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Stephen Katz Oral History I= nterview
National Institutes of Heal= th
Conducted by: Kate Hallgren=
June 18, 2018
KH: Great. So good mornin= g.
SK: Morning.
KH: My name is Kate Hallgren an= d I=E2=80=99m a senior historian at History Associates, in Rockville, Maryl= and. So today, June 18, 2018 I=E2=80=99m interviewing Dr. Stephen Kat= z at the National Institutes of Health in Bethesda. Before we begin, = I=E2=80=99d like to read a short introduction. Dr. Katz has served th= e public through his research and leadership roles at NIH since 1974. = He was first hired as a senior investigator at the National Cancer Institu= te. By 1980, he was serving as Chief of the Dermatology Branch of NCI= , a position he held until 2001. In 1995, he was appointed Director o= f the National Institute of Arthritis and Musculoskeletal and Skin Diseases= , a position he maintains today. Dr. Katz, I am so happy that you can= be here.
SK: Thank you.
KH: So I understand that you we= re born in New York.
SK: I was.
KH: Do you have any memories of= the city?
SK: Oh, I do. I lived the= re for close to eleven years. I have good memories of New York City.&= nbsp; I went to school there. I went to a parochial school. It= =E2=80=99s called a yeshiva. We studied Hebrew half the day and Engli= sh half the day. English, history, math, etc. Then my family mo= ved to Washington, D.C., and then from there, three years later, we moved t= o Bethesda. So I actually grew up in Bethesda. I went to high s= chool at Bethesda-Chevy Chase High School.
KH: Very close.
SK: Very close.
KH: Do you remember enjoying sc= ience classes when you were younger?
SK: No. Not at all. = I had no interest in science. I was a very good mathematician, I thi= nk, but I had no proclivity to science.
KH: Were there any teachers who= had an influence on you?
SK: No. None. I had= a very, I would say, negative experience in both junior high school and hi= gh school. I graduated from high school with a general diploma, which= was just between an academic diploma and a vocational diploma because I di= dn=E2=80=99t have enough credits to graduate with an academic diploma. = ; My major course was shop, either metal shop or wood shop. I had to = repeat some classes in high school. I was a rather ignominious studen= t.
KH: Did you enjoy working with = your hands?
SK: Yes. Yes. I enj= oyed seeing the product.
KH: I=E2=80=99ve read that you = wanted to join the Coast Guard.
SK: Correct. During the l= ast year of high school, friends of mine had decided, well, let=E2=80=99s g= o to the Coast Guard for six months rather than going into the Army for two= years. The three of us signed up for the Coast Guard. The only= problem I had was that I was only seventeen-and-a-half. When we went= to the Treasury Building downtown, we had to sign up for the Coast Guard, = and my father said that he didn=E2=80=99t care what I did, but he=E2=80=99s= not signing me up for the Coast Guard.
My ot= her alternative was to go to college and in those days, it was easy to get = into the University of Maryland. You have to realize that I had a bro= ther, unfortunately, who recently died, who was at the other end of the aca= demic spectrum from me, and he was sixteen when he graduated from high scho= ol, nineteen when he was in medical school. He was three-and-a-half y= ears older than I am, but I think about seven years ahead of me in school, = so I had a classic sibling rivalry in retrospect, and he was my ultimate he= ro.
KH: So when you went to the Uni= versity of Maryland, you had a little bit of your brother on your mind.
SK: I knew that if I didn=E2=80= =99t do at least acceptably, I would end up going into the Army. At t= hat time, the Vietnam conflict was starting, and so fear . . . I=E2=80=99d = either have to go into the Army or I=E2=80=99d have to go out to work. = ; I did pretty well in college and I finally read a book and I found that I= enjoyed learning.
KH: So you turned it around?
SK: I turned it around. Y= es. I was meant to be an optometrist. My father, my uncle, my c= ousins, my great uncles, were all optometrists, so I was destined to be an = optometrist. That=E2=80=99s why I took physics early on in my college= career, but my last year at college, when I was ready to apply to optometr= y schools, my brother said to me, he said it in words other than this. = ; He said, =E2=80=9CDon=E2=80=99t be a jerk. If you want to examine e= yes, go to medical school. Don=E2=80=99t go to optometry school.=E2= =80=9D Disappointed my father for a little while because my father an= d I were very close, but it was a good suggestion on his part.
KH: Did you have any additional= courses to complete once you decided to go to medical school or did you ha= ve all of the prerequisites?
SK: No. It happened that = I had all the prerequisites because the prerequisites for optometry school = are pretty much the same as medical school. I think I didn=E2=80=99t = have calculus, which was something that I didn=E2=80=99t really know that I= needed, but for medical school, I had all the biology and physics that I n= eeded so I could apply to medical school.
KH: Did you enjoy them when you= were taking them in college?
SK: Yes. Yeah. I en= joyed those science classes. I was not passionate about them, but I e= njoyed them.
KH: Do you remember laboratory = experiences in college?
SK: I do. Again, I enjoye= d them. I was not passionate about them. My passion started in = medical school.
KH: Okay. I want to ask y= ou about that next, as you can imagine. So, you went on to Tulane.
SK: Right.
KH: What was that experience li= ke?
SK: It was a great experience.&= nbsp; I was on the upslope of learning and I devoured it. I loved lea= rning new things. I thought biology of the human system was fantastic= and I just couldn=E2=80=99t get enough. So as a medical student, I r= eally, really enjoyed learning new things and I was totally engaged. = I=E2=80=99ll say as an aside, I gave the commencement speech for my medical= school this year, fifty-two years after graduation, just about two or thre= e weeks ago. I hope that I transmitted to the students, I think I did= , what Tulane medical school did for me in terms of opening up the world as= a really small place to live and as people have the same issues all over t= he world and I had lots of opportunities at Tulane that have lasted me a li= fetime.
KH: Like what?
SK: Like in 1965, spending a lo= ng summer in Kampala, Uganda through the auspices of Tulane, where I was ab= le to do research. It was my real first exposure to any type of resea= rch. In fact, I thought to be a pediatric nutritionist after I finish= ed that summer, but I was not really prepared to walk the walk or talk the = talk. But I did like the idea of research. It just sort of occu= rred to me that that is interesting. I worked with really interesting= people and it was the first time outside the country and I got to meet lot= s and lots of people. I had an interpreter who helped me do the studi= es on the effect of urbanization on marginal malnutrition. That was, = I think, my first published paper in the Journal of Tropical Medicine a= nd Hygiene and it was just a wonderful experience.
There= was a woman named Dr. Grace Goldsmith, who set the whole thing up. S= he was not well-known in our university, but she was worldwide known, very = well known for vitamin B deficiency. None of us knew her, but I was referre= d to her because I really wanted to work in England, and when I met her she= said =E2=80=9CWell, I don=E2=80=99t know anybody in England, but I know lo= ts of people in Kampala in Uganda,=E2=80=9D and it was great. It gave= me quite an experience.
My fa= ther didn=E2=80=99t like the idea because he thought I might be eaten by th= e cannibals, but actually when I was in Uganda, I made many friends who wer= e also from Kenya, and when I sent him home pictures of a synagogue in Keny= a, then he knew everything was civilized in East Africa. It was a gre= at time. East Africa had just been liberated from the British, so Tan= zania, Kenya, and Uganda had really a triumvirate of leadership. It w= as a great experience. Made the world a small place for me.
KH: That sounds very exciting.&= nbsp; What about that research excited you the most?
SK: Oh, I think learning new th= ings. For me, it was a great thing. I think that learning new t= hings, it turned me on. It didn=E2=80=99t make me into a researcher, = but it did give me that exposure that when you learn something that nobody = else knows, it=E2=80=99s exciting. Is that what spurred me onto a res= earch career? Not really, but it certainly spurred me on to my career= as to all of the international things that I=E2=80=99ve been involved with= .
KH: I want to get back to that,= but I also wanted to ask you about going on after Tulane to Los Angel= es for your one-year internship there, as I understand it.
SK: Correct. I thought to= go into either ENT or dermatology. I was heavily influenced by my br= other who was an internist first and then during his internal medicine resi= dency decided to become a dermatologist, which I thought was basically laug= hable. I thought it was laughable because I didn=E2=80=99t know that = people went to medical school to be dermatologists. I guess in retros= pect, I=E2=80=99m wrong. I decided to do a medical internship and all= the places that I applied to had medical internships.
Most = internships were rotating internships, that is, they did a lot of surgery a= s well as internal medicine. I just wanted to do internal medicine, s= o I decided to go to LA County Hospital. They accepted me. Ther= e were about 180 interns total. Only twelve of us were medical intern= s, and that was also a great experience. It was a very active experie= nce. In fact, if I didn=E2=80=99t have the Army facing me, all male physici= ans had to go into the Army in those days, I probably would have gone into = general practice for a little while because I thought I was at the top of m= y game as an internist or as a general practitioner. But I had signed= up for what=E2=80=99s called the Berry Plan, which was an agreement betwee= n the student or the doctor and the armed forces that you would go in after= either one year of residency or three years of residency. I preferre= d three years of residency, and as a consequence, I did the Berry Plan afte= r three years of residency.
Right= , so I decided that I would rather do a full residency and then go into the= Army, so the Berry Plan enabled you to make an agreement with the armed fo= rces, not necessarily the Army. It could be the Navy, the Air Force, = but the armed forces, that you would go in after three years. You wer= e basically assigned to go in after three years, so I knew that after three= years of residency, I would go into the Army for two years. I didn= =E2=80=99t know where I was going, but I knew I was going for two years.
KH: So then you went on to Miam= i to a dermatology residency?
SK: Correct. I went to th= e University of Miami as a resident. Nowadays it=E2=80=99s much harde= r to get a residency program, although I was not a bad medical student.&nbs= p; Actually, I did quite well in medical school, but I went to the Universi= ty of Miami because that was one of the great training programs in the coun= try. Miami, Oregon, Harvard. Those were the three great dermato= logy residency programs. My brother had been at Miami and I had visit= ed him on many occasions, and I became a dermatologist enthusiast because o= f what I actually saw. My preconceived notions were nullified by my e= xposure to my brother and his residency program. So when I was lookin= g for a residency program, I looked at three or four places and something h= appened that never happens now. The head of the residency program met= me on Friday.
I was= vacationing in Miami during my internship and the head of the program, Dr.= Harvey Blank, met me on Friday, interviewed me for a short while. He= knew me because he knew that I visited my brother and I made rounds with h= im on several occasions. He said, =E2=80=9CWell, Steve, we=E2=80=99d = really like to have you here. Let me know by Monday if you want to co= me.=E2=80=9D Now residency programs in dermatology are really hard, s= ought -after nowadays, but in those days, it was a little bit easier, and o= f course, I did have the connection with my brother, so they had Katzs for = six years. The day he left the residency program and the day he went = into the Army was the day that I started my residency program. In fac= t, he left a car for me there.
KH: That=E2=80=99s great. = I=E2=80=99m sure that was very convenient moving to Miami.
SK: Yes. Very convenient,= also convenient that my soon-to-be-wife=E2=80=99s family was from Miami.&n= bsp; That=E2=80=99s not why I chose that residency program, but it just so = happened that she was finishing her master=E2=80=99s degree at Stanford and= was going to University of Miami because of me to do her Ph.D. in Spanish = literature.
KH: That=E2=80=99s fantastic.&n= bsp; That sounds fantastic. May I dig down? What about your bro= ther=E2=80=99s experience there appealed to you? You said it was a ch= ange for you?
SK: Oh, it was intellectually v= ery stimulating. It was a tremendous variety of things that you did a= s a dermatologist and you did clinical medicine. You could really be = an expert in what you were doing. You also did microbiology. Yo= u did histopathology. You did some surgery. That all attracted = me to dermatology, and of course at the time, I never thought that I would = do investigative dermatology. I thought I would be a real doctor and = go into practice one day, perhaps with him. That really was my motiva= tion, but it was a highly academic residency program. It turns out al= l residents were really expected to do some research project at the Univers= ity of Miami.
KH: I was wondering if that was= hard to balance, your research with your other training, clinical roles th= ere.
SK: It was. I worked hard= , but there were some things that were happening in dermatology nationally = that were discovered in the area of immunology and it actually intrigued me= , so when I started my project, it was really in the immunology of skin.&nb= sp; It was a relatively new field and there was somebody from Boston who ca= me to Miami as an adjunct professor who was very helpful to me. His n= ame was Theo Inderbitzen, the head of the Dermatology program at Miami, Har= vey Blank, was also a very encouraging person. High standards, but ve= ry encouraging, so whatever field you went into, he would encourage what yo= u did. So I worked long hours, but I loved my residency program, my c= o-residents, and my project, actually.
KH: What was your project?
SK: My project was to develop a= program where we could diagnose patients with severe blistering skin disea= ses using immunological methods, which were just then coming to the fore, a= nd it was exciting for me.
KH: That sounds very exciting.<= /p>
SK: Yes.
KH: I understand that Harvey Bl= ank had used an electron micrograph to photograph the varicella virus.
SK: Right.
KH: Right, so were your new met= hods involved with some of this equipment that was getting more and more so= phisticated?
SK: No. Not at all. = It was in a completely different area. He actually didn=E2=80=99t ca= re what area you pursued, as long as you pursued something. He and I = remained friends throughout his life. He died in, I think, the late n= ineties. Even though I didn=E2=80=99t go into virology, which was his= field, he was fine with it.
KH: That=E2=80=99s fantastic.&n= bsp; What kind of equipment were you using?
SK: I was using immunofluoresce= nce microscopy, basically, cryostats, microscopy, skin, mouse esophagus.&nb= sp; It was really just wonderful seeing these patients and making definitiv= e diagnoses. It=E2=80=99s like anything else. If you see a lot = of patients and you pay attention to them, you can become an expert at that= .
KH: I think that=E2=80=99s very= interesting and we=E2=80=99ll get back to that a little bit. I want = to know more about your research, but I also want to go forward and ask you= about your service at Walter Reed then, which followed.
SK: Right, so of course I had t= o go into the Army after my residency. There was no question about it= . The only question is where I would go. You could, at that tim= e, if you wanted to do research, and there were not so many people doing re= search in dermatology spend three years, for example, at Letterman Army Bas= e. When I interviewed out there, I didn=E2=80=99t like it at all and = I decided to just take my chances on where I would be assigned. Fortu= nately for me, the residency program at Walter Reed was in danger of losing= their accreditation. They had a big residency program, but there was= a lot of inbreeding in that residency program, inbreeding meaning that the= y only had people on staff who had trained there, so I was fortunate in tha= t I was identified as a Berry Planner who was going to come in and bring so= me new blood into the program as an outsider.
So, t= he head of the program who I met at one of the dermatology meetings, happen= ed to be a big dermatology meeting that was in Miami, I guess in December o= f 1969. When I met him, he said, =E2=80=9CI want to tell you that we= =E2=80=99re going to take you to Walter Reed for your two years, but if you= tell anybody, I=E2=80=99m gonna shoot you,=E2=80=9D because the word wasn= =E2=80=99t out in terms of what the assignments were. But for me it w= as a great thing because I was also coming home. This is my home.&nbs= p; Washington, D.C., Bethesda is my home, so it was great for me and my bro= ther had just established his practice in Silver Spring at that time, then = moved to Bethesda. It was a great thing for me and I was basically br= ought in to bring an academic focus, an academic dimension to the residency= program at Walter Reed in addition to being in charge of the outpatient cl= inic.
KH: Wow. That=E2=80=99s a= lot of responsibility.
SK: Well, it was. It was.= I went into the Army as a captain. It was disconcerting for ma= ny people because of course I didn=E2=80=99t know captain from major to lie= utenant. I didn=E2=80=99t know any of the stuff, but I went in as a c= aptain and many of the residents there were either majors or lieutenant col= onels, and the patients couldn=E2=80=99t understand how a captain was telli= ng a major or a lieutenant colonel what to do with the patient. So th= ere some complaints, actually, and very quickly I was promoted to a major s= o there were fewer questions. I had a wonderful experience in the Arm= y. It was just a great two-year experience, and I was also able to do= some research. They assigned someone to me who had done a one-year B= erry Plan, but he had done it in research, so he knew no clinical dermatolo= gy, and as a consequence, he could only work in my lab. I had a small= lab in the Army and I continued doing the same research that I had been do= ing as a resident.
KH: On blistering skin diseases= ?
SK: On blistering skin diseases= . That was my first interaction with people from the NIH who sought m= e out because they were studying patients with a certain gastrointestinal p= roblem called celiac disease. Celiac disease is associated with a cer= tain blistering skin disease, so they sought me out to do a collaboration. = I collected a group of patients with what=E2=80=99s called dermatitis herpe= tiformis, patients who I still study to this day. We did collaborativ= e studies between the Army and NIH. We also developed a program which= was a monthly combined rheumatology/dermatology conference, which was a gr= eat conference with John Decker, who was then head of rheumatology. = p>
He th= en became head of the clinical center, and it was a wonderful collaboration= that we had, so that=E2=80=99s actually how I got to know NIH. Even = though my father had been a patient at NIH in, I guess, 1964 or 1965, I rea= lly didn=E2=80=99t understand what the NIH was even though I was a medical = student. My father had a rheumatic heart, rheumatic heart disease and= he was brought to the NIH on a few occasions for study, so I knew about th= e NIH, but I didn=E2=80=99t really know about the NIH.
KH: Then when you were at the A= rmy, you actually wound up helping to advance collaboration and research wi= th the NIH.
SK: Right. That was my fi= rst exposure and in fact, it was those people with whom I worked who encour= aged me after I did my postdoctoral fellowship, to come to the NIH.
KH: Yeah. So shall we go = to London first?
SK: London first. I decid= ed well, I like this research. I wanted to try my hand at research, b= ut I knew that I had to become an expert. I just couldn=E2=80=99t do = it without becoming an expert and I knew that I had to do a postdoctoral fe= llowship. I had gone to a meeting in 1969 where I met two people, one= from England, one from Australia, with whom I thought, well, it might be f= un to work with them, particularly since those were interesting places to g= o. I wanted to go someplace where, if I did a fellowship and then dec= ided to go into practice, I could look back and say, gee, I had a wonderful= time. My family had a wonderful time. My wife was very recepti= ve. She was not looking for me to make a lot of money quickly and was= very receptive to our going abroad. She had lived abroad for a year = and a summer, and she said she had familiarity with it, so we decided to go= abroad.
I was= accepted to actually three places to do postdoctoral fellowship. One= was in Australia, and I just couldn=E2=80=99t go there. I had two ki= ds at the time, and I just couldn=E2=80=99t do that to my in-laws. My= parents were not alive, but my wife=E2=80=99s parents were alive, and I co= uldn=E2=80=99t take the kids that far away, so I decided to go to England a= nd to work with John Turk. So in July of 1972 when I was finished wit= h the Army, we took off and we went to London not knowing anyone except thi= s one person who I barely knew, and I learned about the G.I. Bill, whi= ch I had never heard of. I learned that I was eligible if I matricula= ted for the Ph.D. program at the University of London. So for =C2=A36= , $15 in those days, I matriculated and ended up getting an additional $400= a month for my fellowship, which was then I think $12,000 a year which cam= e from the Dermatology Foundation of America.
KH: Fantastic.
SK: Yeah. It was a great = experience.
KH: When you were at the Univer= sity of London, I=E2=80=99m just trying to =E2=80=93
SK: I was at the University of = London, but University of London had many different parts and I was at the = Institute of Basic Medical Science at the Royal College of Surgeons, which = was where Professor Turk was.
KH: Were you directly a part of= his laboratory?
SK: Oh, yeah. Directly a = part of his team. My project was looking at this unusual evanescent, = delayed type hypersensitivity response called the Jones-Mote hypersensitivi= ty. Now we can interpret it in more contemporary immunological terms = rather than what I did with my Ph.D., but I matriculated for a Ph.D. at the= University of London.
KH: Uh-huh. Was it hard t= o give up your blistering skin diseases for it?
SK: No. No because I knew= that I wanted to balance the two arms of the immune system. One with= blistering skin diseases had more to do with serum, and what I really want= ed to do was I wanted to expose myself to working with cells so that I had = a balance in terms of understanding the immune system. So that was a = deliberative process and I only looked at places for fellowship where I wou= ld be working with cells. Even T-cells and B-cells were just coming t= o their own in terms of the knowledge base. Subsets of T-cells weren= =E2=80=99t known. Subsets of B-cells were basically known because of = the different immunoglobulins they would produce, but that was coming into = its own. That=E2=80=99s why I thought that working with cells would b= e a very good balance to my knowledge base.
KH: That=E2=80=99s fascinating.= What was it like working in Dr. Turk=E2=80=99s laboratory?
SK: Oh, it was wonderful. = It was wonderful. We moved to London. We didn=E2=80=99t know t= hat we were going to be on the fifth floor of a hotel for the first week or= so, and there was no =E2=80=9Clift=E2=80=9D as they say. We were sor= t of in dire straits to look for an apartment or a house. It happened= that Professor Turk=E2=80=99s wife was the head of a big group of general = practitioners in a certain area, and she found the house for us. That= was the first time we lived in a house, a big, four-bedroom house, so it w= as a wonderful social experience for us, and scientifically, I worked with = a woman who, unfortunately, recently died. She was great. Darie= n Parker was really a wonderful partner for me. We had two technician= s who helped us and the project was one that was an ongoing project that I = picked up.
Most = experiments didn=E2=80=99t work, which we know that to be the case, but the= hypothesis was right, and the question was how to go about it. Profe= ssor Turk became a very close friend. Actually, we lived almost a few= blocks from the Turks, but it was a wonderful experience. Scientific= ally, it was a wonderful experience also because somebody came to his lab t= o do a sabbatical, somebody named Morris Reichlin. He was a very famo= us rheumatologist who came to John=E2=80=99s lab actually for the same reas= on that I came to his lab, to learn about cells. We also became very = good friends and to this day have been good friends. (Dr. Reichlin died sho= rtly after this interview was recorded)
KH: Fantastic.
SK: That was forty-seven years = ago.
KH: And just checking on my, ok= ay, so I understand. Great. So then you mentioned before that w= hen you went there, you still thought you might have some clinical work ahe= ad of you. You weren=E2=80=99t completely committed to research?
SK: Absolutely. Don=E2=80= =99t mean to interrupt you, but in fact, I was never committed to having a = research career. I had an open mind. If I was not successful, i= f I didn=E2=80=99t like it, I was going to go into practice. I loved = seeing patients. I loved the field of dermatology. I still do.&= nbsp; I couldn=E2=80=99t go into practice now, but I could have for a long = time. I was actually asked to join someone=E2=80=99s practice in Miam= i, but I didn=E2=80=99t do that. I thought, well, if I don=E2=80=99t = like what I=E2=80=99m doing or I=E2=80=99m not successful, I=E2=80=99ll go = work with my brother who had a practice here in the suburban Maryland area.= If not, if I liked it, then I=E2=80=99d go to some academic program,= never thinking that the NIH was a possibility.
KH: So how did you make that tr= ansition back to the NIH?
SK: I made the transition becau= se in December of 1973, after one-and-a-half years of fellowship, I knew it= was time to think about getting a real job. In September of 1973, I = got a letter from the head of dermatology here, Marvin Lutzner, and he said= that a senior investigator was leaving, and they had a position open. = ; Would I be interested? He said that the pay would be $25,000 a year= . This would be in 1974. Despite the fact that I was attracted = to that job, there was no way that I would take that job for $25,000 a year= .
My da= ughter was born in London, so we had three kids, and it was virtually impos= sible to take a job at $25,000 a year. Couldn=E2=80=99t live on it ev= en in those days. When we came back in December of 1973, I looked at = several jobs. I looked at this job at NIH, where my collaborators fro= m 1972 from the Army strongly encouraged me to come here even though I didn= =E2=80=99t really want to be affiliated with the dermatology branch, which = didn=E2=80=99t have a great reputation. I was not attracted to anythi= ng that was going on in the dermatology branch, but they convinced me that = if you come here, I could collaborate with anybody I want, which is true.&n= bsp;
I als= o looked at places like Hopkins, the University of Virginia, and the Univer= sity of Miami, which everyone thought, there wasn=E2=80=99t so many =E2=80= =9Ceveryones,=E2=80=9Dbut the anticipation was that I would go back to the = University of Miami, particularly since my wife=E2=80=99s family was there = and I had such a wonderful experience as a resident. But when I came = here, it was intriguing to me to think about working here and collaborating= with such smart people. It raises the level if you work with really = smart people. Warren Strober and Ira Green were very encouraging= for me to come here.
When = I went to the University of Miami for my interview, it seemed like they wer= e sort of taking me for granted as a senior resident and anyway, it was an = interesting experience. I had very good relationships with people on = the staff there, but finally I decided, well, I=E2=80=99d come to the NIH.&= nbsp; If I liked doing research, if I was successful, I=E2=80=99d come here= for a few years and then I=E2=80=99d go to an academic medical center; I l= ove teaching students, residents, and if I don=E2=80=99t, I=E2=80=99d go in= to practice with my brother or on my own. Either way, it was okay wit= h me, so I was not absolutely committed to an academic career even when I c= ame here in September of 1974.
KH: Do you think that having th= ese different options allowed you to take risks?
SK: Absolutely. Still to = this day, risks, I think, are really important. Obviously, you can=E2= =80=99t take too many risks financially when you have a wife and three chil= dren. Although my wife was a professional, at that time she was not w= orking, so I couldn=E2=80=99t take too many financial risks, but I knew as = a physician, I could do almost anything I wanted to do. So the risk w= as which place to go. At the NIH, I was assured that if I came here, = I could work with anybody I wanted. I was not restricted to the derma= tology branch, which I had not a very high regard for.
Actua= lly, when I left the Army in 1972, I did call John Decker, with whom I had = a very good relationship, who was head of rheumatology here. I told h= im that I would consider coming to the NIH if I could work in rheumatology = because there=E2=80=99s a lot of crossover between rheumatology and dermato= logy. Rheumatic diseases and skin diseases go together, and he said, = =E2=80=9CNo.=E2=80=9D He said, =E2=80=9CI=E2=80=99d love to have you,= but,=E2=80=9D at that time, =E2=80=9CWe=E2=80=99re looking for an orthoped= ic surgeon,=E2=80=9D so he was discouraging of that possibility.
KH: So you decided to come here= instead of the University of Miami.
SK: Right, to the shock of many= people.
KH: And were you hired by Dr. F= rank Joseph Rauscher, Jr.?
SK: Dr. Rauscher was the head o= f the Cancer Institute, but what happened was when I came here for my inter= view, =E2=80=9Cwe,=E2=80=9D Dr. Lutzner, who was head of the derm branch an= d I, met with the scientific director of the Cancer Institute, Nat Berlin.&= nbsp; Nat Berlin started the discussion by saying, =E2=80=9CSteve, we reall= y want you to come here.=E2=80=9D I had a pretty good record, and he = said, =E2=80=9CWhat will it take to get you here?=E2=80=9D I didn=E2= =80=99t know you could negotiate with the government because I had been in = the Army. No negotiating in the Army, so I knew he was asking me what= price. I said, =E2=80=9CWell, 30, 31, 32, 33,000.=E2=80=9D He = said, =E2=80=9COkay. We can do that.=E2=80=9D So it was a 30 pe= rcent increase of what I was offered, and in consultation actually with my = brother, we thought, well I could do it with $33,000 year. That was m= y salary, and I decided that this is where I was going to come.
KH: And they really wanted you.=
SK: Yeah. It=E2=80=99s al= ways nice to be wanted. Yes.
KH: So if I understand correctl= y, as the senior investigator, you had your own personnel, budget, and spac= e for research?
SK: Right.
KH: I was thinking this was a b= ig change from being a Ph.D. student, but maybe not.
SK: Oh, big change. Big c= hange to run a lab. From being a postdoc to running a lab is a big ch= ange. It=E2=80=99s a big learning process philosophically, emotionall= y, and actually in reality, it=E2=80=99s a very big change because then you= =E2=80=99re responsible not only for yourself, but you=E2=80=99re responsib= le for others. Fortunately, when I came here, there were people who w= ere already waiting for me to be their mentors. Of course, we didn=E2= =80=99t use the term =E2=80=9Cmentors=E2=80=9D in those days, but their sup= ervisors.
So th= e first day I walked into the office, which was I think September 15 or 16 = of 1974, someone named Ken Hertz stood up, shook my hand, and he said, =E2= =80=9CHi, I=E2=80=99m Ken Hertz. I=E2=80=99m going to be your clinica= l fellow.=E2=80=9D I didn=E2=80=99t even know what a clinical fellow = was at that time. He said, =E2=80=9CI=E2=80=99m going to be your clin= ical fellow,=E2=80=9D and then I hired a technician and Ken was very helpfu= l in getting my lab started. Basically, that was my lab with a techni= cian, and Ken Hertz.
Then = shortly thereafter, I started seeing patients. My brother actually re= ferred me the first patient who I saw, a woman who had blistering disease o= f pregnancy. So that was my clinical outlet, blistering skin diseases= , which I studied for many years, still do. He referred me the patien= t with the herpes gestationis and we worked that patient up, and that was t= he first of many patients. I also had many patients who I had seen at= Walter Reed continue to see me because their physicians would refer them t= o me because they knew I was studying dermatitis herpetiformis as well.&nbs= p;
So my= clinical side became enriched and there was a woman here who was not a der= matologist, wanted to be a dermatologist with whom I=E2=80=99m still very g= ood friends, Peggy Crawford. She didn=E2=80=99t like what she was doi= ng in the lab, so she started helping me in the clinic. People loved = her. I had to go back to England to defend my thesis in October, but = November, December, the lab had four of us. I hired a technician.&nbs= p; It didn=E2=80=99t work out. I changed that shortly thereafter.&nbs= p; In 1974, we interviewed several candidates for fellowships here, three o= f them. It turned out that all three wanted to work in my lab, but I = found out that only one could work with me because they had to be split amo= ngst the other labs, so I thought it was a little false advertising. <= /p>
The p= erson who I chose of the three ended up being a dean at Emory Medical Schoo= l for about fifteen years, so it was a good choice. He was a great gu= y and he expanded my lab. Oh, and there was one other person who I di= dn=E2=80=99t know was working with me. I happened to go to the cafete= ria one day. We had clinical rounds on Wednesdays at that time, and I= saw this Japanese guy. I had worked with Japanese at Miami, so I saw= this Japanese guy in the cafeteria. I was by myself and I sat down n= ext to him. I asked him what he was doing, and it turns out that he w= as told that was going to work with me as well, but nobody told me that he = was going to work with me. He was Japanese, so he had this certain sh= yness that he was not going to tell me, but it turns out that he and I work= ed together for four years, and we produced lots of new, interesting things= . Hideo Yaoita was his name, and so the lab became four or five peopl= e, I guess, in July of 1975.
Then = another good thing happened. In April of =E2=80=9975, we saw a patien= t. I was always interested in seeing patients. The chief, Dr. L= utzner, was not interested at all in seeing patients, so I saw a lot of the= patients. I was asked to consult with a patient who came in with a r= ash and a chemotactic defect. This was a six-year-old who had had dis= ease for four years, and they were at the end of the line in terms of what = to do. She had been treated with =E2=80=9Ceverything.=E2=80=9D = Well, we did biopsies in April or May of 1975, and the patient was schedule= d to come back the beginning of July without a diagnosis, but my brother an= d I, on long phone calls, decided that this child had a rare disease. =
I kne= w that this rare disease (erythema elevatum diutinum) responded to a drug t= hat wasn=E2=80=99t usually included when one says, =E2=80=9CShe was treated= with everything.=E2=80=9D This is a drug called dapsone which was ot= herwise used as a treatment of leprosy. She came in over the July 4 w= eekend in 1975, and I would say the way to make a reputation in a hospital = is to make a right diagnosis, and then to treat a patient who=E2=80=99s got= disease for four years and, over the weekend, gets 98 percent better.=
Now, = when I initially went to the fellow who was in charge of this patient, I to= ld him, =E2=80=9CI think this patient has erythema elevatum diutinum.=E2=80= =9D Very unusual. He laughed at me. Then I said, =E2=80= =9CWell, and I think we should treat the patient with dapsone.=E2=80=9D&nbs= p; He laughed at me again, so I wasn=E2=80=99t taking that laugh. I w= ent to his boss who I knew, actually, was a friend of Professor Turk=E2=80= =99s, and he asked me, =E2=80=9CWhat would you do if it were your daughter?= =E2=80=9D I say I=E2=80=99d do the same thing. We treated that = patient over that July 4 weekend. She was 98 percent better, and inte= restingly, she=E2=80=99s been on that drug for forty-some years because if = she stops the drug, the disease comes back.
A few= years ago, I was called by her doctor to ask if the drug is associated wit= h thyroid disease. It=E2=80=99s not. I was telling the doctor w= ho was in West Virginia, the family was from West Virginia. I knew th= at the mother and father had divorced, and I told the doctor. I said,= =E2=80=9CYou know, that=E2=80=99s a very unusual family. This woman = really took her daughter to lots and lots of doctors in 1974 until we final= ly got the diagnosis and got the treatment.=E2=80=9D I said, =E2=80= =9CDo you ever see the mother?=E2=80=9D To which he said, =E2=80=9CI= =E2=80=99m married to her.=E2=80=9D Good story, huh? (Laughter.= )
KH: That=E2=80=99s a great stor= y.
SK: Good story. Yeah.&nbs= p;
KH: How fabulous to be able =E2= =80=93
SK: So we shared that treatment= with Drs. Gallin and Fauci. They were young in those days, as was I,= and it was a wonderful thing to really change this kid=E2=80=99s life.&nbs= p; She had really widespread not only skin disease, she had bad arthritis.&= nbsp; She had some pulmonary problems, and this drug, which acts on neutrop= hils, helped her a lot, and still does.
KH: That=E2=80=99s fantastic.&n= bsp; Could you talk a little bit about what the culture was like when you c= ame to NCI?
SK: I didn=E2=80=99t know much = about the organization of NIH, not what I know now. I know a lot abou= t the organization of NIH. It was a very collegial place. It in= tramurally was very collegial. When I say =E2=80=9Cintramurally,=E2= =80=9D the scientists here on campus, so when I actually started, we didn= =E2=80=99t have an immunofluorescence microscope. I used the microsco= pe from another institute, but I didn=E2=80=99t even know I was using a mic= roscope from another institute. It was just all collegial. Coul= d I use this? I didn=E2=80=99t know one institute from the other, bas= ically. I had no idea about the organization at NIH, but it was an ex= traordinary, collegial place with lots of really, really, smart people to i= nteract with, and they were very receptive.
They = were very receptive to me. I hadn=E2=80=99t done my fellowship at the= NIH. Many of the people who came here as fellows stayed on to become= senior investigators. I didn=E2=80=99t do that because I was in the = real Army. They used to call them the yellow beret because you could = come here for two years instead of going into the military. In those = days, you could get out of the Berry Plan. But I didn=E2=80=99t want = to come here because I didn=E2=80=99t want to be a part of that dermatology= branch, which I ultimately not only became part of, but became the chief o= f, and hopefully, people felt differently after I became the chief.
KH: Well, I want to ask you abo= ut that. I also wanted to ask you about your work on the Langerhans c= ells. Did that work start when you came here?
SK: No. That work started= in 1977. In 1976, I had met someone at a meeting in Lund, Sweden, a = person by the name of Klaus Wolff, who is a world-renowned dermatologist fr= om Vienna. I=E2=80=99d given a talk on dermatitis herpetiformis. = ; While we were having lunch one day, he said, =E2=80=9CI have this really = bright fellow who I think would benefit from going to work with you, and hi= s name is Georg Stingl,=E2=80=9D somebody with whom I=E2=80=99m still very,= very close friends with. So we agreed. I met Stingl. He = came to visit, and it turns out that Stingl had been working on Langerhans = cells in Vienna and had just published a very interesting paper in Natu= re showing that they had cell surface markers that were related to the= immune system.
So we= embarked on that as a major endeavor in the lab, first with guinea pigs, t= hen with mice, to try to identify what their immunological functions were, = and we collaborated with many people around the NIH, some in NIAID, some at= NCI. It was a win-win situation for all concerned, and we continued = that work as did Georg Stingl continued that work when he went back to Vien= na. He did go back to Austria and told me in his farewell discussion = with me, we were very good friends, but one thing I didn=E2=80=99t know is = that he fell in love with my technician, and he was going back, and he was = marrying her, and they were going to live in Innsbruck where he had a posit= ion.
So I = had to get a new technician, but she was great. She was Laura Gazze. = Unfortunately, she died after they were married for twenty-five years= . Died from an unusual type of tumor. He and I remain good friends.&n= bsp; He recently retired, but still does academic research. Brilliant= , brilliant guy. My claim to fame is I have had many really smart peo= ple work with me and together we have forged new areas.
KH: I do want to talk about tha= t too, but one result that fascinated me, I read, one of your articles abou= t the bone marrow transplants on mice that was published in Nature= in 1979. It said that 68 to 80 percent of the resulting Langerhans c= ells were of donor bone marrow origin. How did you feel when you star= ted to get these results back?
SK: Oh, they were fabulous.&nbs= p; That collaboration occurred with David Sachs, who was in the Cancer Inst= itute, and that came about because somebody came to give a talk. We u= sed to have an immunology series. They still do immunology talks and = there=E2=80=99s maybe fifty of us in a room. After the talk, Ira Gree= n, who I mentioned earlier, said to David Sachs, =E2=80=9CDavid, I think yo= u should talk to Steve Katz,=E2=80=9D because they were interested in chime= rism, David was. Then we got together, and we did these experiments t= o try to look at the origin of epidermal Langerhans cells, and that=E2=80= =99s how that came about. It was really very exciting.
KH: Some very exciting results.= So by 1980, you were the chief of the dermatology branch?
SK: But I had been acting [as c= hief] since 1977 because the chief of the branch went on sabbatical. = Maybe he went in =E2=80=9978. Again, I was not supposed to be the act= ing chief, but the scientific director, who was then Al Rabson, came to me = and asked me why I didn=E2=80=99t want to be the acting chief. I told= him that I thought I should be the acting chief because they were building= this new building, the outpatient clinic. I thought it was important= to have an assertive spokesperson for dermatology, in terms of space. = ; He said, =E2=80=9CWell, Dr. Lutzner wanted Dr. Peck to be the acting chie= f, but it=E2=80=99s my call, so I=E2=80=99m going to make you the acting ch= ief.=E2=80=9D
When = Dr. Lutzner asked to be on sabbatical for a second year, the deal was that = he could go on sabbatical for a second year, but he would not come back as = the chief of the branch. He was not so interested, I think, in dermat= ology per se. He=E2=80=99s a very nice guy. Then I was appointe= d as chief. There was no search. Nowadays, you never do things = that way, you know. You always have to have a search, national search= , or international search, as we do for almost everything, particularly wit= h branch chiefs and clinical directors, scientific directors, but it was ni= ce to be just appointed as branch chief.
KH: And you were able to play a= role in continuing to transform the branch.
SK: Right. There was a ba= lance we had, but it became more immunological. We kept a few of the = fellows who did great. Tom Lawley, who ultimately became dean at Emor= y, he stayed on as a senior investigator. Then we also had another gr= eat resource at the Uniform Services University of the Health Sciences (USU= HS) across the street was just started. I think it must have been sta= rted in the early to mid-eighties, and the dean there was a friend of mine,= Jay Sanford.
He wa= nted to have a dermatology program because =E2=80=9CScoop=E2=80=9D [Henry M= .] Jackson, who was a senator from the state of Washington, had put in one = of the appropriations bills that a million dollars was to go to the USUHS U= niversity to develop a dermatology program, because his doctor, who I knew = well, his dermatologist was Naomi Kanof. She got Scoop Jackson to put= that million dollars there. So Jay Sanford needed to spend some of t= hat money. We knew each other scientifically. He was an infecti= ous disease person and he called me one day. He said, =E2=80=9CSteve,= I=E2=80=99d like for you to become the professor.=E2=80=9D The Sulzb= erger Professor, that=E2=80=99s what it was called, so it must have been mi= d-eighties. It must have been =E2=80=9985.
KH: Eighty-nine?
SK: Eighty-six or even =E2=80= =9989 because Sulzberger died in =E2=80=9984, I think. He said, =E2= =80=9CI want you to be the Sulzberger Professor, and you=E2=80=99ll work at= USUHS. We=E2=80=99ll pay you more money than NIH is paying you, but = you can stay in your current position. I worked it out with Vincent D= eVita (head of the NCI).=E2=80=9D That didn=E2=80=99t work out. = I said that no, I wouldn=E2=80=99t do that because it=E2=80=99s just basic= ally using that money to benefit me. Then he said, =E2=80=9CWell, I k= now what your issue is.=E2=80=9D He knew that I had three kids. = He said, =E2=80=9CI=E2=80=99ll pay each of your kids $20,000 a year for wh= en they go to university.=E2=80=9D I said, =E2=80=9CJay, I=E2=80=99m = sure that=E2=80=99s not legal.=E2=80=9D He said, =E2=80=9CWell, let= =E2=80=99s see what happens.=E2=80=9D
We sp= oke to our lawyers. Of course, it wasn=E2=80=99t legal. Then ul= timately, I became the Sulzberger Professor and I was paid a salary over an= d above my current salary for working extra time, which is an unusual circu= mstance in the government. But the reason I mention all that is becau= se it enabled us to establish a laboratory at USUHS, so we were able to tak= e some of our senior people here who were finishing fellowship who I really= thought would expand the program and be beneficial to them to stay on beca= use USUHS is right across the street.
So, t= his all transpired when John Stanley, who was ready to leave and was lookin= g at jobs. Jay called me and showed me some space across the street.&= nbsp; I thought it was great space, and then I called John when he was on v= acation in Maine. I said, =E2=80=9CJohn, don=E2=80=99t look at any ot= her jobs because you=E2=80=99re going to stay here at the Uniformed Service= s.=E2=80=9D That=E2=80=99s how we expanded our program. John St= anley went there at first, and then a few years later, he came back to the = NIH. John ultimately became head of dermatology at University of Penn= sylvania and Kim Yancey, who was from Georgia and finished his fellowship w= ith Tom Lawley at the NIH then went to USUHS next, He ultimatel= y became head of dermatology at Wisconsin, then at the University of Texas = Southwestern. Now they have, as head of dermatology there, I think, T= om Darling, also came through our fellowship program. It=E2=80=99s a = wonderful collaboration, win-win situation with the Uniformed Services of t= he Health Sciences.
KH: Were there any research are= as that you had also identified as places you wanted to make sure you expan= ded into?
SK: No. My philosophy was= , and this is a famous quote by Josh Lederberg that I can=E2=80=99t come to= , but it=E2=80=99s a quote that talks about what you need to do to get a cr= eative environment is get really smart people and let them do what they do.= So basically, that=E2=80=99s what my philosophy has been. Retr= ospective, it aligns with Lederberg=E2=80=99s famous quote, but that=E2=80= =99s what basically I did. That=E2=80=99s how I chose the senior inve= stigators of the branch because we had searches, but it was basically getti= ng smart people to do their thing that they could be excited about. = p>
KH: Fantastic. That sound= s like a lot of great collaboration.
SK: A lot of great collaboratio= n. I was not a collaborator with them. They could do whatever t= hey wanted. I was not necessarily a co-author with them, but we had a= very exciting time because there was a lot of good science being discussed= .
KH: As chief, you had other res= ponsibilities too, right? How was that learning process?
SK: As chief, I would say I had= very few other responsibilities. I had a responsibility to go to the= chief=E2=80=99s meeting. In those days, I had much more responsibili= ty for the budget of the branch, make sure we kept within budget, but other= than that, there were no real administrative responsibilities. Now, = I undertook many responsibilities outside of NIH. Outside of NIH, tho= se responsibilities were with the Society for Investigative Dermatology, th= e American Academy of Dermatology, the Clinical Immunology Society, all of = which I became not necessarily an officer, but I became very active. <= /p>
Going= back to talking about the world being a small place I became very active i= n the World Congress of Dermatology, the International Society of Dermatolo= gy and the International League of Dermatological Societies, ultimately bei= ng on the board for twenty years and being president for five years, which = was a very long term, and in 1992, in being the secretary general of the 18= th World Congress of Dermatology in New York. So I was ver= y active, I would say, administratively here at the NIH, but also on the wo= rld scene of dermatology, and investigative dermatology particularly. = I was president of the Society for Investigative Dermatology in 1994/1995.= I was very active in that area, but my job here was really recruitin= g good people, making sure we were within budget, and making sure that peop= le were publishing and that when we had our reviews, we did well on reviews= .
KH: As you got involved with th= e societies and associations, did you see your work as communicating scient= ific discoveries and disseminating them?
SK: Always. I always gave= lots and lots of talks. I know our communication plan here at the NI= H is much greater than that, but as a scientist, perhaps selfishly at first= , but when I gave talks, it was a great source of referrals. So this = little girl who had this rare disease, it was only by talking about her tha= t I got other referrals from people around the country, and that=E2=80=99s = another great thing about this place is that you can get referrals from any= where to bring patients in, to study those patients. It=E2=80=99s a b= enefit to the research program and it=E2=80=99s also a benefit, hopefully, = to these patients. In terms of communication, I was not as aware of c= ommunicating with the public-public at that time, but certainly with the sc= ientific and medical public. Really important, so I went as visiting = professor probably, maybe I said this, ten times a year at the various acad= emic centers and enjoyed that very much.
KH: That=E2=80=99s fantastic.&n= bsp; Did you enjoy teaching at USUHS?
SK: I did. I taught two c= ourses in biochemistry. They didn=E2=80=99t have a graduate program.&= nbsp; I taught two courses in biochemistry and a few other courses, but in = biochemistry, I taught courses where I could bring a patient. These w= ere first year medical students, but I could bring a patient who had the di= sease and demonstrate what the problem was, both with porphyria, and also w= ith xeroderma pigmentosum. So I could talk about pathways. I th= ink I would give four or five lectures during the year. For two of th= em I could bring patients in who actually were there because of a fault in = the biochemical pathway, biological pathway.
KH: How do you think that impac= ted your students?
SK: Oh, great. It=E2=80= =99s great, nothing like it. Nothing like it, I think, and not becaus= e it was me, but there=E2=80=99s nothing like being a medical student and l= earning these intricate pathways and then seeing what happens if they go wr= ong.
KH: Then by 1995, you were appo= inted director of the National Institute of Arthritis, Musculoskeletal, and= Skin Diseases.
SK: Arthritis and Musculoskelet= al and Skin Diseases.
KH: Okay. I always stumbl= e on that. Thank you. You were appointed by Harold Varmus?
SK: Right.
KH: Tell me about that process.=
SK: So I had been recruited to = various positions around the country. I wasn=E2=80=99t interested in = leaving the NIH. The only place that I really looked was at the Rocke= feller Institute. I was recruited there in 1994. I didn=E2=80= =99t really think much about it, except one morning I told my wife that I w= as having lunch with somebody who was going to try to recruit me to New Yor= k. Our three children were living in New York at the time. She said, = =E2=80=9CWell, let=E2=80=99s go for it.=E2=80=9D She got queasy after= I actually went there, but I wasn=E2=80=99t really interested in going the= re. Then they called me back and they made me a sweeter deal, but I w= asn=E2=80=99t looking for a sweet deal. I didn=E2=80=99t really look = at other places, although I went as a consultant to some of these search co= mmittees at Yale and at Hopkins, but I wasn=E2=80=99t interested.
I was= very happy here. I was very, very satisfied with what I was doing an= d the changes that were being made, the support that I got, and I knew if I= made big bucks as I could have, I just would spend those big bucks! = I was very, very happy here. I guess in the beginning of 1995 or the = end of 1994, the director of the Institute of Arthritis and Musculoskeletal= and Skin Diseases resigned. There was an acting chief, acting direct= or, and two people from the search committee called me and asked me to appl= y and I applied, and frankly, I didn=E2=80=99t have my ego in it because I = actually knew very little about running an institute. It=E2=80=99s ve= ry different than being an intramural scientist, so I applied, and I had a = very good interview.
Then = I had an interview with Harold Varmus and also his staff in Building 1, and= that went well. Those all went well. Then he called me up in t= he beginning of June and he asked me to be the director. Of course, I= didn=E2=80=99t know what I was getting into, but it was a great honor, and= it was really more than great. It was a fantastic honor to work with= him, and that he chose me to lead the institute was a great honor for me.&= nbsp; I started on August 1 of 1995, so I=E2=80=99m looking at the end of m= y twenty-third year as director of the institute, a great honor. I&nb= sp;had great teachers at the institute that taught me all about how the NIH= is run. After all, 85 to 90 percent of our dollars are in the extram= ural program.
I had= been asked to look at two other jobs at NIH, which I said that I was not i= nterested. One was to run the general clinical research centers aroun= d the country. Ruth Kirschstein called me and asked me to consider do= ing that. I said, =E2=80=9CI=E2=80=99m not interested.=E2=80=9D = Then she called me before the Institute of Aging had a really good candida= te in Richard Hodes, who=E2=80=99s still the director. She called me = and asked me to look at that portfolio. I told her I wasn=E2=80=99t i= nterested. She said, =E2=80=9CYou have to look at the portfolio.=E2= =80=9D I looked at the portfolio. It was a lot of behavioral an= d social science, too much for my brain, and I told her that although I mig= ht be interested in being a director of an institute one day, I was not goi= ng to put my hat in that ring.
But t= hen when this institute directorship came up, Arthritis and Musculoskeletal= and Skin Disease, that was something that I thought that my experien= ces could be translated to a bigger stage. I have had experience with= the rheumatologists, with the clinical immunologists. I felt comfort= able in that environment, in that venue and I thought, well, that would be = a fit. If they want me, that would be a fit. I had a very good = interview, and then all the other interviews afterwards were very good.&nbs= p; I was delighted to be asked. It was an adventure for me, but where= I didn=E2=80=99t have to move very far.
Actua= lly, I wasn=E2=80=99t going to continue as branch chief, but the people in = the branch, the senior investigators asked me to continue to be the branch = chief because they thought I had some moxie, which maybe I did. We hi= red two new people instead of one new person, and they continued to do some= of the organizational work that I had done as chief, people like Jonathan = Vogel, who=E2=80=99s since died unfortunately, and Mark Udey. They co= ntinued to do much of the scheduling for the branch because I just couldn= =E2=80=99t do it, but they agreed to do it because they wanted me to contin= ue as branch chief.
That = continued until I decided that people in the branch were mature enough that= they could endure either getting somebody from outside of the branch, or s= omebody from within the branch to run the branch. I didn=E2=80=99t ha= ve to do both jobs anymore, but I did continue running my lab until about 2= 015 or 2014 when I decided to give up my lab. But I continued the lab= until, I think it must have been 2015. Mark Udey was chosen as the b= ranch chief, and he was somebody who I had hired in 1989 from Washington Un= iversity in St. Louis, so it was nice to see that he did that job until ver= y recently.
KH: It was an honor for them to= ask you to maintain that position even as you took on the directorship.
SK: Yes. Well, I think it= was in their defense because they were concerned that bad things might hap= pen to the branch because there was a new scientific director in the Cancer= Institute who had no history with the dermatology branch. They thoug= ht at least in my role as director of another institute, nobody would squan= der the resources of the dermatology branch. It was a matter of survi= val, but I would say that we were all very good friends. We had lunch= almost every day together and we had great respect for each other and thei= r success was your success. Everybody=E2=80=99s success was everybody= else=E2=80=99s success. It was a wonderful, wonderful environment.= p>
KH: That=E2=80=99s fantastic.&n= bsp; For you, the extramural portfolio was the new addition when you took o= n the directorship.
SK: Absolutely. At first,= some constituents thought that I was going to turn the institute into a de= rmatology institute or skin biology, skin disease institute, which was ridi= culous. They thought it was an arthritis institute, there should be r= heumatologists running that institute. Harold, who=E2=80=99s an icono= clast anyways, wonderful brain, also just wonderful to work with. He = said publicly, maybe it=E2=80=99s a good time for a change. We should= have a dermatologist running this institute. So he was not intimidat= ed by them and I had a lot to do with that, with establishing myself as a s= cientist, as someone who had science as the highest priority for the instit= ute in no two ways, having clinical medicine as well as basic science as pr= iorities.
I mad= e it clear to all the constituents. We had many constituents. W= e have a rheumatology community. We have a bone biology community.&nb= sp; We have the orthopedic community. We have the skin biology and sk= in disease community. We have the muscle community with regard to mus= cle dystrophies and others, so all of those communities, I had to make it k= nown that science and science advances, new knowledge was my highest priori= ty. I was not going to do anything to interfere with our commitment t= o outstanding science, and I think that by now, people understand that.
KH: How did you set their fears= at rest when you started?
SK: Actions. It was clear that I evened the= playing field across these various constituencies and by attending their m= eetings, by speaking to them, by answering sometimes very difficult and ind= elicate questions. I was not afraid of doing that because I knew that= if we adhered to outstanding science, both extramurally and intramurally, = nobody could argue with that. I think that=E2=80=99s been born out ov= er the years. I think the successful institute directors who have mad= e that their mantra; that has been born out.
KH: I have a few different ques= tions relating to that, but maybe you can just walk me through some of the = NIAMS accomplishments or contributions that you=E2=80=99re proud of and you= want to discuss for the record.
SK: Well, for the record, there= are many. I think in the portfolio that we have, one of the early in= vestments that we made was in a public-private partnership to try to better= understand and develop biomarkers for osteoarthritis or degenerative arthr= itis. This is the arthritis that affects twenty to twenty-five millio= n people in the country as they age. Obesity is also a factor here.&n= bsp; What we=E2=80=99ve done is, over the years, developed biomarkers in th= is public-private partnership for osteoarthritis, which means that companie= s can invest in certain drugs by using biomarkers rather than having to wai= t twenty years to see if a drug works. That=E2=80=99s the importance = of biomarkers. They work as surrogates for go/no-go situations for in= terventions.
The o= ther area that we have done a lot of work in is in the area of osteoporosis= . Not only osteoporosis in women, which is seen at an earlier age tha= n in men, but also the study of osteoporotic factors in men, what we call M= r. Os, Mr. Osteoporosis, rather than the study of osteoporotic factors in w= omen. So we study these patients for many, many years to see what the= ir risk factors are. When you know what those risk factors are, you c= an better mitigate those risk factors, whether it=E2=80=99s the drugs peopl= e are on, whether it=E2=80=99s their visual acuity, those types of things a= re very important we now know in terms of susceptibility to fracture. =
Osteo= porosis is not a problem. The only problem with it is you get fractur= es, so what you want to do is mitigate those fractures or obviate those fra= ctures. In the area of muscular dystrophy, we=E2=80=99ve, I think, mo= ved the field tremendously forward from the first definition of the mutatio= n that occurs in Duchenne muscular dystrophy, which is dystrophy of the boy= s who end up dying in their late teens or twenties. Now that=E2=80=99= s moved because of various types of better support systems for those boys, = but I think we=E2=80=99re moving into a time where we will have some drugs = or gene therapies that will really make a difference in terms of muscular d= ystrophy.
In te= rms of skin biology and skin disease, there are overwhelming advances in te= rms of stem cell therapy, iPS therapy for patients with epidermolysis bullo= sa and other skin diseases. In the rheumatic diseases, there=E2=80=99= s been a sea change because in the mid-1990s, the TNF inhibitors came about= , and those were great until other pathways were discovered. Those ot= her pathways led to the development of newer drugs that are far more effect= ive not only in rheumatic disease, but also in rheumatic disease associated= with skin disease, like psoriatic arthritis. So in all of these area= s that I talked about that we cover, there have been major advances today c= ompared to what we knew twenty-three years ago, and I like to think it=E2= =80=99s at least in part because of the investments that have been made, th= e judicious investments that been made in terms of good science leading to = these advances.
KH: I noticed that over the 200= 0s and up to 2014, Congress has called on NIAMS specifically to focus on di= fferent areas, many of which you have mentioned, muscular dystrophy, lupus,= juvenile arthritis. How does this sort of policy intervention or pol= itical attention influence . . . ?
SK: We pay attention. Obv= iously, all of us have to pay attention to what the congress wants us to do= . Sometimes it=E2=80=99s really reinforcing what we are doing, so we = have a major effort in trying to better understand lupus, lupus that occurs= primarily in women, a much higher prevalence percentage-wise in African-Am= erican and Asian women, so it really has an element of health disparity.&nb= sp; We still don=E2=80=99t understand exactly why it occurs in women. = We don=E2=80=99t understand the disparity, but I can tell you that over th= e years, the treatment of patients and the support of patients has been tre= mendous. When I was a medical student, one of the first patients I sa= w was a patient with lupus who had central nervous system lupus, and it was= clear that she was going to die very soon. Now that=E2= =80=99s not the case. Now it=E2=80=99s much more of chronic disease.&= nbsp; Systemic sclerosis (scleroderma), the same way.
The m= uscular dystrophies, we=E2=80=99ve made major efforts. We have the ce= nters=E2=80=99 program that=E2=80=99s been in existence for fifteen years.&= nbsp; We=E2=80=99re currently trying to review that centers=E2=80=99 progra= m, and my philosophy has been that all programs that have been going on for= some time should undergo review. Not the specific grants, but the pr= ogram itself, so we have these muscular dystrophy centers called Wellstone = Centers in memory of Senator [Paul D.] Wellstone, in whose office thes= e were originated, actually. When he died in 2004, we decided to name= them the Wellstone Centers.
We=E2= =80=99re currently looking at, should the program be as it is? Is it = delivering what we wanted to deliver? Do we want more of a training p= rogram? Do we want more outreach in terms of this program? Thos= e are the types of things that we do all the time. Very first thing I= did as director was I asked a group to come together from around the count= ry to look at our big centers=E2=80=99 program. They had a big center= s=E2=80=99 program that comprised about 11.7 percent of our institute budge= t, and it turns out that we changed our centers=E2=80=99 program as a conse= quence of that review. My job is constantly to look at what we=E2=80= =99re doing on a big scale to know that those investments are right investm= ents. The congressional mandates are very few. They reinforce t= he paying attention to this or paying attention to that, but we are on it.&= nbsp; We=E2=80=99re always on it, and we are always very responsive to thos= e requests.
KH: You also have written about= the need for NIH to keep funding basic science, right? So is that a = tension between a focus as Congress mandates on some of these specific area= s and the basic science funding and research?
SK: For me, it=E2=80=99s not a = tension because for me, if you don=E2=80=99t invest in basic research, then= in twenty years, you got nothing to go on. If you don=E2=80=99t inve= st in basic research, if you don=E2=80=99t invest in training the next gene= ration, there won=E2=80=99t be any next generation and there won=E2=80=99t = be any basic research upon which to grow. That commitment, from my st= andpoint and from our institute, there=E2=80=99s no questions about it.&nbs= p; There=E2=80=99s no real tension from my standpoint. There may be t= ension from the community, but from my standpoint, there is no tension.&nbs= p; Good science will be supported whether it=E2=80=99s basic, translational= , or clinical. I think most of my co-directors feel the same way.&nbs= p; I can=E2=80=99t speak for them, but I can speak for myself, and that is = the commitment to basic science has to be there, and I think as an institut= ion, as the NIH, we have to have that commitment. I think Francis Col= lins feels the same way.
KH: I only have one or two more= questions. One of them is about funding. I know in the 1990s t= here was an external board who asked NIH to cooperate more with private ind= ustry, to collaborate with private industry for funding. Then you kno= w there=E2=80=99s been criticism of collaboration with private industry and= suspicion of that funding, so again, I=E2=80=99m asking, is there a tensio= n in negotiating these demands as a director?
SK: I would say that they are n= ot demands from Congress, but they=E2=80=99re expectations that we at least= consider them, consider public-private partnerships. Lately, some of= those public partnerships, one in particular, the alcohol public-private p= artnership to which you=E2=80=99re referring, has gone awry. That wen= t awry not because of the inherent problem with public-private partnerships= , but it went awry because of, I think, although it=E2=80=99s not proven, t= he malfeasance of some of our employees. Now, the other public-privat= e partnership that went awry was the NFL public-private partnership that NF= L wanted to sort of have more input than they should have. Once we do= a public-private partnership, the money is spent according to NIH rules, w= ithout prejudice, without bias, going for the best science that will delive= r the answer.
As I = mentioned earlier, the Osteoarthritis Initiative public-private partnership= , we paid two-thirds with the Institute of Aging. The industry paid a= third. In the AMP, the Advancing [Accelerating] Medicines Partnershi= p, we pay fifty-fifty, and that=E2=80=99s to look at and develop new pathwa= ys for the study of patients with lupus and with rheumatoid arthritis. = ; Absolutely novel concepts. Those are much more basic research endea= vors that are really precompetitive. Everybody wants to know the answ= er to those things. If you stay in that realm, it=E2=80=99s much easi= er to avoid these types of conflicts. I have been involved with the F= oundation for NIH as part of the steering committee from the NIH to steer w= hat goes to the FNIH. I think the FNIH does a great job. We try= to do a job at our end to make sure that what goes there is legitimate, is= institute-driven, and is without prejudice or bias. Sometimes that g= oes awry. I hope that people won=E2=80=99t think that that is the mod= us operandi at NIH because I think that=E2=80=99s a rare occurrence.
KH: A theme of our interview to= day has been relationships, relationships between different scientists.&nbs= p; Do you think that the ability to mentor, to be mentored and to have coll= egial relationships is integral to scientific success?
SK: Well, I do. I think i= t=E2=80=99s been a big part of whatever success I=E2=80=99ve had. It= =E2=80=99s been a big part of my success. It=E2=80=99s been a big par= t of whatever accolades I=E2=80=99ve gotten from various groups and people.= I would be the last to say I=E2=80=99ve done it on my own. I t= hink that I=E2=80=99ve been helped enormously from my colleagues, coworkers= in the scientific community, from my tremendous colleagues as institute di= rectors, and also from my family with tremendous support. All those i= nteractions I think are important.
I thi= nk if you don=E2=80=99t have those interactions, it=E2=80=99s a much harder= road to hoe than if you do have good relationships, so the relationships e= ncourage interaction. They encourage leveraging. They encourage= scientific and clinical interactions with other institutes because we all = have parts of our institute that are very specific to what we do, but then = there are many things that we do that can be done with other institutes, an= d that=E2=80=99s when we collaborate.
I thi= nk that one of the things that Harold Varmus had in mind when he appointed = me which he said was basically not only to be a good steward of taxpayer do= llars, but also to play well in the sandbox, and to be fair. Those we= re the three things that he asked me to do. I think those are the thr= ee things that I=E2=80=99ve tried to do, but to play well in the sandbox me= ans interacting with other institutes in a very positive way to identify co= mmon goals, not only with other institutes, but with other institutions, an= d that=E2=80=99s where public-private partnerships come in.
KH: So I wanted to ask you abou= t anything else I haven=E2=80=99t mentioned that you might want to discuss.=
SK: I would say the one thing t= hat we didn=E2=80=99t discuss is my family and the importance of family and= family support in decisions that one makes to have a research career. = ; Having a research career in the government means that you=E2=80=99re goin= g to make much less of an income than your compatriots elsewhere. The= re=E2=80=99s no question about it. Many of my fellows, when they left= , they would make double or triple what I was making. I never minded.= It was their decision and it was my decision to be where I am. = I think those priorities I set for myself, I set for my family, and the co= mmitment to science and medicine.
They = knew it, and as a consequence, although we never would have predicted it, m= y oldest son is an internist, also an epidemiologist who does research, muc= h to his surprise, probably half the time. He lives in Tel Aviv. = ; My second son, also a physician, works at Kaiser as a dermatologist. = ; The dermatology couldn=E2=80=99t get out of our system. My brother,= of course, was a dermatologist. His son is a dermatologist, and my n= umber two son is a dermatologist. Perhaps the most interesting person= in my family is my daughter, who=E2=80=99s a fitness instructor who is now= pregnant with our first grandchild. My wife has been tremendously su= pportive over all these years. It takes a village. It takes a f= amily. I never complained about my salary. Clearly, the salary is far= less than the equivalent salary would be in most academic medical centers.= I think that=E2=80=99s it.
KH: My last question is, there= =E2=80=99s a young scientist starting out today. What=E2=80=99s your = advice to this person?
SK: Try it, you might like it.&= nbsp; That=E2=80=99s my advice. Of course, I always had this insuranc= e policy of, if I didn=E2=80=99t like it, I would be able to do something t= hat I would love anyway. That was practicing medicine. I saw a = lot of patients here at NIH, but not like I would have seen in private prac= tice, which would have been a very different kind of a life. But if y= ou had that option, if you go about it enthusiastically, and take risks, an= d listen to your mentors, and be honest with people, I think that that=E2= =80=99s a good way to go.
KH: Fantastic. Thank you = so much.
SK: You=E2=80=99re welcome.
KH: Thank you for your time.
SK: You=E2=80=99re very welcome= .
End of Interview