Anthony D'Amico, MD, PhD, FASTRO
By Lior Braunstein, MD and Timothy Showalter, MD, MPH
The following interview of Anthony D'Amico, MD, PhD, FASTRO, was conducted on June 22, 2018, by Lior Braunstein, MD and Timothy Showalter, MD, MPH.
Lior Braunstein: Good morning, Anthony. You’ve had a far ranging career. I think many of us are very familiar with the work that you’ve done in radiation, but I think fewer people know about your earlier story - where you came from, your family life, and what your childhood was like. We are wondering if you might start by telling us a little bit about that.
Anthony D’Amico: Okay. So first of all, thank you all for including me as part of this. I’m very appreciative. I appreciate the time that you’re making out to do this.
So in terms of the beginning, I grew up on the lower east side of Manhattan, New York City. I’m the oldest of three. I have two younger sisters. My parents were in the theatrical world and met actually at a church dance when they were 23, 24. Not too long after that, within a year, they were married. They were not people who came from the kind of backgrounds that I myself and my sisters had been blessed to have, that is college education and post college education, because at that time there just wasn’t that opportunity for them. They were helping to provide for their parents. They both had a number of siblings. My mother had four older brothers. My father was one of five as well. And so they did the best they could.
They raised us to be independent, to be seekers in terms of what’s most important in life - and that’s the sense of family and community that they fostered so well. About eight years after spending time in New York my father, who had spent time in the service, was able to get a loan for a down payment on a house. And that’s when we moved to East Brunswick, New Jersey. That’s where I finished up grade school, middle school and high school.
When I was in high school, I was very attracted to not so much subject matter but more people. I remember very explicitly three high school teachers. One was an American literature teacher, Michael Michaud. One was a physics professor or a physics teacher. We called him Mr. Weston. Then there was someone we called Dr. Kimmel who was a chemistry teacher. Finally, Mrs. Triozzi who taught us trigonometry and of all the teachers she challenged me the most and prepared me for what came next. Each of them was very dynamic in terms of how they were able to teach, so things that they taught stuck with me. And it was really the people who got me interested in science, particularly mathematical science because that’s what I seem to have a knack for.
I applied to many, many different colleges and it wasn’t until literally the middle of April 1979 when I got an acceptance letter from MIT, the Massachusetts Institute of Technology. I had already sought a letter from the senator of New Jersey because I was planning to go to WestPoint, because that was the background I was heading in. I was a martial artist at that point. I was somewhat I would say militaristic in my approach to life, very regimented, and so that kind of setting would have fit me well.
But when I got the acceptance to MIT, I just thought it was an opportunity that was really very rare and so I took it. I arrived in MIT at the fall of ‘79 and found that it was very challenging. I met for the first time people who were really geniuses. People who would speak literally five, six, seven, eight different languages would just sit in the classroom and figure out the entire three‑month course after hearing just one‑half of the first lecture. So really gifted. Well, I was not that. I was smart. I worked hard. But I wasn’t a genius and so it was intimidating.
In the first year at MIT, like many colleges at that time, it was pass/fail which was fortunate because it gave a chance to learn how to study and how to learn in this environment that was extremely high achieving and filled with brilliant people. It took me the whole year to learn how to master that. At the end of the year, I declared a physics major. So I took classes in math, chemistry and physics and I was enrolled on a physics track which at that time was considered more advanced then people who were just were taking physics courses as a requirement but not necessarily on a physics track.
I went through the first three years, and by the third year I met a man named Alan Nelson who came from Berkeley who later became my PhD advisor. I wasn’t planning on doing a master’s or a PhD but this man who came from Berkeley, very similar to the men and women I met in high school, was an extraordinary teacher and mentor. His way of thinking was the basis for how I think today, that is anything is possible. You just have to dream and think about how to create something and make it come to fruition. He was a nuclear engineer with specialization in nuclear/medical physics, and so I added on another major which was nuclear engineering.
I completed my first two bachelor’s degrees. That was four years. I graduated in ‘83. I stayed on for one more year to do a master’s degree, and then two more years after that for my PhD with Professor Nelson which was really in an area of applying physics and mathematical principles to biological systems. At that time, in mid‑ ‘80, things like how tumors created blood vessels was not well understood. There were these principles that had not yet come along at the time. e.g. Tumor angiogenesis factor.
We collaborated with physicians and scientists. I was exploring the etiology of tumor angiogenesis using mathematical and physics principles, e.g. Bernoulli’s rules and fluid mechanics as opposed to more biological thinking. That was the basis of my PhD thesis i.e. how the tumors create new blood vessels and how cells from primary tumor circulates and metastasizes. And it’s really more again from an engineering physics standpoint.
It was later in graduate school when I started to become interested in medicine and it was a number of events, most of them personal. First and foremost, my wife Diane - not at that time, at that time my girlfriend - her mother was an infectious disease nurse at one of the hospitals in Boston. I sat with her often and we spoke of what she did. I found it interesting that she had this knack for really being interested in the well‑being of others. That sort of emulated my family. What my parents taught me reflected that. She invited me once to come and see what she did. I took her up on it and Diane actually worked at that time in the hospital as the administrative assistant. For me, it was very interesting to see her interactions with people.
It was not too long before that that a woman that I grew up with who was the mom of my best friend, her name was Eleanor Walters, developed breast cancer. Unfortunately she didn’t live more than a year, and I watched her decline and die. Back then there were no advanced directives. She was very sick although completely alert and awake though until two days before she was gone. It was very difficult to watch. Particularly the medical team that was taking care of her probably were some very, very nice people, but there were also some people - particularly the doctor in charge, the medical oncologist - who didn’t seem to really have people skills or was not very interested in what he was doing.
I remember very clearly that I went in to speak with him and said that the family really is concerned about what’s going on and were at a loss for words. I was kind of the spokesperson for the family because they were pretty quiet people. And he turned and looked at me and said, “I don’t speak to anybody except the family. Tell them to come talk to me.” When I did bring the family together, he put us all in this room. Right in front of Mrs. Walters, all he did was look at us and say, “you have to just face that she is dying.” And he walked out of the room. I was horrified by that exchange because she was right there awake and alert, intubated and couldn’t speak. She was a very understanding and forgiving woman and she let that go, but the family was really taken aback as was I.
It was that experience that got me to think as to, what is was about doctors that they could behave like that. Over time, I came to realize that that was just a poor example of somebody who probably wasn’t very happy with his life and took it out at work. However in that moment, I became more curious and so I cross-registered at Harvard Medical School for a couple of courses - one in anatomy and one in pathology - taught by real giants who also were amazingly charismatic, just like the high school teachers that I had. One was named Ferris Jenkins who taught anatomy and Daniel Goodenough who taught me pathology.
I was looking to understand why Mrs. Walter died. What was it about her body that went wrong. I wasn’t going to learn that in anatomy and pathology but I didn’t really recognize that at the time. What I did see was that the students in the class, the medical students, were all so curious about who I was because I was the new kid on the block who would sit in 2 of the 5 classes they were taking at the time. They were people very much like myself, very much interested in building community through service of others, and I got along with them in ways that I didn’t get along necessarily with the graduate students who I was working with at MIT.
That got me to start to think about, what field am I really suited for? That’s when I decided, after discussing it with my PhD advisor Alan Nelson, to go to medical school. So I was in medical school, and there the first two years in the classroom were not actually that much fun. Because here I am, I’ve been a graduate student now for three years and mostly independent, designing experiments, thinking on my own and now I have to sit in the classroom and take in a lot of material and just remember it and regurgitate it. But once we got to the third year and we entered the hospital, I say that I never worked another day in my life after that. I really loved the interactions with the people and being able to actually apply what I learned in the classroom and have a real impact on people’s lives in real time.
There, I heard about radiation oncology serendipitously because the person they paired me with as my medical school adviser was Robert Goodman, who happened to be the chair of radiation oncology at the University of Pennsylvania at the time where I went to medical school. So he would take me around and show me what he did. I said, wow, amazing how one could apply principles of math and physics to effectively treat people in such great need who have cancer. And that was my first introduction to the field.
So after going through all of third year, it came down at the end of third year to trying to decide between radiation oncology and going through OB-GYN to get to gynecologic oncology. After much discussion, radiation oncology became the choice. Back then interestingly the residency is unlike today. It was not four years but three years, I did an internship in medicine starting in 1990 and then my radiation oncology residency at Penn completing in 1994.
The day I entered the radiation oncology residency, I was expecting Dr. Robert Goodman to be the chair. However, he had stepped out because they had asked him to become the interim president of the hospital. Because at that time there were some transitions that were occurring. I didn’t quite understand at the time. I do now. So we were actually without a chair for my first two years as a resident, which was quite challenging because the faculty was very focused on trying to figure out who the next leader there would be. And so the residents were really left to learn a lot on their own. That was an opportunity in disguise, I didn’t realize it at the time, but I needed to learn how to try to become innovative in terms of how I worked and studied. I started by talking with the senior residents about various cases and learning simulation from the senior radiation therapists which was possible then everything was based on bony anatomy.
A couple of years after that I became chief resident. By that point Gillies McKenna, who was elected chair, was put into place. We were without a chair for two of the three years of my residency, but in the third year I became the chief resident along with James Pearlman who was one of my five co-residents. It was actually a wonderful set up now to be able to give back to our junior colleagues, which I loved to do. Throughout most of my life, I’ve met great teachers and I aspired to become a great teacher and that was the first opportunity to really do that in medicine.
So Jim and I created a curriculum for residents that didn't exist before which brought in specialists from other areas - medical oncology, various aspects of surgical oncology, radiology, pathology - to teach us what they did and how their contribution contributed to the overall management of the patients with cancer. Back then, believe it or not - now we’re talking about 1993 when I was chief resident - tumor boards really didn't exist. They were just being invented. So multi-disciplinary clinic tumor boards were not part of the language like they are in common place today. So by bringing in talented radiologists and med oncology surgeons to our conferences was actually a novel thought. Although today it's not so novel because it’s bringing all the disciplines that work together for the care of the patient.
But in a way that really was helpful because one of the leaders at that time, his name was Morton Kligerman, came from I think Yale, taught me head and neck cancer. He was the one who said that we need to understand the discipline of oncology from all the various aspects - surgical, medical, and radiation, as well as radiological from the pathologic standpoint. We need to learn these principles as well if not better then our colleagues. We needed to be the master of whatever it is that we're doing in order be able to speak with our colleagues in our specialties in a language that they understand to optimize the care of our mutual patients.
At that time Diane and I had been married since the end of medical school, so for four years by the end of residency and internship - Diane had come from Boston, where we had met. We met back at the early days when I was still at MIT. We were picked to be on the same jury at a courthouse Cambridge, MA in 1981. That was an amazing happening in my life, I made a promise to Diane when we left Boston to go to Philly for internship and residency that we would go back to Boston where is would work. It just turned out in 1994, when I was graduating from residency and applying for an attending position that there were no in town jobs at the Massachusetts General, Brigham Women’s Hospital/Dana-Farber Cancer Institute, The Beth Israel Deaconess for a new grad. There was not a single job in Boston here in the academic center, and I really wanted to have an academic career.
One job though that was available although not in an academic center was a job in a facility in Fall River, Massachusetts which is about 65 miles southeast of Boston at a place called Saint Anne Medical Center which was part of the Caritas Christi system. And the Dana Farber and the Brigham had an experiment that they wanted to try to see if medicine that would be in practice in Boston could be translated into the community. This type of satellite position was the first of its kind to my knowledge. Norman Coleman, when he was experimenting, dreamed this up - that you could have outstanding care in the community delivered if you hired the right people and put the appropriate people on site and in charge.
So it was an experiment. I was nervous about it because I wasn't sure if it was right for me given I wanted to be an academic clinician. Was I going to be able to do so in a setting that really didn't have the resource, the faculty or the statistical underpinning, the data mining and the data analysts that you need to create databases? None of that was there. I took the job because I promised Diane we would return to Boston. But that promise actually paid off a million fold because what I found was something I could have never predicted or foreseen. But now I understand the point. Because we were in Boston, my wife Diane was happy. So that made a huge difference. I’m able to do what I needed to do in that first year as an attending to pass oral boards, but more importantly to establish the beginning of an academic career despite the very limited academic set up.
What happened was that there were a number of things that were just almost mind-boggling as I look back on it because it was not something I could've ever mapped out. The first thing that happened was -- I wrote a bunch of papers still using data from the University of PENN. Specifically, there were four papers I wrote. But if you can believe it back then, there wasn't word processing. There weren't computers and laptops. So I typed these papers on a typewriter, it’s so hard to believe, and mailed them in to the journal. I'll never forget I got back reviews, that were just really, I don't know how to say it but unkind. I'll never forget, one, that was from a journal now that we would consider mid-to-low level, certainly not high impact, which basically had one line in the review stating that “mathematical models have no place in medicine”. That was the entire review.
So there was a lot of frustration and difficulty when that paper got rejected as well as the other three, and I said I'll never be able to do this. Then something changed. Two things changed. One, I was treating a patient who had come from New York and was summering in this area. He was a man who I couldn’t tell at the time, but a man of some means. He was really happy with the care that was delivered, and as a result he wanted to make a contribution. I didn't have a research fund or anything of that sort but we created one. With that gift that he gave me, which was a $60,000 grant, I was able to hire a nurse to work with me on research projects - Marian Loffredo. A woman who had been in the business world but decided to go back to nursing in her late 30s to early 40s because she had a daughter afflicted with a craniopharyngioma and who had radiation for this problem. The child was successfully treated but had some developmental issues as a result.
Marian is a woman with a big heart and wanted to give back. There she came to the door just at the time when I needed someone like that. I couldn't offer her much. You know, $30,000 for a nurse for a year even in the 1994 was not a lot of money. But she accepted the offer and I hired her, we agreed for just 1 year and to play it by ear, and she became my right arm. She still is to this day, 24 years later, working with me and has been the one who really has overseen much of the clinical trial work along with Elizabeth McMahon who was hired about 7 year later.
She was the first piece. The second piece was when I would go into Boston one day a week (I worked four days in the satellite and one day/week in town), I met with a statistical group there and started talking about support. I had an idea for a project but I had to buy one of the master’s level statisticians for it to be done well. I remember the statistician saying to me that this idea as just a little too sophisticated for what I do, but I know somebody who would be terrific with this and who personally trained me. So he gave me the name of Ming-Hui Chen who to this day is the statistician I work with, who at that time was an assistant professor at the Worcester Polytechnic Institute in Worcester, Massachusetts. Next we met in person. We’re the same age. We're both athletic and fit and interestingly had a lot of other things in common. I taught him about prostate cancer, he taught me about statistics. And he became the person who worked with me from then until now.
But the amazing thing about Ming-Hui Chen is that when he didn't understand something, he would go and read about it and then could understand it. He was one of these rare statisticians who could understand medicine, and I was a doctor who could understand math. So we really did very well together. Time-dependent covariates and interaction models were concepts that we learned together. I didn't know these concepts graduating from residency. We learned this together as we explored the different investigations in prostate cancer.
I think the other points that I'll make too is that even though I was 65 miles southeast of Boston, a woman there named Rita Linggood, who was the pediatric and eye radiation oncologist at Massachusetts General, had taken on a senior role and was who I worked with and for. She was amazingly supportive of my career. When I would go into Boston on Thursdays, she would cover my beeper so I’d have a completely undisturbed day. I was able to get a lot done with her help. The other four days Rita and I were able to educate the physicians in that area on the principles of modern oncologic practice. We brought people down from Boston to teach them. These doctors to their credit were open and receptive to the teaching that oncology evolved to where it is today. That is to the same level of practice/care that we have in Boston.
Marian and I wrote a clinical trial, which was the radiation plus or minus six months of combined oral blockade for men with unfavorable risk prostate cancer – although unfavorable risk wasn’t defined just yet. We ran it there at that facility. It was amazing and I could not appreciate it at the time that I would be running a randomized trial of people mostly comprised of Portuguese fishermen. It was really amazing because there they were so appreciative. Patients were happy that we were there that they would go on the clinical trial with little hesitation. Almost everybody we talked to were interested and were happy to be getting something that they felt was Boston medicine in the place where they lived and they didn't have to travel into Boston.
So in doing that trial, the whole concept of risk groups then involved all confirmed by Professor Chen, and another statistician, Delray Schultz who I got to know as a resident at PENN. We combined thoughts together and experimented. We were thinking about what could we come up with in trying to solve an issue that's really prevalent at that time, which was the way that physicians decided on whether a man with non-metastatic prostate cancer was treated with surgery or radiation was simply whether or not at that time they were fit enough to undergo an operation. It didn't matter what their PSA was. It didn't matter what their Gleason Score was. It didn't matter what their rectal exam showed. And literally that was the way it was decided not just in the community but also in the academic setting.
We had a hypothesis that if you know cancers were more advanced, perhaps they would do better with the combined approach of surgery and radiation or maybe radiation and hormonal therapy which we studied on the randomized trial. We were also trying to find a way to see whether there was a way to figure out if the cancer was more aggressive. So PSA was just becoming available and it was evolving toward being, a benchmark for clinical success or failure. It hadn’t been around long enough to look at long term outcomes, But we used PSA and we just ran models, which we had a lot of fun doing, playing with numbers with PSA Gleason and a clinical tumor category. And that was how risk groups were developed.
So as your PSA went up we defined different categories – zero to 10, 10 to 20 and greater than 20 and similar with the Gleason Score went up to 6 versus 7 versus 8 to 10, and the clinical tumor Category (T1c.2a vs @b vs 2c or higher) We put groups together. We come up with groups that defined a low, intermediate high risk or either having a PSA success or failure within five years after various treatments. The databases that we used for that were from PENN and the Joint Center for Radiation Therapy. At that time it was called the Joint Center for Radiation Therapy which was the Harvard hospital system, and that was how that paper was created. We never imagined that those groups would actually be used. And now they are being built upon to establish even better risk assessment.
I think the last thing I'll say then that was the highlight of my career, was really not the clinical trials or the risk groups. But it really was the relationships that I was able to form along the way. The relationships with the patients and their family, the gratitude that they've shown. The care and how wonderful it was to see them succeed. Or if they didn't succeed in terms of curing whatever the illness was, that they at least had their last day with a physician and team that really cared about them as a fellow human being. I didn’t say this earlier but when I first went to Saint Anne’s Hospital, in the first five years I was a generalist, treated everything - including pediatrics. I didn’t focus on prostate cancer until five years after I was an attending. You could do that then. So I was actually a hospice doc to my sick and dying patients and a general radiation oncologist.
That was one of the fulfilling aspects of my career. The next most fulfilling aspect was teaching residents. It was really a gift that Jay Harris blessed me with when he asked me would I like to help him with the residents. I was longing to teach young minds. I didn’t have that opportunity in the satellite facility. So when I was offered that, I immediately said yes. So I started getting involved with residents fairly early on in my career because at that point I was an attending for three or four years.
Then an opportunity at the medical school came along, which was a story on itself. Essentially I applied for a job. I wasn’t qualified for. It was what was then called a master of one of the societies which they now call learning communities throughout the country where students are put into these groups and where faculty follow them from the white coat ceremony to graduation. We take care of everything, helping them with course selection and career choice. We would help them if they had a tragedy or a difficulty in their own family or personal life. That I started about eight years after I became an attending.
I still see that to this day the relationships that I formed with the residents, students, later on with the fellows and now the young faculty and mid-faculty is just invaluable. It feels like a family where ever I go. Starting with the family, I leave in the morning when I go to work. A family I have there at work with the clinical team and the research team. The family with the residents and the family with the medical students is really just an outstanding success, in terms of living a life of joy and fulfilment.
I think I’ll stop there. I don’t know if I’ve answered all the questions here on the sheet that I read and you sent, but I’d be happy to answer anything that may involve that.
Lior Braunstein: You’ve covered a tremendous amount and you paint a really beautifully vivid picture of a fulfilled life and a full life that’s largely been punctuated by a lot of very special people along the way. You mentioned Alan Nelson and Daniel Goodenough, certainly Eleanor Walters who now - if I understand correctly - you have an endowed chair that is named after her. Is that right?
Anthony D’Amico: That’s correct. Based on some philanthropic support that we gained over the course of the time in Boston. There was one donor, who wanted to be anonymous, who allowed me the opportunity to name a chair after anyone I wanted. So I chose Mrs. Walters because it was her life and her love that allowed me to complete my vow to take on medicine as a career.
Lior Braunstein: And then you also mentioned Marian Loffredo and Ming-Hui Chen, and of course Diane along the way, as all being very formative in shaping your trajectory. I’m curious at this point to what extent does the mentorship for which you’re legendary -- all the people that you meet throughout the day in terms of medical students or faculty members and colleagues, to what extent do they continue to shape your priorities and what motivates you and to what extent do they continue to shape your career and your life?
Anthony D’Amico: Well, I could just say that there are so many people now around the country - not just GU radiation oncologists but just radiation oncologists - that I have the blessing to come to know many of whom started as medical students. I saw them through residency either in Boston or other places, and now I see them as attendings. And I get to not only know them as doctors but as people. One example would be Paul Nguyen, my colleague. He was a student who I met when he was in the Holmes Society at Harvard Medical school that I was overseeing at that time. He later became one of our chief residents.
There he met his wife, Sophia Koo, at Harvard Medical School. They had two twin daughters (Isabella and Liliac) and I’m the godfather of those two girls. It’s something I am extremely proud of and cherish. It’s that kind of relationship that I’ve been able to develop with so many people around the country who are radiation oncologists. This results from being able to get to know them and love them from their beginning as medical students or residents.
How did it shape my life now? Well, I would say as I talk about all these different families that I live with and exist in throughout the course of my day from home to work and back to home again. That when I go anywhere in the country, there’s a family out there too - whether it be Salt Lake City, or Los Angeles, or New York or Milwaukee. I know people essentially in almost any city you can name or country because I have had the opportunity to meet these wonderful people at some point along their way. And now t at the medical school, I get to meet students who go into every specialty - from plastic surgery to dermatology to primary care. So it really is any place I go to there is always a welcoming family on any given day and at any given place. I’ll get maybe 50 or 20 emails a day from people who I’ve known in the past just saying, hello, we just had our first baby and was thinking about you because I had the opportunity to mentor someone the way you mentored me.
I see these things happen every day and for this countless blessing in my life, I thank God, that I was given such great gifts in the people he has sent to mw and the insights he has allowed me to share. I recognize that a life is not based or valued or determined based on what it accomplishes but rather based on what it shares. Mentoring and teaching is one of the most invaluable ways of sharing and that is what matters most in the field in which I’m blessed to practice in.
Lior Braunstein: That’s a very profound principle and one that I remember that you imparted upon your mentees many times along the way. I had the privilege to meet you right from the very start of medical school. That was the human interaction and the human component of what we do. The relationships even outside of the hospital walls were something that you always emphasized as being a sort of critical component of anything that one does and of a fulfilled life, and you clearly have been so successful at that.
I was wondering if you think that there were particularly formative experiences that brought you to that principle or if it was the aggregate of the whole story that you shared with us that was punctuated by really meaningful people along the way. Because certainly not everyone has the privilege of surrounding themselves with such great friends and mentors and even mentees who keep in touch over the course of one’s life. There is something about the earnestness that you bring to it that makes it very real and very lasting.
Anthony D’Amico: I’ll answer that question, Lior. But first I want to say that you mentioned that we met when you were a first year medical student. The things that I value I know you value too, and so it important to realize you have to give yourself credit too. Fifteen people can hear the same thing but not everybody will actually absorb it, and take it in, and pay it forward in life like you have, Lior. In terms of what was it that made this message come to my heart, I have to say I started with a reverse direction. I think the story is to be told backwards to make it understandable. I come to realize that things happen for a reason. I came to Boston, having made that promise to my wife that we would come back to Boston, and that found there was no academic job at that time in town, SO ,such that I took all that was available in the New Bedford area where I met Marian Loffredo and came to know Rita Linggood and then stumbled upon a statistician at that time at Dana-Farber on that one day a week I could go on to town. That statistician introduces me to Ming-Hui Chen because he needed someone with more sophisticated statistical skills to address what the question I brought to him., By being in the satellite 4 days/week I was also protected from what was going on in town at that time which was a lot of internal politics that if I had been a part of as a brand new faculty member I may not have stayed. It was just way, way over my head. I didn’t realize by being 65 miles southeast of it, how protected I was and how productive I could be as a result of not having to get involved with what was going on in Boston at the time.
So all of those things are not things you can plan for or map out. Those are things that some people would call serendipity or luck, and at one point in my life I would have looked it at that way too. But there has been too many things that have happened in my life. I gave you one example of it there, but there are other facets of my life where that’s true as well. That had caused me to come to the realization that things happen for a reason; that there is a bigger picture that we can understand; that things happen in a way that if you pursue truth and do what is right and just, that you will succeed because right is on your side and right always prevails. That sounds like a lot of philosophy, but I gave you one chapter of my life which was my professional and personal life. But there are other chapters too, you know, paralleled circumstances that seemed to be serendipitous when in fact, when I look back on it, there is no way that all of these things would just happen by chance.
Lior Braunstein: Along those lines, I’m sure there are likely multiple of these parallel influences. One which I’m at least partially familiar with is this very robust involvement and relationship that you have with taekwondo. I was wondering if you could speak a little bit to that, how you got into that and how that influenced this entirely parallel professional career.
Anthony D’Amico: So that is one of the other chapters, Lior. In fact, I started martial arts when I was very young. I was somewhere around nine and ten years old because my best friend Arthur Walters, the son of Eleanor Walters, wanted to do something like that. I really didn’t but at that age he wanted to do it, so I did it along with him.
I started out in a style called Ishan Ryo with an instructor whose name is Sensei Botnick. He was a very good instructor, a very strict instructor. He carried the principles of martial arts in terms of the physical principle and taught them very well but none of the more far reaching principles that I follow now which are the emotional, social, spiritual wellbeing. What happened was after four years there, his father became ill and he went back to Japan. That was the end of that school. Students tried to take over but they were not the leader that he was, and I understand now why - because Sensei Botnick was an excellent physical instructor but didn’t teach beyond that.
What happened next then was there was a flyer placed under the windshield wiper of my family’s car one day when we had gone into a place to shop. The master’s name was Ye Bong Choi. He had just come to New Jersey. He opened a school, called the Dojang, in taekwondo and he was letting people know in this way.
So we went there, Arthur and I, with my father and Arthur’s father. By this point, having done martial arts for four years, we were at that point blue belts. It’s like the fourth rank out of ten toward first degree black belt. So first would be the black belt. Master Choi saw the form that we had and the belt we had acquired. He interviewed each of us separately, which I realize now was very wise. He asked us the same questions. He asked me why did I want to do taekwondo. I started to mutter something about self-defense. He looked at my father and said, thank you, that’s all, go home. I was shocked. My father took me home. Similarly Arthur was sent home too. I didn’t ask Arthur what he said, but it probably was something similar.
This went on three times. The second time I went back was the same thing. The third time on my way there, my father said, “Anthony, if he sends you home again, I think that’s it, this is probably not right for you.” So he asked me the same question, why do you want to study taekwondo. I didn’t answer at first because I wasn’t sure what he was looking for. At this point I was 10 years old. So I sat there in silence and he looked up at me and he said with a big smile on his face, “Very good, Anthony. That’s the right answer. You’re too young to know why you are are.” And that was the beginning of the first lesson, when he said a young child can’t understand the true manifestation of martial arts. I came to appreciate in time, that Master Choi didn’t just teach the physical. He taught what was beyond that.
I’ll give you an example. He taught about self-assurance and self-confidence. He taught about perseverance and how not to give up when you’re doing something you believe is right. How did he do that? Well, the way he would do it is physically in class, when you were exhausted, you couldn’t go on. When you are doing say push up and you fell on the floor, he’ll come down and put his face right on the floor next to yours and say to you, Anthony, do you want to give up? You could give up at that point and leave. Sometimes people did. But I would say, no, sir. I’d get up and I’d try again even though I had very little left. That’s how he taught physical perseverance.
How did he teach mental perseverance? Well, he kept track of my life when I went to MIT. I was floored by how smart people were. We would talk weekly. He would ask me about how things were going and I would share with him. And he would tell me that, you know, you have to go on. Just find a different way. You can study in a way people studied before. Ask for help. He would have advice along the way which caused me to look for other ways to succeed. And that was the mental perseverance.
But then the last one which I didn’t learn until later on - in my late 20s, early 30s - is the spiritual part of martial arts. It goes even beyond the physical and the mental. He showed me that by him teaching me, he gave me the opportunity to teach others. To teach them what? To try to kick and punch, how to block, how to jump right forward? No. To teach them the principles of confidence, courtesy, perseverance, integrity, self-control. Those are the things he taught me the value of, and those are the things I ascribe to today so I could teach the students in the Dojang but also the residents and medical students and fellows and attendings. By teaching those principles, I came to realize that by sharing that, we’ve actually given them something much more than how to kick, punch, how to treat prostate cancer to how to learn basic physiology. We’ve given them a way of thinking about life, a way of living life. And it leads to happiness and success.
So now just to come back to what I’ve said earlier, after I first met Sensei Botnick, if his father hadn’t gotten ill and he had to go back to Japan, I never would have met Master Choi. Someone put that flyer on the windshield. If we hadn’t been parked in that parking lot that day, we would not have met him either. And finally I had to talk to him three times before I decided not to answer his question because I wasn’t sure what he was looking for before he finally accepted me as a student. Look at how many things has to fall into place to make that great mentor a part of my life. That’s just another example of things happening for a reason.
Lior Braunstein: There’s a very deep and meaningful lesson in there certainly. When I imagine patients come to you and things have fallen potentially in a way that they would not have liked, perhaps you used some of that guidance to show them that maybe some good can come out of their experience, I imagine, or to comfort them to some measure.
Anthony D’Amico: Eleanor Walters, Rita Linggood, Ming-Hui Chen, Master Choi, Marian Loffredo. The basis of their interactions is so significant and impactful. It is because it is out of love. With a patient and a family, that’s what it’s like. So you may not have something to say to them in the moment that’s going to alleviate their stress, their concern, their fear. But if they feel the presence of the love that you have by just the way you look at them, pause, listen to them; be there with them and listen to their kids who are present in the consult, their spouse or partner who called in on a conference line if need be, they recognize, hey, this guy really cares.
I think that’s what I learned. I realize that it is important for a patient to know that there’s a loving doctor and a caring doctor; a mindful, intelligent, and confident doctor there willing to listen and understand and be with you no matter what. That I think is really what I take into the clinic, what I try to teach the resident students in addition to how to treat the patient.
Lior Braunstein: Absolutely. In having had plenty of conversations with you over the years, I can think of no better way to conclude the interview than on the point about love unless there is anything that you wanted to bring up for posterity. I think that that paints a very nice and vivid picture of a profound, and meaningful, and successful career that has influenced certainly many people in the field and will yet influence many more to come through their mentees.
Anthony D’Amico: A big thank you, Lior. I think the last thing I’ll say is that during this conversation my wife, Diane, has been present to hear the story she knows well and to have validated again that our of my love for her my career was born 65 miles southeast of Boston in a place where academic medicine had not been practiced before. I would not have planned this path on purpose. It’s just how it turned out. But you know there’s value with that thought because it is the basis for faith in something more then ourselves, it is faith in a loving presence that watches and guides each of us during our human existence. I’m still teaching learning but now have no doubt that no matter what happens on any given day, it is out of love for me and those around me. I try to teach and share this wisdom I have been given with all those I meet.
Lior Braunstein: And we’re all tremendously grateful for it. Thank you for that. This has been a real privilege. Thanks for the opportunity to participate in this conversation.
Anthony D’Amico: Okay. Thank you, Lior and Timothy, for inviting me. Keep me posted for the transcript.
The following interview of Anthony D'Amico, MD, PhD, FASTRO, was conducted on June 22, 2018, by Lior Braunstein, MD and Timothy Showalter, MD, MPH.
Lior Braunstein: Good morning, Anthony. You’ve had a far ranging career. I think many of us are very familiar with the work that you’ve done in radiation, but I think fewer people know about your earlier story - where you came from, your family life, and what your childhood was like. We are wondering if you might start by telling us a little bit about that.
Anthony D’Amico: Okay. So first of all, thank you all for including me as part of this. I’m very appreciative. I appreciate the time that you’re making out to do this.
So in terms of the beginning, I grew up on the lower east side of Manhattan, New York City. I’m the oldest of three. I have two younger sisters. My parents were in the theatrical world and met actually at a church dance when they were 23, 24. Not too long after that, within a year, they were married. They were not people who came from the kind of backgrounds that I myself and my sisters had been blessed to have, that is college education and post college education, because at that time there just wasn’t that opportunity for them. They were helping to provide for their parents. They both had a number of siblings. My mother had four older brothers. My father was one of five as well. And so they did the best they could.
They raised us to be independent, to be seekers in terms of what’s most important in life - and that’s the sense of family and community that they fostered so well. About eight years after spending time in New York my father, who had spent time in the service, was able to get a loan for a down payment on a house. And that’s when we moved to East Brunswick, New Jersey. That’s where I finished up grade school, middle school and high school.
When I was in high school, I was very attracted to not so much subject matter but more people. I remember very explicitly three high school teachers. One was an American literature teacher, Michael Michaud. One was a physics professor or a physics teacher. We called him Mr. Weston. Then there was someone we called Dr. Kimmel who was a chemistry teacher. Finally, Mrs. Triozzi who taught us trigonometry and of all the teachers she challenged me the most and prepared me for what came next. Each of them was very dynamic in terms of how they were able to teach, so things that they taught stuck with me. And it was really the people who got me interested in science, particularly mathematical science because that’s what I seem to have a knack for.
I applied to many, many different colleges and it wasn’t until literally the middle of April 1979 when I got an acceptance letter from MIT, the Massachusetts Institute of Technology. I had already sought a letter from the senator of New Jersey because I was planning to go to WestPoint, because that was the background I was heading in. I was a martial artist at that point. I was somewhat I would say militaristic in my approach to life, very regimented, and so that kind of setting would have fit me well.
But when I got the acceptance to MIT, I just thought it was an opportunity that was really very rare and so I took it. I arrived in MIT at the fall of ‘79 and found that it was very challenging. I met for the first time people who were really geniuses. People who would speak literally five, six, seven, eight different languages would just sit in the classroom and figure out the entire three‑month course after hearing just one‑half of the first lecture. So really gifted. Well, I was not that. I was smart. I worked hard. But I wasn’t a genius and so it was intimidating.
In the first year at MIT, like many colleges at that time, it was pass/fail which was fortunate because it gave a chance to learn how to study and how to learn in this environment that was extremely high achieving and filled with brilliant people. It took me the whole year to learn how to master that. At the end of the year, I declared a physics major. So I took classes in math, chemistry and physics and I was enrolled on a physics track which at that time was considered more advanced then people who were just were taking physics courses as a requirement but not necessarily on a physics track.
I went through the first three years, and by the third year I met a man named Alan Nelson who came from Berkeley who later became my PhD advisor. I wasn’t planning on doing a master’s or a PhD but this man who came from Berkeley, very similar to the men and women I met in high school, was an extraordinary teacher and mentor. His way of thinking was the basis for how I think today, that is anything is possible. You just have to dream and think about how to create something and make it come to fruition. He was a nuclear engineer with specialization in nuclear/medical physics, and so I added on another major which was nuclear engineering.
I completed my first two bachelor’s degrees. That was four years. I graduated in ‘83. I stayed on for one more year to do a master’s degree, and then two more years after that for my PhD with Professor Nelson which was really in an area of applying physics and mathematical principles to biological systems. At that time, in mid‑ ‘80, things like how tumors created blood vessels was not well understood. There were these principles that had not yet come along at the time. e.g. Tumor angiogenesis factor.
We collaborated with physicians and scientists. I was exploring the etiology of tumor angiogenesis using mathematical and physics principles, e.g. Bernoulli’s rules and fluid mechanics as opposed to more biological thinking. That was the basis of my PhD thesis i.e. how the tumors create new blood vessels and how cells from primary tumor circulates and metastasizes. And it’s really more again from an engineering physics standpoint.
It was later in graduate school when I started to become interested in medicine and it was a number of events, most of them personal. First and foremost, my wife Diane - not at that time, at that time my girlfriend - her mother was an infectious disease nurse at one of the hospitals in Boston. I sat with her often and we spoke of what she did. I found it interesting that she had this knack for really being interested in the well‑being of others. That sort of emulated my family. What my parents taught me reflected that. She invited me once to come and see what she did. I took her up on it and Diane actually worked at that time in the hospital as the administrative assistant. For me, it was very interesting to see her interactions with people.
It was not too long before that that a woman that I grew up with who was the mom of my best friend, her name was Eleanor Walters, developed breast cancer. Unfortunately she didn’t live more than a year, and I watched her decline and die. Back then there were no advanced directives. She was very sick although completely alert and awake though until two days before she was gone. It was very difficult to watch. Particularly the medical team that was taking care of her probably were some very, very nice people, but there were also some people - particularly the doctor in charge, the medical oncologist - who didn’t seem to really have people skills or was not very interested in what he was doing.
I remember very clearly that I went in to speak with him and said that the family really is concerned about what’s going on and were at a loss for words. I was kind of the spokesperson for the family because they were pretty quiet people. And he turned and looked at me and said, “I don’t speak to anybody except the family. Tell them to come talk to me.” When I did bring the family together, he put us all in this room. Right in front of Mrs. Walters, all he did was look at us and say, “you have to just face that she is dying.” And he walked out of the room. I was horrified by that exchange because she was right there awake and alert, intubated and couldn’t speak. She was a very understanding and forgiving woman and she let that go, but the family was really taken aback as was I.
It was that experience that got me to think as to, what is was about doctors that they could behave like that. Over time, I came to realize that that was just a poor example of somebody who probably wasn’t very happy with his life and took it out at work. However in that moment, I became more curious and so I cross-registered at Harvard Medical School for a couple of courses - one in anatomy and one in pathology - taught by real giants who also were amazingly charismatic, just like the high school teachers that I had. One was named Ferris Jenkins who taught anatomy and Daniel Goodenough who taught me pathology.
I was looking to understand why Mrs. Walter died. What was it about her body that went wrong. I wasn’t going to learn that in anatomy and pathology but I didn’t really recognize that at the time. What I did see was that the students in the class, the medical students, were all so curious about who I was because I was the new kid on the block who would sit in 2 of the 5 classes they were taking at the time. They were people very much like myself, very much interested in building community through service of others, and I got along with them in ways that I didn’t get along necessarily with the graduate students who I was working with at MIT.
That got me to start to think about, what field am I really suited for? That’s when I decided, after discussing it with my PhD advisor Alan Nelson, to go to medical school. So I was in medical school, and there the first two years in the classroom were not actually that much fun. Because here I am, I’ve been a graduate student now for three years and mostly independent, designing experiments, thinking on my own and now I have to sit in the classroom and take in a lot of material and just remember it and regurgitate it. But once we got to the third year and we entered the hospital, I say that I never worked another day in my life after that. I really loved the interactions with the people and being able to actually apply what I learned in the classroom and have a real impact on people’s lives in real time.
There, I heard about radiation oncology serendipitously because the person they paired me with as my medical school adviser was Robert Goodman, who happened to be the chair of radiation oncology at the University of Pennsylvania at the time where I went to medical school. So he would take me around and show me what he did. I said, wow, amazing how one could apply principles of math and physics to effectively treat people in such great need who have cancer. And that was my first introduction to the field.
So after going through all of third year, it came down at the end of third year to trying to decide between radiation oncology and going through OB-GYN to get to gynecologic oncology. After much discussion, radiation oncology became the choice. Back then interestingly the residency is unlike today. It was not four years but three years, I did an internship in medicine starting in 1990 and then my radiation oncology residency at Penn completing in 1994.
The day I entered the radiation oncology residency, I was expecting Dr. Robert Goodman to be the chair. However, he had stepped out because they had asked him to become the interim president of the hospital. Because at that time there were some transitions that were occurring. I didn’t quite understand at the time. I do now. So we were actually without a chair for my first two years as a resident, which was quite challenging because the faculty was very focused on trying to figure out who the next leader there would be. And so the residents were really left to learn a lot on their own. That was an opportunity in disguise, I didn’t realize it at the time, but I needed to learn how to try to become innovative in terms of how I worked and studied. I started by talking with the senior residents about various cases and learning simulation from the senior radiation therapists which was possible then everything was based on bony anatomy.
A couple of years after that I became chief resident. By that point Gillies McKenna, who was elected chair, was put into place. We were without a chair for two of the three years of my residency, but in the third year I became the chief resident along with James Pearlman who was one of my five co-residents. It was actually a wonderful set up now to be able to give back to our junior colleagues, which I loved to do. Throughout most of my life, I’ve met great teachers and I aspired to become a great teacher and that was the first opportunity to really do that in medicine.
So Jim and I created a curriculum for residents that didn't exist before which brought in specialists from other areas - medical oncology, various aspects of surgical oncology, radiology, pathology - to teach us what they did and how their contribution contributed to the overall management of the patients with cancer. Back then, believe it or not - now we’re talking about 1993 when I was chief resident - tumor boards really didn't exist. They were just being invented. So multi-disciplinary clinic tumor boards were not part of the language like they are in common place today. So by bringing in talented radiologists and med oncology surgeons to our conferences was actually a novel thought. Although today it's not so novel because it’s bringing all the disciplines that work together for the care of the patient.
But in a way that really was helpful because one of the leaders at that time, his name was Morton Kligerman, came from I think Yale, taught me head and neck cancer. He was the one who said that we need to understand the discipline of oncology from all the various aspects - surgical, medical, and radiation, as well as radiological from the pathologic standpoint. We need to learn these principles as well if not better then our colleagues. We needed to be the master of whatever it is that we're doing in order be able to speak with our colleagues in our specialties in a language that they understand to optimize the care of our mutual patients.
At that time Diane and I had been married since the end of medical school, so for four years by the end of residency and internship - Diane had come from Boston, where we had met. We met back at the early days when I was still at MIT. We were picked to be on the same jury at a courthouse Cambridge, MA in 1981. That was an amazing happening in my life, I made a promise to Diane when we left Boston to go to Philly for internship and residency that we would go back to Boston where is would work. It just turned out in 1994, when I was graduating from residency and applying for an attending position that there were no in town jobs at the Massachusetts General, Brigham Women’s Hospital/Dana-Farber Cancer Institute, The Beth Israel Deaconess for a new grad. There was not a single job in Boston here in the academic center, and I really wanted to have an academic career.
One job though that was available although not in an academic center was a job in a facility in Fall River, Massachusetts which is about 65 miles southeast of Boston at a place called Saint Anne Medical Center which was part of the Caritas Christi system. And the Dana Farber and the Brigham had an experiment that they wanted to try to see if medicine that would be in practice in Boston could be translated into the community. This type of satellite position was the first of its kind to my knowledge. Norman Coleman, when he was experimenting, dreamed this up - that you could have outstanding care in the community delivered if you hired the right people and put the appropriate people on site and in charge.
So it was an experiment. I was nervous about it because I wasn't sure if it was right for me given I wanted to be an academic clinician. Was I going to be able to do so in a setting that really didn't have the resource, the faculty or the statistical underpinning, the data mining and the data analysts that you need to create databases? None of that was there. I took the job because I promised Diane we would return to Boston. But that promise actually paid off a million fold because what I found was something I could have never predicted or foreseen. But now I understand the point. Because we were in Boston, my wife Diane was happy. So that made a huge difference. I’m able to do what I needed to do in that first year as an attending to pass oral boards, but more importantly to establish the beginning of an academic career despite the very limited academic set up.
What happened was that there were a number of things that were just almost mind-boggling as I look back on it because it was not something I could've ever mapped out. The first thing that happened was -- I wrote a bunch of papers still using data from the University of PENN. Specifically, there were four papers I wrote. But if you can believe it back then, there wasn't word processing. There weren't computers and laptops. So I typed these papers on a typewriter, it’s so hard to believe, and mailed them in to the journal. I'll never forget I got back reviews, that were just really, I don't know how to say it but unkind. I'll never forget, one, that was from a journal now that we would consider mid-to-low level, certainly not high impact, which basically had one line in the review stating that “mathematical models have no place in medicine”. That was the entire review.
So there was a lot of frustration and difficulty when that paper got rejected as well as the other three, and I said I'll never be able to do this. Then something changed. Two things changed. One, I was treating a patient who had come from New York and was summering in this area. He was a man who I couldn’t tell at the time, but a man of some means. He was really happy with the care that was delivered, and as a result he wanted to make a contribution. I didn't have a research fund or anything of that sort but we created one. With that gift that he gave me, which was a $60,000 grant, I was able to hire a nurse to work with me on research projects - Marian Loffredo. A woman who had been in the business world but decided to go back to nursing in her late 30s to early 40s because she had a daughter afflicted with a craniopharyngioma and who had radiation for this problem. The child was successfully treated but had some developmental issues as a result.
Marian is a woman with a big heart and wanted to give back. There she came to the door just at the time when I needed someone like that. I couldn't offer her much. You know, $30,000 for a nurse for a year even in the 1994 was not a lot of money. But she accepted the offer and I hired her, we agreed for just 1 year and to play it by ear, and she became my right arm. She still is to this day, 24 years later, working with me and has been the one who really has overseen much of the clinical trial work along with Elizabeth McMahon who was hired about 7 year later.
She was the first piece. The second piece was when I would go into Boston one day a week (I worked four days in the satellite and one day/week in town), I met with a statistical group there and started talking about support. I had an idea for a project but I had to buy one of the master’s level statisticians for it to be done well. I remember the statistician saying to me that this idea as just a little too sophisticated for what I do, but I know somebody who would be terrific with this and who personally trained me. So he gave me the name of Ming-Hui Chen who to this day is the statistician I work with, who at that time was an assistant professor at the Worcester Polytechnic Institute in Worcester, Massachusetts. Next we met in person. We’re the same age. We're both athletic and fit and interestingly had a lot of other things in common. I taught him about prostate cancer, he taught me about statistics. And he became the person who worked with me from then until now.
But the amazing thing about Ming-Hui Chen is that when he didn't understand something, he would go and read about it and then could understand it. He was one of these rare statisticians who could understand medicine, and I was a doctor who could understand math. So we really did very well together. Time-dependent covariates and interaction models were concepts that we learned together. I didn't know these concepts graduating from residency. We learned this together as we explored the different investigations in prostate cancer.
I think the other points that I'll make too is that even though I was 65 miles southeast of Boston, a woman there named Rita Linggood, who was the pediatric and eye radiation oncologist at Massachusetts General, had taken on a senior role and was who I worked with and for. She was amazingly supportive of my career. When I would go into Boston on Thursdays, she would cover my beeper so I’d have a completely undisturbed day. I was able to get a lot done with her help. The other four days Rita and I were able to educate the physicians in that area on the principles of modern oncologic practice. We brought people down from Boston to teach them. These doctors to their credit were open and receptive to the teaching that oncology evolved to where it is today. That is to the same level of practice/care that we have in Boston.
Marian and I wrote a clinical trial, which was the radiation plus or minus six months of combined oral blockade for men with unfavorable risk prostate cancer – although unfavorable risk wasn’t defined just yet. We ran it there at that facility. It was amazing and I could not appreciate it at the time that I would be running a randomized trial of people mostly comprised of Portuguese fishermen. It was really amazing because there they were so appreciative. Patients were happy that we were there that they would go on the clinical trial with little hesitation. Almost everybody we talked to were interested and were happy to be getting something that they felt was Boston medicine in the place where they lived and they didn't have to travel into Boston.
So in doing that trial, the whole concept of risk groups then involved all confirmed by Professor Chen, and another statistician, Delray Schultz who I got to know as a resident at PENN. We combined thoughts together and experimented. We were thinking about what could we come up with in trying to solve an issue that's really prevalent at that time, which was the way that physicians decided on whether a man with non-metastatic prostate cancer was treated with surgery or radiation was simply whether or not at that time they were fit enough to undergo an operation. It didn't matter what their PSA was. It didn't matter what their Gleason Score was. It didn't matter what their rectal exam showed. And literally that was the way it was decided not just in the community but also in the academic setting.
We had a hypothesis that if you know cancers were more advanced, perhaps they would do better with the combined approach of surgery and radiation or maybe radiation and hormonal therapy which we studied on the randomized trial. We were also trying to find a way to see whether there was a way to figure out if the cancer was more aggressive. So PSA was just becoming available and it was evolving toward being, a benchmark for clinical success or failure. It hadn’t been around long enough to look at long term outcomes, But we used PSA and we just ran models, which we had a lot of fun doing, playing with numbers with PSA Gleason and a clinical tumor category. And that was how risk groups were developed.
So as your PSA went up we defined different categories – zero to 10, 10 to 20 and greater than 20 and similar with the Gleason Score went up to 6 versus 7 versus 8 to 10, and the clinical tumor Category (T1c.2a vs @b vs 2c or higher) We put groups together. We come up with groups that defined a low, intermediate high risk or either having a PSA success or failure within five years after various treatments. The databases that we used for that were from PENN and the Joint Center for Radiation Therapy. At that time it was called the Joint Center for Radiation Therapy which was the Harvard hospital system, and that was how that paper was created. We never imagined that those groups would actually be used. And now they are being built upon to establish even better risk assessment.
I think the last thing I'll say then that was the highlight of my career, was really not the clinical trials or the risk groups. But it really was the relationships that I was able to form along the way. The relationships with the patients and their family, the gratitude that they've shown. The care and how wonderful it was to see them succeed. Or if they didn't succeed in terms of curing whatever the illness was, that they at least had their last day with a physician and team that really cared about them as a fellow human being. I didn’t say this earlier but when I first went to Saint Anne’s Hospital, in the first five years I was a generalist, treated everything - including pediatrics. I didn’t focus on prostate cancer until five years after I was an attending. You could do that then. So I was actually a hospice doc to my sick and dying patients and a general radiation oncologist.
That was one of the fulfilling aspects of my career. The next most fulfilling aspect was teaching residents. It was really a gift that Jay Harris blessed me with when he asked me would I like to help him with the residents. I was longing to teach young minds. I didn’t have that opportunity in the satellite facility. So when I was offered that, I immediately said yes. So I started getting involved with residents fairly early on in my career because at that point I was an attending for three or four years.
Then an opportunity at the medical school came along, which was a story on itself. Essentially I applied for a job. I wasn’t qualified for. It was what was then called a master of one of the societies which they now call learning communities throughout the country where students are put into these groups and where faculty follow them from the white coat ceremony to graduation. We take care of everything, helping them with course selection and career choice. We would help them if they had a tragedy or a difficulty in their own family or personal life. That I started about eight years after I became an attending.
I still see that to this day the relationships that I formed with the residents, students, later on with the fellows and now the young faculty and mid-faculty is just invaluable. It feels like a family where ever I go. Starting with the family, I leave in the morning when I go to work. A family I have there at work with the clinical team and the research team. The family with the residents and the family with the medical students is really just an outstanding success, in terms of living a life of joy and fulfilment.
I think I’ll stop there. I don’t know if I’ve answered all the questions here on the sheet that I read and you sent, but I’d be happy to answer anything that may involve that.
Lior Braunstein: You’ve covered a tremendous amount and you paint a really beautifully vivid picture of a fulfilled life and a full life that’s largely been punctuated by a lot of very special people along the way. You mentioned Alan Nelson and Daniel Goodenough, certainly Eleanor Walters who now - if I understand correctly - you have an endowed chair that is named after her. Is that right?
Anthony D’Amico: That’s correct. Based on some philanthropic support that we gained over the course of the time in Boston. There was one donor, who wanted to be anonymous, who allowed me the opportunity to name a chair after anyone I wanted. So I chose Mrs. Walters because it was her life and her love that allowed me to complete my vow to take on medicine as a career.
Lior Braunstein: And then you also mentioned Marian Loffredo and Ming-Hui Chen, and of course Diane along the way, as all being very formative in shaping your trajectory. I’m curious at this point to what extent does the mentorship for which you’re legendary -- all the people that you meet throughout the day in terms of medical students or faculty members and colleagues, to what extent do they continue to shape your priorities and what motivates you and to what extent do they continue to shape your career and your life?
Anthony D’Amico: Well, I could just say that there are so many people now around the country - not just GU radiation oncologists but just radiation oncologists - that I have the blessing to come to know many of whom started as medical students. I saw them through residency either in Boston or other places, and now I see them as attendings. And I get to not only know them as doctors but as people. One example would be Paul Nguyen, my colleague. He was a student who I met when he was in the Holmes Society at Harvard Medical school that I was overseeing at that time. He later became one of our chief residents.
There he met his wife, Sophia Koo, at Harvard Medical School. They had two twin daughters (Isabella and Liliac) and I’m the godfather of those two girls. It’s something I am extremely proud of and cherish. It’s that kind of relationship that I’ve been able to develop with so many people around the country who are radiation oncologists. This results from being able to get to know them and love them from their beginning as medical students or residents.
How did it shape my life now? Well, I would say as I talk about all these different families that I live with and exist in throughout the course of my day from home to work and back to home again. That when I go anywhere in the country, there’s a family out there too - whether it be Salt Lake City, or Los Angeles, or New York or Milwaukee. I know people essentially in almost any city you can name or country because I have had the opportunity to meet these wonderful people at some point along their way. And now t at the medical school, I get to meet students who go into every specialty - from plastic surgery to dermatology to primary care. So it really is any place I go to there is always a welcoming family on any given day and at any given place. I’ll get maybe 50 or 20 emails a day from people who I’ve known in the past just saying, hello, we just had our first baby and was thinking about you because I had the opportunity to mentor someone the way you mentored me.
I see these things happen every day and for this countless blessing in my life, I thank God, that I was given such great gifts in the people he has sent to mw and the insights he has allowed me to share. I recognize that a life is not based or valued or determined based on what it accomplishes but rather based on what it shares. Mentoring and teaching is one of the most invaluable ways of sharing and that is what matters most in the field in which I’m blessed to practice in.
Lior Braunstein: That’s a very profound principle and one that I remember that you imparted upon your mentees many times along the way. I had the privilege to meet you right from the very start of medical school. That was the human interaction and the human component of what we do. The relationships even outside of the hospital walls were something that you always emphasized as being a sort of critical component of anything that one does and of a fulfilled life, and you clearly have been so successful at that.
I was wondering if you think that there were particularly formative experiences that brought you to that principle or if it was the aggregate of the whole story that you shared with us that was punctuated by really meaningful people along the way. Because certainly not everyone has the privilege of surrounding themselves with such great friends and mentors and even mentees who keep in touch over the course of one’s life. There is something about the earnestness that you bring to it that makes it very real and very lasting.
Anthony D’Amico: I’ll answer that question, Lior. But first I want to say that you mentioned that we met when you were a first year medical student. The things that I value I know you value too, and so it important to realize you have to give yourself credit too. Fifteen people can hear the same thing but not everybody will actually absorb it, and take it in, and pay it forward in life like you have, Lior. In terms of what was it that made this message come to my heart, I have to say I started with a reverse direction. I think the story is to be told backwards to make it understandable. I come to realize that things happen for a reason. I came to Boston, having made that promise to my wife that we would come back to Boston, and that found there was no academic job at that time in town, SO ,such that I took all that was available in the New Bedford area where I met Marian Loffredo and came to know Rita Linggood and then stumbled upon a statistician at that time at Dana-Farber on that one day a week I could go on to town. That statistician introduces me to Ming-Hui Chen because he needed someone with more sophisticated statistical skills to address what the question I brought to him., By being in the satellite 4 days/week I was also protected from what was going on in town at that time which was a lot of internal politics that if I had been a part of as a brand new faculty member I may not have stayed. It was just way, way over my head. I didn’t realize by being 65 miles southeast of it, how protected I was and how productive I could be as a result of not having to get involved with what was going on in Boston at the time.
So all of those things are not things you can plan for or map out. Those are things that some people would call serendipity or luck, and at one point in my life I would have looked it at that way too. But there has been too many things that have happened in my life. I gave you one example of it there, but there are other facets of my life where that’s true as well. That had caused me to come to the realization that things happen for a reason; that there is a bigger picture that we can understand; that things happen in a way that if you pursue truth and do what is right and just, that you will succeed because right is on your side and right always prevails. That sounds like a lot of philosophy, but I gave you one chapter of my life which was my professional and personal life. But there are other chapters too, you know, paralleled circumstances that seemed to be serendipitous when in fact, when I look back on it, there is no way that all of these things would just happen by chance.
Lior Braunstein: Along those lines, I’m sure there are likely multiple of these parallel influences. One which I’m at least partially familiar with is this very robust involvement and relationship that you have with taekwondo. I was wondering if you could speak a little bit to that, how you got into that and how that influenced this entirely parallel professional career.
Anthony D’Amico: So that is one of the other chapters, Lior. In fact, I started martial arts when I was very young. I was somewhere around nine and ten years old because my best friend Arthur Walters, the son of Eleanor Walters, wanted to do something like that. I really didn’t but at that age he wanted to do it, so I did it along with him.
I started out in a style called Ishan Ryo with an instructor whose name is Sensei Botnick. He was a very good instructor, a very strict instructor. He carried the principles of martial arts in terms of the physical principle and taught them very well but none of the more far reaching principles that I follow now which are the emotional, social, spiritual wellbeing. What happened was after four years there, his father became ill and he went back to Japan. That was the end of that school. Students tried to take over but they were not the leader that he was, and I understand now why - because Sensei Botnick was an excellent physical instructor but didn’t teach beyond that.
What happened next then was there was a flyer placed under the windshield wiper of my family’s car one day when we had gone into a place to shop. The master’s name was Ye Bong Choi. He had just come to New Jersey. He opened a school, called the Dojang, in taekwondo and he was letting people know in this way.
So we went there, Arthur and I, with my father and Arthur’s father. By this point, having done martial arts for four years, we were at that point blue belts. It’s like the fourth rank out of ten toward first degree black belt. So first would be the black belt. Master Choi saw the form that we had and the belt we had acquired. He interviewed each of us separately, which I realize now was very wise. He asked us the same questions. He asked me why did I want to do taekwondo. I started to mutter something about self-defense. He looked at my father and said, thank you, that’s all, go home. I was shocked. My father took me home. Similarly Arthur was sent home too. I didn’t ask Arthur what he said, but it probably was something similar.
This went on three times. The second time I went back was the same thing. The third time on my way there, my father said, “Anthony, if he sends you home again, I think that’s it, this is probably not right for you.” So he asked me the same question, why do you want to study taekwondo. I didn’t answer at first because I wasn’t sure what he was looking for. At this point I was 10 years old. So I sat there in silence and he looked up at me and he said with a big smile on his face, “Very good, Anthony. That’s the right answer. You’re too young to know why you are are.” And that was the beginning of the first lesson, when he said a young child can’t understand the true manifestation of martial arts. I came to appreciate in time, that Master Choi didn’t just teach the physical. He taught what was beyond that.
I’ll give you an example. He taught about self-assurance and self-confidence. He taught about perseverance and how not to give up when you’re doing something you believe is right. How did he do that? Well, the way he would do it is physically in class, when you were exhausted, you couldn’t go on. When you are doing say push up and you fell on the floor, he’ll come down and put his face right on the floor next to yours and say to you, Anthony, do you want to give up? You could give up at that point and leave. Sometimes people did. But I would say, no, sir. I’d get up and I’d try again even though I had very little left. That’s how he taught physical perseverance.
How did he teach mental perseverance? Well, he kept track of my life when I went to MIT. I was floored by how smart people were. We would talk weekly. He would ask me about how things were going and I would share with him. And he would tell me that, you know, you have to go on. Just find a different way. You can study in a way people studied before. Ask for help. He would have advice along the way which caused me to look for other ways to succeed. And that was the mental perseverance.
But then the last one which I didn’t learn until later on - in my late 20s, early 30s - is the spiritual part of martial arts. It goes even beyond the physical and the mental. He showed me that by him teaching me, he gave me the opportunity to teach others. To teach them what? To try to kick and punch, how to block, how to jump right forward? No. To teach them the principles of confidence, courtesy, perseverance, integrity, self-control. Those are the things he taught me the value of, and those are the things I ascribe to today so I could teach the students in the Dojang but also the residents and medical students and fellows and attendings. By teaching those principles, I came to realize that by sharing that, we’ve actually given them something much more than how to kick, punch, how to treat prostate cancer to how to learn basic physiology. We’ve given them a way of thinking about life, a way of living life. And it leads to happiness and success.
So now just to come back to what I’ve said earlier, after I first met Sensei Botnick, if his father hadn’t gotten ill and he had to go back to Japan, I never would have met Master Choi. Someone put that flyer on the windshield. If we hadn’t been parked in that parking lot that day, we would not have met him either. And finally I had to talk to him three times before I decided not to answer his question because I wasn’t sure what he was looking for before he finally accepted me as a student. Look at how many things has to fall into place to make that great mentor a part of my life. That’s just another example of things happening for a reason.
Lior Braunstein: There’s a very deep and meaningful lesson in there certainly. When I imagine patients come to you and things have fallen potentially in a way that they would not have liked, perhaps you used some of that guidance to show them that maybe some good can come out of their experience, I imagine, or to comfort them to some measure.
Anthony D’Amico: Eleanor Walters, Rita Linggood, Ming-Hui Chen, Master Choi, Marian Loffredo. The basis of their interactions is so significant and impactful. It is because it is out of love. With a patient and a family, that’s what it’s like. So you may not have something to say to them in the moment that’s going to alleviate their stress, their concern, their fear. But if they feel the presence of the love that you have by just the way you look at them, pause, listen to them; be there with them and listen to their kids who are present in the consult, their spouse or partner who called in on a conference line if need be, they recognize, hey, this guy really cares.
I think that’s what I learned. I realize that it is important for a patient to know that there’s a loving doctor and a caring doctor; a mindful, intelligent, and confident doctor there willing to listen and understand and be with you no matter what. That I think is really what I take into the clinic, what I try to teach the resident students in addition to how to treat the patient.
Lior Braunstein: Absolutely. In having had plenty of conversations with you over the years, I can think of no better way to conclude the interview than on the point about love unless there is anything that you wanted to bring up for posterity. I think that that paints a very nice and vivid picture of a profound, and meaningful, and successful career that has influenced certainly many people in the field and will yet influence many more to come through their mentees.
Anthony D’Amico: A big thank you, Lior. I think the last thing I’ll say is that during this conversation my wife, Diane, has been present to hear the story she knows well and to have validated again that our of my love for her my career was born 65 miles southeast of Boston in a place where academic medicine had not been practiced before. I would not have planned this path on purpose. It’s just how it turned out. But you know there’s value with that thought because it is the basis for faith in something more then ourselves, it is faith in a loving presence that watches and guides each of us during our human existence. I’m still teaching learning but now have no doubt that no matter what happens on any given day, it is out of love for me and those around me. I try to teach and share this wisdom I have been given with all those I meet.
Lior Braunstein: And we’re all tremendously grateful for it. Thank you for that. This has been a real privilege. Thanks for the opportunity to participate in this conversation.
Anthony D’Amico: Okay. Thank you, Lior and Timothy, for inviting me. Keep me posted for the transcript.
