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National Cancer Institute
Interview with Paul Marks
Conducted on July 14, 1999, by Gretchen Case= in the Office of Dr. Marks at Memorial Sloan-Kettering
PM: My name is Paul Marks.
GC: Today is July 14, 1999.&nbs= p; This is Gretchen Case, talking with Dr. Paul Marks in his office in New = York City at Memorial Sloan-Kettering. What I'm really interested in = is your role in the National Cancer Institute's history, and I was interest= ed to learn why you chose to become involved with the National Cancer Insti= tute. Do you remember a particular reason you became involved?
PM: Yes. Very specificall= y. When the legislation was passed in, I guess, 1972, the National Ca= ncer Act establishing the National Cancer Program, I frankly was very conce= rned that it would distort the funding for biomedical research. I fel= t that a most important area for funding was basic research. By defin= ition this couldn't be defined as cancer research or heart research or diab= etes, but fundamental investigations into human biology or mammalian biolog= y or even lower forms [of life] was extremely important and had to go forwa= rd if we were really to understand and make progress in the cancer problem.=
So, I wrote a long letter=E2=80=94after a lot of thought and consultatio= n with my seniors=E2=80=94to Benno Schmidt, who was then chairman of the co= mmittee making recommendations with regard to the legislation and then its = implementation, expressing my concern that this might distort the pattern o= f funding and have a particularly adverse effect on medical schools, which = were a major site of basic biomedical research. Much to my surprise, = I got an answer, and he invited me to come to Washington and meet with him = and the then head of the National Cancer Institute.
The next thing . . . the next involvement I had was that . . . I don't k= now who requested it, but the National Academy of Sciences was requested to= set up a committee to evaluate the National Cancer Act and its implementat= ion, and I was invited to be a member of that committee as a member of the = Academy. The committee was chaired by Lew Thomas and it had . . . I r= emember George Palade was on it, David Baltimore was on it. It was a = terrific committee. We went about our mandate and that included an ex= tensive interview with Benno Schmidt by the committee. And so, you kn= ow, through that I got more involved, if you will, in the National Cancer P= rogram, and then I was invited to become a member of the National Cancer Pa= nel.
GC: Right. The President'= s Cancer Panel?
PM: The President's Cancer Pane= l. This was a three-person panel, chaired by Benno Schmidt at the tim= e. I think it met monthly, and then it met four more times a year wit= h the National Cancer Advisory Board as a whole. I was on that for th= ree years=E2=80=94I think from something like '76 to '79.
GC: That's what your CV says.= p>
PM: Yes. And in the meant= ime, back at the ranch, my own research, which had been focused on, if you = will, the molecular biology of globin gene, hemoglobin synthesis, globin ge= ne expression, and so on, and I got involved in looking at a model system, = which had originally been described by Charlotte Friend, a virus transforme= d murine erythroleukemia cell system which, when exposed to dimethyl sulfox= ide, induced hemoglobin formation. So I thought this might be a good = model to further explore how the globin gene was regulated.
In fact, what happened over a period of my research was that I got more = and more involved in the molecular and cellular aspects of transformation a= nd the block in normal differentiation of these cells. My research re= ally became focused on understanding some of what went wrong in these cells= and also why dimethyl sulfoxide induced the cells to differentiate and die= like their normal counterpart. So, I was, you know, fully committed = to cancer, to research that was related to the cancer problem by the middle= of the '70s.
Also at that time I was vice-president of the Health Sciences at Columbi= a University and we developed a Cancer Center. I became head of that = Cancer Center. We got a large grant from the government to build a bu= ilding and to run our Comprehensive Cancer Center at Columbia Presbyterian.= In 1980 I was offered this position and came here.
GC: And this is also a Comprehe= nsive Cancer Center.
PM: &= nbsp; Memorial Sloan Kettering was one of the models used in the legislatio= n to establish the characteristics of Comprehensive Cancer Centers. M= emorial is unique in the sense that it is the only free-standing, not-for-p= rofit, nongovernmental Comprehensive Cancer Center in the United States.
GC: Is that right?
PM: That's right.
GC: Can you go back for just a = minute and tell me about that first meeting with Benno Schmidt? So yo= u didn't know him previously?
PM: No.
GC: When you wrote the letter t= o him?
PM: No.
GC: You just knew that he was i= n charge of . . .
PM: &= nbsp; Yes. Through the newspapers, scientific magazines, and so on.&n= bsp; I also didn't really even know at the time what he did. He just = was, he is, an incredible person.= We were fortunate that Benno Schmidt was head of this commission and= then was the first chairman of the President's Cancer Panel, because for a= lay person, he had an unusual un= derstanding of the needs of basic research and the importance of basic rese= arch to making progress in the cancer problem. I think his leadership= was providential. I think it was key to the success of the whole can= cer, the National Cancer Program. I might also say that, in the spiri= t of full disclosure, he was vice-chairman of the board at Memorial Sloan-K= ettering at the time I was offered the position here.
You know, it's sort of curious that this letter which I wrote after much= [laughs] struggling with myself=E2=80=94"Do I do it? Don't I do it?"= I didn't know whether it would be a waste of time, but on the other = hand I didn't want to sort of antagonize these people further, who= ever they were, by being critical of what could potentially be a source of = increased funding for biomedical research.
I have gotten to know Benno Schmidt pretty well through that first encou= nter and then subsequently with the Academy committee and then being on the= Panel. He had recommended me for this position [president of Memoria= l Sloan-Kettering Cancer Center] to the then-chairman of the board, w= ho was Laurence Rockefeller. Laurence Rockefeller was the one who cal= led me and invited me here and in this very room offered me the position in= 1980.
GC: Is that right?
PM: &= nbsp; That's right. This has always been the president's office. = ; Actually, the job I was offered was a new position=E2=80=94as president o= f Memorial Sloan-Kettering Cancer Center as a unified Center. Memoria= l Sloan-Kettering, I think, is a = very important element in the National Cancer Program. Prior to 1980,= the Memorial Hospital and the Sloan-Kettering Institute were separate corp= orations, separately administered.
That was sort of historically interesting in this sense: The found= ers of the Sloan-Kettering Institute, who were Mr. Sloan, who was then CEO = of General Motors, and Mr. Kettering, who was the chief inventor of things = like the automatic starter and so on, felt that the research commitment in = cancer should be separate from the clinical care, which was just the opposi= te of what Mr. John D. Rockefeller, Jr., who was one of the founding father= s of Memorial, believed. He believed that . . . in fact, his whole su= pport for what was originally New York City Cancer Hospital and then rename= d the Memorial Hospital was based on the fact that he felt that the best ca= re in cancer required an environment in which research and teaching went fo= rward.
And then Sloan and Kettering come along and split out the research. = ; That was in the late '40s. It wasn't until 1980, Mr. Sloan had pass= ed away and Mr. Laurence Rockefeller, John D.'s son, as chairman of the boa= rd, brought these entities together as a single operating Center.
GC: And that's right when you c= ame in.
PM: That's when I came. I= 'm the first incumbent, if you will, of this office.
GC: Over both institutions.
PM: Over both institutions.&nbs= p; Right. I think that the wisdom of sort of bringing together labora= tory research and clinical care is really now bearing fruit in a major way = in the cancer program. So that's a brief history of this place. = The New York City Cancer Hospital was actually started in 1884.
GC: Really?
PM: Yes. And the original= building still stands on Central Park West at 106th Street.
GC: What is it now? Do yo= u know?
PM: It's a nursing home, I thin= k. It's a Historic Landmark building and certainly, as the first canc= er hospital in the United States, it should be part of the history of cance= r.
GC: Yes. Absolutely. = ;
PM: Our archives can probably p= roduce some pictures of the original building. It wasn't until the '3= 0s that it was moved to this site, because Mr. John D. Rockefeller, Jr. fel= t that, as I said, the best cancer care required research and teaching, and= so he brought it into proximity with Rockefeller, then Institute and now U= niversity, and Cornell Medical School.
GC: Well, I'd like to go back j= ust a little bit again and have you tell me about . . . you said the Presid= ent's Cancer Panel met monthly?
PM: Yes.
GC: So would you fly to D.C. fo= r those meetings?
PM: Well, if the weather was ok= ay. [Laughs] We had a number of times during the winter, as you= know, when the East Corridor gets pretty rough and you would wind up on th= e train. The meeting would be a day long. Benno Schmidt was a v= ery involved chairman of the Panel. We worked closely with the NCI Di= rectors. The Director when I first started was Arthur Upton, and then= Vince DeVita. The whole budgetary process was one of the big issues = that we would always have on our agenda.
And there's no question that Benno was an advocate and a very powerful a= dvocate. He could pick up the phone and get the President at the othe= r end, if he had to. And he didn't hesitate as an advocate with senat= ors, particularly Kennedy, and others. He just was very strongly comm= itted to funding the best possible research effort. He did have a pro= found understanding of what was required, and he commanded a lot of respect= at both the White House and on the Hill. So he was very effective.= p>
GC: Can you tell me a little bi= t about how you worked with the Directors? What kind of contact you h= ad with them?
PM: Well, we would meet with them and members of their staff, as they wou= ld be required on the basis of the agenda. But the contact was really= very close. And I would say that we clearly had as our objecti= ve to be as supportive and facilitating as possible, as a non-government em= ployees' panel and with Benno there as a very effective political force.&nb= sp; We would review new initiatives and programs. I don't think we wo= uld try to second-guess scientific priorities as a member of the Panel.&nbs= p; As members of a Panel, our major priority was to responsibly over-view t= he requested budget for the coming fiscal year and have some sense of what = was being achieved with the current budget.
GC: But you didn't necessarily = affect day-to-day operations.
PM: No.
GC: Or particular projects of s= cientists.
PM: No. At least I ho= pe we didn't. During the 80's I was on the Council of the Therap= eutics, Division of . . .
GC: Division of Cancer Treatmen= t?
PM: Yes.
GC: The Board of Scientific Cou= nselors?
PM: &= nbsp; Yes. I was on that and that got more involved in programs, as y= ou mentioned. I was always concerned about the effectiveness of the s= o-called screening programs for new agents. That was a particular are= a where I thought there had to be a better way, because this didn't seem to= be as productive as it should be.
GC: That was a fairly controver= sial issue.
PM: Right. Right.
GC: How did you feel it could h= ave been more productive and what did you see the problems . .&nb= sp;.
PM: Well, I thought that a lot = more thought and money could be invested in what is being done now, identif= ying specific targets for interfering with, or reversing the cancer process= , rather than sort of non-mechanistic screening using a cell-based assay or= , even more cumbersome, an animal-based assay for anti-cancer agents. = I think we have some of that problem still.
GC: Really?
PM: Yes.
GC: Here?
PM: Hopefully not here, but in = the NCI.
GC: In the NCI. You conti= nue to be active with the NCI in different ways. I saw that you were = on one of the committees for the Frederick Cancer Center.
PM: I was on the committee for = the Frederick Cancer Center. And then I was a member of the Director = of the NIH's Advisory [Board]. As a member of that committee, I was a= sked to co-chair a committee to review the structure of the NIH and each of= its Institutes. We spent a fair amount of time looking at the Nation= al Cancer Institute; I think we developed a pretty good report and a set of= recommendations. That was also a good committee. Mike Brown, M= axine Singer, Roy Vagelos, among others, were on that committee. A lo= t of the recommendations of the committee were implemented=E2=80=94particul= arly those with regard to more rigorous review of individual laboratories, = and more of a uniform approach to appointment and promotion throughout the = NIH and all the Institutes.
The thrust of a number of the recommendations was to try to improve the = quality of the enterprise. I think a great deal has happened= under Harold Varmus and Rick Klausner. The NIH and NCI, in my view, = are substantially different and much better. They are getting higher = quality recruitments. They are recruiting and promoting young people = using rigorous standards of quality. They are more creative in the pr= ograms they are developing.
GC: Now you were also on the se= arch committee that ended up hiring Dr. Klausner.
PM: Yes. I was chairman o= f that.
GC: &= nbsp; You were the chairman of that. And how did you come to be on th= at committee?
PM: I believe Harold Varmus mus= t have asked me to be chairman because I was on his Advisory Council.
GC: Do you remember what that p= rocess was like? Selecting a Director? Can you tell me about th= at?
PM: Yes. To the best of m= y ability to recall . . . the vice-president of Academic Affairs of Memoria= l Sloan-Kettering was the staff for the search if my memory is correct, but= what we did was solicit very broadly names of possible candidates for the = position. We went about getting documentation of every candidate, cur= riculum vitae, reprints, and information either in writing or verbally from= colleagues familiar with a particular candidate. I forgot exactly ho= w many we had, we must have had a hundred, plus or minus, names.
We put together this entire package, with all the backup material, and d= istributed it to all the members of the committee, who were all over the Un= ited States, and asked them to rank every name that had been submitted=E2= =80=94to read the material carefully and rank each proposed candidate on a = scale of one to four, one being the highest. I think we arranged it i= n such a way that the ranking was anonymous to the committee as a whole.&nb= sp; In other words, each committee member was assigned a number by the head= of the staff and what we received was, there were eight or nine members of= the committee, each member's ranking of all candidates without attribution= to a particular committee member.
Then we decided to have a meeting, which was here in New York, in which = we would carefully consider in depth all the candidates who received rankin= g of "ones" and "twos." I forget how many that amounted to, but= it was, say, twenty-plus. During the course of our deliberations, we= reduced the number to five or six lead candidates. That afternoon a = member of the committee who knew the individual best got on the phone=E2=80= =94it was remarkable that it worked=E2=80=94and said, who we are: We'= re the committee to identify a possible head of the NCI, and you are on a v= ery short list and we're calling to find out if you would be willing to con= sider the position.
And by that process and . . . the telephone conversations were long and = some back and forth. During that process, three individuals withdrew.= They said they, for personal reasons usually, didn't want to be cons= idered and were not prepared to move to Washington for one or another impor= tant personal reason. At that point, we were left with three individu= als, who we then=E2=80=94miracle of miracles=E2=80=94were able to arrange t= o interview in depth by phone.
We set up a loud speaker and the committee sat around the table and by t= he phone interviewed the three individuals. In terms of an efficient = search, [laughs] it was unbelievable! And the most unbelievable thing= is that everybody was available for the telephone conferences. By th= e end of the day=E2=80=94it was a long day, it was now, I think, after dinn= er=E2=80=94we had spent at least an hour or more with each of the three ind= ividuals. After the first few questions, it was like the person was i= n the room with the committee. We had told each candidate who was aro= und the table if I asked the question, I would say, "This is Paul Marks."&n= bsp; And then ask my question. So he or she [the interviewee] knew wh= o was asking the question and was answering their questions.
Then by evening we had pretty much come to rank ordering the three indiv= iduals. We were a presidential committee and our report was to be for= warded to the White House.
GC: Right. Because the Di= rector is appointed by the President.
PM: Right. Our letter, wh= ich was drafted that night by one of the members of the committee . .&= nbsp;. I don't know if this should be off the record, we had a lawyer on th= e committee who was one of the activists. She was terrific. By = the end of the day she was ready to draft the letter to the President and w= anted to say something to the effect "This is our recommendation and if you= , for any reason, don't want to pursue this recommendation, please come bac= k to us and we'll tell you who our number two choice is." I said, "Ho= w can you say to that to the President of the United States? We were = mandated to give him no fewer than two and no more than three names. = How can you . . ." She said [Marks pounds the table for emphasis] "We= all feel this is the leading candidate=E2=80=94it was Rick Klausner=E2=80= =94 and that's the way it is."
So [laughs] I said, "I don't know if we can do this." But the comm= ittee decided yes, they liked the tone of the letter. It was very= respectful but very firm. So we all signed it and that was it.&= nbsp; I called Harold Varmus and told him the results of the delibera= tions and after a short silence he said, "Wow." [Laughs] And th= at went right ahead.
GC: &= nbsp; That was great.
PM: Yes. I think that's t= he way all search committees should function!
GC: That's a great story about = a search. That's a case study.
PM: Yes. And everybody fe= lt good about it. That was it. I mean, it wasn't pushing anybod= y. It was a process that just went right along and there was consensu= s. We arrived at a consensus about each of the people on the first li= st of six and then we came back from our phone calls and reported to the co= mmittee as a whole. We then went on to focus on the three individuals= and we set a conference call with each and the whole committee. It w= as a loudspeaker with the other person at the end of the phone and everybod= y could hear the questions and answers. It was very effective. = I wish more of our searches went that way.
GC: Because you're in the midst= of one right now?
PM: [Laughs] Yes. I= 'm going to have to go, unfortunately.
GC: Yes, I realize that.
PM: I really apologize for bein= g late.
GC: That's no problem. Th= ank you for your time. I appreciate this.
PM: Right. Okay. We= ll, if other issues come up .