In this edition, Gary Gilliland, MD, PhD, talks about the detours in his path to academic medicine, the patient that inspired him to pursue hematology, and the exciting ways the field has evolved since he began his career. Dr. Gilliland is president and director of Fred Hutchinson Cancer Research Center in Seattle, Washington.
What did you want to be when you grew up?
I decided in grade school that I wanted to be a doctor, and I never shook that idea. I’m not sure exactly where the idea originated, but I suppose it was a combination of what I saw each of my parents doing.
My dad worked as an engineer for General Electric, where he operated test nuclear reactors that generated isotopes for medical purposes. The work he did was great, but I gravitated more toward science than math.
My mom was a stay-at-home mother and she often did volunteer work visiting people who were sick, at the hospital or their homes. I would occasionally accompany her on these visits, and it gave me some early exposure to the value of helping people. After that, the eventual goal became medical training so that I could help people more fully. Whatever successes my three younger brothers and I enjoy, we owe to my mom.
We grew up with one general family rule: We should be out in the world trying to do good for other people. One of my brothers is an anesthesiologist, another is a general surgeon, and the youngest was the president/CEO of the travel technology company Sabre, which is the parent company for Travelocity.
Who were the mentors that helped shape your career path to medicine?
The two most important mentors in my career were John Collier, PhD, and H. Franklin Bunn, MD.
Dr. Collier was my professor and laboratory mentor in microbiology while I was a graduate student at the University of California, Los Angeles. He had a profound influence on the way I think about conducting science and the value of crisp, clean experiments that can produce robust results. I went to graduate school before I went to medical school, and that proved to be a wonderful decision because it helped me approach clinical translational research from a rigorous, scientific perspective.
I moved to Brigham and Women’s Hospital for my internship – my first real job – in my early 30s, when I met Dr. Bunn. He studied hemoglobinopathies like sickle cell disease primarily, but he also was interested in other types of bone marrow failure syndromes like myelodysplastic syndromes. Like Dr. Collier, Dr. Bunn was a rigorous protein biochemist, which is one of the things that made me want to work with him. He let me work in hematologic malignancies – a relatively new area for his lab.
What lessons did you learn from working with them?
Do good science and get good answers. However, not everything in science will work as you expect, so perseverance is key. Don’t do things because they’re easy to do; do things because they’re hard.
When did you decide to focus on hematology?
Undoubtedly, Dr. Bunn inspired me to pursue hematology, and one patient I cared for early on truly compelled me to work in hematologic malignancies. When I first met the young woman, she presented with acute leukemia. Her disease was treated into remission. It relapsed, and then we treated it again with more intensive chemotherapy. The good news was that her leukemia didn’t come back, and the bad news was that her marrow never came back either. She eventually died, leaving behind her husband and two young children, as we hoped against hope that her marrow would recover from complications of infection.
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Caring for her was a moving experience. We had failed her and her family. Although we had the best intentions, I felt culpable because she ultimately died from complications of our treatment – not from her leukemia. Our patients deserve better; this patient and her beautiful family didn’t deserve to deal with this out-of-the-blue, fatal disease.
This experience represented the confluence of many factors that led me to pursue hematology: the need to apply a rigorous metric that I learned from Dr. Collier, the fascination with the science of blood disorder that was spawned by Dr. Bunn, and the desire to help people instilled by my parents. Caring for her was the crystallizing event of my career, and it’s why I do what I do today.
How has hematology changed since your experience caring for that patient?
That was in 1985, when we had no clue about the genetic basis for diseases like myeloid leukemias or myelodysplastic syndrome. We could see translocations through cytogenetics, but we did not know whether those translocations were causal or what genes were involved in them. This also was more than a decade before the first version of the human genome sequence was released.
Today, of course, we have a near-complete catalog of every single mutation that contributes to the development of leukemia. For me, it’s exciting to have come from a time when we didn’t know the identity of a single gene that caused acute leukemia, to today, when we know what those genes are, how they function, and how we can target those genes and reactivate the immune system.
We’re able to help patients in new ways. We can take the progress that has been made about the genetics and molecular biology of the cancer itself – how the tumors are able to suppress the immune system and how we can override that to the benefit of patients – and translate those into clinically meaningful advances for our patients.
And, though I’m a bit more removed from the clinical frontlines than I used to be, part of the joy of being in hematology today is hearing from patients whose disease – which they were told was fatal – is responding well to the treatment they’re receiving at our center. When patients or their family members stop by my office to say thank you, it puts a lot of sunshine into any day, which counts for a lot in Seattle.
Now that the opportunity is there, what do you think are the barriers to bringing these curative approaches to patients?
There are a broad range of challenges for us. One, of course, is the complexity of the science. We need a deep understanding of the DNA sequence, the expressed gene products, and the epigenetic changes that happen in cancer. We are generating massive datasets; now we need to develop the analytic tools to integrate terabytes of data with clinical patient information to understand how the data and the sequence relate to each other.
Funding issues are a serious concern, as well. I spend more time than I’d like working with our legislators on this issue. Generally, we enjoy wonderful bipartisan support on medical research funding. However, when ill-advised policymakers suggest that we should be cutting the NIH budget by 18 percent at a time when we are at an inflection point in developing curative approaches to cancer, that is a travesty – and, in my opinion, unconscionable.
Policymakers appear to be attacking the finance of administration rates and the real costs of doing research. Recently, I testified before the House Appropriations Committee on what the indirect cost rates are, their importance, and why we can’t cut them. We will ultimately get to the point where we are curing cancer, but cutting funding means we will get there slower. There are people who died from cancer while I was testifying on the Hill; that’s the sense of urgency that we need to feel going forward.
There also is a bit of a mental obstacle to overcome among hematologists who have been in the field for a long time. We have been stuck in the frame of mind that, based on everything we have witnessed in clinical practice, once a patient’s cancer become metastatic, it can’t be cured. We use the euphemism, “We can treat your cancer” – the implication being that we can’t cure it. But, today, we can say that there are curative approaches for some of our patients.
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It’s a different way of thinking, and, honestly, it might be a little scary for some of us. Accepting that we have therapies with curative potential puts the burden of responsibility on the health-care system and health-care professionals to make sure that we implement them. We have to make sure that we have that shared vision moving forward.
The important thing to remember is it is possible. The science shows we can get there. The fun part is seeing hematologists and oncologists as thrilled as I am about the responses we are seeing. The crowd of believers is growing rapidly.
You worked in the pharmaceutical industry for five years before returning to academic medicine. How did that experience change your perspective?
That experience was incredibly helpful for me, both to gain insight into how the pharmaceutical industry functions and the value that it brings. It was a humbling experience for me because I think many people assume that academicians are smarter, more passionate, and more compassionate than people in industry, but I learned firsthand that that’s not true. I think people don’t always appreciate how important the pharmaceutical industry is. We wouldn’t have the drugs that we have today without their help.
What do you enjoy doing outside of medicine?
I enjoy playing piano – it was torture for me when I was young, but I’ve finally grown to love it. My wife and I also love to go camping, although these days that takes its toll on the body more than it used to. We’ve been to Yellowstone National Park about 25 times – we love it there. It’s our favorite place to camp and fly-fish. It’s also a place where we can just get away from the outside world; there are only a few areas in the park with cell service, which we assiduously avoid.
What would people be surprised to learn about you?
In all areas of science, one is expected to have a relatively extroverted personality – big handshakes, big smiles, self-confidence – to help push success forward. We speak with patients, we talk at scientific meetings, we work with philanthropists, we meet with our local politicians. This is all part of being successful in my role as a representative of Fred Hutch. In reality, though, I am deeply private and value the quiet time that I have away from the manic crowd. That’s why I find camping in the middle of nowhere or tuning out from the rest of the world by playing piano so enjoyable. Then I come back, put on my game face for upcoming meetings, and switch back into extrovert mode.