Pulling Back the Curtain: Cindy Dunbar, MD

In this edition, Cindy Dunbar, MD, discusses the personal experience that led her to hematology and her lifelong love of music.

What was your childhood like?

I grew up in Westport, Connecticut, a suburb of New York City. A lot of Broadway directors, choreographers, and actors lived in Westport, and it was an interesting place to grow up because it was more religiously and culturally diverse than some of the surrounding towns. My large public high school had fantastic opportunities in music and theater that I took full advantage of, along with a great academic curriculum.

My childhood was somewhat unusual for the time in that my mother was in her late 40s when I was born, and my father was 10 years younger than she was. My mother had been a college dean and teacher at Syracuse University at a time when women in such careers often didn’t marry. She met my father, a Scottish exchange student, when she was 42 years old. He had come to Syracuse as a Marshall Plan business and engineering student for World War II veterans to get an accelerated completion to his education. He asked her, as the dean of women, to chaperone a party. They fell in love, got married, and moved to Scotland for a couple of years before returning to the U.S. for better professional opportunities.

What was your first job?

My first job was exercising and caring for horses at a stable. I also coached soccer in a youth league (despite knowing almost nothing about playing soccer personally!), worked in a gift store, and babysat – typical suburban teenager jobs.

When did you know that you wanted to go into medicine?

As a child and teenager, I was always attracted to science. I think that at one point I wanted to be a meteorologist. Nobody in my family worked in medical professions, but math and science were by far my best subjects in school.

My interest in medicine, and hematology specifically, began when I was a high school sophomore. A close friend was diagnosed with Hodgkin lymphoma (HL). This was just before combination chemotherapy started routinely curing patients with HL. I spent a lot of time at Yale New Haven Hospital visiting him during his treatment. He was dating my best friend, and I was dating his best friend, so we all went through it together. He died when I was a senior in high school. From that time forward, I was pretty sure I was going to go to medical school.

I went to college in Boston at Harvard-Radcliffe and majored in history of science so I could take classes in both history and science and learn to write. I thought that would be more useful for a career in medicine than being in a huge biology or biochemistry department, which were not very undergraduate-oriented at Harvard at the time.

Tell us about your early mentors.

After my freshman year of college, the first lab I worked in was run by a pediatric cancer surgeon named Judah Folkman, MD. He was ahead of his time in suggesting that tumors grew rapidly by stimulating the growth of new blood vessels, and if you could block blood vessel growth in the tumors you might be able to stop their growth. This idea came to him in the 1970s, and it took him about 25 years to isolate some of the proteins that were involved in the tumor angiogenesis process. In his lab, I worked on blood vessels in cartilage. Dr. Folkman figured out that since cartilage had no blood vessels, something in cartilage must be preventing blood vessel growth.

How did you come to work for the NIH?

After I finished my internal residency in Boston, I was applying for fellowships in hematology/oncology and I checked a confusing box on an application to the NIH. I thought I had applied for both hematology and oncology training, but it turned out the NIH didn’t have hematology clinical fellowship training at the time, and instead I ended up in a group interview for an extra residency year sponsored by the National Heart, Lung, and Blood Institute (NHLBI) that I really had no interest in. It turned out that Arthur Nienhuis, MD, then chief of the Clinical Hematology Branch at NHLBI, was one of the interviewers and he came to me afterward and said, “You can come work in my lab for a couple of years. It’ll count for your fellowship, and it sounds like you’re really interested in hematology.” I guess he was impressed that I had heard of hemoglobin switching and that I was interested in fetal hemoglobin induction based on seeing patients with sickle cell disease during residency.

I went back to Boston and talked to my mentors there. The other place I was considering for my fellowship was Dana-Farber Cancer Institute, but I was in the process of divorcing someone who worked there and I had been in Boston for 11 years already, so I decided to take Dr. Nienhuis up on his offer. I had worked in labs in the summers during college and medical school, but I’d never had an intensive experience.

I spent 3 years at the NIH working with Dr. Nienhuis as postdoctoral fellow, and he was an incredible mentor for me, both in the laboratory and clinically. It was an exciting time at NHLBI – he and Griffin Rodgers, MD, MACP, were running the initial hydroxyurea phase I/II trials in sickle cell disease and in thalassemia. I ended up working on basic hematopoiesis and on optimization of stem cell retroviral gene transfer, not on hemoglobin switching in the lab. That was lucky – I made progress in my work on hematopoiesis, while the hemoglobin gene therapy work was at that point very challenging and frustrating.

After my postdoc, I did a full-time year of clinical hematology training at University of California, San Francisco (UCSF) so I could take the American Board of Internal Medicine hematology exam. I knew I was coming back to the NIH as a faculty member, so I decided to spend a year in a nice place I had always wanted to live. In 1991, after 3 years in Dr. Nienhuis’ lab and 1 year at UCSF, I came back to NHLBI and started my own research program as a tenure-track investigator. Since then, I have spent my entire career in the NIH intramural program as a physician-scientist, educator, and administrator.

As soon as I returned from San Francisco, I also started a hematology fellowship program at the NIH so that people like me wouldn’t have to leave the institute to finish their training in hematology. We certainly had enough clinical activity at the NIH and at some collaborating hospitals in the region for it. I directed the fellowship program for 17 years.

What made Dr. Nienhuis a great mentor?

His mantra was, “Just do it.” He wanted you to learn by doing and not obsess too much over the results you were getting, but instead ask a question, find the answers, let them lead you to the next step, and try to ignore all the unimportant chaos going on around you. He was good at working around interpersonal conflicts or institutional politics, and there were some strong personalities in the lab at that time. He always kept his eye on the prize of improving the lives of people with serious blood diseases. As an MD who did not train in the laboratory extensively before his fellowship, he was patient with MDs’ lack of previous scientific training and committed to taking on mentees with enthusiasm but little prior lab experience.

Is there any advice would you pass on to early-career hematologists and oncologists?

Most of my advice about becoming an academic hematologist/oncologist comes from my time as a fellow with Dr. Nienhuis. He was good at instilling a sense of confidence that you could do it – it didn’t matter if you didn’t have a PhD or if you hadn’t spent 7 years in a Nobel Prize-winner’s lab. You could still contribute.

If you’re focused and interested enough, anyone can do science. It just requires commitment and confidence to do the experiments and move forward.

Tell us about your involvement with the American Society of Hematology’s Blood journal.

Kenneth Kaushansky, MD, who was editor-in-chief of Blood from 1998 to 2002, asked me to be an associate editor seemingly out of the blue. At that point, I was under 40 and not very well known. But I knew him because of overlapping scientific interests, and I said yes. I served in that role for 10 years, and it really increased my confidence and gave me a huge new network of colleagues as authors and reviewers.

I’m very grateful to Dr. Kaushansky – he’s a great scientist and has been another major mentor for me, and is now the Dean of Renaissance School of Medicine at Stony Brook University in Long Island, New York.

What is the best and worst part of your typical day?

Usually the best part of the day is when somebody who’s working for me comes in to talk about new results from the laboratory that are exciting and stimulating and tell us what to do next, especially when the results are unexpected. I like surprises in terms of data and my research.

The worst part of the day is dealing with regulations and bureaucracy as a government employee. On the other hand, I’m fortunate to have worked for the NIH Intramural Program for 30 years and to be well supported in my research. I’m certainly willing to put up with the headaches that come with working for the government because of the benefits that I get from it, and because we’re all working together to improve health.

Could you tell us about your life outside of medicine? Do you have any hobbies?

Outside of work, the major activity I’ve been involved with throughout my life has been music. As an adult, I’ve sung classical music. Within 6 months of moving to Washington, DC, I met my husband while singing with the Choral Arts Society of Washington, which performs frequently with the National Symphony Orchestra at the John F. Kennedy Center for the Performing Arts. We got married a couple of years later and have made many friends through music.

However, from the mid-1990s until 7 or 8 years ago, I spent most of my time raising my two daughters, caring for my elderly parents as an only child, running Blood, and growing my lab. I had little time for any hobbies during that period. I look back on all of those responsibilities that I had taken on and think I must have been out of my mind! I didn’t sleep much.

Once my kids launched, I began singing more seriously again. Unfortunately, that hobby has now been interrupted by the COVID-19 pandemic. I am unlikely to start again until there is a vaccine!

I also enjoy outdoor activities, like hiking or rowing on the Potomac River – or Lake Champlain in the Adirondacks, where we have a family home. I love being outside with my kids, husband, and friends. Three mornings a week, I walk in Rock Creek Park at 6:00 a.m. with three other women (two hematologists and a surgeon), which I’ve done for years. Music and being outside are the two most important ways that I relax.

Tell us a little-known fact about yourself.

I worked as a park ranger for a couple of summers in college. I decided I wanted to spend some time outside hiking instead of working in labs.

What does your perfect Sunday look like?

I would start the day by waking up for the sunrise over Lake Champlain, then go down and take a row, and the water would be crystal clear and quiet. After that, I’d have brunch with my two daughters who are now in their 20s and are great cooks, and then we might go for a hike. Then I’d read a trashy novel to relax and go to bed early, perhaps after attending a concert at the classical music summer program nearby, where one finds musicians like Josh Bell and Hilary Hahn before they become famous.