Selwyn M. Vickers wants Memorial Sloan Kettering Cancer Center to become better known in Harlem, Coney Island, and other parts of New York City where the elite institution he now leads is not a go-to place.
“I can go to Harlem, and my barber has never heard of Memorial Sloan Kettering Cancer Center. I can go to Coney Island, and there are people there who’ve never heard of Memorial Sloan Kettering Cancer Center,” Vickers, president and CEO of Memorial Sloan Kettering Cancer Center, said to The Cancer Letter. “Now, I can’t drop a dime without somebody on the Upper East Side of New York knowing about it. But the reality is that there are worlds in the spectrum of what we call New York that don’t know us.”
In a conversation with Robert A. Winn, director and Lipman Chair in Oncology at VCU Massey Cancer Center and senior associate dean for cancer innovation and professor of pulmonary disease and critical care medicine at VCU School of Medicine, Vickers said he feels a responsibility to expand access to MSK. Winn is guest editor of The Cancer Letter and the Cancer History Project during Black History Month.
“Being stewards of the resources that this organization has been blessed to have comes with a responsibility to give others access to it. I think that’s the grand opportunity through partnerships and collaborations,” Vickers said.
Vickers started his job at MSK on Sept. 19, 2022. He is one of three Black directors of NCI-designated cancer centers. Until 2022, Vickers was senior vice president for medicine and dean of the University of Alabama at Birmingham’s Marnix E. Heersink School of Medicine. He was also CEO of both the UAB Health System and the UAB/Ascension St. Vincent’s Alliance.
Vickers said his path to surgery can be traced to a patient he treated while on surgical rotation in medical school. The patient was an elderly Black man with peripheral vascular disease, resulting in a necrotic big toe.
“I would go by, wake him up, allow him to get a chance to get a cigarette in his mouth, because I was going to debride his foot,” Vickers said to The Cancer Letter. “No lidocaine, no numbing, it was dead tissue I was taking off. He would wince in pain as I cleaned it up and got dead tissue removed so that when my attending would come by at 5:30, I would’ve had that done.”
He cared for this man for five weeks, through the rotation. When he moved on, Vickers received a call from one of the surgery attending physicians asking him to come to the clinic.
“The nurse came on the phone and said, ‘There’s a patient here who won’t leave until he sees you,’” he said. “So, I go down to that surgery clinic, and there’s that man sitting there. He said, ‘I wanted to see my doctor,’ and that was me.
“He wouldn’t go until I came to see him, because his foot was healed. The pain I put him through—he knew I didn’t intend it—and he knew I did it for his good. After that experience, I had the sense that I could do surgery and still build the relationships with patients that I wanted to have. I could still have a career and a passion in an area that fit me as a person.”
Health disparities are inseparable from a broad range of social and economic problems, many of which are rooted in this country’s legacy of slavery.
“What drove me was the legacy of the challenge that this country’s been dealing with since 1865 when there was an abolition [freeing] three million Black slaves,” he said. “We’re still struggling with how to integrate them in our society. We had an opportunity, and we created a surrogate slave system and caste system that continually created the second class citizenry for people of color. That’s been pervasive in several areas that we deal with across the landscape of economics, education, and certainly not the least of them, health care.”
When you resolve those issues related to access, targeted therapy, inclusion, you make the system better for everybody.
A system based on unequal access, creating haves and have-nots, does harm to the entire society. Conversely, equitable access provides an all-around—society-wide—benefit, Vickers said.
“When you resolve those issues related to access, targeted therapy, inclusion, you make the system better for everybody,” he said. “Because we framed this as a zero-sum game—somebody wins and somebody loses—we often struggle to take this on at the core of who we are. Because the reality is, if we actually can achieve it, we make it better for everybody. It improves the care for our country, not just for one segment.”
Growing up in Alabama, Vickers took inspiration from his grandmother, who sought out education later in life, and his uncle, who was a doctor.
In seventh grade, his grandmother was told she didn’t need any additional education—but she badly wanted to graduate college. She attended Snow Hill Normal and Industrial Institute, a segregated school and the only place where Black people could get a high school degree in that part of Alabama.
“What I saw in her was a woman who overcame all odds,” he said. “But then taking that to commit her life to teaching, raising a family, and then going 10 summers to get her college degree.”
Had her circumstances been different, his grandmother would have earned a PhD.
“She had a tremendous impact on me to believe education was the great equalizer. Independent of her color, it defined her ability to speak cogently and boldly to anybody no matter who they were,” Vickers said. “It was all because of what she had learned and the dignity of which she carried herself in her role.”
Vickers notes that his story is not unique. “Every person, particularly in this country, who’s achieved, stands on the shoulders—and particularly every person of color—stands on the shoulders of individuals who’ve sacrificed in some significant way,” he said.
A recording of this conversation appears on the Cancer History Project podcast, and as a video.
Robert A. Winn: Dr. Vickers, I couldn’t think of anyone better to highlight who has made an impact on the field of cancer, particularly on young people.
I was thinking about not only your role now, but the roles that you have had over your history. And given that this is Black History Month, I wanted to open up with a question. What has the impact of physicians like Jack White, or LaSalle Leffall, or Harold B. Freeman had on your career or how you want to make an impact in the field of cancer?
Selwyn M. Vickers: Thank you so much, Robert, for that question. I would say like many things in America as it relates to Black history, most of our lives have been a part of achieving our dreams, but overcoming society perceptions and limitations that have often been placed on us by incomplete narratives.
Because of that, the value of actually seeing someone who’s gone before you and touching someone who’s done what you’ve wanted to do is unbelievably powerful in both energizing and giving you the possibility of hope that you can do something similar.
Jack White, being the first Black surgeon to train at Memorial, gives all of us a chance to understand what is possible once the door is open. LaSalle Leffall, who also had that experience to train here, even further highlighted the excellence of both achievement and character that could overcome perceptions and bias.
LaSalle, in so many ways, gave me a chance to touch a man who was so remarkably dignified in the capacity that he had as a leader, that one respect of the world of surgeons and in the world of cancer leaders. His grace, his intellect, and his challenge to the world, as in the case of Jack White, to understand the disparities in cancer outcomes and care for people of color.
They highlight excellence comes in all shades. They highlight resilience and grit of a level of achievement that often required them to sacrifice much. And they also remind me that if what they did was possible in their time, there is much that I can do in mine.
That’s fantastic. It also reminds me that in addition to those giants, you even have personal giants within your own family. Talk about your maternal grandmother and the impact and the influence that she had on you in Alabama.
SV: I didn’t understand it until over time, but she was a woman who I got to know as a young kid, largely because she was a school teacher.
She was different from other women in rural Alabama. She was getting up and dressed in her best outfit to go to school to teach. I followed her at the age of five because I needed something to do.
As I grew my own educational pathway in college, I would drive 100 miles back to see my grandmother because of the relationship I had with her. And the same thing for my grandfather. I didn’t think about it much then, but they had such an impact on me.
I’d come home from college, they lived about 100 miles away. I’d get in the car, and I would drive by myself just to go spend time with them and with her, in particular. Because what I saw in her was a woman who overcame all odds, who in the seventh grade was told she needed no more education but had a passion to be a college graduate, who had to then go her own journey to a little place called Snow Hill Academy.
It looked nothing like Andover or Choate. It was a rural Black school and the only place where you could get a high school degree for Blacks in the South in that part of her state.
But then taking that to commit her life to teaching, raising a family, and then going 10 summers to get her college degree. With all that, she told me of her aspirations had circumstances been different. She said, “I would’ve gotten my PhD, but I had daughters and a husband and there was a limit on what I could do, but my aspirations go further than that.”
She had a tremendous impact on me to believe education was the great equalizer. Independent of her color, it defined her ability to speak cogently and boldly to anybody no matter who they were. It was all because of what she had learned and the dignity of which she carried herself in her role.
Thank you for that. It leads me to think about our young people today and how they make choices. There were so many pathways for you to go down in medicine. You could have been a [medical] oncologist, you could have been in radiation—why surgery, and why your focus on, particularly, pancreatic [cancer]?
SV: I had the fortune to have an uncle who was a physician, and that was very rare. He was the first physician to graduate from his small college of Stillman in Alabama. I was very blessed to have someone I could touch and gain passion. But I also realized that because of DNA, I had the intellect to do what seemed to be impossible to me. I could be a doctor because I knew him and he could tell me, “You’re smart enough to do this.”
That was a bit out of reach for my mindset. I knew I could be a teacher because I’d seen [my grandmother’s career], but I didn’t know that I really could be a doctor. Because of the journey of getting there, [my uncle] helped me understand that it was all possible.
Surgery was something I actually tried to avoid. At the time that I did my rotations, one of my goals, Robert, was to leave that one with faculty members asking me, “Had you thought about being a pediatrician? Had you thought about being a psychiatrist?”
I wanted to be agnostic when I started a rotation and delve into it to the degree that I could eventually see myself doing it. Surgery was one that was very hard for me in some ways and very easy in others. It was easy because it was always outcomes-driven, and there was always a goal of getting someone out or getting in the OR and fixing something. That was easy.
What was hard was that I didn’t see the relationships that I wanted to build with patients often in surgery because it was episodic.
Not until I had finished my surgery rotation, I had an older Black man who had peripheral vascular disease. He had gotten a fairly complex bypass procedure to save his foot, but he had a necrotic big toe. My job as the intern or sub, at 4:30 I would go by, wake him up, allow him to get a chance to get a cigarette in his mouth, because I was going to debride his foot. No lidocaine, no numbing, it was dead tissue I was taking off. He would wince in pain as I cleaned it up and got dead tissue removed so that when my attending would come by at 5:30, I would’ve had that done.
I did that for probably four or five weeks until he got discharged, and I was off the service doing medicine. I got a call from one of the surgery attendings who said, “You need to come to the surgery clinic.”
And I said, “I’m not on the surgery rotation anymore.”
And the nurse came on the phone and said, “There’s a patient here who won’t leave until he sees you.”
So, I go down to that surgery clinic, and there’s that man sitting there.
He said, “I wanted to see my doctor,” and that was me. He wouldn’t go until I came to see him because his foot was healed. The pain I put him through—he knew I didn’t intend it—and he knew I did it for his good.
After that experience, I had the sense that I could do surgery and still build the relationships with patients that I wanted to have. I could still have a career and a passion in an area that fit me as a person.
Wow. Talk about inspiration. Following up on that, it’s clear that you’ve always wanted to have connections with people in our communities, and equity has always been also a part of what you do. All the way back to Minnesota, I remember your doing things for the Center for Healthy African American Men.
Could you talk a little bit more about it? Knowing that science is evolving, how can we get our communities to have more access to clinical trials? What drove your passion around the equity issue?
SV: I think what drove me was the legacy of the challenge that this country’s been dealing with since 1865 when there was an abolition [freeing] three million Black slaves.
We’re still struggling with how to integrate them in our society. We had an opportunity, and we created a surrogate slave system and caste system that continually created the second class citizenry for people of color. That’s been pervasive in several areas that we deal with across the landscape of economics, education, and certainly not the least of them, health care.
I saw that strikingly in the South because of poverty and access. And as you know, disparities didn’t occur really until issues of opportunities were presented.
The classic example is that before mammography existed, Black women died at the same rate as white women. There was no way to detect [breast cancer] early, and there were no treatments for anybody. But you now advance both therapies and early detection. Then the haves get access and the have-nots remain, unfortunately, in the status they were before. And so you see the gap grow, and that’s whether you’re in Alabama, Minnesota, or New York. Those principles still exist.
The secondary principle that I think we often don’t speak enough about is, what would we look like if we did have equity? What would it look like if we didn’t have disparities? And what might that mean for everybody? I think, you as well as I know that when we improve disparities for people—whether they’re poor Appalachian whites, or Blacks in urban or rural areas—you actually improve the care for everybody.
When you resolve those issues related to access, targeted therapy, inclusion, you make the system better for everybody. Because we framed this as a zero-sum game—somebody wins and somebody loses—we often struggle to take this on at the core of who we are. Because the reality is, if we actually can achieve it, we make it better for everybody. It improves the care for our country, not just for one segment.
Oh, that’s fantastic. From where you began in your career as a medical student to where we are now, what progress has been made during that period of time?
SV: I think the progress has been made in large part in multiple areas. I had a chance to be a part of the lens of the NIH’s formation of the National Institute of Minority and Health Disparities. One of my close friends and mentors was John Ruffin.
I, in the early days, was with John when he left North Carolina to go to Bethesda to form an office that Louis Sullivan thought was important. I saw him fight the battles of having the science of health disparities become fully integrated and distinct as a problem to be solved—and questions to be answered—to a field that now has had a chance to both impact our country and build careers.
Looking back where I began, this was not even perceived as something to be addressed. We knew it was a problem, but we didn’t have any mechanism to actually frame it as a true discipline where there could be both discovery and implementation. That has evolved now, where we understand both broadly, that many young people want to see this scientific track to be a part of who they are. Secondly, we understand that it’s a pervasive problem throughout our health care world that needs to be addressed by all of us. It’s, arguably, the most challenging burden of academic medicine or even community medicine that exists.
Thirdly, we still have the barrier in the areas that we want to address under the rubric of healthcare disparities. The etiologies often extend beyond the reach of academic medical centers.
It’s the conundrum of getting an R01 to look at breast cancer or pancreas cancer, at a gene mutation, a new canonical pathway or a non-canonical pathway. Everything in that grant and in the sphere of what you’re doing can answer your questions and give you solutions. But when you get a health disparities grant, 70-80% of what you need to resolve is not within the scope of what you control.
And so you are often in a process of making progress by cobbling together various partnerships. It’s how to address the fundamental problems that show up as a healthcare problem of disparity, but they’re actually driven by so many other social determinants.
That’s still the Holy Grail. How do you get all of those mechanisms to the table to actually address those determinants that end up showing up as a healthcare problem? How do you address the multiple social determinants that lend themselves to affect how we live?
Absolutely. Thank you for framing it that way because I think most people don’t always see the complexity. There are also possibilities and opportunities to address health disparities as not a “side-science,” but as a science. When you really think about health disparities research, it is person-based, community-based, and real precision medicine at its core.
With the few minutes that we have left, I want to talk about your new position. You did amazing work at Minnesota and at UAB. What are the opportunities that you see coming from your time at Memorial Sloan and how they will make an impact on our field?
SV: I think it’s a unique opportunity. It was a hard decision. I had two really difficult emotional decisions when I left home, and arguably, I should say three. When I first left to go to Baltimore to Hopkins—and I stayed there 16 years—Baltimore had become a home. I accepted a job for about a week to stay as a faculty member and then decided to leave.
That was an emotional and really challenging experience for at least the first two years of going back to Alabama. That part of Alabama was only something I’d visited. I hadn’t lived in Birmingham. It was new and had no ties to UAB at all.
I would encourage all of the people who are fostering and making moves for their careers to continually be resilient.
I was fortunate, I was blessed to have a great experience to hopefully have an impact in the organization. I went to Minnesota, had a really good run of running a surgery department and creating, hopefully, value for that institution during my time. I decided that probably I’d head south, but I didn’t know where that would end up. It happened to be back at UAB, which most people—including me—thought would probably be where my career would end and in the roles that I had taken on.
I didn’t see this coming, and it wasn’t on the radar necessarily. I certainly still had very fond affiliations with Hopkins. But Memorial was an unexpected opportunity where there seemed to be a match of both my academic background as a cancer surgeon, having led both complex cancer research programs, pancreatic cancer SPOREs, as well as my work in cancer disparitie. I also had functioned as a senior leader who had run major organizations and complex healthcare systems. Memorial could benefit from that leadership.
The match seemed to be one that was appropriate and fortunately worked itself out. And as I arrived, I think it was timely. The leaders prior to me, Paul Marks, Harold Varmus, and Craig Thompson—all phenomenal scientists—built an incredible institution that has impeccable, if you would, cancer biology research and great clinical care.
I think one of the blessings of New York is that you’re in a really resource rich environment. There are tremendous resources that have been generously given by our benefactors to Memorial to create a treasure trove of both discovery, translation, and clinical trials in clinical care. One of the curses of New York is that you can get isolated just focusing on New York. You can go 50 miles in a circle, and there are 35 million people. You can get locked into that being the world.
I’ve said my broad vision for Memorial is to continually grasp at being the world’s authority on cancer and, of equal importance, to continually run it as the cancer center to the world.
I clarify that being both geographically and culturally. I’ve said to my constituents that I can go to Harlem, and my barber has never heard of Memorial Sloan Kettering Cancer Center. I can go to Coney Island, and there are people there who’ve never heard of Memorial Sloan Kettering Cancer Center.
Now, I can’t drop a dime without somebody on the Upper East Side of New York knowing about it. But the reality is that there are worlds in the spectrum of what we call New York that don’t know us. We’ve been seen as exclusive and selected.
I want to broaden that aperture for the organization.
Being stewards of the resources that this organization has been blessed to have comes with a responsibility to give others access to it. I think that’s the grand opportunity through partnerships and collaborations. We can’t do it all on our own. We need those partners to help us do it, and we need the ability to have a vision that casts our scope broader than just this area where we are, even though there is a large population.
I’m excited for you, for Memorial Sloan and the people who you’ll impact. Before we end this discussion, I just want to give you an opportunity to share advice. What’s one piece of advice that you would give our young people as they’re looking forward to their careers and trying to make an impact?
SV: I’ve often shared the story of my paternal and maternal ancestors, and I’ve written about it in the context of burnout and resilience. My story is not unique. Every person, particularly in this country, who’s achieved, stands on the shoulders—and particularly every person of color—stands on the shoulders of individuals who’ve sacrificed in some significant way.
I would challenge all [young people] who face hurdles and challenges the mindfulness to understand that their loved ones could never spell the word burnout; it wasn’t in their vocabulary. They had no ability to even think about it. In many ways, as our ancestor says, “That when we face that next challenge, I could be no ways tired.”
I would encourage all of the people who are fostering and making moves for their careers to continually be resilient. In mathematical terms, it means the ability to take on an obstacle or an impediment without having it leave a permanent defect. It only makes you stronger to move forward.
That’s awesome. This is the end of our interview, Dr. Vickers, and I just want to thank you so much for your time and for being with us. I wish you well, and I’m excited for everything you’re going to do.
Alex Carolan contributed to this story.
