Pulling Back the Curtain: Robert P. Gale, MD, PhD

Visiting professor of hematology at the Imperial College London, executive director of Clinical Research in Hematology and Oncology at Celgene Corporation, and editorial board member for several scientific journals

What was your first job?

My first job was working in my family’s haute couture business in New York. I started delivering fabrics and, after several years, advanced to working with famous designers like Norman Norell and Donald Brooks. I liked draping the models! Many stars came in to purchase costumes when I was there. I was especially impressed whenever Cary Grant visited; all the models swooned. Grant had five wives and a partner, so he was an expert at buying dresses.

Eventually, I realized that most people in the haute couture industry die of a massive heart attack at an early age. Not for the faint-hearted, as they say – especially if you have to deal with Parisians in August to meet deadlines. Medicine seemed a more rewarding, and less nerve-racking, direction.

How did you decide you wanted to specialize in hematology?

From the beginning of my medical training, I wanted to focus on trying to improve leukemia therapy because it seemed like a dreadful disease, robbing children and young adults of their lives. Before I even went to college, I had picked out hematology, and leukemia specifically.

At the end of my training in internal medicine, I sought counsel from my chief of medicine at the University of California, Los Angeles (UCLA), William Valentine, MD. I was deciding between hematology and cardiology. Two things he said influenced my decision: First, he noted the heart is merely a pump whose role it is to distribute blood to the body – the blood’s the thing! He also asked me if I wanted to write the music or play the music. I said write; he said hematology. (I won’t repeat his opinion of oncologists.)

Who were the mentors who helped shape your career, particularly at its start?

There were many, of course, but most important were Martin Cline, MD, the chief of hematology and oncology at UCLA; David Golde, MD, a professor of medicine at UCLA where I was pursuing my PhD; Dr. Valentine; and John Fahey, MD, my PhD advisor.

And, of course, the great philosophers Montaigne and Woody Allen.

What advice would you pass on to beginning-career hematologists and oncologists?

Identify your talents early on – figure out what makes you happy and challenges you both professionally and personally. Is it the rigor of science, the art of medicine, a combination of both? Where do you want to be in 10 years?

Sometimes there’s a perverse disconnect: Many people want to do things they are least-suited for and avoid areas where their talents shine. If introspection and mindfulness fail to answer this question, ask your spouse. He or she will set you straight.

What have been the biggest changes you’ve seen in medicine throughout your career?

Several come to mind. First, when I started my career, it was possible to be a superb clinician and also to make a substantial basic science contribution in the laboratory. The recent buzzword “translational medicine” was not in vogue then, but that’s what it was: the physician−scientist. I think those days are quite over.

Achieving this balance is increasingly difficult for a few reasons. Clinical medicine and basic science have become far more complex. One cannot simply pop into the lab after a day making rounds or in the clinic and hope to make a meaningful scientific contribution. Second, therapy options and treatment algorithms have become increasingly complex and sophisticated. For example, when I began treating patients with chronic myeloid leukemia, all we had was busulfan and hydroxyurea. Now, we have several tyrosine kinase inhibitors, interferon, transplantation, and more. This is marvelous for our patients, but determining the best use of these interventions for each of them is challenging. This is especially true because clinical trials are designed to determine the best therapy or therapeutic strategy for a cohort, not for an individual. However, as physicians we make decisions on the person level, not the cohort level. Many people forget this important distinction. Third, there are now massive amounts of data one needs to process to be a competent physician–scientist. Finally, the electronic medical record – a useful but diabolical invention – has entered our lives.

What types of questions do you ask in an interview?

My goal is to identify smart people. There’s a difference between a person who seems smart because he or she has mastered a specific technology and someone who can think through problems. My goal is to train physicians to make complex decisions that will result in the best outcomes for people diagnosed with complex diseases. This requires many skills. Mastering considerable data is one of these skills. However, the skills needed to be a good physician are far more complex – for example, the ability to deal with uncertainty or to formulate a probabilistic approach to diagnosis. These are the traits I look for.

As we learned from an informal study my UCLA colleagues and I conducted several years ago, the interview questions may not be as important as who the interviewee is. We asked applicants, “Where do you see yourself in five or 10 years?” Predictably, most said something along the lines of, “a clinician-scientist at a university.” Any other answer would have been seppuku. We next asked their wives (at that time most applicants were men), “Where do you see your husband in five or 10 years?” Their answers were rather different; usually something along the line of, “I think he will be in private practice in Pebble Beach.” We tracked down the applicants a decade later to see where they were. Readers will not be surprised to learn many were in Pebble Beach.

Today, over one-half of applicants are female, so we have to change the approach. I have found that men are far less insightful and less realistic! But the point is, spouses, partners, life partners, or significant others are often a better judge of career trajectories than the applicants themselves.

What is the strangest interview question you’ve ever been asked?

My career has touched on many different areas besides traditional hematology. I’ve been an expert in dealing with the aftermath of nuclear accidents and the role of nuclear energy on an international level.

Immediately after the Chernobyl accident 30 years ago, Mikhail Gorbachev invited me to a press conference with the international press corps in Moscow. The press had been kept in the dark about the accident for two weeks; I was the only foreigner who knew the medical details of the accident. Wild claims of hundreds or even thousands of deaths had been published – some by seemingly trustworthy news sources.

The interview room was filled with about 1,000 journalists from around the world. I went up to the podium and was handed a stack of supposedly spontaneously written questions. (In the Soviet Union, a press conference is not an open-ended question-and-answer situation.) I took the first question from the top of the stack and read it to myself: “Why are Western countries taking advantage of this tragedy in the Soviet Union?”

I realized I was alone on the podium, the only person with a microphone (well, the only person in front of more than 100 microphones), and the only person who could see the question. I looked at the slip of paper for about 30 seconds (a long time in a press conference) and said, “The first question is: ‘Why are the Western countries helping the Soviet Union cope with this terrible tragedy?’”

Needless to say my KGB handlers were not happy. But what could they do? The U.S. delegation and I had shared several vodkas when it was over!

Has helping the victims of nuclear accidents always been an interest of yours?

I’ve spent much of my life on several different fronts: Soviet/American relations; nuclear issues, including nuclear weapons and nuclear energy; and bone marrow transplantation. The interaction between these spheres is what I like to call “atomic hematology.”

I was born in 1945, just after the atomic bombing [of Japan]. My generation grew up during the Cold War and the idea that either the United States or Soviet Union could launch a nuclear attack. This was not an abstract theory; the basement of my apartment building in New York was designated a bomb shelter (not that it would have been useful). It was also suggested you put newspapers over your head in the event of a nuclear attack; I never tried this approach but recommend The New York Times if the occasion arises, so at least you will finish your days with high-quality journalism!

My first visit to the Soviet Union was in 1974, during the darkest days of the Cold War, and these visits continued frequently. I have many talented Russian colleagues with whom I continue to collaborate on consequences of the Chernobyl nuclear power facility accident in 1986. I have similarly close relationships with Japanese colleagues with whom I collaborated after the Tokaimura and Fukushima accidents and with Brazilian colleagues after the Goiania accident.

Interestingly, bone marrow transplantation and the discovery of molecularly cloned hematopoietic growth factors resulted from efforts to deal with the threat of nuclear war. Today we use these technologies to save lives, perhaps a fulfillment of the Bible verse, Isaiah 2:4, “and they shall hammer their swords into plowshares.”

So, it is only logical my colleagues and I would use these technologies to rescue victims of nuclear and radiation accidents. We all need to remember that when it comes to nuclear weapons and nuclear power facilities, as in all of medicine, prevention is better than cure.

In a typical day, what is your rose and what is your thorn?

Obviously, the rose is my wife. And, the thorn, or the greatest challenge to me, is participating in dumb things. Remember bank robber Willie Sutton’s amazement when an FBI agent ask him why he robbed banks? His reply, “That’s where the money is.”

Perhaps the politically correct way to say this is “poorly done work that consumes resources, time, and careers, but that can’t possibly reach definitive answers.” There’s a saying that “No science is better than bad science,” and I’ve learned how true that is over the course of my career.

And I’m not exactly sure where to place the daily two hours of brushing and flossing.

What accomplishments are you most proud of in your career?

The philosopher Bertrand Russell said, “Most people would rather die than think; many do.” I hope some of my analyses and writings have caused people to think more critically about the substantial challenges we face in hematology and oncology.

More concretely, I’m proud of our accomplishments in the fields of leukemia therapy and bone marrow transplantation. I am especially proud of the work my colleagues at the Center for International Blood and Marrow Transplantation (CIBMTR), led by Mary Horowitz, MD, have done – coordinating the contributions of hundreds of transplant experts from more than 60 countries.

I am also pleased that my colleague Eli Canaani, PhD, of the Weizmann Institute of Science in Israel and I were able to molecularly clone BCR/ABL1, the gene that causes chronic myeloid leukemia. That information led to the development of drugs that come close to curing this disease in some people.

Those are my greatest accomplishments in medicine, but, of course, my greatest accomplishment in life is my family.

With my wife and our children. I have six beautiful girls, so keeping suitors away is a full-time job. I’ve started taking lessons from Ulysses and Telemachus.

How do you spend your time outside of medicine?

When not discouraging suitors or brushing and flossing, I swim, jog, snowshoe, ice climb, ski, kayak, and skydive – one at a time, though.

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