You’re the physician-in-chief at the University of Minnesota Masonic Children’s Hospital. You’re also involved in childhood cancer research. What does a typical day or week look like for you?
The days and weeks all vary a lot. Last week was spent doing work at our Children’s Oncology Group meeting in St. Louis. The focus for those 3 days was on pediatric oncology, our clinical trials operations, and planning for further research.
This week will be many more administrative meetings that will cover a wide variety of topics from clinic operations to academic recruitments. I continue to do my weekly clinic and to attend on the heme/onc service here at the University of Minnesota Masonic Children’s Hospital as well, so interspersed in all of this is clinical work.
You received your medical degree from Loma Linda University School of Medicine in 1981 and completed your residency in pediatrics at Baylor College of Medicine in 1984. From there, you completed an MPH in epidemiology and fellowship in hematology/oncology at the University of Minnesota in 1987. What drew you to pediatric hematology/oncology?
It is hard to give a single thing, but mostly was a process. In medical school the question was internal medicine or pediatrics. I was able to do a pediatric endocrine rotation at the Hospital for Sick Children in Toronto and a rheumatology rotation at Stanford early in my 4th year. These were both great places, and even better, I had friends in the cities I could stay with. At the end of it, I realized that the challenges of both were similar but what was different was how much I enjoyed working with children and families. Small changes early on can make huge changes later and that was exciting.
I went to my residency convinced I was going to do Peds Endocrine. While in Houston, I found I really enjoyed caring for the oncology population and was drawn to the research opportunities in oncology. The fit, for me, felt right and it’s a decision I’ve never regretted.
Over the 30+ years as an oncologist, I realize the great bonus of seeing kids you treated for cancer over 20 years ago now as adults with families of their own. You also remain continually aware of the cases that did not end with such a positive result and that drives the need to do better for the children we’ll see next week.
You’ve been selected for various awards and recognition over the past decade. Which award or accomplishment are you most proud of?
Receiving awards is nice, but really is only important if you’ve been a part of something that is bigger than you. I’m very proud to be a member of the faculty at the University of Minnesota. I go to work with great people every day. As the department head, I have a real opportunity and obligation to facilitate the work of this department across all of our missions. Medicine is a dynamic field and every day brings new challenges. Meeting those as a department is something we are all proud of.
Your research interests include the long-term effects of cancer therapy and occurrence of second malignancies following childhood cancer. What might pediatricians be interested in knowing about the research you have been or are currently involved with?
We study these late effects (including second cancers) to better understand how to either prevent them or, if we can’t do that, how to minimize the impact of those on our survivors as they move forward with the rest of their lives. We are making real progress in many areas. We’ve significantly decreased the risk of second cancers by limiting the use of radiation therapy. That’s great, but we’ve increased our use of chemotherapy in its place. We’re now trying to understand how chemotherapy agents may interact to increase risk.
As we move toward a better understanding of an individual’s genetic composition, we may find additional layers of interaction that could allow a much more individualized treatment plan that could minimize the risk of late effects and maximize the opportunity for cure. We’re not there yet, but it is getting closer.
Practicing pediatricians do need to know that children who are cancer survivors are at increased risk of chronic health conditions that can range from cardiovascular to neuro-cognitive problems. It is very important to connect those survivors to a “Long-Term Follow-up Clinic” to get a better understanding of those risks and what can be done to mitigate them.
There are many factors that affect children’s overall health and well-being. Which factors concern you most, and why?
We are not investing in children and families as much as we need to as a society. The gap between the haves and have-nots is getting larger and the children are on the wrong side of this. We’re wasting a huge resource by not putting resources here.
What do you enjoy most about your career?
The people I get to work with are dedicated and smart. There is an ongoing energy to move things forward.
What do you enjoy doing outside of work to build resiliency?
Exercise is a good relief and I really try to do something most days. I’ve been riding motorcycles since I was about 10 and that’s a good way to detach from work for a bit. Our sons are in New York and San Diego, so we enjoy some travel as well.