Pulling Back the Curtain: Richard W. Childs, MD

Richard W. Childs, MD
Dr. Childs is a rear admiral (RADM) in the United States Public Health Service Commissioned Corps, Assistant U.S. Surgeon General, and the clinical director of the National Heart, Lung, and Blood Institute’s Division of Intramural Research in the National Institutes of Health.

In this edition, Richard W. Childs, MD, talks about his accomplishments in immunotherapy, his role in the response to the 2014 West Africa Ebola outbreak, and his several patented inventions.

In Sound Bites, hear more from our interview with Dr. Childs.

What was your first job in the medical industry?

During summer breaks from college, I worked as an orderly in a psychiatric ward at Broward General Hospital in Fort Lauderdale, Florida. I worked in what was called the “closed acute unit,” which housed patients with psychiatric illnesses who were considered to be a threat to themselves or to the community. I performed the typical duties of an orderly – helping transport patients or assisting them with simple tasks – but I also played cards and spent time just interacting with them. And if they became violent, I was involved in restraining them.

Did you ever consider pursuing a career other than medicine?

There’s only one thing that I feel like I could ever have done, and that is to be a physician. It’s been my lifelong passion. Fortunately, I think it’s also something I excel at; I’m good at listening to patients talking about their symptoms, checking labs and collecting information, and generating differential diagnoses. Sometimes I feel like it’s the only true talent I have.

I have always been fascinated by the detective work involved in making a medical diagnosis. It’s the biggest challenge in managing and treating patients; once the diagnosis has been made, a big chunk of the challenge disappears. Making a diagnosis requires listening to and synthesizing the facts – and occasionally finding the “zebras” that other people might not consider.

Being a clinician is my calling, but I think the qualities that make me a good clinician – my creative mind and inventive streak – would also make me a good inventor. In fact, I already hold several patents.

Tell us about your inventions. 

The first patent was issued for a portable alcohol detector, which my father helped me develop when I was only 15 years old. This was during the late 1970s and early 1980s, when drunk driving was becoming an epidemic. My father and I had talked about how neat it would be if people could do a self-assessment to determine if they were too inebriated to drive safely.

I headed to the library to research methods for assessing the presence of alcohol on one’s breath. The first breathalyzers relied on a chemical reaction: A person breathed into a machine, the breath was pumped through a chemical solution, and the solution would change color in the presence of alcohol.

Using these same principles, my father and I developed our device. He did the plastics work and I did the chemistry, figuring out what catalysts were needed to detect alcohol. We created and patented the cartridges to be used in the device, under the trademarked name “Test and Tell.” We licensed it to a company, and it actually was used by a couple of police departments as an on-site screening tool to test drivers for alcohol consumption.

I hold about 10 other patents in the medical field. Inventing things and coming up with new solutions to problems has always been something I’ve enjoyed.

What other accomplishments are you proud of?

First and foremost, my greatest accomplishment is my family. I am blessed with an incredibly supportive wife and great children who have allowed me to fulfill my role as a physician-scientist and as an officer in the Commissioned Corps of the U.S. Public Health Service. It has taken a personal sacrifice on the part of my wife and our children, and I am so grateful for their support.

In my medical career, my greatest accomplishment has been my involvement in the field of tumor immunotherapy. I have been fortunate to participate in the development of new therapeutics that use the body’s immune system to treat cancer, including demonstrating for the first time that transplanted donor T cells could eradicate widely metastatic and treatment-refractory kidney cancer.

This involved going back to formulas in the laboratory to understand the mechanisms of disease resistance, dissecting the exact target of these immune effects, and identifying the target antigen. In the lab, we found a human endogenous retrovirus that was expressed in most cancerous kidney tumors; using that virus as our target, we identified the exact molecular mechanisms that led to its selective expression in kidney cancer.

More recently, we have cloned T-cell receptors that recognize peptides and proteins derived from this virus. We have demonstrated the ability to transduce human T cells to express T-cell receptors that target the virus. We have taken this approach from bench to bedside and are now about to treat patients with metastatic kidney cancer using their own modified T cells.

This entire process – from proof-of-principle experiments to manipulating a patient’s own immune system to target this virus – has taken 20 years. But it has been an incredibly rewarding 20 years.

Also, the project was only possible through the efforts of the National Institutes of Health (NIH). When I started conducting the research, I knew that this idea was off-the-wall; luckily, the NIH is supportive of cutting-edge, first-in-human, paradigm-shifting research.

What disappointments have you experienced in your career and how have you handled them?

The biggest disappointments relate to the ever-increasing number of regulatory requirements and hurdles that stand between investigators and cutting-edge clinical research. While I realize that these processes are necessary and important to ensuring patient safety and the integrity of the science that we perform, it is becoming progressively more difficult to quickly translate our bench findings to the clinic. This increasing oversight can delay trial openings and make trials even more expensive to conduct.

And despite the successes of our kidney cancer trial, that experience was marked with disappointments. For example, some patients would benefit tremendously from the procedure – experiencing disease remission and cure – but many patients did not respond to treatment. However, those disappointments were a major driver to try to dissect what exactly was happening in the patients in whom treatment was successful.

Do you have any advice for trainees about dealing with disappointments in their careers? 

My advice is to find a good mentor who can provide perspective. Also, be open to the constructive criticism and feedback they offer. When you are young in your career, it’s easy to think that you have everything figured out and that there is only one path to take. But you quickly will find that there are many avenues available to you in reaching your goal. The more willing you are to solicit feedback and input from others, the better off you’ll be for it – and the more successful you will be.

I would also emphasize finding those mentors as early as possible. When I was a resident at the University of Florida, I was fortunate to work with Craig Kitchens, MD, and Richard Lottenberg, MD, two hematologists whose excellent clinical skills and diagnostic abilities inspired me. Each took me under his wing and continue to mentor me to this day.

Their advice and encouragement motivated me to avoid the path of least resistance. Instead, they propelled me to pursue high-risk, high-reward research that truly would make a difference in how we practice medicine and in our patients’ lives.

Many times, I wanted to quit in the face of challenges. That’s when they would tell me, “Stick with what you’re doing. Don’t give up on your projects.” The research that took 20 years to move from the bench to the clinic would not have happened without their guidance and mentorship.

No matter how strong-willed you are, no matter how creative you are, you need to have the perspective of your mentor from a different angle. So, in my role now, I try to pay that forward and serve as the mentor for our fellows and junior faculty.

After completing fellowships in oncology and hematology at the National Cancer Institute and the National Heart, Lung, and Blood Institute, you became an active duty officer in the Commissioned Corps. Can you explain what you do in that role?

I am incredibly honored to serve in the Commissioned Corps since 1995 and to have since become a rear admiral. The Commission Corps is one of seven uniformed services of the U.S. government, so I get to wear the uniform to work every day.

I am dedicated to the mission of the Commissioned Corps to advance public health in the United States through my role as a physician researcher. I also had the opportunity to serve as the chief medical officer on a Commissioned Corps deployment team to West Africa during the Ebola crisis response in 2014 and 2015. As the Chief Medical Officer of this mission, which was ordered by President Barack Obama, I led a group of health-care professionals who were charged with caring for patients infected with the Ebola virus and helping to contain the virus and prevent it from coming to the U.S. That mission was incredibly successful, and our efforts contributed to bringing about the conclusion of that outbreak in West Africa.

At the time, the Centers for Disease Control and Prevention projected that the number of cases of Ebola virus could jump to more than one million if it were not contained quickly. Ultimately, there were approximately 30,000 total cases – substantially lower than the early predictions. We were able to pull many sick patients through who I’m sure would not have survived without our team’s presence in Liberia. Being part of that great team working on such a dangerous and important mission was an amazing experience.

I also spend a substantial amount of my time serving in the role of Assistant U.S. Surgeon General, supporting the efforts of the U.S. Public Health Service to protect and promote the health and safety of our nation.

What is your biggest pet peeve?

To have a high-reliability operation, you need reliable people, so my biggest pet peeve is when someone promises to do something and then doesn’t. If you’re not sure that you can do something, make that clear. However, once you tell me you’re going to do something, my expectation is that it will get done. I don’t expect that you won’t face hurdles and difficulties, so be upfront about those and we can work through the problems together.

What do you enjoy doing when you are not working? 

I actually have a lot of hobbies. I’m an avid bicyclist, riding my road bike five or six times a week. I would venture to say that I’m addicted to riding my bike. I started riding fewer than four years ago, so it’s a recent addiction, but I have already ridden across the state of Iowa in a 500-mile bike ride called RAGBRAI (The Register’s Annual Great Bicycle Ride Across Iowa) in 2015.

Cycling is one of my great passions, but I also am an avid boater. I like to sail, fish, and go crabbing on the Chesapeake Bay. Flying remote-controlled airplanes is another hobby I’ve picked up.

If you could have dinner with any person from history, who would it be and what would you ask him or her?

I probably have a different answer to this question depending on what time of day you ask me. But I would say General George S. Patton would be an amazing guest.

I’ve read quite a bit about him and found him to be an incredibly interesting historical figure. He always believed that he was created for the singular purpose of fighting and beating the Germans in World War II. You can formulate all the plans in the world, but the execution is what counts; he was a master of executing plans. The odds were stacked against him and his troops on many occasions; nevertheless, he found innovative ways to adapt and improvise and, ultimately, conquer the enemy.

There is much to learn from a person like him about overcoming obstacles – whether they’re scientific difficulties that come up in the lab or budgetary constraints preventing you from advancing your research. I would love to sit down and talk with Gen. Patton about how he tackled seemingly insurmountable obstacles.