publication date: Aug. 6, 2020

Conversation with The Cancer Letter

Walter Lawrence, 95, reflects on the National Cancer Act, medicine, social justice, COVID-19, and Richmond’s vanishing monuments

walter-lawrence

Walter Lawrence, Jr., MD

Director emeritus, Virginia Commonwealth University Massey Cancer Center

 

This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage is available here. 

In 1971, when the National Cancer Act was signed, Walter Lawrence, Jr., was one of the surgeons eager for a push forward, driven by rigorous science reviewed and funded by the federal government.

The entire field of scientific inquiry needed to evolve, and his colleagues—the surgeons—needed to be educated in cancer biology, and methodology of clinical trials.

Today, at 95, Lawrence continues to teach medical students at Virginia Commonwealth University and advise the new director of the VCU Massey Cancer Center, the place where, in 1966, Lawrence set up the first-ever university-based division of surgical oncology.

Were it not for his disarming smile and a gift for cracking a knee-slapper of a joke, the towering, lanky Lawrence might be an intimidating presence. He is, after all, one of the giants from the time when giants walked the earth.

More than that, Lawrence has combined scientific vision with walking the walk for social justice, advocating for enrolling minority patients in clinical trials, mentoring young Black oncologists, and—at a time when the American Medical Association refused to take a stand against racism—attending the Society of Black Academic Surgeons, a group of distinguished surgeons that made him an honorary member.

In fact, Lawrence had resigned from the Southern Surgical Association in protest against that organization’s refusal to admit LaSalle Leffall, Jr., a Black surgeon. Lawrence rejoined the association years later, only after Leffall was admitted.

The 50th anniversary of the National Cancer Act—a document signed on Dec. 23, 1971—comes at a time when science and health equity have become inseparable. Walter Lawrence was ahead of his time, and now, with the world catching up, The Cancer Letter invited Lawrence to reflect on the past half-century of pursuit of truth and justice.

Lawrence saw promise in the National Cancer Act, and earning the Cancer Center designation from NCI in 1975 allowed VCU, then called the Medical College of Virginia, to become systematically involved in clinical trials.

“Randomized clinical trials were the only way we had of really improving patient cancer care—things like the one that Bernie Fisher in Pittsburgh started, the National Surgical Adjuvant Breast and Bowel Project,” Lawrence said in an interview.

“I was a good friend of Bernie’s, so we were a big producer in his program.

“Starting that clinical trials program here, as part of the cancer center, benefited patients quite a bit. And, actually, our grant from the NIH at that time was for introducing minority patients.

“Because, as my head of radiotherapy at that time pointed out, 50% of Richmond were African American, we were an ideal place to bring in more minorities into the trials, because the trials up to that point were somewhat in question, because they didn’t include the balance of people who live here in America.”

Lawrence spoke with Paul Goldberg, editor and publisher of The Cancer Letter, and Robert Winn, director of the VCU Massey Cancer Center, the only Black director of an NCI-designated cancer center.

“The thing that was exciting about the National Cancer Act, which I think was one of the best things President Nixon did, among things that weren’t so good, was that it did bring the federal government into the funding of various kinds of research,” Lawrence said.

In recent weeks, the statues of leaders of the Confederacy came down on Richmond’s Monument Avenue. Only two statues remain on the wide, leafy street—Robert E. Lee, whose horsed likeness sits on federal land, and Arthur Ashe, a Richmond-born Black tennis star.

Our conversation meandered from history of oncology, to America’s reappraisal of its past, to the COVID-19 pandemic, to the killing of George Floyd, to the problem of health disparities.

“It’s amazing how so many of us were totally insensitive to the harm and the injury that those monuments did give to certain parts of our population. We looked at them as nice historic artistic things that dolled up the avenue,” Lawrence said.

“But I think all the recent demonstrations, mainly peaceful, have really awakened a lot of us to how much those things did hurt. So, even though we’ve lost some of the beauty temporarily by losing some artistic monuments, I think we’ve got real progress already in that dimension, by having them removed.

“I have confidence that we are going to have other things to doll up the street and make us just as proud as before, but it’ll take a little time. Of course, I, again, want to emphasize, I think we aren’t going to solve this racism problem by just getting rid of monuments, but it really is a first step that I think is important in this whole procedure of improving the relationship with certain parts of our population in every way.”

A video recording of the conversation is posted here and appears in transcript below.

“Walter Lawrence is a pioneer in so many ways, and he never became an anachronism,” said Norman Wolmark, chairman of the National Surgical Adjuvant Breast and Bowel Project, a component of NRG Oncology, a clinical trials group. “He was always on the leading edge. MCV was always the incubator for surgical oncology in so many ways.

“He believed that the field of surgical oncology was more than cloistering in the operating room and churning out cases.”

In the 1970s, at a time when it was said that lesser surgeons did lesser mastectomies, Lawrence and Fisher questioned whether “heroic” surgeries benefited patients. Such heresy meant being ostracized by the profession.

“He saw surgery as an integral part of the evolving paradigm in solid tumors, and he saw surgeons as more than just gatherers of tissue,” Wolmark said to The Cancer Letter. “He had perfect credentials. He was at UChicago, he was at Hopkins, he was at MSK, he could have been churning cases. Instead, he was willing to study biology and behavior, becoming—deservedly—the first surgeon to head a cancer center.

“I knew him as a man of great intellect, who could be counted on to do what’s right and just, and whenever he made a comment, you knew it would be well-thought-out, and relevant, and often funny, reflecting his unique sense of humor. People like Walter Lawrence don’t come along very often.”

Otis W. Brawley, Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, met Lawrence in the late 1980s.

“Medicine, like all scientific disciplines evolves over time. Those who are most successful in medicine do not just evolve with it, they drive the evolution,” Brawley said to The Cancer Letter. “Walter Lawrence the physician/scientist/civil rights advocate has been in the forefront driving the evolution of medicine for decades.  He is the consummate physician and gentleman.“

Friends speculate that Lawrence, who was a surgeon at the 46th Army Surgical Hospital during the Korean War, was a prototype for the surgeon Hawkeye Pierce in the novel, movie, and television series M*A*S*H.

There are other surgeons who are purported to be the prototypes for Hawkeye, and an argument can be made that surgeon Hiester Richard Hornberger, Jr., a co-author, with the writer W.C. Heinz, of the autobiographical novel, had a wealth of his own material—and his own cast of characters from 8055th M.A.S.H., where he served.

Lawrence doesn’t recall having met Hornberger, but he does love the television show his work inspired. “I had the same job as Hawkeye Pierce—chief of surgery,” he said to The Cancer Letter. “I think all of us would like to claim we were the model for him, but I don’t know.”

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Lawrence, as director of the VCU Massey Cancer Center, which he founded and ran from NCI designation in 1975 through 1988.

 

That said, Lawrence’s drive, his advocacy for patients, his lack of tolerance for nonsense of any sort, and his sense of humor invite one to think of Hawkeye.

Consider a Lawrence teaching moment captured in a 30-year-old issue of The Cancer Letter

Lawrence, then a member of the NCI Board of Scientific Counselors, was presenting a report of a BSC subcommittee recommending instituting a special grant program aimed at educating surgeons to systematize staging of disease—and bring them into the fold of the institute’s cooperative groups.

Asked whether surgeons could be expected to apply for standard grants, Lawrence responded with a simple No.

“Pitifully few surgical oncologists are trained as researchers,” he declared (The Cancer Letter, April 11, 1980).

Having Lawrence as a mentor was life-changing.

“He’s very much responsible for my career,” said Harry D. Bear, the Walter Lawrence, Jr., Distinguished Professor of Oncology and chair of the Division of Surgical Oncology at the Department of Surgery, and associate director of clinical research at VCU Massey. “He encouraged me to get involved with the NSABP, and that certainly has been a big part of my career.

“He was an example to follow in terms of getting involved, understanding the importance of clinical trials and cancer research from somebody who was a busy clinician and a leader and an administrator. He got the NCI designation, and he ran the cancer center from 1975 to 1988, and he was a very effective administrator—some people called him ‘the velvet hook.’

“He got things done.”

In 1971, a young woman named Edith Mitchell, a native of Brownsville, Tenn., came to MCV and enrolled in the more rigorous three-year program. A year later, Mitchell was placed on Lawrence’s service in surgical oncology.

“Only select students could do surgery on Dr. Lawrence’s service,” said Mitchell, a clinical professor, director of the Center to Eliminate Cancer Disparities, program leader for gastrointestinal oncology at Thomas Jefferson University, and a member of the President’s Cancer Panel.

At the time, Black patients at MCV were treated at the E.G. Williams Hospital, and patients were seen in different areas based on race.

“But when it came to surgery and taking care of patients, I never saw Dr. Lawrence make a difference in what he did for the Black patients, compared to the white patients,” Mitchell said to The Cancer Letter. “And he never taught us to make a difference.”

Mitchell performed physical examinations and took histories on all patients, regardless of race.

“It was the situation where the Black patients were in one hospital, the whites were in another, and if a patient requested that this little Black girl not be a part of their medical team, Dr. Lawrence never went along with it.

“I never saw him make a difference in what he recommended to patients, or his management of patients based on race; and his insistence, that I be included in the patient’s care,” Mitchell said. “And the patients could not elect to have me omitted from their care because of my skin. So, I can understand why he walked out of the Southern Surgical Association because they did not accept LaSalle Leffall.”

Mitchell was the first Black student to graduate from MCV’s three-year program. Before graduation, Lawrence gave her helpful advice.

“He said to me, ‘Edith, don’t ever put anything on a form in the next few years that you graduated in three years.’ And I said, ‘Why not?’ He said, ‘There are some state statutes that state that you must have four years of medical school. You will not have four years of medical school. In fact, you won’t even have three. So, you don’t ever put that on a form, because you never know in what state you will apply for a license.’ We knew that racial things could be stumbling blocks. Somebody could use that against me.”

Mitchell said she didn’t recall thinking deeply about the Confederate statues on Monument Avenue while she was at MCV.

“One of the things that I learned early on in the South was when to choose battles. The statues were not among the battles that I chose, but now, in 2020, when we are recognizing all of the things in the past, I think it is very much important that we give due honor to the United States of America,” said Mitchell, a retired brigadier general of the U. S. Air Force.

“These were people who fought against the United States of America. Therefore, I am very much a proponent of bringing to light the actual history. And that’s what Dr. Lawrence did for me—making sure I knew what was real, and that cancer patients had real needs, and that cancer research needed to be put at the forefront, and that we needed to engage,” Mitchell said.

Lawrence remains active in the VCU medical school and at Massey.

“We have our teaching conferences for fellows and residents on Zoom on Tuesdays and Thursday mornings and Thursday afternoons,” Bear said. “Walter comes, he pays attention, he asks questions, he provides a historical perspective when it’s needed. I am, actually, getting to the point where I’m providing historical perspective, but he has a much longer view of history in medicine and surgery. So, it’s always good to have him there. And he comments on the articles and the presentation—he’s still quite engaged.”

Five years ago, at 90, Lawrence gave up skiing and tennis.

However, his buddies still gather regularly at the tennis court in his backyard. 

“He stopped playing about five years ago; I’m in charge of organizing the games,” Bear said. “But we still play at his house, and he comes out, and sits in the chair, and gives us advice or comments on our shots.”

 

Paul Goldberg:

Dr. Lawrence, thank you for sitting down and talking with us. We deputized Dr. Winn to be an interviewer for The Cancer Letter—it’s an adjunct position. Let’s go back to 1971. What were your thoughts about the National Cancer Act, and why did you decide to seek NCI Cancer Center designation for MCV?

Walter Lawrence:

Well, thank you for having me. I would say that back in 1971, most of the support, in terms of research, support and emotional support, in a way, for cancer programs at universities, really, was organizations like the American Cancer Society.

Although here in Richmond, we had the Virginia Federation of Women’s Clubs and the local Masons outfit, and other organizations were very supportive, but none of these could provide the kind of support that our friendly government could do.

The thing that was exciting about the National Cancer Act, which I think was one of the best things President Nixon did, among things that weren’t so good, was that it did bring the federal government into the funding of various kinds of research.

We were pretty excited here when we had a lot of people at the basic science level and at the clinical level who all wanted to work together and collaborate. But having a cancer center funded by the government would really be helpful in that regard.

The National Cancer Act really gave us a lot of enthusiasm about the future, getting more things done in terms of improving the whole problem of cancer overall, patient wise and in the laboratory.

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Lawrence as an army surgeon in Korea in 1952.

 

PG:

What does it take to make it happen, to make the NCI designation happen in Richmond?

WL:

Well, in ’71, it’s different than now, I could tell you. Because then the government group working with the idea of cancer centers really were hung up on the fact that you had to have authority that made you more or less independent of a lot of the other administrative people at the school.

Many schools, the deans or the departmental chairmen had their noses out of joint by having another new organization that was taking over some authority. But the advantages here in Richmond were that the deans, and at that time the departmental chairman and everything, were gung ho about having this new coordinating entity.

Now, it wasn’t suddenly going to give us a lot of money for our research and other activity. What it was going to do was to give us those kinds of support funds that would help coordinate what was already funded on its own merit.

We did have a number of basic investigators and clinical investigators here at the time, all of whom had various kinds of research grants, sometimes through the American Cancer Society, some through the federal government, and various parts of the NIH.

Having this additional funding source of a coordinating entity really was exciting for both the basic scientists we were collaborating with, I say we—those who were clinical people dealing with cancer—and the basic science people who suddenly felt they were going to have some clinical advantage come from the work they were doing in the research labs.

 

PG:

When did you get the designation?

WL:

We had a planning grant that helped us. I must admit, they were very helpful in getting our heads straight on how to go about it. We put in our core grant in ’74, and it was approved in 1975. In that time, we became an NCI grantee.

Now, I’m glad you mentioned that, because the other thing that happened at that time, a lot of little commercial outfits, if they did a little cancer work and they would call themselves a cancer center. Being called an NCI Cancer Center was a big-deal difference, because you could just go down the street and call yourself a cancer center if you treated a few patients.

And, of course, the NCI Cancer Center in those days was primarily research, both basic and clinical. It didn’t really cover clinical treatment programs. We just had to have those as a background for having this wonderful coordinated cancer center.

But the main thing was to get funded, and to be named a Cancer Center, like we were, required us having grants. And we did have a number of grants, some from the NIH and some from the American Cancer Society.

I think we measured up, because we also had administrative support at the vice president and dean level, and departmental chairman level—everybody saying it was a good idea. I think that emotional support we had was also very helpful.

 

PG:

This happened at the same time as Alabama, really the first batch of cancer centers, right?

WL:

Yeah.

 

PG:

Maybe we should just go back—your coming to Richmond. You’re from the Midwest, you’ve been in New York a long time, what brought you to Richmond?

WL:

Well, actually, it’s really not the cancer deal at all.

I spent 15 years, my first career, at Memorial Sloan Kettering, and I was really excited about working there in both research and in clinical work. Ran one of the services there. But in those days, the only dialysis unit for kidney dialysis was Memorial, none of the other universities.

So, it turned out that when kidney transplantation was started here in Richmond, by Dr. [David M.] Hume, he couldn’t take our patients very well who had renal failure. So, I ended up, by being a young surgeon, they said, well, why don’t you start doing transplants here? So, I did all the first kidney transplants as a side issue of my cancer work at the cancer center and got to know Dr. Hume.

And Dr. Hume needed a vice chairman to answer the phone and to run things, because he was on the run [all over] the country all the time, selling kidney transplantation. So, I came down here as a transplanter, but I quickly shifted, because my big deal was really cancer work.

So, I told Dr. Hume I could be his vice chairman if he would let me start an entirely different, a separate cancer service, called the Division of Surgical Oncology. And he said, “Whatever you want, whatever you want.”

So, I really came here interested in getting cancer surgery going, and I had no idea when I came of wanting to start a cancer center.

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Lawrence performing surgery at a M.A.S.H. unit in Korea.

 

Robert Winn:

That’s really great. You’ve talked a little bit about the National Cancer Act and its founding in 1971. What did the National Cancer Act accomplish for cancer patients in Richmond, in the country, and worldwide?

WL:

Well, actually, I think the National Cancer Act was really mainly benefiting those people who were doing research, and there was much less concentration on patients.

On the other hand, you had to have a substantial relationship with the management of cancer patients for you to get funded. In a way, I think the way the cancer patients actually benefited, besides us possibly getting much more knowledgeable about how to manage their care, was the fact that it did allow us to really get going on clinical trials.

Randomized clinical trials were the only way we had of really improving patient cancer care—things like the one that Bernie Fisher in Pittsburgh started, the National Surgical Adjuvant Breast and Bowel Project.

I was a good friend of Bernie’s, so we were a big producer in his program.

Starting that clinical trials program here, as part of the cancer center, benefited patients quite a bit. And, actually, our grant from the NIH at that time was for introducing minority patients.

Because, as my head of radiotherapy at that time pointed out, 50% of Richmond were African American, we were an ideal place to bring in more minorities into the trials, because the trials up to that point were somewhat in question, because they didn’t include the balance of people who live here in America.

 

RW:

You have a lot of distinctions. Any number of them.

WL:

You’re just going on.

 

RW:

But one of them has been really something that has motivated me from when I was a medical student and, certainly, a resident. You were one of the few white surgeons who were active in the Black Academic Surgical Association. Could you talk about that just a little?

WL:

Well, actually, I snuck in. There is a very distinguished group of surgeons called the Black Academic Surgical Society.

It’s a national organization with lots of surgical leaders in it, and one of the major leaders then was LaSalle Leffall, who recently died. He was in Washington, and he was at Howard, and he was chairman of surgery there, but he was also a nationally known cancer surgeon.

LaSalle happened to get his training at Memorial when I was a junior doctor, so I started training him, sort of, but we became mainly friends over the years, and due to LaSalle, and a number of other members of that organization that I was friends with, to be nice to me, they made me an honorary member.

Naturally, if you get to be an honorary member, you better go to the meeting every year, and it was very worthwhile, because they’re a wonderful group of people, and continue to be, and it’s quite a national organization that I’m proud of being an honorary member of.

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Lawrence, third from the right, at a 1986 dedication of North Hospital which today houses VCU Massey Cancer Center’s Dalton Oncology Clinic, Radiation Oncology Department, BMT inpatient and outpatient clinics, and Thomas Palliative Care Unit. Then NCI Director Vincent T. DeVita is second from the right.

 

RW:

Well, thank you. This question, there has been a change at VCU Massey recently, they had a new appointed cancer center director, I think the guy’s name is Dr. Winn. Are there any reflections you have on being in this position and any advice that you would give to this new cancer center director?

WL:

Well, that’s a tough one. That’s a tough question.

Well, first of all, I must state here, I’m excited that you’re the new director, but not because you’re a minority or anything else. It’s because of what you’ve done and what you bring to the cancer center. Dr. Winn is very well known for his work in pulmonary work.

Everybody in the world knows that our leading cancer—that’s our biggest problem still—is lung cancer, so, having somebody who has a special research interest in pulmonology is especially good.

The second thing that is especially good, is since you came here, you’ve got so much energy and zip that I’m sure you’re going to rev things up even further. We are looking forward to great, great things from you.

Lastly, the fact that you are African American means that we are going to be guaranteed to have diversity in our workforce, so we are winning on all levels on this thing. So, thank you for coming.

And, incidentally, he’s from the same hometown that I came from. He didn’t really grow up there. He came from somewhere in the East, but both of us are from Chicago, so we are straightening out these Southerners a little bit.

 

PG:

You certainly have seen polio in your career. You have gone through the HIV era. And now there’s COVID. What has the COVID pandemic told us about the U.S. healthcare system?

WL:

Well, first of all, I might say that this COVID epidemic is so much more overwhelming than all those previous problems, at least from the standpoint of public perception.

The polio hit us when I was mainly a kid, and the main thing I noticed was that we couldn’t go to the movies, and it did worry us, but we still went to school.

Since then, we’ve learned a lot, and, of course, we benefited a lot from the work on polio, but this epidemic is so much more overwhelming. When you say, what did we learn, I’m really impressed with how well our medical facilities nationwide have anted up and come through and dealt with a disease for which we have no real treatment.

We have things that help, the dexamethasone and so forth, but still it’s really impressive how nurses and physicians and other healthcare workers have really anted up when it was needed.

What’s really worried me is how our culture has really not responded as well as they might. I’m afraid it has something to do with leadership, but I’m not going to get into politics. But I think we needed a little more leadership than we seem to be getting at the present time.

 

PG:

What about disparities that you see in cancer and that we saw in HIV, and what we are seeing in COVID? They seem to be working very similarly.

WL:

Actually, I bet this business of the disparities in both the incidence and in the severity of all these things is, it’s a mixed bag. Some of it may well have genetic aspects, but most of it is more in the social realm.

A lot of it probably has to do with underrepresented minorities having less satisfactory social systems. It’s bringing to our attention, the fact that we have to do a lot about that. I’m hoping now, with some of the recent activity that’s gone on, that we will get improvement.

 

RW:

It seems that almost after every big event, after polio, after HIV, and, certainly, after COVID, that people get fatigued, people have the protest, people have the energy, and then all of a sudden it goes away. Do you think that there’ll be any difference after this COVID crisis is over?

WL:

Of course, we all say we hope so. But I honestly think so. It’s another similar situation as that little young girl that sailed across the Atlantic on climate change.

I think the younger generation may have a lot more pizzazz in response to seeing some of the awful things that are happening, and that the younger generation may have more impact on how we do things than our elderly one and your middle-aged ones.

The other thing is with the cell phones and that, a lot of us really had some of these things brought to our attention much more dramatically than before.

Watching the killing of somebody on your phone is just pretty earthshaking. I think some of these things may have a lot more impact than things in the past. We certainly deserve to get more benefits, because this epidemic is so much worse than all the other ones.

 

PG:

What are your thoughts, as you navigate Monument Avenue in Richmond these days? I hear Jeff Davis is not there anymore, and a few others might be coming down.

WL:

When you go there, it’s really impressive. It’s amazing how so many of us were totally insensitive to the harm and the injury that those monuments did give to certain parts of our population. We looked at them as nice historic artistic things that dolled up the avenue.

But I think all the recent demonstrations, mainly peaceful, have really awakened a lot of us to how much those things did hurt.

So, even though we’ve lost some of the beauty temporarily by losing some artistic monuments, I think we’ve got real progress already in that dimension, by having them removed.

I have confidence that we are going to have other things to doll up the street and make us just as proud as before, but it’ll take a little time.

Of course, I, again, want to emphasize, I think we aren’t going to solve this racism problem by just getting rid of monuments, but it really is a first step that I think is important in this whole procedure of improving the relationship with certain parts of our population in every way.

 

PG:

Let me just disagree with you on one point, which is that I don’t think you’re giving yourself enough credit, because you really were seeing, were very sensitive to these matters all along, as your career shows and, certainly, a lot of people regard you—and I’m one of them—as a civil rights hero. Given that, maybe I should ask you if you ever expected that in your lifetime you will see an African American director of Massey Cancer Center.

WL:

It’s an interesting question, but it never occurred to me one way or another, but now that it’s happened, I’m just as excited about it.

But it just wasn’t one of those things. One of the reasons I never really thought about it too much is that even in my retirement, I was head of admissions for the medical school for a while, and we were always trying to encourage minority groups admission to the school, but we never really accomplished as much as we wanted to, because there weren’t enough applicants.

And the reason there weren’t enough applicants is, if we are going to develop somebody like Dr. Winn, we got to start improving things at the kindergarten level and not wait until they go to medical school or wait until they go into the faculty of medical school.

Solving this whole problem of racism in this country is going to require repairing a lot of our systems.

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Circa 1980; from left: Alan Kaplan, Walter Lawrence, S. Elmer Bear (then chair of oral surgery at MCV) and Jose Terz (fellow surgical oncologist who came from MSKCC with Lawrence)

 

RW:

Going back to science and the impact of the NCI Cancer Centers, what’s been the thing for you, the one either miracle drug or the one surgery, or maybe the combination of the surgical approaches or the medical approaches? I think when I began my career, for example, I know that we were not really enthusiastic, or there wasn’t any real hope in curing lung cancer, really treating lung cancer. What were some of the big wow moments when you were a sitting director? What are the big wow moments since?

WL:

Well, I have to admit when I was in surgical training, one of the things that led me to being interested in cancer was that I thought the operations that we did for cancer were the most interesting operations we did.

As a young surgeon, they were thrilling, because they were some of the bigger ones. Of course at the time I entered into this cancer field, which is in the early fifties, I’ll have to admit the only good treatment for most cancers was surgery.

As I go along here, what excites me about the future? What’s exciting me about the future is the fact that we finally began to see where there are some—this happened right along, of course—but we now begin to see that there’s some real excitement about things like immunotherapy.

And this is only the last 10 years that we see what we always wanted to have happen is happening, so the thing that’s exciting is that the non-surgical, or at least non-destructive methods of treating cancer, have a big hope now for the first time.

We were really looking forward to immunotherapy when I started in the fifties, but it never seemed to work out. It was a good idea, too bad it didn’t work.

There’ve been breakthroughs in cancer research in this last decade that are now being profited from, in terms of development. It’s not developed yet, but is in the process of development at the cancer center. I think the work there is exciting for the future, and I think you’re going to do it.

 

RW:

I was thinking about from where you started to where we are now about the impact of technology in the field of cancer. Do you have any reflections about that, because there’s always this battle about too much technology. Is it really working? Is it just snake oil? But it’s clear that the technology all along, whether we are talking about robotic surgeries, whether we are talking about… How has technology added?

WL:

When technology hit surgery, that’s when laparoscopic surgery, robotic surgery, and those things came along.

Of course, those of us who had been doing something another way all along resisted a little bit, but it became clear that there were tremendous advantages.

There had been some disadvantages. Part of the disadvantages is the increase in technology has increased subspecialization, so many of the people treating patients have shifted from being, in a sense, physicians to technologists, and they only do one kind of treatment, and they suddenly lose sight of the disease and all its aspects and focus more on the mechanics of treatment.

But it’s one of those things that goes with the territory. I think that, all in all, the technology of some of these improvements in surgery, for example, have really made this less damaging treatment and one that’s better tolerated, and so it is progress overall, it just has a few of those things that make me worried.

That’s part of the reason I still teach medical students, because I don’t spend time teaching them how to treat cancer now. I teach them how to take care of people. That’s still something that’s very necessary in cancer management, and I’m sure you do that well.

 

RW:

Paul, any other questions from you?

PG:

Thank you so much.

WL:

Well, thank you. I’m flattered that you would think I know anything at the age of 95. Thank you very much.

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Walter Lawrence (right, seated), with Harry Bear (left, seated) and friends in a recent photo

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