A CONVERSATION HITB HENRY S. KAPLAN

Interviews conducted December 7, 9 and 14, 1983 (&yvo'
                   &U&&t DpJL)

Q:    Let's begin with the history and see where it takes us.
Then I'll pose some specific questions.

A:

                                                              ') _.
I can't recall anymore all the dates with precision,

except that I arrived at Stanford on September 1, 1948. I have
been here a little over 35 years. Wally Sterling was appointed
President of Stanford the following year. By 1952, if my memory
is correct, Sterling had heard arguments on both sides of the
issue of moving the medical school t`rom San b'rancisco to the

main campus. He decided to form a committee, but instead of
picking its membership from among the old guard--which at the
time included people like Arthur Bloomfield in medicine, Harold
Faber in pediatrics and Emile Holman in su,rgery--he reached out
for some of the younger faculty of whom I was one. Indeed, I

was the youngest, because when I accepted the job at Stanford I

wasn't quite 30 years old. Incidentally, Bloomfield, Faber and
Holman had served on a committee which a year earlier had
rejected the idea of moving the school.
    We (the Sterling-appointed committee) met many times in
the evening, I remember, at very attractive places like the
Bohemian Club--places I had no knowledge of, and was quite
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I '

overwrought especially when I looked at the prices on the menu.

Lloyd Dinkelspiel who was then chairman of the board of

trustees was a committee member.

     We reviewed demographic charts with projections for

Santa Clara and San Mateo Counties and it was perfectly clear

that although we might initially have some paucity of patients

ultimately we would have more patients than we could ever have

in the city. That was, incidentally,  the basis upon which the

Faber committee had rejected the idea of the move--that there

weren't going to be enough patients. But it was a very static

view of things. The Faber committee didn't project forward into

the next decade or two. In addition, the old guard in the

medical school really were a bunch of pure clinicians, all very

good in their fields, but with essentially zero track record in

research or anything that could be remotely considered

research.  To them, therefore,  it meant nothing that the medical
school would be located on the main campus harking side by side,

with chemistry, biology, physiology, physics etc. Moreover, the

medical school was already a divided school: all the clinical

departments were at the hospital in the city, but there was a

small unit on campus that included anatomy, physiology,

pharmacology, and a so-called division of biochemistry in the

department of chemistry which was manned by two people, Hubert

Loring and Murray Luck. Their general attitude was that they

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condescended to teach medical students--it was a painful duty

for them. This was not a very satisfactory arrangement. Our

committee (which Sterling really ran, because he knew where he

was going) built a very strong case for the move and one of my

assignments was to build the general argument about the

increasing interdependence of the sciences and the increasing

scientific basis of medicine,  and the fact the medical school

could not flourish unless it was located in proximity to the

scientific departments of the main university.

     I might say parenthetically that all of this happened

in a way that was most painful for me, because we had a

stunning house high up on a hill in Sausalito, about a thousand

feet above the water, designed by Mario Corbett. It was like a

piece of sculpture. And I had labored long to develop the

landscape and so on. And I absolutely loved the place. But I

saw no alternative to the answer that the school must move down

if it were to try to become anything but a*third rate clinical

medical school. It was sort of second rate clinically then and

it would have slipped backward in time.

      So that is one set of memories and that decision was

firmly taken, and of course almost immediately there were howls

of outrage from people like Holman, Bloomfield and Faber. To a

degree they were all gentlemen and their howls were rather

restrained, but they were forceful. They kept after Wally,

through the alumni, saying this was the worst decision

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imaginable, it would mean the death of the medical school, and


so on. And I'd say Wally deserves a medal for the courage that

he showed in sticking with that decision.

Q:    Was there any indication at the time that the proposed
move of the medical school might not go through?

A:    There were circumstances that made the move happen,
which were ironic and ludicrous. For example, Yank Chandler,

who was a fine dean,  could not live with this decision. So he

resigned. I thought this was all right. It's an honorable way

to behave.  His successor, Windsor Cutting, a professor of

pharmacology, was chosen. That was a very bad choice, however.

Cutting wanted to build mediocrity. He wanted to build in the

absence of argument and debate. Those things were anathema to

him. In 1954 I went off on sabbatical and meanwhile I heard

that he had concluded this crazy deal with'the Veterans

Administration to construct a hospital near the campus. I also
heard they were going to woo the Palo Alto City Council that

planned to expand the Palo Alto Hospital (Hoover Pavillion).

Somebody had gotten the brilliant idea of building two
hospitals belonging to two different owners under one roof! And

this was Windsor, the great compromiser. And I think you know
the trouble that decision has given us and continues to do so

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to this present day.

     When I heard about it I was in Bethesda, Maryland. That

made me so upset that I sat down and wrote Windsor a long

letter explaining what I thought was wrong about the two

hospitals under one roof, and also about that separate deal

with the Veterans Administration Hospital five miles away on

campus.  My tone must have been very rough. As you know I am not

noted for being a diplomat. And in time I got  back a letter

from Windsor at  the National Cancer Institute where I was doing

my sabbatical, which in essence said, "Perhaps it's not

possible for you to be happy at Stanford and you should think

about going somewhere else." I was hurt by that but then I

considered the source and I decided that this man was so stupid

he couldn't understand my arguments.

     There was an intervening period, which seemed to last

forever, during which the medical school project was going

nowhere. While Cutting was down on the campus wheeling and
dealing, committing the faculty in ways that would pose great

difficulty,  I got a call from Wally Sterling asking if he could

see me privately. Much to my amazement he asked me what I

thought of Cutting as dean.  I said he was an embarrassment and

a catastrophy. And Wally said it had taken him much too long to

come around to the same point of view.  But he now felt that way

and he was going to ask Windsor Cutting to step down. He asked

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who did I think among the existing faculty would make a good

dean. I paused briefly and I said I thought it would be very

tough on him, because he didn't make decisions easily, but in
terms of having integrity and the respect of the faculty and

some dynamism, Robert Alway would be my choice. So Alway was
appointed acting dean initially for six months, and then Wally
decided he liked the way he worked with him, and made Alway

permanent dean.

     That was in 1957. Meanwhile, I had served as chairman
of the committee to find an architect. I had visited Eero
Saarinen in his offices in Bloomfield Hills and the
Owens-Skidmore-Merrill architectural firm and been taken to
lunch by an executive vice president and I knew immediately
that if we had signed up with Owens-Skidmore-Merrill, a huge

firm, there'd be some nameless, faceless person in the back
room doing our work while we would be dined and wined by the
brass out in front.  That was not what we wanted.

    We also interviewed local architects, one of whom tried
to use political influence to get the job. It was a difficult

business. In the end we had several groups of architects to

choose from. There were local architects who had built
buildings of distinction but had never done a hospital or a

medical school, there were the hospital architects as such, and
we ruled them out because we knew their imaginations were very

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limited. They worked from old formulas. That left us with a

group we called the great solo architects and that included

Saarinen,  Edward Stone,  and a man in Boston whose name I seem

to have obliterated but who was in that category.

    I was sent on a trip to interview these three gentlemen

and also to see the  Owens-Skidmore-Merrill people, and I

started with Bloomfield Hills where Saarinen lived. He was a

wonderful man, very kindly, soft-spoken, and he took me on a

personally escorted tour of the new General Motors technical

center which at that time was considered one of the wonders of

the architectural world, and yet had been designed essentially
by one man's firm--not a big outfit. I was deeply impressed
with Saarinen. When we got back to his office, he said, "I'm
very interested in your project. I have never designed a

hospital. There are of course guidebooks and brochures from the

Public Health  Service-- every architect has access to those. It
would be a great challenge to design a trul'y beautiful hospital

and medical school. But there is a problem."

     The problem,  Saarinen said, was that his firm was busy
designing a complete campus for some small university,
renovating the harbor of New Orleans and he went on describing

one project after another. The consequence of this is that he

could not leave his office. "If you decide that you want me to

work with you," he said, "then delegations of your faculty

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would have to fly to Bloomfield Hills every two or three weeks

to review progress and help refine our thinking."

    My heart sank on hearing this news. I knew his proposal

would be quite unacceptable to the faculty and it wouldn't

work. But I must tell you, Eero Saarinen was a fantastically

impressive figure. Unfortunately,  he died of a heart attack

sometime thereafter.  After this I went on to see the architect

in Boston.  I wasn't impressed with him and that's maybe why his

name doesn't register with me anymore. In successive days I

flew to New York and visited Owens-Skidmore-Merrill, and the

latter was exactly what I had expected. Some smooth-talking

vice president immediately was available to take me to lunch

and tell me all about their vast design, engineering resources

and so on. But it was really not what we wanted because we

would have gotten a carbon copy in slightly different size of

some of the other hospitals they had done and they had done

plenty.                                                 .

     Next I went to see  Edward Stone. When I arrived the

Chancellor of Vanderbilt University was there, finishing up a

visit. Stone had been doing some new large hall for Vanderbilt
and I looked at the design and it was just beautiful. When he

left, Stone and I sat down.  I told him about the scope of our

project. I asked him whether he had.ever done a hospital. He

had done two, one in Lima,  Peru-- a huge obstetrical hospital
which is still there and looks quite good-- and the University

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of Arkansas Hospital and Medical School which, he said, we were

welcome to visit. He had developed a very novel arrangement of

beds in relation to nursing units, which worked out quite well

and lent itself to a beautiful looking building. While we

talked,  I told him we were interested in building about a

400-bed hospital, a complete set of clinics, classrooms and

research laboratories. for students and faculty. He said, "If I

were offered this job, it would be the biggest single design

job that I have every undertaken in my life. I will put my New

York office on a skeleton force and I will move my family out

with me and I will guarantee to stay in the Palo Alto area for

no less than 18 months until the project is well off the

ground. After that I will make arrangements for continuing

supervision by one of my staff."

     The difference was so night and day that when I

returned I reported all this to the committee and they voted

unanimously to select Edward Stone. Then WAlly and the trustees

said the Palo Alto City Council members needed convincing and a

junket was arranged to Arkansas.  I went along and saw the

building. We were all most impressed and it was clear the

councilmen and the university were ready to give the job to Ed

Stone. It was at this point that he approached me and said

there was something he had to tell me. He said he was a member

of Alcoholics Anonymous,  but that he had not had a drink in

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several years. He said he didn't think he'd fall off the wagon

on this job, but he would not accept the offer unless Wally
Sterling knew this and was willing to make the offer in spite

of it.  Here was a man,  staring at more than $22 million worth

of buildings and willing to lay it all on the line because of

this question, which I thought showed great courage and

integrity.

Q:    What difficulties did Stone face in this project? I saw

some blueprints that looked different from what we now have.

Who changed his plans?

A:     I'm glad you asked that.  It brings up a very important

and absolutely true episode. Stone's original design for the

medical center included a vertical, high-rise hospital,

intersecting with a clinic building of four stories, and then
the medical school at the other end. It wou)d have taken a
totally different shape, saved miles of walking, and most of
all it would have cut down about 10 percent in personnel costs.

He took the plan to the board of trustees at the time David

Packard was head of the board.  And so help me God, Stone was

voted down on the grounds that no building on campus could be

taller than the Hoover Tower. That was it.

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      We went to the Stones' house that evening for dinner
and he was in despair. He had fought hard with the board on
that issue and he had lost.

      He said, "Henry, you watch and see. In the course of
time there will be thousands of people who will say this
goddamned thing is so spread out, and I have to walk my leg off

in it, and everyone of them will blame Ed Stone and not the

board of trustees." It is also not widely known that when the
hospital building committee wanted to save costs by deleting
the beautiful hanging gardens, Ed Stone shamed them out of it
by offering to pay for them out of his own pocket.
    I'd like to have that put straight.
    There's another item I must mention related to that
particular era. One problem, as I mentioned, was that the

Stanford trustees in their wisdom-- and of course they always do
things in their wisdom-- and the Palo Alto city fathers had
decided to build a hospital, owned by two different owners,

under one roof. This led to a curious kind of struggle. It was
clear that if there was to be a Palo Alto wing, there would be
a Palo Alto medical staff and a Stanford medical staff. That

was no problem, except when you got to Pathology and Radiology,
two services seldom duplicated in hospitals. There was an
agreement to unify Pathology because the doctor who ran the
pathology labs for the community was then retiring and it was
simple to ease him out and build a single, unified department.

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But in the case of Radiology there was Howard Jones and Robert

Brown as one group. They were already the established

diagnostic radiology people for the Palo Alto crowd, and there

were other demands beginning to surface from the Palo Alto

Medical Clinic radiologists for access to machines and space

and time, I was called to a hearing of the Palo Alto City

Council with a couple.of the university trustees of whom

Packard was one.

      The council asked me,  "Does it make sense to have two

departments of Diagnostic Radiology?" Apparently, nobody cared

about radiotherapy and nuclear medicine because they lost

m~pc=y .' a+ least in the way they were being practiced in Palo

Alto at that time. So the only issue that was a matter of

principle-- money being a matter of principle--was diagnostic

radiology.

     They asked me,  "Do you believe that there should be two
departments under one roof in this hospita< or do you feel they,

should be amalgamated into a larger, stronger department?"

     I knew what they were fishing for. They wanted me to be

the fall guy who would vote to throw Howard Jones and Robert

Brown into the street. Then I would have inherited 30 years of

hatred from the Palo Alto staff. And I said just as much.

     "First," I said,  "I don't believe in two departments of

diagnostic radiology under one roof in one hospital. But this

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isn't one hospital. This is two hospitals owned by two   owners.

If you can put up with anything as silly as that, then you
ought to be able to put up with something as silly as two
departments of diagnostic radiology."
    I knew some university people were very unhappy with me

for saying this, but certainly the Palo Alto medical staff were
relieved although none of them came up and thanked me. I might

say even to the present day, not a single one of them has

thanked me.

    Things became more complicated four weeks later. I got
a phone call from Windsor Cutting who was still a dean, so the
date of this episode must have been early 1957. He said David
Packard wanted to come up to San Francisco and have dinner with
the two of us. I accepted, went along to dinner and argued the
same thing all over again.and I thought I had made my point
convincingly and clearly and the whole matter was resolved. We
parted company very amicably. Then about tw,o days later I get a
call from Cutting saying, "Henry, it's been decided to unify
diagnostic radiology into one department after all."
    I said that was interesting and asked who decided that.
"Did you decide that?"

    Cutting replied the matter had been decided at the
trustee level and specifically by David Packard.

     I said, "Would you mind giving me his phone number, I'd
like to call him up." I was in the middle of a busy clinic full

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of patients when this happened.

     He said, "That's not necessary because David Packard is

right here in my office."

    Minutes later I marched into Cutting's office, still in

my white coat, and said to Packard, "Hello, David, I understand

you decided to unify the department of radiology after all."

    And he started out to explain and to apologize, and I
cut him off saying that he didn't have to explain all that to


me. I said you are the president of the board of trustees of

Stanford University. It's entirely within your power to make

that decision." And I added,  "But there are other decisions


that n~ec-7 makinG." I then took off my white coat. handed it to

him and said,  "For instance, there are a lot of patients down
in the radiology clinic in need of care. And you've just become
the chairman of the department of radiology by default. So you
better get on down there and start taking care of them."

      Packard was dumbstruck. He said "WhAt is all this?"

      I said, "It's very simple.  In any of these situations
there can be only one president of the board of trustees, there

can be only one chairman of radiology. Who is .it, you or me?"

     He took a long look at me,  I am sure he wanted to kill

me, but he handed me my white coat and said, "You are the

chairman and we'll do it your way."

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PART II

0:     It has been my impression since I came to Stanford

twenty years ago that the medical center is operating under
very restrictive financial conditions. The arguments being made
against building the hospital modernization program today, for
example, are the same made against constructing the Stone

building in the fifties. Do you share that impression?

A:     I don't know if this is well-known fact. But the

trustees of Stanford University had originally budgeted the
total sum of $6 million for the entire medical center

project-- a project that included a library, a medical school

building,  a hospital and clinics.  (The figure excluded the
budget committed by the city of Palo Alto for its hospital

wing). The budget incidentally was supplied to them by Windsor
Cutting and they accepted it! The final figure, of courser
turned out to be $22 million and that was accomplished by
leaving out one of the important buildings for the clinical
sciences which was eventually constructed four years later.

    It might be of interest to point out that in contrast
to these early years and based on my recent contacts,  our
trustees today are very much more on the ball. In those days
there was a lot of nepotism,  family connections and other

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factors that got you on the board.  So there were some people

who could be tycoons of industry, but who did not have the

brains to check a figure of $6 million to build such a large

enterprise. Moreover,  it's clear they would not have approved a

bigger budget. In a sense, therefore, this medical center and

school were built by mistake or by a ludicrous misunderstanding

of anticipated costs. This is an intriguing historical fact.

Q:    During your years as chairman you built a department of

radiology noted internationally. What was the secret behind

this development?

A:      When I became  department chairman in 1948 there was

not a single department of radiology in the world in which

there was any scientific research. The only thing being called

research for diagnostic radiologists was to sit on their butts

in front of a viewing box and look at film% and perhaps collect

one or-two cases of some rare malformation. That was the only

notion of research.

     I felt it was very important for therapeutic radiology

to have an experimental as well as a clinical research base. I

insisted on laboratory space from the start. We were housed in

a little corner of the old Lucy Stern Building in San

Francisco. We had very little space and at one time I made a

desperate attempt to persuade Dean Yank Chandler to give me

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additional space.  I pointed out that in the small space we had

there were 28,000 mice and three technicians and two

physicians, which added up to 28,005 breathing, living

organisms in a space of about 700 square feet. I made it clear

that this was not feasible. He laughed so hard that he gave me

the space I had asked for.

     In those days I had a mouse colony. I had inherited it

when I was at Yale from Lionel Strong. He was an anatomist and

geneticist who spent his entire time in his mouse laboratory.

He had hundreds of thousands of pure-bred mice that he used for

various kinds of research.  When I was recruited I had asked if

I could have a couple of shelves where I could keep my mice.

When I arrived at New Haven I was given a budget of $300 a year

to take care of my animals, which meant taking care of them

personally.  I cleaned the cages,  replacing the dirty with clean

sawdust, and put in fresh food and water. This mouse colony was
the original C-57 black strain developed b) a colleague of

Strong's named Clarence C. Little, the founder of the Jackson

Bal Harbor Laboratories.  These mice turned out to be

extraordinarily useful in our research and we have used them

ever since.

    I had taken this mouse colony to Bethesda during the

year I had spent there.  And then, after I had joined Stanford,

they arrived one night at the San Francisco airport from

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Bethesda, and my assistant Mary Brown and I were there at three
o'clock in the morning to receive them and see that they got

put to bed.

      In a sense, I had a laboratory from the start. I felt
intuitively that it was no good having a department chairman
make big speeches about how important research is and himself

do no research whatever. I felt on the contrary that in
radiology which was then so backward with respect to research,
the only way it would work was for me to see just as many

films, just as many patients as anybody else, and to be
chairman on top of that and do research. That would shame my
faculty into feeling that they too could and should do

research. Obviously, not everyone I selected turned out to be a

red-hot research man.  But in the course of time I weeded out

most of the ones that were not productive in both areas--the

laboratory and the bedside.

     Simultaneously, I took steps designed to advance our
field in a broader sense. In those days, Russell Morgan at
Johns Hopkins was an active researcher in the field, although
his specific work was in imaging and electronics.  We got
together and invited my former chief at Yale, Hugh Wilson, and
the radiology departments from the University of Chicago,
University of Rochester and University of Michigan. Our six
departments founded the Association of University Radiologists.

We met once a year by rotating the sessions at different

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institutions for two or three days. Papers presented at these

meetings had to be strictly on research and little by little

that organization grew to more than 100 departments and several

hundred radiologists. Russell Morgan was the first president

since he was senior to me, and I was the second.

     If I had to focus on some central theme in my

endeavors, you might say that I created the idea of doing

laboratory research in an academic department of radiology, and

I insisted on doing it myself, partly because I was interested
and because it closed off an escape hatch for other faculty

members who could have found excuses for not doing research.

Q:    What were the conditions in which you worked in those

early years?

A:     They were godawful. Our physical plant was

indescribably bad. There had been a famous'engineer at General

Electric named Snook. He had designed X-ray machines in the

192os, and Stanford had bought some of them. On the day I
arrived I observed that his machines had an extraordinary

feature--bare wires, carrying up to 200,000 volts, dangling

above the patient. We had three non-shock proof machines for
radiography and one other for fluoroscopy. I insisted that

money be provided to change all that, and the dean was as good

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as his word and it was changed.  But it took several months to

do it, and I had more nightmares than in all the rest of my
life put together, and every single one of those nightmares, no

matter what form they took, always ended in a brilliant

blue-white flash! Until we moved these machines out of the

department I just couldn't rest.

     In those days Henry Jones, now professor of radiology

in our department, and I were the entire faculty. He was loyal
enough to be willing to stick around on an instructor's salary
and work like a dog on Saturdays and Sundays to help get the

job done.  And I did the same.  I was finally able to recruit
somebody a year later and begin the process of bringing more
people in and weeding out those that lacked research

orientation.

     Meanwhile, by sheer luck, among three young residents
that I had inherited when I arrived was a young man named

Herbert Abrams. The other two residents wer,e good, hard-working
but not outstanding. But Herb was clearly special. Moreover, I
had the feeling that radiotherapy was such a shambles, a
disgrace physically, that I had to do something about it. So
when Herb finished his residency, I appointed him to an
assistant professorship and gave him more responsibility over
the diagnostic division which up to'that time I ran also. The

only specialty we didn't have was nuclear medicine. This was

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later created by Robert Newell, my predecessor who had resigned

the radiology chairmanship in order to do this. He was a very

sweet man who never interfered in what I was doing.

     When I think of the young faculty we recruit today--for

instance,  those we have attracted to staff the Structural

Biology program in the Fairchild Building--they were given

everything on a silver platter. We had to struggle for years

with an inadequate physical plant, even after those old

machines were replaced.

     Meanwhile, in the early fifties another development

became of overriding importance.  I began to hear cocktail party

conversations about an interesting new atom smasher being

developed on the campus by Bill Hansen and Edward Ginzton and

their colleagues. I became increasingly interested because of

the properties of this machine. In the fall of 1951 I asked

Yank Chandler to introduce me at a luncheon to Fred Terman who

was then head of the School of Electrical E;ngineering, Leonard

Schiff who was chairman of physics, and Edward Ginzton who in

the meantime had replaced Hansen who unfortunately had died of

pneumonia at an early age.  I met Ed for the first time at that

luncheon and, as you know, we have become lifelong friends.

     He and I spent our time at that luncheon talking about

the properties of the linear accelerator, and what we could do.

One of the nicest things about it was that you could get very

high energies out of it for a very low energy input. You

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accelerated electrons with these high energies, and you could

hit a heavy metal target and make them into X rays. I explained

to Ed that's what radiotherapists were for years dreaming

about. We needed much higher energies than we could possibly

get from the crude devices then available.

     Here was a microwave device which by the clever

positioning of the electron pulse-- just ahead of each microwave

peak-- could force that pulse to ride along the microwave at

almost the speed of light. The farther it went the greater

energy it got.  This sounded miraculous and I became convinced

that this was to become the radiotherapy machine of the future.

Mnt nnly had I convinced myself, but bv the end of that

luncheon I had convinced all of them. And so a committee of Ed

Ginzton and myself was formed to look into the possible

applications of the linear accelerator in radiotherapy. But

then sadly we ran into problems.
   There was an MIT professor whose name is no longer

important but who was a stockholder in the company that made

Van de Graaff machines. Every time we submitted a grant

application to the government he knocked it down. It took us

more than two years in the richest country on earth to raise
$150,000. Hard to believe. Of course, in those days I had no

wealthy contacts. It was strictly dealing with the American

Cancer Society and the National Institutes of Health. But with

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some additional help from the Office of Naval Research, we got

started. Ginzton was in charge of the design and construction

of the machine. I used to come to the campus from San Francisco

as often as I could, to meet with him and members of his staff

to see where things were. I participated, of course, most
actively in the clinical design because I was interested in
having a machine that was functional therapeutically, not just

a gadget.

     By 1955 we had our first linear accelerator for

radiation treatment finished.  We were about six months behind
the British who had built a machine totally different from


ours. The delay was, of course,  because of the time it took us

to raise the money. We began steps to have our machine
assembled in the department in San Francisco. But there was a

new problem.  Before we could assemble the six-million volt

machine, it was clear we had to have protection from its beam.
   Wally Sterling again came to our aid. He went to the
Irvine Foundation and they met with us. He made an impassioned
speech and I made an ordinary technical speech. At that time it
was publicly known that the medical school was preparing to
move to Palo Alto within four years. But I said to the Irvine
Foundation people that if they helped usI we could learn a
great deal in four years of work in'San Francisco, because the
techniques of treatment with this machine were different. "This

is like a rifle," I said. "Whereas the past machines had been

                   - 23 -


like shotguns. And we're going to have to learn our profession

all over again. We're going to have to work out technical

procedures that have never been done before. The opportunity to

have four years to do that before moving the machine was to us

crucial."

     The Irvine Foundation made a one-time gift of $75,000.

We built a tiny concrete pillbox into the hillside. It was

well-protected and had a hatch on top because we knew that

someday we would have to bring a crane along to pick that

machine right up through the ceiling and move it to Palo Alto.

     In January 1956 the installation of the machine was

completed and a team of physicists calibrated it. I should

mention here that all this time, if I hadn't given free rein to

Herb Abrams and Henry Jones to run diagnostic radiology, I

would not have been able to do all this. I was devoting my

efforts to patients,  to the work on the linear accelerator, and

to keeping my lab running.                       .


     The great day finally came and we were ready to turn on

the machine for a patient. The true story of what happened is

somewhat stranger than anything I could have made up. It was

quite unbelievable. We had had many bull sessions of what kind

of cancer patient would be our first referral. The very first

patient was a seven-month-old baby with retinoblastoma of the

only remaining eye, because surgeons had already removed the

- 24 -


tumor in the other eye. This was one of those genetically
determined tumors since his father had had it. I don't think I
will ever forget the puzzled look on the face of the garage
owner down on Fillmore Street when I asked him to borrow a

heavy duty automobile jack, and then explained that it was to
carry a huge block of lead with a pinhole in it, to enable us
to position that pinhole day-after-day for six weeks directly
opposite the tumor in the baby's eye while missing the lens and

the cornea. That boy is now in his twenties and doing very

well, with his vision in the treated eye intact.

Q:    Wasn't there some controversy generated by some San
Francisco doctors who had questioned the use ot the machine in

patients?

A:    That came mostly from a dirty bastard named Henry

Garland. He didn't believe in high energy X,rays. He was SO
cynical that he was once heard to say that the only reason he
would like to have a cobalt machine was not to use it in order
to prove to everybody that it wasn't essential. He was just a
private entrepreneur but he hated me because he had the feeling
that if I had not accepted the job at Stanford, he might have
been selected instead.  He had demanded at one time that he not
only be the chairman of radiology at Stanford, but be permitted

- 25 -


to continue with his private practice at 450 Sutter Street. And

the university would not agree to that.  And he felt that I had

pre-empted that possibility by accepting the chairmanship. So

he hated me with a passion. And he had a scurrilous tongue

which he used very freely. I dealt with him mostly by ignoring

him.  It worked.

0:    What do you think were the major milestones in your

work, not only in radiotherapy but also the biology of cancer?

A:     The fact that I was carrying a major laboratory program

made matters difficult, because it did not directly parallel

and support the clinical program. There was no easy way to do

that anyhow at the time. But I did begin to build up a group of

radiobiologists who could-try to understand the fundamental

mechanisms of radiation on patients. And we did develop an

unusually strong program of radiobiology at Stanford.
                                                         a

    - However, my own research started off with those mice.

I could induce lymphomas of the thymus in them with radiation.

At that time the absolute gospel was that this happened because

of mutation. We proved little by little that the mechanism

couldn't be mutation. And we succeeded in isolating a virus

from these mouse tumors which would induce exactly the same

lymphoma in unirradiated baby mice of the same strain. I called

that the radiation leukemia virus. We spent probably the better

                   - 26 -


part of the last 30 years trying to understand how that initial

exposure to radiation results in activation of such a virus.

Only just now do we have some extremely exciting leads. It's

curious that this work has gone from one end of my professional

life to the other, and is still very active and in an extremely

fascinating state.

     Without going into major technicalities, there are two

broad classes of these so-called retroviruses. There are the

ecotropic viruses which grow in the species of origin. If you

get a virus out of a mouse it will grow in mouse cells. If you

get a virus from human cells it will grow in human cells. Then,

some years ago, it was discovered that there is a very strange

class of a virus known as xenotropic, which comes out of a

mouse or other species, but the only strain on which it will

not grow is its own.  Yet it is clearly present in the genome
of the cells--you can prove that beyond any question.
   We have recently generated some strbng evidence showing

that in all of the virus-induced lymphomas a complete
infectious virus is present from day one when you first harvest

the tumor. That virus is ecotropic. However, when you take

successive radiation-induced lymphomas, you'll find some of
them will also produce virus which is ecotropic, will grow in

mouse cells and cause lymphomas in mice. But the great majority

of the radiation-induced thymic lymphomas seem to be devoid of

- 27 -


any sign of virus even though we know a virus is present. They
present no viral antigens, nothing that grows when there's

passage from cell to cell, and here is the great mystery.
    I should explain that when xenotropic viruses were

discovered, an all out effort was made to find what they do.
People thought maybe they induce certain types of tumors, but
nobody has ever induced a tumor with a complete infectious

xenotropic virus.

Q:    Did you find this discouraging?

A:     Marty Scott, one of Kirk Fry's students, has now shown
in about 15 consecutive radiation-induced lymphomas that a
radioactive probe, prepared from a specific region of the
envelope gene of a xenotropic virus, will detect in every
single one of them, without exception, an altered size of
messenger RNA. So far we have not found any,tumor that lacks
this messenger RNA. Currently, he is studying those messages
through cloning techniques. Since we have a tumor already in
existence by the time the message is detected, we suspect the
xenotropic message for just this short region of the viral
genome, the envelope gene, to be sufficient by itself to switch
on or induce the tumor. Then, by happenstance, there may be a
secondary event in which an ecotropic virus comes along in the
same mouse or the same tumor cells grown in culture, undergoes

- 28 -


recombination with this little bit of xenotropic virus and

rescues it,  so what comes out is a recombinant virus with a

small patch of xenotropic virus envelope gene in it, which

carries the message for tumor induction.

     If that secondary event happens, then you see virus. If
it doesn't happen, then you're looking at apparently virus-free

tumors. So we are dealing with a remarkable phenomenon which        -

appears to be an alternative to mutation. We know that it

applies not only to radiation but to certain chemical

carcinogens or leukemogens as well. I think our lab has been

the only one in the world to have been stubborn or foolish

enough to have stuck with this.  I don't know how globally
significant it's going to turn out to be, but I think we really

are now on the threshhold of breaking open this very

long-standing mystery.

Q:    Some years ago when we talked aboui this, you mentioned

how difficult it was to actually prove the existence of a human

cancer virus. But you said your gut feeling was that in fact
many lymphomas were induced by viruses. Can you comment?

A:    The implications here are very straight forward. You

don't have to have a virus in order to have a virus-induced

lymphoma. If you have that little bit of genetic information of

- 29 -


the specific type, that may be all that's needed. Humans have

few or no ecotropic viruses that could possibly come along and
rescue that bit so that you could fish it out and detect it.
Our discovery will lend force to that notion and open ways of
looking now for such subviral entities. Until recently I think
we've been looking at the wrong level. People were looking for
typical mouselike viruses and that just didn't work. It's much

more subtle than that.

Q:    Besides developing successful treatments for Hodgkin's
disease and the cancer virus work, what other milestones would

you include in your career?

A:    We made important contributions in several areas. One
point perhaps I should make in connection with your earlier
question of what makes for a good or great department is a
point I frequently stressed to our faculty., It was that no
matter'what they were doing in their research, no matter what

else was going on, it was a given that the quality of patient
care in the department had to be absolutely first class. We
would not undercut the quality of patient care just to find

more time for our research. You may remember I had some
memorable fights with Halsted Holman on issues relating to
that. That's a point worth stressing.

- 30 -


In 1956, shortly after we treated the infant with the

retinoblastoma, a urologist on our staff named James Ownby came

by- He was like a little boy with an electric train. He saw all

the red and green lights on our control panel and he was

fascinated. And he became eager to have one of his patients

treated on our machine.

    One day he asked if I'd be willing to treat a patient
with a large cancer of the prostate but with no known

metastasis. The man was unable to urinate and Ownby was

managing him with estrogens, an acceptable treatment at the

time.

    I told Ownby that I really didn't know whether we could
safely irradiate the prostantic tumor in such close proximity
to the urinary bladder and rectum. Nevertheless, he pleaded and

I started this patient on-treatment. Within a couple of weeks
he no longer needed his estrogen. He could urinate all right,

his prostate was down and was softer. We went on treating him
for several weeks and that patient lived for years. So Jim
Ownby began going up and down the area attending urological

meetings, and drumming up business for us and we treated large
numbers of patients with locally inoperable cancer of the

prostate. Malcolm Bagshaw arrived shortly after I treated the

first patient. As I got busier with Hodgkin's disease patients
I asked him to take over the prostate work which was growing in

volume.

- 31 -


We also evolved new techniques for treating cancer of

the nasopharynx, many of them with lymph node involvement.

These have resulted in survival data reported by Rich Hoppe

several years ago which, as far as I know, are still

unparalleled. We have, of course, done a great deal with cancer

of the larynx of different stages, and the overall result has

been very successful.. In cancer of the ovary our former

colleagues,  Zvi Fuks and Eli Glatstein, had devised a

completely new,  rather aggressive treatment that covers

essentially the entire abdominal surface. Their work has

resulted in improved survival in ovarian cancer. Similar data

were dev~lnped by .lohn Earle for testicular tumors, with cure

rates for some of these of 100 percent.

I would have to say in fairness that the recent

introduction of chemotherapy regimens, including & platinum,

have made an even greater impact on advanced testicular

                                                          o
cancers. Those are a few examples.

PART III

0:     How do you wish your research to evolve by those who

succeed you in the years ahead?

A:     That would depend on who is actually recruited, and

- 32 -


what his interests are.  But there is a case to be made for the

generation of human monoclonal antibodies to cancer-related

antigens.  If I were well, our program would be oriented in a
strong way toward trying to develop such antibodies. I know
this is exceedingly difficult. But antigens capable of
stimulating human lymphocytes do exist in many cancers, and
that would be the direction I would like to see followed. I

know  some of my young people want to continue with this

research as long as they can, and certainly for the next six

months or so. I see no reason why anything should interrupt

them. But after that a lot would depend on the status of our
laboratory funding and on the recruitment of a new endowed
professor who will presumably take over the lab. His interests,

I would presume, might be different.  I would expect a lot of
new, quite unrelated kinds. of things would come to the lab over

which I have no control. That's all I can say about the future
of our program.                                      .

0:    Where do you see radiotherapy going as a specialty?

A:    It's a tough situation. Many of the newer
radiobiological approaches have been tried. It's true some have

not been tried well and our own Norman Coleman and Martin Brown
want to do them really carefully. Nonetheless, there is a good
chance that the so-called radiosensitizers may not pan out as

- 33 -


an effective treatment.  If they do their work well, Coleman and

Brown will prove this point more conclusively than other people

have done already. There is a second area of hyperthermia

interacting with radiation, and Malcolm Bagshaw is very

interested. The underlying mechanisms of hyperthermia are not

well understood. They are being worked on carefully by people

like George Hahn and'others. They are making progress but they

do not know why hyperthermia works when it does and why it

fails.  Nonetheless, Bagshaw and others have acquired machines

that permit the introduction of heat deep within the body in a

more directed way. To the extent they can do that now will take


l'.,1T,  nnrs nf
-.'-A ---- -- the arguments that one couldn't. focus these beams

and get the heat directed to the tumor. It could be an enormous

success if this were true, but it could also fail. It's a

gamble.

Another area in which people are putting a lot of

effort now concerns radiosensitizers. I had been pushing this

idea for years, but no one has been listening.

Let me explain.  There are three classes of

radiosensitizers. One uses the oxygen effect, but I don't think
it will be very important. A second category uses

bromo-deoxyuridine,  a drug that has to be introduced into the

DNA of tumor cells in advance of radiation and must get in

quite uniformly. The radiosensitization is very powerful.   But

- 34 -


the usefulness of this approach is seriously limited by the
consideration that not every tumor cell makes DNA at the same

time.

    There's a third approach that doesn't depend on either

of these. That's the one that shows promise. It can best be
called radiosensitization through inhibition of enzymatic
repair. Radiation produces injury to tissues. A lot of that
injury is repaired almost instantaneously by enzymes. People
now finally are just beginning to look at the metabolic
pathways of the repair system and to consider the use of drugs
which can be introduced through a catheter during and after
radiotherapy. The drugs would block the repair in irradiated
tissues, but would have no effect at all on unirradiated

tissues. I see that as being a valid area for exploration in
radiotherapy.

    There's also renewed interest in the combined use of
external beam radiation and interstitial rqdiation. This
approach does less overall damage to the tissues while still
affording the same probability of eradicating the tumor. The
technique is used with the greatest effect in early breast

cancer. In that I think there will be a big development. We and
Harvard have been using it. The method makes it unnecessary to

remove all the breast. All one has to do is remove the small

lump. It's most appropriate for patients with very small lumps.

- 35 -


If one removes the lump surgically and then does external beam
radiotherapy and performs an interstitial implant, the
long-term cosmetic result on the breast is nearly
indistinguishable from that of the opposite unirradiated

breast.

    A more important consideration is that today many women
are so fearful of a lump when they discover it in their breasts
that they refuse to go to their doctors until the lump has
grown much bigger and their chances of a cure have been

seriously reduced. If they knew they did not have to lose a

breast, that merely removal of this little lump followed by the
radiation procedure would offer them exactly the same long-term
survival,. many more of them would come forward early. That

would change survival. I see this development gradually pushing
radical surgery for breast cancer into a much more restricted

frame. And that's good.

    Beyond that there are people talking about new machines

and types of beams-- neutron beam machines and negative pi


mesons-- but frankly at the moment I don't see any good

arguments in their favor.  There is a trial going on in
Switzerland using a Stanford design for a negative pi meson

machine that we would have liked to have here. If there is

anything to it, they will come up w'ith the hard data because
they are doing the work carefully and objectively.
    I don't appreciate any other major new thrusts in

                  - 36 -


radiotherapy that I can see, just as I see none in chemotherapy
except with the advent of new drugs that are really effective

and not too toxic. The last really good drug was & platinum,
introduced 12 or 15 years ago. That says to me that it isn't so
easy to find new drugs that really have a different mode of
action and are free of toxic effects.

     Vince de Vita, the director of the National Cancer

Institute, is and has to be, because of the nature of his job,

very optimistic that we will continue to push the frontiers of

cancer prognosis forward. I looked at this as dispassionately
as I could before I got sick, not just now when I could take an

unduly pessimistic view.  But even before that time I felt I
could really not see any major directions from which big
increments in the results in cancer therapy were going to come.

    Today there is a lot of excitement in oncogenes. It may
be that some brilliant molecular biologist will be smart enough
to figure out a way, not to put them back &here they belong,
because I don't think that would be feasible, but maybe to
neutralize the effects of their abnormal expression and "put
the cancer to sleep" so to speak. That I believe is a
possibility but it's obviously a very speculative one. And it's
going to take a long time.

    My overall perspective on the cancer problem, however,
is not very favorable except for those tumors that are due to

- 37 -


viruses where I think we can have a handle on the disease. It

could be possible to work through the virus to get at the viral
oncogene and hopefully to eliminate the virus from the tissue.
That would be a way of achieving cure. But we are only

beginning. We know very little so far about viruses in human


cancers. As I mentioned Bob Gallo has succeeded in identifying
a so-called HTLV human T-cell leukemia-lymphoma virus. This

virus occurs in a selected group of T-cell leukemias and
lymphomas in Southern Japan, the Caribbean basin, and adjacent
shores of North and South America. That's fascinating and

important, but it accounts for a very tiny amount of the total

problem. It certainly has nothing to do with cancer of the lung

or of the pancreas, for example.

     In the last 40 years the cure rate of cancer of the

pancreas has remained at l-percent. It has not even increased

to 2 percent. There, we see a measure of the challenge that

still exists. I, for one, am not smart enough to see where to
go to conquer cancer of the lung or pancreas or the esophagus,

some of the major killers. Overall, I come down on a somewhat

pessimistic side.

Q:    Why is it so difficult to develop effective treatments

against these particular cancers?

A:    The main answer is early metastasis. We know very

                   - 38 -


little about how metastasis really occurs within the human

body t except for general patterns of distribution. There are

researchers doing all sorts of fancy and elaborate research on

metastasis with mouse and rat tumors. They can isolate in

substrains of tumor cells certain genetic markers or other

traits and they know those cells will not metastasize at all.

In other tumors they find different genetic markers or traits

and they know they will metastasize very quickly. Every tumor,

however, is a mixture of all of these things, and so it's

likely to contain some cells that will metastasize.

      The rate of metastasis in a cancer of the skin is known

to be extremely slow.  It's for that reason that we achieve very

high cure rates.  We remove the tumor and it doesn't come back

anywhere else.  In lung cancer, instead of something close to a

100 percent cure rate,  the best that de Vita can report in his

newest data is 12 percent survival, and the best he can report

for pancreatic cancer is 1 percent. For cancer of the esophagus

the survival rate is somewhere between 5 and 10 percent. And

the answer is metastasis. These are silent areas, the tumors

tend to get rather large before they can be detected, and the
chance of metastasis is linked to the size and type of the

tumor and to its location. One reason that lung cancer is so
bad is that we are breathing 20 times a minute, and so we are

massaging the tumor as often.

- 39 -


0:     Are you concerned about the level of cancer research
funding? Are there areas of cancer research for which you'd
like to see more money spent?

A:    For some years viral oncology was underfunded after a
brief period of generous support. But then the environmental
carcinogenesis people jumped into the act and made big noises.
These are people like Bruce Ames of the University of

California, who argued that we must identify every mutagen in

the environment. Today we know that most mutagens are not
cancer inducing so that a lot of that thrust was false and

unwarranted. Agents that can break chromosomes or alter
chromosomal structure are much more dangerous. I suppose you
can refer to them as mutagens, but that definition to me is
outside the general meaning of the term, mutation. So
structural rearrangements of chromosomes afe meaningful in
cancer- and what brings them about is an important area of

future research.

As to funding, the biggest problem I see is the

politicization of the boards that are called upon to make final

decisions, at least at the federal level. Today, the National
Cancer Advisory Board is a heavily politicized body with
relatively little scientific competence. That was not true 15

- 40 -


or 20 years ago. I think each president in recent years has

carried this one step further, and Mr. Reagan has really done

it much more than before. Now, we have Republican businessmen

and Republican writers and conservative right-wing thinkers,

all of them pronouncing judgments on how funds for cancer

research should be allocated, while a tiny handful of very

frustrated, competent scientists on the board cannot get their

opinions through. I think that's the most dangerous thing. It

has not yet happened at the lower echelons of the National

Cancer Institute.  The boards of scientific counselors of the

different branches of the Institute are still made up entirely

of scientists and physicians, and they really function very

weii. Row iong this will last i don't know. Rut i know that de

Vita is much aware and concerned about this problem.

Q:    You mentioned recently that you have some yet to be

published important research. Can you tell me about it?
                                                          o

A:    We have developed two new sets of human monoclonal

antibodies. One of them protects against endotoxin, and thus

should contribute to a decreased mortality in gram-negative

sepsis, which is a major problem throughout the world. It's

estimated that in this country alone.there are about 100,000

cases a year, with about 35,000 deaths. In many instances

antibiotics not only don't help, but their use makes things

                   - 41 -


worse by causing the release of endotoxin from the bacteria as

they are killed. That in turn causes circulatory collapse and

shock.

     We have developed a highly potent broad spectrum

anti-endotoxin. Stanford has applied for patents, and we are

currently negotiating with some companies to select one or


more. We want to have this scaled up first and carry out

clinical trials,  then hopefully market it with the usual

royalty agreement with Stanford.  So that development will

generate royalty income to support research in the lab in the

future.

     The other set of antibodies we have developed are

directed against the blood group antigen Rh Type D, the major

Rh antigen. About 15 percent of people are Rh negative and 85

percent are Rh positive.  If an Rh negative woman is married to

an Rh positive man, there is a very strong chance that the

first progeny will be Rh positive. Some of the blood of that

baby during birth,  through the force of the delivery, somehow

finds its way into the maternal circulation so that now Rh

positive cells, which are foreign to the mother, are residing

in her circulation. And obviously it doesn't take long until

her immune system will make antibody to this antigen.

During subsequent pregnancies with Rh-positive

children, the process is repeated, stimulating an increasingly

- 42 -


strong response,  with more antibodies formed. These  antibodies

move across the placenta into the fetal circulation  now

destroying the red cells of the baby. The baby will develop

jaundice and be mentally retarded. Often the baby is born dead.

If the baby is born alive a technique of exchange transfusion
has been developed to save his life. Another way to prevent
this from happening though is to give the Rh-negative mother an
injection of serum containing powerful anti-Rh antibodies,
which sweeps the baby's red cells out of her system.

    Today in some countries there are extreme shortages of

immune serum. In this country there are about two of three
companies supplying immune serum, but their supplies are also

dwindling. 'I'nese companies often have to procure ~~;UIII~ tif their
blood products from people who may have hepatitis or AIDS,
whereas a monoclonal antibody is a pure substance.
    We are sending manuscripts of this work to the
Proceedings of the National Academy of Sciences very shortly.
                                                        .

Dr. Abe Braude at UC, San Diego, the chief of infectious

diseases, has worked with me on the anti-endotoxin project.

Q:    Let's go back to the question we left unanswered last
time. What role did you play in the recruitment of faculty
before the medical school moved to.the campus?

A:

My role had to do mainly with two faculty

             - 43 -


members-- Arthur Kornberg and Joshua Lederberg.
     With Arthur, his entire team of what was then the
department of medical microbiology at Washington University in
St. Louis came right along with him.  I suppose I can take some
of the credit for that. It happened this way. I had been
invited to Harvard to become the Cook Professor and Chairman of
Radiology of all the Harvard-affiliated hospitals. It was a
tempting offer and it came at a time when I was losing my
conviction that the new school when it moved down really would
become a first-class scientific school. I felt that way because
I saw no action on the part of anybody in the recruitment of a
new chairman for the department of biochemistry, which did not
exist except as a small division in the department of
chemistry, with a very limited research base.

     Fred Terman, who was then university provost, became
chairman of a search committee to recruit the biochemistry

chairman. I was beginning to lean more towArd accepting the
position at Harvard. Leonard Schiff, who was a very dear

personal friend, was then on sabbatical leave in Paris. He had
sent a very anguished telegram to Wally Sterling saying, "For
Christ's sake, do something, don't let this happen." In time I
was asked to come to the campus and see Terman. As we talked, I

was amazed by his negative attitude, because it was clear he
didn't think he could compete with Harvard. But I made it clear

- 44 -


I really didn't want anything for myself. I was already well on

the way to building a fine department. I didn't need anything

that I couldn't get in the normal course of events.

     I told him what I wanted--literally the word was

"playmates," intellectual playmates.  I said the medical school

had been so strongly clinically oriented--and I have no quarrel

with strong clinical care because I believe in it and I

practice it --but  I also believed in fundamental basic research

in order to make future care better than what we can do today.

I said,  for example, there's biochemistry. We've talked about

it now for two years,  but there has been no action that I know

of.

     On the contrary, T~LIN~IL Sbid, I  viii1  the chairman of the

search committee.  He reached in the drawer and he fished out a

list, and there was Arthur Kornberg's name at the top of the

list.

I said that's wonderful,  because Arthur is a dear
                                             s

friend and one of the greatest biochemists in the world. But 1.
added that having him on the top of the list and getting him to
come to Stanford are two different things. I said I hope you'll
pardon my being cynical,  but I've watched how Stanford does

some of its recruiting. Typically, from what I've been able to
observe in some other recent episodes, you wait until you hear
that the guy has been invited out to give a seminar at Berkeley

- 45 -


so that you won't have to pay his plane fare, and then you'll
invite him across the bay to the Farm and you'll talk to him
about the sunshine, the climate, and the bay and you won't
offer him any budget or any space, and then you won't
understand why he won't come.

    Terman turned kind of green, because this was a rough
way to talk to a provost and especially one as tight-laced as

Fred Terman. But I didn't give a damn, I had nothing to lose.

He said, "What would you like us to do?"

     I said, "I'd like you to invite Mrs. Kornberg with
Arthur on the first visit. I'd like them to come first class.
I'd like to have a car waiting for them at the airport,
preterably'a convertible.  Iid Pike them to have a suite at

Rickey's. All these are just creature comforts, but they make a
difference because they indicate the level of your interest.
Beyond that, I want you to promise him every square inch of
space and every dollar of budget that he asks for, because I

.

know Arthur well enough to know that he won't ask for more than.

he can use."

    As I got up to leave I said to Terman, "I'll make it
very simple for you. If you recruit Kornberg successfully' I'll

stay. If you fail, I'm going to Harvard." It was just as simple

as that.

Terman's jaw, of course, by this time was hanging kind

of slack..But he was as good as his word. A few days later

                   - 46 -


Arthur and Sylvie came out,  and before he returned he had

accepted the Stanford job.

     A few months after that I was returning to Stanford

from Bethesda by way of St.  Louis to offer whatever help I

could to Arthur in getting his department ready for the move

to

Stanford. There was a party that evening at Paul Berg's to

celebrate this great.new venture. Just as we walked in the

door,  the phone rang.  It was Lederberg wanting to speak to

Arthur.

    Lederberg simply wanted to know'what was going on at

Stanford.  "I was out there last year looking at a job in

biological sciences," he said. "It seemed like the same old

sleepy place as ever,  and I turned them down. But now I hear

that Henry is staying and you are going. I want to find out

what's happening to inject this degree of excitement."

     We took turns on the phone and talked about the new and

improved curriculum, outstanding students 'and so on, and Josh

said, "Gee, that sounds wonderful! I'd be very interested."

    I flew back to Stanford that night and the next morning

I went in to see Bob Alway. This time I didn't request, 1

demanded that he forthwith create a new department of genetics,

which didn't exist in the medical school, with Josh as

chairman. Alway had to dig down into some temporary dean's
funds in order to get it off the ground. Alway, to his

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ever-lasting credit, was never afraid of people who were

smarter than he was.  And he was not afraid to do battle with

the university administration if the issue seemed important

enough. That's how it happened. And, of course, the two Nobel

prizes came a year apart at just about that time. Because of

that, suddenly Stanford was catapulted literally from a second

or third rate clinical school into some kind of mysterious but

very exciting place that students thought of in the context of

Harvard.

     Subsequently, more faculty were recruited, some good,

some not so good.  We had, of course,  Avram Goldstein who was as

good as gold, a very strong effective leader. Alway was dean

and was doing a good job.  But one or our most terrible mistakes

that started us on the road to losing our momentum was the

selection of David Hamburg as professor and chairman of

psychiatry.  I take personal responsibility, because I was

chairman of the selection committee. It took me three more

.

years to realize that he was the original three dollar bill.

The second bad mistake was the selection of Halsted Holman as

chairman of medicine.

Q:     Do you think the school today offers the same

excitement as it did when it was first started--especially in

its ability to attract topnotch faculty, or has it 106t it6

momentum?

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A:    Losing momentum is a very real threat. Another threat
is that over the years quite a number of people have been
brought in for not absolutely first rate work. They are better
than mediocre certainly but not great. Our ratio of Paul Bergs
to other types of people is gradually changing. Another aspect
that's important is perhaps inevitable.  When we were a little

grow even though there were 16 departments, only seven
departments were calling the shots on everything. We would meet
evenings and weekends to try to keep up with our own work as
well as the planning for the school. We'd meet with Alway and
try to function as a very active and dynamic kind of

sub-executive committee.  There was tremendous idealism and a

willingness  among us to give up things for the greater good of

the school. The school improved dramatically because of that. I
don't see that anymore. Perhaps this is a function of size, but
it seems there are an awful lot of people rrtore concerned about

maintaining their own territory and don't want anything that
would expose them to possible discomfort or loss of power or
anything that might help the school, but not directly help
them. The dean has a tremendous problem in that whole area of
motivation and I don't know how he's going to get around it.

QX    The same question comes to mind when you consider what

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happened with the faculty practice plan. Why after 20 years of
debate about it, we still have no plan that satisfies everyone?

A:    It's too painful for me to talk about it. The major

reason is simple. We have never been a true faculty practice

except for a brief period before Bob Glaser's arrival as dean.
We used to have a faculty practice plan run by the chairmen of

the clinical departments. They arrived at 7:15 a.m. every
Wednesday morning and met with the lady who was doing all the
accounting and bookkeeping for the practice. After a year or so

we got her an assistant. But we were making money. We were
willing to distribute some of that money to the dean as long as
the earning faculty got their share. When Glaser came he made
it an absolute issue that he take over that program. That very

nearly destroyed the school, and it almost led to my departure.

What we have had since then has not been a faculty practice

plan-- it has been a dean-run practice suppo:ed to be carried
out by the faculty as hired hands.  It's not our own practice

plan. And even now, in my view, we have to ask only one

question. It's the acid test. That is, who appointed and who

can fire Don Tower. You know damn well it's not the faculty.

With each of the respective deans, every single one of them

after Alway, the faculty was given no incentive to give a damn.

They were helpless. They had no control over how these pieces

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of paper were shuffled.  And this has led to losses of millions

of dollars of faculty hard-earned income.

0:     This is my final question.  It's a difficult one to ask,

but it would be important to do 60. The question is how would

Dr. Kaplan like to be remembered?

A:     That's a tough one. Well, I guess I'd say, on the one

hand,  I'd like to be remembered for those of my accomplishments

that stand the test of time such as Hodgkin's disease and

malignant lymphomas.  That is an area where there will be

continued further improvement, but I think we contributed a

foundation stone which today is leading to the cure woridwide

of hundreds of thousands of patients.

     It's hard for me to know whether my work on mouse virus

or radiation-induced lymphomas will be remembered or not. I
happen to think it's very interesting, but.1 have the feeling
people tend to gloss over it.

     I'd like to be remembered as the co-developer of the

medical linear accelerator for cancer treatment, which today is

a standard of excellence throughout the world, and has

dramatically improved cure rates for many types of cancer

despite of what I said about cancer'of the lung and pancreas

which are among the areas of failure. There are many other

cancers in which radiotherapy is extremely effective and has

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.

changed prognosis significantly. That's another area I'd like

to be remembered for. And not just for developing the machine,

but the standards for its use. We had to learn to think

differently since we were working with a rifle and not with a

shotgun. We had to develop techniques of precision that were

utterly new. Those are part and parcel of that development.

     I'd like to be remembered for my service on the

National Cancer Advisory Council in 1960 at a time when the
total number of radiotherapists in the United States was about

120 and the number of physicians in radiotherapy training was

18, of whom 6 were from other countries and scheduled to go

hack  to their native lands.  In other words we were not training

enough people to take care of our own natural attrition. I was

asked to give a lecture on radiation therapy to the Cancer

Council,  one of several such invited lectures at a time when

that body wanted to educate itself. I decided not to fear

washing dirty linen in public. So I broughi out these numbers.

I pointed out that radiotherapy was dying of attrition. The

presentation must have been compelling, because the council

voted to have the National Cancer Institute director, Kenneth

Endicott,  create a committee to look into this. Six weeks later

Endicott came into my office at Stanford, sat down, and in his

typical, and distinguished gravelly voice, he announced that he

had been asked to form the committee, and he added, "Henry, you

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and I both know that the optimal size of any committee is one.

I'd like you to be the committee.  You're free to consult anyone

you want to, but you call the shots on what you recommend."

     I talked to other leaders in the field extensively. I

finally put in a program both for research training and

clinical training with decent stipends, and it was accepted

with enthusiasm. Today there are close to 2,000 board-certified

radiation therapists.

     I was also instrumental in fighting a battle with the

American Board of Radiology to certify specialists in

radiotherapy alone. At one time you were forced to do both

diagnostic radiology and therapy, and I won that battle too.

Today, there are departments of radiotherapy of good quality in

a high proportion in all the medical schools in the country,

and some of the major community hospitals. That went

hand-in-hand with the linear accelerator. There was no point

having an expensive gadget, which was supesior to all other

known gadgets, without enough people around who knew how to use

it.  I believe I'm generally credited as the person who created

that.

     Those are just accomplishments. As for the rest, I

guess I'd like to be remembered as somebody who has been

basically kind and deeply concerned about his patients, and

very humane in dealing with them. At the same time I want to be

remembered as somebody who was tough enough to be willing to

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fight the battles with a number of deans--battles that were

needed to create and maintain high standards not just for our

department but for the school.  I fought more battles that had
nothing to do with radiology than almost anybody in the school

except Avram Goldstein. And he'll probably back that up.

    So viewed from one side I think I was a kindly

physician,  a role model.  Viewed from another side I was a

malignant son-of-a-bitch that drove deans to despair and was

known as a dean killer. These two kinds of things were sort of

hard to reconcile. I must say I never enjoyed fighting with

deans,  I never enjoyed it for one minute. It took an awful lot

out of me. But if I believed in what I was fiohting for, I

didn't care how hard I fought.

    I guess I'd also like to be remembered as somebody with

a reasonably good sense of humor, with a love of art and music

and literature, and hopefully as a good husband and a good

father and a loyal friend. That's about all I can say.

end

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