornell award, and I had a student loan, with payments I was able to stretch out over a long period of time. I also had a small scholarship from my high school that was established in honor of a girl who was a classmate of mine, whom I actually had dated, who died of leukemia when she was in eighth grade. The funds that were raised in her memory were set aside for a scholarship in her honor. I also worked in the library at Cornell. The first year I worked in the rare book collection. They taught me how to do some minor restoration work, and I spent a lot of time shelving books that people had taken out from the collection. That was great, because I could just roam around and peruse the rare and old books.
DL: So, you completed college and then what were your options? What was the decision you made that that point?
RH: I tried to do as well as possible in college, and medical school was always in my sight, so I took the exams, and on schedule sent in my applications. I covered a pretty broad territory along the East Coast when I was applying to medical school. I can remember applying to Yale and Hopkins and Cornell specifically, and I think I applied to others as well. Cornell Medical School was a popular option for Cornell undergrads because it was in Manhattan, not on the Ithaca campus, and there was the perception that Cornell undergrads might be given preference for admission. You could remain a part of the Cornell family, but it was in a much different place, more appropriate, of course, for a medical school.
DL: You ended up going to Cornell.
RH: Yes, I got into Cornell. I honestly don't remember whether I got into the others, but I dropped those applications and went to Cornell.
DL: At this point in time, did you have a notion of what kind of physician you were going to be?
RH: Absolutely not.
DL: What were you thinking? Just anything?
RH: No idea.
DL: See what happened as time went by?
RH: I figured something would capture my fancy.
DL: What were your favorite rotations, clinical rotations in medical school?
RH: I enjoyed pathology. I enjoyed radiology. Some of the medical sub-specialties, GI, neurology. Not particularly any of the surgical disciplines.
DL: Did you live in the city or at home?
RH: I lived in Manhattan, the first year in the dorms. Then Bebe and I got married, between the first and second year, and I moved next door. They had apartments for married students, so we lived in a studio apartment there, until I graduated from medical school.
DL: So, you were right across the street from Sloan-Kettering this whole time.
RH: Right.
DL: Did that have an influence on your subsequent career?
RH: Well, it may have, because I took several electives at Memorial Hospital. I had a GI elective with Paul Sherlock and Sidney Winawer, a pain management elective and ultimately, a radiation oncology elective, but that's another part of the story. I guess it was cancer that caught my fancy and influenced my career direction.
DL: So, let's find out, now, how you got interested in radiation oncology. Was that after medical school was totally completed or during medical school?
RH: It was during medical school, and it's a long story.DL: Good. That's the most enjoyable thing in these interviews.
RH: Okay, I'll give it a try. There was a woman on her way from Israel to California with her husband, a physician, who was also Israeli. They stopped over in New York, in Forest Hills specifically, because they had some friends who lived there. The woman was in a shop, and she heard some other women speaking Polish. The Israeli woman was born in Poland and emigrated to Israel after the war, so she understood their conversation. She also recalled that she has an aunt, also born in Poland, with whom she had lost contact, and who was living somewhere in Forest Hills. So, the Israeli woman approached the women who were speaking Polish, and asked, "Do you know Rega Hanna?" and the woman said, "Oh, yes. I know Rega. She lives on Yellowstone Boulevard, and I'll give you her phone number." So the woman from Israel called her aunt, Rega, who said, '"Oh, that's wonderful that you're here. Why don't you come to dinner and I will invite my daughter and son-in-law to come to dinner as well. He's in medical school and he can talk with your husband."
It turned out that the Israeli woman was Miriam Fuks, married to Zvi Fuks, and Rega Hanna was my mother-in-law! Bebe and I took the subway out from Manhattan to Forest Hills and had dinner. I was on a pediatric rotation at the time, somewhat exhausted, but we made the trip and met the entire Fuks family – Zvi and Miriam and their kids Yaron and Tamar. We went back to Manhattan that night, not knowing how this would play out in later years.
DL: I believe he was on his way out to Stanford.
RH: That’s right. Henry Kaplan had arranged an appointment for him in the Radiology Department at Stanford.
DL: That was in 1969?
RH: No, the fall of 1968. Anyway, I forgot all about that evening. Then fast forward a couple of years. I was in my last year of medical school and thinking about where to go for internship and what to do for residency. I still hadn’t defined an area that I was interested in as a specialty. I just assumed neurology or GI or one of those medical subspecialties that I found interesting. At that time, everyone on the East coast wanted to go to the West Coast for internship or residency. I was no different, and it just so happened that the medical intern who was on the medical service where I was doing a subinternship had been a medical student at Stanford. He told me, "Well, if you want to go out to the West Coast and look around at internships and residencies, you can travel up and down the coast, take an elective in radiology at Stanford and you'll have plenty of free time." So that sounded good and a good friend of mine from med school had gone out to Stanford for most of the year taking different electives. I told Bebe about this, and she was supportive. She thought it would be great to try a new place, and so I called up Les Zatz in Radiology at Stanford, the person who this medical intern had suggested, asking about doing a visiting clerkship. Les said, "Sure, fine. When do you want to come?" We had two-month electives at that time and I said, well, I can come on such-and-such a date, and he said, "Fine." And that was that.
The next issue to resolve was where I would stay once I got to Stanford. I mentioned I had this friend who was out here somewhere, and I tried to contact him. I don't know if I sent him a letter or whatever, and I asked him to find me a place to stay and he said he would, but then I never heard back from him. And the time was getting closer and closer to when I was going to be coming out to Stanford, and I mentioned this to my mother-in-law and she said, "Oh, well, you know, Zvi is somewhere in California. I'll try to find out where." So, she called her cousin in Israel, Miriam's mother, Zvi's mother-in-law, to find out where Zvi and Miriam were. She found out that he was at Stanford. We got the contact information and got a hold of Zvi. So, it turned out that not only was he in California, but he was at Stanford, and not only was he at Stanford, but he was in the Department of Radiology!
So, Zvi picked me up at the airport and brought me back to his house, and I stayed on a couch in his living room for a few days until I found a room to rent in someone’s house. But on the first Monday I was there I came into the Radiology Department and was informed that the clerkship rotation didn’t start for another two weeks. I told this to Zvi, who said, "Oh, well, why don't you just spend the time with me in radiation therapy?" And that’s what I did. I spent a brief two weeks in radiation therapy. But that was enough. I spent the time with Zvi and he turned me on to the specialty. And that was a very special time because Henry Kaplan was there, also Mal Bagshaw and Bob Stewart, and Joe Kriss in Nuclear Medicine, Ron Castellino and other notables in diagnostic radiology. Ron was the preceptor for my radiology clerkship. And since I knew Zvi, we sometimes had lunch together with Mal and some of the other faculty in radiation therapy or would go to the Stanford football games together (that was one of the years that Stanford went to the Rose Bowl – and won). Also, I vividly recall the Monday afternoon lymphoma clinic with Saul Rosenberg. Toward the end of those two months at Stanford, I came down with a bad pneumonia and was admitted as an in-patient to the student health center. I was hospitalized for a couple of days, but by that time I realized that radiation therapy was the field for me. I was interested in it, not simply because of the technology, but for the cancer care part of it, oncology was a fascinating discipline, and radiation was such an effective modality.
I went back to Cornell, and decided I should make sure that this is what I really wanted to do. I took a clerkship at Memorial Hospital, where Giulio D'Angio was the Chair at the time. This confirmed for me that radiation therapy was the correct choice. It was now the spring of my senior year, and I started to apply for radiation therapy residency programs. I sent an application to Stanford and fortunately they didn't require I come out for an interview. But I did fly down to MD Anderson where I remember meeting Gilbert Fletcher and Joe Castro. I also met Herman Suit, who was still there, and Herman said, "Would you be interested in going to Boston?" I interviewed at a couple of other places around New York, but Stanford continued to hold a special attraction.
Then, as I recall, it was on Father's Day, and Bebe and I were driving through New England on the weekend. I called my father to wish him Happy Father’s Day and he told me that Dr. Bagshaw had called and left a message that I should contact him. I did, and Mal offered me a residency position at Stanford. I accepted on the spot.
DL: Given your choices and possibilities, was it clear at the time?
RH: No question in my mind from that two-month experience that I had that Stanford was just a fabulous place.
DL: So, who was in your residency class?
RH: There were five in our class. Mike Chen, who joined the faculty at Yale, later the Mayo Clinic, and is now retired. The other three went into private practice – Rich Carmel, Ed Gilbert, and Steve Weller.
DL: Was it clear from the outset that some were destined for private practice and others for academics?
RH: It was a time of fabulous opportunity for young people in the specialty. There was such demand for graduates of good programs you could almost write your ticket. I think any of us could have differentiated in any direction. I think our choices were largely based on geographical preferences.
DL: When did you start your residency?
RH: In '72.
DL: The same year as Steve Leibel?
RH: Yes, I think we were in the same year.
DL: What happened between medical school and residency?
RH: Well, for starters, Bebe and I were married between first and second year of medical school. Then I decided I wanted to go to Stanford for my residency. Knowing we would likely move west, we decided we may as well stay in New York for one more year, so I matched with an internship program at North Shore Hospital and Memorial. It was a combined program where we spent nine months at North Shore Hospital in Manhasset and three months at Memorial Hospital. At the time they were both Cornell-cooperating hospitals.
DL: Was it straight medicine?
RH: Yes, it was. And in fact, it was for the full residency, so at some point I had to tell them that I was only going to be staying for that internship year.
DL: They put you in the ER for the rest of the year?
RH: Not quite, but after that I felt somewhat persona non grata. The Memorial part of the experience was great because, again, there were fabulous people there at the time, Jerry Posner in neurology - he's still there - Paul Sherlock and Sidney Winawer, as well as a number of notable oncologists and surgeons including ** It was the beginning of cis-platinum and bleomycin. I remember particularly the patients who had been on the early trials of cis-platinum - they all developed serious hearing defects. Dan Ihde was there as a resident and a number of other people who subsequently had important careers in oncology. The types of patients we were taking care of were truly fascinating - interesting physical findings and X-ray findings. Actually, I enjoyed that three months at Memorial much more than the nine months I had on the medical service at North Shore.
DL: You've written hundreds of papers. What was the first radiation oncology paper that had your name on it?
RH: The first radiation oncology paper that had my name on it was on nasopharynx cancer. Like all residents at that time during residency, I was looking for a project and the one that I settled on was the Stanford experience treating nasopharynx cancer. It must have been because I saw a patient with nasopharynx cancer and thought we must have hundreds of cases since the last Stanford review. So that's the project I settled on. I had all the charts pulled, I abstracted all the data, analyzed it by hand, including the Berkson-Gage actuarial curves, and I presented it at the ASTRO meeting in 1975, at the Hyatt Regency in San Francisco. That was the first paper I published.
DL: So, you started in nasopharynx, but what led to your interest in lymphoma?
RH: Another long story. I finished my residency, and I was looking around at jobs. At first it didn't seem like there was going to be a job available at Stanford, so I checked out other opportunities. I recall going back to Yale to look at an opportunity there. Then, sometime in May, Mal Bagshaw said, "Oh, I think we will have a job for you at Stanford, but I'm not sure what you'll to be doing other than taking care of patients with mycosis fungoides." This was because Zvi had run the MF program, and when he left, John Earle took it over, but now John was leaving to become Chair at Mayo clinic, in Rochester. Mal said, "We don't have anybody to do MF, so you must do MF if you want this job. Other than that, I don't know what." So, I said okay!
So, at first, I took care of all the patients with MF and beyond that it was just miscellaneous, helping out where needed. Don Goffinet was involved in the non-Hodgkin lymphoma program, but he was getting busier and busier with head and neck, so I started doing some non-Hodgkin lymphoma. Don had given a refresher course on non-Hodgkin’s lymphoma at the RSNA each year, and the ASTR (now ASTRO) decided to have refresher courses at their meeting. Don decided to focus his activity on head and neck cancer and offered me the non-Hodgkin opportunity, which I enthusiastically accepted, taking responsibility for the refresher course at ASTR for several years beginning in **.
At that point, I became the third person in line for lymphoma patients in the Department at Stanford. There was Henry Kaplan, Eli Glatstein and me. I was third man up to see patients with lymphoma, mostly when both Kaplan and Glatstein were out of town! But after a couple of years, Eli was recruited to go to the NCI. Just before this, at a time when there was heated controversy regarding the classification systems being used world-wide for the non-Hodgkin lymphomas, Eli had been awarded a contract from the NCI to evaluate the different classifications. This was to include having expert pathologists from around the world look at consecutive slides from biopsies of patients with lymphoma at major clinical centers, use their own systems to classify the material, and correlate it with clinical outcomes. There were to be six expert pathologists and six panel pathologists, all reviewing the same slides at each clinical center. The experts classified slides according to their own system and the panel pathologists used all classification systems. A random group of slides were reviewed twice, which would enable also both intra- and inter-pathologist agreement on interpretation.
So, there were Bob Lukes, Henry Rappaport, Karl Lennert, Ron Dorfman, Kristin Henry, Greg O’Conor as the expert pathologists. The clinical centers abstracted all the clinical information, treatment and outcome data for the same patients. Eli was to be the PI for this project and Stanford was to be the data center. The other clinical centers were Tufts University, the Tumor Institute in Milan and the University of Minnesota. But Eli decided to go to the NCI and he couldn’t take the project with him. Saul Rosenberg took over as PI, but he needed someone who could make a major investment of time on the program. That opportunity came my way. I was heavily involved in all aspects of the project – data review, analysis, meeting planning, manuscript preparation, etc. This was my true entrée to the lymphoma world. I met innumerable other “lymphomaniacs” and began to develop my own reputation by publication, presentation at meetings, and clinical practice. That project eventuated in what we called ”The Working Formulation of Non-Hodgkin’s Lymphoma for Clinical Usage.” Of course, the working formulation is now in the garbage can, it has been replaced, by a more scientifically valid classification scheme, but it served oncology well for quite some time.
DL: It was a salient piece of work.
RH: Thanks. So, I began to establish a reputation of my own, and then there was the unfortunate circumstance of Henry Kaplan getting ill and dying, which left me at the head of the table for lymphoma patients at Stanford, working closely with Saul Rosenberg, and helping to develop the new generations of clinical trials for lymphoma. Then, for a period of several years, together with the residents I mined our database. Virtually every resident who came through the program wrote a paper with me related to some aspect of lymphoma. We looked at a host of issues, usually sparked by a patient we saw and wondering, well, what has our experience really been with that?
DL: You've had leadership positions. Tell us about some of your honors.
RH: It was an honor to be in all those leadership positions. You both share those same experiences. First there was ASTRO. I was elected President early during the years of contested elections. That was nerve-racking, to say the least.
DL: What year were you President . . . in '97?
RH: Yes, in '97.
DL: And who was president before you?
RH: Steve Leibel. Steve was president the year before me and Jay Harris the year before that.
DL: Were those all contested?
RH: Yes. I think the first contested election was won by Frank Wilson. Or maybe it was Jay Harris, who was next. He ran against Allan Lichter but Jay won. Then Steve and then me.
DL: Who did you run against?
RH: I ran against Dave Hussey. I was calculating in my mind that M. D. Anderson was Dave’s alma mater, and they had a lot more people, so I was surprised to win the election.
DL: Did any loser ever come back to win?
RH: Yes, Dave Hussey.
DL: Oh, Dave did. Okay. And Tim Williams, the current incoming President. He had lost a few years ago. So those two, I think.
RH: Yes, I don't know of any others. Some people have lost twice, unfortunately, Paul Wallner lost twice.
DL: What were the important things that happened during your reign as head of ASTRO?
RH: Just after my election, when I came on the Board, as President-Elect, with Steve as President and Jay as Chairman of the Board, was the point where we had the sudden break-up with ACR. ACR had been providing all the administrative services for ASTRO and Nick Croce, who was the person handling ASTRO for the ACR was booted out, so we were left without administrative leadership. Also, at about that time, the ACR contract to manage ASTRO was about to expire. So, I was coming in as President, ACR still had another year or so in its contract to manage us, and Steve Leibel initiated a strategic planning process, to decide where ASTRO would be going as an organization. So, for some period, it was the elected officers of the Board, Steve and myself, Jay as ex-president, later Larry Kun and then Chris Rose who were trying to run the show in every respect, until we could reorganize and arrange for administrative support. It was a tough time until we could get that all settled. In fact, it took a good few years. It wasn't until I was halfway through my term as Chair of the Board when we finally hired Frank Malouff to come on as the Executive Director.
DL: It was a necessary step, in retrospect, essential to allow ASTRO to truly flourish.
RH: Yes. It was a major step. And a major responsibility for all of us who were involved.
DL: During those years, didn't ACR provide you with any support?
RH: Yes, they did. Greg Robinson was an ACR employee and provided us with some interim support, but this clearly wasn’t his forte. He may even have had the title of Acting Executive Director, I’m not sure. But he did provide some continuity. We also had some help from the meeting planning staff at ACR.
DL: Did you have to spend a lot of time back in Washington getting things organized?
RH: By that time, a lot of the activity was by email. It was difficult for me to spend a lot of time on the East Coast because of my responsibilities at Stanford. I had been Chair for only five years as and we were deep into the process of planning a new building and department.
DL: That was also the year of the UCSF-Stanford merger, wasn't it?
RH: No, that was a little bit later. Nevertheless, there was so much going on here that I couldn't be traveling across the country all the time. I was completing my first term as Chair at Stanford and preparing for an external review of our Department, so I needed to ensure that things were running well here. Also, Steve Leibel was still in New York. It was easier for him to travel to Virginia, so he could handle a lot of the responsibilities in the office, and certainly he did so while he was Chairman of the Board.
DL: You were mentored by some well-known people. You probably mentored a whole bunch of people yourself. Who were some of the people you've mentored and gone on to great things?
RH: Mentorship is often informal. Zvi was one of my important mentors, but there were others who were important to specific activities. I remember, for example, the first paper I wrote, that one on nasopharynx cancer. Mal was the senior author on that paper, but he would give his manuscripts for editing to his wife, Muriel, who was also a physician, because she was an excellent medical writer. And Kaplan’s detailed comments on my drafts were also fantastically helpful. He would go through generously with a red pen. I learned immensely from all the papers I wrote with him.
DL: When one of your residents writes a paper, do you use a red pen?
RH: I did. Now I use track changes! I like to think that I have mentored many of them with respect to their clinical writing skills.
DL: There's probably a whole lot that have gone on to successful careers.
RH: Yes, some have become Chairs of departments or program directors. But the person whom I have mentored most closely and for the longest time is not a radiation oncologist. It's Dr. Youn Kim, who is a professor of dermatology. In fact, she has endowed professorship, the Peter and Joanne Haas Professorship in Cutaneous Lymphoma Research. I have worked with her in our cutaneous lymphoma program since 1992, when she was an assistant professor.
DL: That must relate to your interest in mycosis fungoides.
RH: That’s right. Mycosis fungoides is what helped start my academic career. In 1976, when I joined the faculty, I was the designated radiation oncologist to oversee the MF program. Eugene Farber was the dermatologist of record, but there was a succession of young dermatologists who came to the program, and every few years there was somebody new. It was a revolving door of dermatologists and I was the clinician providing the continuity in the program. Finally, in '92, Gene Bauer, who was chair of dermatology at the time and would later become Dean of the School of Medicine, identified Youn Kim as a potential person to work with me. In the preceding two years, there was no full-time faculty dermatologist working in the program, but rather three community dermatologists who were rotating on the service. That was not acceptable. Anyway, Gene identified Youn Kim, early during her initial appointment as an Assistant Professor, as a potential partner. Youn came onboard and quickly educated herself on cutaneous lymphoma, and together we've had a quite productive collaboration. But writing papers was something she hadn't a lot of experience with. I remember giving her drafts back with the red ink in a similar fashion to the ones I had received from Kaplan. She talks about it still. But after a while there was less and less red ink on those papers, and now they’re nearly perfect! As time went on it became a true partnership, and ultimately, she was responsible for notable growth of the program, both in academic and clinical terms. We even have been successful with philanthropy, including funding for an endowed professorship, that she holds, and significant research support.
DL: With your visiting professorships, are there any memorable experiences?
RH: They've always been fun. I've loved to do it, but I haven't done as many in the last several years just because of so many service obligations in the institution and to national organizations.
DL: Tell us about teaching people, teaching residents and students and those kinds of interactions, pleasures and satisfaction of that kind of thing.
RH: That's one of the reasons I'm here. I enjoy immensely the interaction. I became residency program director after the departure of Dave Pistenmaa from our faculty, which was when I was still an Assistant Professor. I continued in that position after I became Chair, until I realized I couldn't do both, and Sarah Donaldson then took over as program director. I enjoyed it tremendously, and I enjoyed working with the residents. I've written a lot of papers with them. I've also enjoyed working with the medical students who have come through on our elective. We have a popular clerkship.
DL: At your graduation ceremony each year for the residents, do they tend to skewer the faculty?
RH: That hasn't happened in recent years. It was a tradition when I was still a resident, but that tradition has passed.
DL: Have you taken any Sabbaticals?
RH: I did. I've taken one Sabbatical and I'm long overdue for the second. In 1986, I took a six-month Sabbatical. Four months of it was at Stanford. What I did was to set up our clinical database for mycosis fungoides. I retrieved all the old records and, in those pre-HIPAA days, I contacted patients and referring doctors and everybody possible whom I could identify from the old records to track down patients and get their follow up information. I set up what has become an important database for our program because we have mined that database for numerous studies, just as we previously mined the Hodgkin and non-Hodgkin databases, and we've expanded it over the years. I spent four months doing that and then our entire family went for two months to Europe. We spent a month in Paris and a month in London and what I did there was to spend some time at different hospitals and cancer centers where people were active in clinical trials for the lymphomas. Most of these visits were arranged through contacts I had made when people visited Stanford. At the same time, my family had the opportunity to sample life in a couple of major European capitals. It was great.
DL: You've had, I think, some important roles here at the campus in administrative jobs outside of the department. Could you tell us a little bit about that?
RH: Well, beyond being the chair, for a period of time I was essentially the acting medical director for the cancer center, although I did not take that title. That was before Steve Leibel was recruited to the position. This was around the time of the merger with UCSF. We had worked carefully with an architect to design an out-patient cancer center, which was under construction. There was renewed momentum for the cancer program at Stanford, with Charlotte Jacobs and Sarah Donaldson leading the way. In fact, Charlotte served as director of the cancer program for the merged UCSF-Stanford entity.
DL: The cancer director for both places?
RH: That's right. And then there was the de-merger. As a result of all the funds flow from south to north (Stanford to UCSF), we came out of the merger significantly disadvantaged financially. The administration decided a number of cuts were necessary and notable among those cuts was support for the cancer program director. The building was being built and there was a vacuum of leadership, so the dean said, "Rich, your department is intimately involved in the cancer program, you're going to be moving into this building. You should take on this responsibility." What was I going to say? So, I did it. I oversaw the transition to a new building as well as coordinating the whole spectrum of cancer center activities. This continued for about two years. I didn’t accept the title as “acting” because I didn't want them to think they had an excuse not to go ahead and recruit someone. Ultimately, Steve Leibel was the successful recruit for that position, but until he arrived, I had to deal with all the issues, trying to get people to work together, trying to figure out where they were going to fit in this building and get all of the programs running. Another significant administrative appointment I have had is to the Board of Directors of Stanford Hospital and Clinics, although my term is expiring this year.
DL: Weren't you also active on the UCSF-Stanford Board?
RH: No, but there were plenty of activities to keep me busy during the merger. We had meetings every Tuesday afternoon in the offices at Candlestick, the contracts committee, which I co-chaired, the operations committee, etc. You were part of that too, weren’t you, Ted?
TP: Yes, I was. I think they were weekly meetings.
RH: Right. Every week.
TP: That's why I retired as chairman. Can you tell us something about your hobbies? I know you love baseball.
RH: Well, I wish I had more time for hobbies. We do enjoy baseball and going to see the Giants play – we have season tickets, but usually only go to games on the weekends. We also have a season subscription for the San Francisco opera. We like San Francisco, we have a condo there, we can walk to the ferry building, the ballpark, and Union square.
TP: So how many children do you have?
RH: Two. Our daughter, Kristin, was born about ten days after my internship began, nine days to be exact. Bebe was pregnant during my internship and her due date was, we thought, some time in mid to late June. The plan was to have the baby and then I would travel to the West Coast for my internship, find a place for her to live, and then she would come out and join me. That wasn’t a great plan, and it didn't work out, anyway. What happened was that we got to the last week of June and she still hadn't delivered and the gynecologist said, "Oh, you've still got at least another week. Why don't you go with your husband to California?" So that’s what we did. Within 48 hours we were on a plane going to California with Bebe nine months' pregnant. We didn't have a place to stay once we got there, so we called up Zvi and Miriam and they loaned us an apartment to stay in until we found a place to live. Kristin was born on July 9. Of course, at that time I no longer had any medical insurance from New York and there were no COBRA plans, and we didn't have any insurance for a pre-existing condition in California, so we had no insurance coverage whatsoever for Bebe delivering a baby. But at that time doctors gave professional courtesy and the hospital wrote off its portion since I was on the house staff. Our son Brad was born four years later, days just before the end of my residency, on June 14. I started my job on the faculty two weeks later. So, our two children’s births marked the beginning and end of my residency.
TP: And what is Kristin doing?
RH: Kristin is a teacher. She teaches middle school in San Jose, math for the most part, but she's taught history, leadership, and computers as well. She's currently in the eighth month of her second pregnancy.
TP: So, you're a grandfather.
RH: Yes, I have a granddaughter, Carmen, who turns three in February, and we'll have another granddaughter in May.
DL: And Brad, for the record?
RH: Brad is finishing up his residency in radiation oncology at Sloan-Kettering. He's engaged to be married in August to Sonia Coto, who is a therapist at Sloan-Kettering. They're getting married in Portugal in Arcos de Valdevez, which is an hour or so outside of Porto. Brad’s first job is at the proton therapy center in Jacksonville, University of Florida.
DL: That should be fun.
RH: Yeah, he can teach me a few things.
DL: Do you have any favorite sayings? It's part of our routine.
RH: Oh, favorite sayings? Yes. This relates to radiation oncology, and I use this in different contexts depending on whom I'm talking to, and I even sneak it into publications, whenever possible, namely, that “radiation therapy is the most effective single agent for the treatment of cancer.” I especially like to use that when I'm talking to the medical oncologists. I even included it as a multiple-choice question on a radiation oncology in-service exam many years ago – hopefully all the residents got that one right!
TP: That's good. Anything else that you want to add? We didn't get to honors.
RH: I’ve been privileged to have a number of leadership opportunities in ASTRO, and I consider those to have been an honor - to have been President and Board Chair. Being nominated to be a Trustee of the ABR was an honor. A great honor at Stanford, in addition to being Chair of the Department, was being awarded the Henry Kaplan professorship, technically the Henry S. Kaplan - Harry Lebeson Professorship in Cancer Biology. Harry Lebeson was Henry Kaplan's father-in-law, and he funded a large portion of the professorship. So that's a really important honor. And then beyond that, certainly the key ones would have to be the ASTRO Gold Medal and the Janeway Award from the Radium Society. But I'd say honors that are attached to people's names have special significance. I was invited to give the Vera Peters lecture several years ago at the Princess Margaret Hospital, which was very special, since Vera was a pioneer in the treatment of Hodgkin lymphoma. I received the Robert Reid Newell Award from the Department of Radiology at Stanford while I was a resident. I shared the award with Reed Dunnick who is currently the Chair of Radiology at the University of Michigan. Robert Reid Newell directed the Radiology service at Stanford before Henry Kaplan was recruited to become Chair. I gave the John Ultmann lecture at the International Hodgkin’s disease symposium; I delivered the Richard King lecture at the Medical College of Virginia. You probably knew Richard King.
TP: Oh, yeah.
RH: Actually, the only time that I met Richard King was when he was one of my three examiners for the oral exam of the ABR. Fortunately, I passed! And I was honored just two days ago to get a call from Mack Roach, inviting me to give the Franz Buschke lecture this year. I remember being at one of the first Buschke lectures, when Henry Kaplan was the awardee. As I recall it was not linked to a meeting, so the lecture was in a small classroom, not a large lecture hall. But Dr. Bushke was there.
TP: When we first started having them on the campus, the first few were held in one of the pie-shaped rooms. Then it moved to a hotel there.
RH: Right, right. So, I can say that I have a connection there since I did meet Dr. Buschke on that occasion and I was at that first Buschke lecture, and I had the pleasure of meeting Vera Peters before she died, that was also special. All of these honors are doubly special when it's named after someone you know!
