Hudis, who served as ASCO president in 2013 and 2014, is chief of Breast Medicine Service as well as vice president for government relations and chief advocacy officer at Memorial Sloan Kettering Cancer Center.
Hudis, 56, will start the job at the society’s headquarters in Alexandria, Va., June 27. He will succeed Allen Lichter, who is retiring after having held that job for ten years.
“When the board of directors began its executive search nearly a year ago, we couldn’t have imagined finding a candidate more ideally suited for the position,” ASCO President Julie Vose said in a statement. “Dr. Hudis is one of the most highly respected, well-regarded oncology leaders in the world.”
Announcing his move to his MSKCC colleagues in an email dated March 23, Hudis wrote: “I have been extraordinarily lucky to be part of the MSKCC community for nearly three decades and I have the greatest respect and personal affection for everyone here and our shared mission. This new opportunity is in large measure a direct consequence of the experiences I have had in working with so many of you since I arrived in 1988. Indeed, I have no desire to actually leave MSK and, while I will assume this new fulltime role, I will remain a member of our community with a very limited clinical practice on the Breast Medicine Service.”
Later that day, Hudis spoke with Paul Goldberg, editor and publisher of The Cancer Letter.
Paul Goldberg: Why did you decide to take this job?
Clifford Hudis: Because this is the most fun, exciting and invigorating thing I can imagine doing at this stage of my life. It leverages the experiences and opportunities that I’ve been fortunate to have for three decades in oncology, and it’s a chance to influence the quality of care that people get around the world. And I don’t see any better place to accomplish all of that.
PG: What would be the three top issues for ASCO under your leadership?
CH: I think it might change from what I tell you today. One of the things about ASCO is that it’s a flexible, responsive, vibrant organization; maybe we’ll talk a little more about some of these things in a moment. But besides that caution, obviously the cost of care in the United States is a critical issue, and I think we’re going to need a pretty thoughtful, considerate collaboration from all the stakeholders that allows us to preserve what’s good about our system, but addresses some of its weaknesses.
At the same time, the other obvious big thing, that we will be committed to for a long time, is the use of Big Data, which is increasingly sitting in front of us from all of our electronic records, but also from other sources. With it we can bring more of medical care and research into the 21st century.
We have to match what else is going on in the broad digital economy. Finally, I think that there’s an opportunity to look at how we do adult education, which is such a critical role for ASCO, specifically, but also an ongoing commitment for all of our members.
PG: Do you mean CME?
CH: Well I’m talking about how we do education; how adults learn most efficiently. I wonder about this because our educational challenges are actually growing very quickly with the exciting advances being made in molecular biology and the translation of that into clinical care. I think we have a very exciting opportunity to improve how we do education and make it more efficient and effective.
I will add a fourth thing, I know you asked for three, but I think it’s worth mentioning the opportunities that are developing around the world. We may come back to this, but from a macroeconomic point of view, the proportion of people in the world who are poor has never been smaller, the number of countries that are rising solidly into middle income ranges is growing, and the number of people who are going to have middle class aspirations for everything, including their health care, is growing. I think there’s a tremendous opportunity for ASCO to help seed the deployment of the ever-improving quality of cancer care around the world.
These are all things that I see right away as opportunities. I humbly suggest to you that I may have all these wrong; I may have the order wrong, but I think these are where we will start.
PG: You recently served as president of ASCO. Who will define ASCO’s priorities? Is it going to be a strong CEO or a strong president?
CH: It’s really multiple players.
ASCO is a member-driven, volunteer-run organization and it’s an association, specifically, of medical professionals. In ideal circumstance, this is a collaboration between a CEO who is identifying possibilities, trends, opportunities, and risks with a board of directors and a president who extend the reach and the range of the CEO tremendously and who can highlight additional opportunities.
So what we do is collaborate. I’ve been on one side of this as a president, and I’ll be on the other side of this as a CEO, and obviously each president works a little differently, and the tone and tenor of a board can evolve over time, but this is very much a collaboration, and it has to be.
PG: Can ASCO continue to grow the way it has in the Lichter years? Should it?
CH: Allen is a tough act to follow, isn’t he? He’s been a really remarkable—not just as a CEO, but as one of several fantastic mentors that I’ve been lucky to have.
I think we may measure ASCO’s future growth in different ways. I don’t know that we can continue to grow the membership or the attendance of the annual meeting at the same pace as in the past. But we’ve made a very big commitment to CancerLinQ, for example. I’m not sure we can make as big of a programmatic bet in the immediate future.
On the other hand, some of the things we were already talking about, I think, represent tremendous opportunities—we clearly have opportunities to grow our impact and, if you will, our footprint on the world. I’m very optimistic that the changes in cancer care and technology are going to let us grow as or more dramatically as we have in the past, but we may be measuring that growth in new ways.
PG: I thought one way to measure that was money—that was really how I was asking the question—revenues continuing to grow.
CH: I see. You mean business opportunities?
PG: Of course.
CH: Well no money, no mission, right? We know that.
And that’s something that, again, has been a great strength of Allen’s. He has been a successful financial steward of the organization, and I think the growth can certainly continue in that regard. I think there can be new products and new services that can appeal to the members, and beyond the members to new constituencies, and that’s something that we’ve already begun to look at and will be looking at even more intensively in the years ahead.
PG: What future do you see for CancerLinQ, or ASCO’s role in big data?
CH: Well, CancerLinQ is a critical initiative. It has the potential to usher in a new type of learning and care, not just for cancer patients, but also for as a model for other areas of medicine.
The opportunities are almost limitless, but a lot of it is catch-up. A lot of what we aim to accomplish in cancer care occurs in other industries; I alluded to this already. The predictive abilities of machine learning, the ability to recognize associations in behaviors and activities, all of that is going to enrich cancer care, but also, I think, all of medical care.
What’s unique and critical about CancerLinQ is that it is run by physicians and its fundamental purpose is quality of care. Yes, ultimately, it has to be self-sustaining, so it has to be financially viable, but our focus, like other things we do, is different from conventional for-profit businesses. So in that regard, I think the success of CancerLinQ is critical to our field. I think this is going to continue to garner a tremendous amount of our attention. It’ll be adjusted; we may change directions a little bit as we realize places where we can succeed and places where maybe it is harder to succeed. But fundamentally, there’s going to be a product from CancerLinQ soon, and it’s going to be a big contribution to how doctors treat patients.
PG: I think last time we talked was about the barriers to data sharing. Is that something that can be fixed?
CH: The answer to that, I think, may come from what was then an unexpected quarter. I think that the vice president and the president’s commitment to what’s been called the cancer moonshot – you’ve covered that already – includes a goal of providing resources to facilitate the use of big data. And one of the things that they’ve zeroed in on already is the idea of interoperability.
I can’t emphasize how important this is—not just for the research aspirations that we have, but, honestly, for day-to-day care. When you walk into an emergency room across town from where you’ve been getting your chronic care for any illness, it really shouldn’t be a project to get all of your records digitally transmitted, especially the key data points, but right now it’s just too hard. So interoperability is going to be a whole lot more than how databases communicate. It’s going to be about how you get your everyday care.
It’s a facile example, but you know, if you walk into the hotel lobby in Budapest and slip your ATM card into a random machine, you manage to get money withdrawn from your checking account in Washington. So there’s interoperability across this system, and we expect it. Why do we tolerate less in medicine?
PG: Well that’s because a lot of it is a little more complicated than an ATM.
CH: But it doesn’t have to be. Not this. Standards could exist and interoperability could be enabled, and to be very frank, it’s my understanding that some of the underpinnings of the original legislative push to get us on EMRs was meant to bring interoperability. I think this is a place where the delivered system has failed the original intent.
PG: I’m sure we will be talking about this for a long time.
CH: Yeah. We have to undo this. It’s an opportunity.
PG: Does ASCO have a role to play in drug pricing?
CH: I would just point out that although our members did not create the current system and its perverse incentives, they’ve clearly been players within it. We also are always going to be relied upon to select the most appropriate and effective treatments for patients. That’s our ethical obligation and our expertise.
Sometimes our choices create financial hardships for patients, and that’s something that’s gotten more and more attention lately. Sometimes our choices increase the cost of care more generally. And that includes within the systems and the practices that employ so many of us too. Cost has many repercussions.
I think we have an obligation to lead this discussion, because we’re the only people who can. We’re the only people who can integrate not just the price, but also the impact, the value of various treatments in terms of the outcomes that we’re trying to achieve. It’s something that we can’t leave to others.
PG: I noticed something you said in your presidential address at ASCO: “If we intend to achieve social justice in cancer care, we must define value in cancer care so that we are best able to optimally use society’s precious resources.”
How do you see ASCO’s role evolving in determining value-based reimbursement?
CH: Make no mistake about it, assessing value is hard. There can be subjectivity. And really smart, well-meaning, well-intentioned, honorable people may not agree on how we do it. Despite those challenges, we have the Value Framework that ASCO has labored over for a long time. It will be refined, and I think we’ll slowly hone in on what people can agree on—or at least what describes the basics of higher- versus lower-value care.
I think it’s very related to the drug pricing question—we have to do this. If we don’t, others will do it for us, and they won’t declare that they’re doing it overtly, they may not call it this, but it will be imposed on us and on our patients, and I’m concerned about how it would potentially restrict choice and access to care. So we have to do this.
PG: You’re an academic’s academic…
CH: You’re flattering me.
PG: It’s your path! And ASCO represents community doctors as well, so how will you address their needs?
CH: You’re exactly right, ASCO represents the full spectrum of clinicians caring for patients, and by the way, that’s going to extend beyond docs, to what are called mid-level providers—PAs and NPs, nurses, many others. We’re all in this together and we’re all trying to help patients.
So that’s the first point. The second point is that you’re right, I’ve been very fortunate to work in a really fantastic and innovative leading institution. I’ve had a variety of interesting research opportunities in my career within the cooperative group system, which is community-based, largely, or at least distributed to the community.
I’ve worked in other research networks; I’ve conducted industry-sponsored research. I’ve always maintained a busy clinical practice, in fact that’s the hardest thing to cut down on as I move into this role – my clinic. Even at an academic center like Memorial, one of the things that people don’t always realize that we have to run a balanced book. At the Service level we have to generate enough revenue to pay everybody’s salaries, staff and doctors; and we have to do it year after year. We have to deliver affable, empathic care to patients who expect and deserve no less. And I’m emphasizing this to point out that the challenges of academic practice are not so different any more from what’s called community practice. And the lines get blurrier.
Many of our big centers, mine included, have built out a network of sites, geographically dispersed, and we’ve sought to distribute the same single standard of care to all of these sites. We’ve been as responsive as we can to the needs of the docs who staff those, some of whom you would call “community” docs. So with all of this, I think that’s there more in common than different across the spectrum of practitioners.
At the same time I recognize the special challenges that many in traditional community practice have to meet. They have to run a business basically, and the leeway in some cases may be less than in others. But in the end I’m optimistic that our shared values and our shared goals are going to make something that ASCO and I can really help them with.
PG: So you’re noting a convergence, coming from both directions.
CH: I am. When you say community docs, for example, how many of our members are working in what used to be traditional small community practice? Some. Others are working in big multidisciplinary practices. Others still work for big commercial entities that are aggregating. And others still are working for academic centers even if they themselves are not pursuing traditional academic careers—meaning primary research, publication and teaching, and so forth. Again I think that we all have more in common than we have that’s different.
PG: What priority will you place on ASCO’s international work?
CH: A big one and a growing one.
I touched on this already, but the United States is of course just a small fraction of the world. We are the American Society of Clinical Oncology and we have been fortunate, as Americans, to have the resources in many cases to lead the development of so many of the therapies that benefit the world. But we also have this opportunity and obligation to share, and so we’re going to be focusing more and more on the ways that we can contribute to the improving quality of care that’s possible around the world.
PG: As a New Yorker, will you be okay in this sleepy Southern town? Should we worry?
CH: I don’t know what you’re worried about, I’ve been commuting to Washington, honestly, for about seven years now, maybe eight. One of my children went to school there. I’ve been on the board of ASCO for six straight years and even in the years since then, I’ve been back and forth in my committee roles. And by the way, I’m originally a Philadelphian, so I grew up halfway between anyway.
PG: So I’ll just withdraw the question.
CH: No, it’s alright! I’m excited by the opportunity actually. I don’t want to minimize it. But I’m going to be down there full time, and it’s not so far from New York.