Simone, the Mudjekeewis, the elder, the statesman of the cancer world

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In American Indian mythology and medical practice, the Mudjekeewis (the Grizzly Bear), Spirit Keeper of the West and the Chief of the Council of all Spirit Keepers and Animal Totems, is a symbol signifying responsibility, resourcefulness, intelligence, wisdom, introspection, physical and spiritual strength, and expertise.

A problem solver, the Mudjekeewis uses both his hands and his heart to find ways to do things that will benefit both himself and all of his brothers and sisters.

Twenty years ago, when we began to build the University of New Mexico Comprehensive Cancer Center, under Dr. Joseph Simone’s guidance, we chose the Mudjekeewis as our symbol, as this Great Spirit Keeper represents our commitment to using our hands and our hearts to serve those whose lives have been touched by cancer, and to do so with courage, knowledge, grace, and great ability.

On reflection this past week, like so many feeling pain and loss with Dr. Simone’s passing, but also appreciating his greatness, I have come to realize that Joe was our cancer center’s Mudjekeewis.

Indeed, he was the Mudjekeewis, the wise indigenous Elder, and the American Statesman of the cancer world. Fittingly, born on September 19, 1935, under the Harvest Moon, Joe’s American Indian birth totem was the Bear.

Joe’s physical persona and Sicilian roots—of which he was very proud—undoubtedly influenced his being, but as a Bear Person, his nature was to seek truth. As the bear hibernates, he digests his year’s experiences, he dreams, and then when he is reborn each spring, he begins his work.

He is fierce. Bear People teach us that to accomplish our goals and dreams, we must understand that the answers to our questions reside within ourselves, and that in self-reflection, we find the strength to achieve those dreams, undeterred.

With tremendous integrity and quiet (and sometimes not so quiet!) forcefulness, Joe Simone was never undeterred from what he believed in and what was true. As he would always say, “leadership matters.”

As many will attest, his impact on cancer research, cancer medicine, the delivery of quality cancer care, leadership, mentorship, and the proper development of cancer centers, was profound and impactful.

His contributions will not be forgotten.

After graduating from the Stritch School of Medicine at Loyola University in Chicago in 1960 and completing a residency and fellowship in Pediatric Hematology at the University of Illinois, Dr. Simone joined St. Jude Children’s Research Hospital in 1967 where he rose quickly to become the chief of Hematology-Oncology, and ultimately the director and CEO of St. Jude from 1983 to 1992.

During the 1970s, early in his career at St. Jude, Dr. Simone worked with Dr. Donald Pinkel and many colleagues to develop the first curative therapy for children with acute lymphoblastic leukemia.

Sensitive to using his hands and his heart to serve all of his brothers and sisters, Dr. Simone was also one of the first oncologists in the nation to report ethnic and racial disparities in cancer outcomes, noting in his studies published in Cancer in 1972 that African American children had a far worse outcome than Caucasian children when treated with the new ALL regimens that they had developed.

A comprehensive study of these outcome disparities was published by Simone and colleagues in Leukemia Research in 1985. For his significant body of work in translational and clinical science and for the development and evolution of successful treatments for pediatric leukemia, Dr. Simone was awarded the Richard and Hinda Rosenthal Prize in 1979 from the American Association for Cancer Research.

Following Dr. Simone’s tenure at St. Jude, he served in leadership roles as physician-in-chief and cancer center director at Memorial Hospital for Cancer and Allied Diseases and Memorial Sloan Kettering Cancer Center in New York (from 1983 to 1996) and as the leader and developer with the Huntsman family of the Huntsman Cancer Institute at the University of Utah in Salt Lake City (from 1996-2001).

As Dr. Simone began to transition to retirement, though Joe never truly retired, he formed Simone Consulting and began to assist a number of developing and established NCI Cancer Centers all across the United States.

Serving on key NCI Advisory Boards and as a member and chair of the National Cancer Policy Board at the Institute of Medicine from 1996-2005, Joe undoubtedly had more impact on national cancer policy and the development of American Cancer Centers than any other individual.

His famous “Simone’s Maxims,” his truth-speaking, thoughtful, and often hilarious guide on navigating academic medical centers (Clinical Cancer Research, 1999) and his treatise on “Understanding Cancer Centers” (Journal of Clinical Oncology, 2002) became our bibles, with truisms such as:

  • If you have seen one cancer center, you’ve seen one cancer center. (This pearl can’t be found in any of Joe’s writings, but he said it often.)

  • A weak or tentative institutional commitment to the prosperity of a cancer center is the single most common reason for talented directors to fail or, even worse, to become mired in perpetual mediocrity.

  • The director candidate’s bargaining position begins to deteriorate before the ink is dry on the acceptance letter.

  • If the sitting director of a cancer center does not control sufficient space and reliable sources of revenue to grow and develop the center, he or she should consider other career options.

Thank you Joe. True indeed.

When Dr. Simone accepted my request to become the chair of our cancer center’s External Advisory Board in 2002, I could not have been more thrilled.

Many of my colleagues around the country told me how jealous they were and how lucky we were that Joe accepted. True indeed.

Why did he accept?

I think in part because I am a bit pugnacious, as was Joe, and we were kindred spirits, in part because my research focus was in pediatric and adult leukemia, and in large part because he had an opportunity to help shape the development of an entirely new cancer center from the ground up, serving a highly diverse (49% Hispanic, 37% non-Hispanic White, 11% American Indian, 3% Black), vulnerable, and underserved population with tremendous cancer health disparities.

Joe taught me and our team many things, but mostly, like Bear People, to deeply consider our purpose and to build a cancer center that was truly impactful—through research, cancer care delivery, education and training, and outreach—to the people and communities we served. Joe defined “outreach” and “community engagement” long before these were in the NCI Cancer Center Guideline lexicon.

In fact, I and many of my cancer center director colleagues delighted when Joe would rail against the NCI Cancer Center Guidelines in the past as being too restrictive to NCI Cancer Centers, forcing conformity rather than enhancing and celebrating diversity in the nation’s cancer center program.

Joe taught us that there was a way to honor these guidelines, but to also be courageous enough to be independent and develop centers that were unique with special “distinguishing characteristics.”

Thank you Joe. True indeed.

Among his many accomplishments, Dr. Simone was also a poet.

One of my most treasured gifts from Joe is a signed copy of his Collected Poems (Editorial Rx Press, 2015), and I leave you with these closing thoughts from my favorite poem in this collection, “Journey:”

Until the tree on the track forces hikes and other rides,

hard and easy, smooth and rough.

Then fatigue and boredom sap strength, and pain and failure

Deflate the resolve to continue.

Then, perhaps, the passenger, by wisdom or grace,

May learn the journey often becomes the

Unplanned destination.

True indeed.

The author is the Maurice and Marguerite Liberman Distinguished Chair in Cancer Research, UNM Distinguished Professor of Pathology and Internal Medicine, Director and CEO, University of New Mexico Comprehensive Cancer Center

Joseph V. Simone’s book, “Simone’s Maxims,” is available for download through the Cancer History Project.

Maurice and Marguerite Liberman Distinguished Chair in Cancer Research, UNM Distinguished Professor of Pathology and Internal Medicine
Director and CEO, University of New Mexico Comprehensive Cancer Center
In This Issue


President Joe Biden’s proposed Advanced Research Projects Agency-Health would be a welcome partner to NCI—particularly in conducting large, collaborative clinical investigations, NCI Director Ned Sharpless said.“I think having ARPA-H as part of the NIH is good for the NCI,” Sharpless said April 11 in his remarks at the annual meeting of the American Association for Cancer Research. “How this would fit with the ongoing efforts in cancer at the NCI is still something to work out.”
Maurice and Marguerite Liberman Distinguished Chair in Cancer Research, UNM Distinguished Professor of Pathology and Internal Medicine
Director and CEO, University of New Mexico Comprehensive Cancer Center