C. Norman Coleman, MD, FASTRO
By Theodore Phillips and Arjun Sahgal
The following interview of C. Norman Coleman, MD, FASTRO, was conducted June 9, 2016, by Theodore Phillips, MD, FASTRO and Arjun Sahgal, MD.
Theodore Phillips: Okay. Norm, we’re going to spend about an hour recreating your life for you for ASTRO posterity. So could you start out by telling us where you were born and what your parents did?
C. Norman Coleman: Do you transcribe this or are these all just verbal?
Theodore Phillips: No. It’s transcribed and then you will get a copy to review and edit.
C. Norman Coleman: Okay.
Theodore Phillips: And then it’s put online as a document.
C. Norman Coleman: Okay. I think I did that with Eli, right. Sure. So parents, you want me to start with that?
Theodore Phillips: Yes, please.
C. Norman Coleman: Okay. My parents were Samuel and Minna Coleman. Back in the day when it was rare, they both had master’s degrees. My father had one in chemistry, and my mother had one in French. Being in the Depression, they got the jobs they could. My father set up what ended up being a forward looking company, called, Food Sanitation Consultant Service. He set up preventative food health programs at restaurants in New York City. He ended up traveling around the world for Hilton because he inspected and advised their hotels. My mother was a very bright lady. Her master’s degree was in French. But she had many jobs including selling real estate and doing office work so we could be educated, my sister and me.
Theodore Phillips: Where were you born?
C. Norman Coleman: I was born in Brooklyn, New York City. I stayed there for ten years. Then we moved to New Jersey, to Teaneck, New Jersey where I went to high school.
Theodore Phillips: Were your parents also born in Brooklyn?
C. Norman Coleman: My mother was born in Boston. She was a Bostonian. And my father was born in New York. My father went to CCNY and my mother went to Brooklyn College.
Theodore Phillips: You’ve now gone to high school in Teaneck?
C. Norman Coleman: Yes.
Theodore Phillips: What did you do while you were in high school, any interesting things that had any impact on your subsequent career?
C. Norman Coleman: Other than juvenile delinquency which prepared me for academics. I did a little of that. So in high school, I was a bit of a slow starter. I found school really boring. I was a solid B student at best until I realized in 10th grade that it’s really my own responsibility, so I better get going. So I think I moved from 150th in a class of 600 to 17th by the time I graduated. My major interest in high school was sports. I was a wrestler for one year as a sophomore. And then I was on the track and cross country teams. I spent a lot of my time with them, including being co-captain of indoor track team. That was an interesting multicultural experience because there were blacks, whites, Italians, Jews, everything. It was a really interesting mix of people. We had a coach who had been a Jesuit for a while in Jesuit school. He really helped bring out the best in us. So my coach Don Ryan who I was in touch with until he died last year was a really major influence on my life. And I had jobs. I was a camp chef and a camp waiter. Sort of a lot those jobs that make you realize how important it is to get an education.
Theodore Phillips: Yeah. I had a note that you worked with somebody named Ray Gambino. Do you know him?
C. Norman Coleman: Yes. So I was in college. And that was really influential. I got a job at Englewood Hospital in the laboratory. My job mostly was to do blood drawing and to do EKGs. He was a major clinical pathologist. I forgot the name of the company now (Technicon). But they helped set up the Auto Analyzer. He eventually was the chief of clinical pathology in Columbia Presbyterian Medical Center. He loved having students around. He gave us a few hours a day of sort of learning how to do bloods and EKGs. We became really good at that. And he also had us do research. So we were helping develop assays that eventually got automated. We would do the manual assays. I learned how to do chromatography and things like that. So he was a great influence. And again, he loved young people. And that was a great model.
Theodore Phillips: Was that when you were in high school or in college?
C. Norman Coleman: It was in college.
Theodore Phillips: Was that during your summers in college then?
C. Norman Coleman: Yes. My high school jobs were mostly hard working jobs, I was a camp chef. So I was the assistant breakfast and lunch chef for 600 people in a camp near Starlight, Pennsylvania. That was another great experience in menial labor but a lot of fun. In college I worked in Howard Johnson’s ice cream factory- hard physical and assembly line work.
Theodore Phillips: Good for you. Kids today don’t do that anymore I don’t think, at least none of the ones I know. Tell us about college then. Where did you go?
C. Norman Coleman: Okay. I went to University of Vermont. My sister had gone there. And it was a really terrific place. It was a very socially conscious school. The Bernie Sanders people come from places like Vermont. I went there as a premed. I was sort of interested in medicine. I’m not exactly sure why. I gravitated to math and science, so medicine seemed like a good career to do. When I got there, most of the premeds were biologists.
I sort of hate to say this but I found biology really boring because it was just memorizing various things. So I ended up majoring in mathematics which I think is one of the best things that happened to me. I was a math major but I had minors both in chemistry and in biology. So I had a pretty rigorous premed training. But as a mathematician, your job is to understand things. And I think that has really influenced my entire career is that you try to get to the basic fundamental processes or the concepts rather than just trying to learn them. So, math ended up being an interesting major.
My last year there was a company down the road in Vermont that was starting the thing called computer science. It was called International Business Machines or IBM. So they were just getting going and they had a course in computer science, again, when I was a math major I took it. I was doing machine language programming and punch card programming including Fortran. And I was really quite good at it. In my senior year, IBM and I think Bell Labs and a few others tried to convince me to get a PhD in mathematics or computer science but I ended up going to med school instead.
Theodore Phillips: Were you involved in the same sports while you were at Vermont?
C. Norman Coleman: So intramural, I was involved in sports. I was very active. They had a winter carnival competition that they called Kake Walk which was a really big deal. The fraternities all competed. It was a gymnastic sort of thing. So I did that one year. We were one of the two teams (of 17) that actually won places on both nights. But my time was more spent in intramural. I ran for the track team one day and I realized I was not anywhere near the level of capability that they needed to have in college. I could run a mile in maybe five minutes and these guys are running 4:20s so I was out of my league, although, I kept that up. That set the stage. I’ll get to that later but I still do competitive sports. And as you get old, everybody catches up to you, they slow down.
Theodore Phillips: Okay. So after you graduated, you still pursued your original idea of going to medical school. Is that correct?
C. Norman Coleman: Yes. So again, I think I came into my own in college. I think I was first in my class but I was one of the few summa cum laude graduates and I was a junior Phi Beta Kappa. And I got the award for the outstanding senior male in the year I graduated. From UVM, it was a big deal to get into Ivy League. I got into Yale Medical School which was for me probably the perfect school because they figured if you got into Yale, you should be able to read the textbooks. If you wanted to know what was going to be in the future textbooks, you come to your lectures and your classes. And so the classes were fantastic. So I got interested in pharmacology. Joe Bertino and the whole group of Yale pharmacologists, I was interested in their work. Yale was really instructive. We had to do a thesis. No (or optional) examinations, you weren’t competing with your classmates. You just had to pass national boards. So our classmates, worked together with each other which was different than a lot med schools.
And I did interesting thesis work. I started doing kidney micropuncture but that didn’t interest me too much. I ended up doing work in lead poisoning. But looking at the biochemistry of lead poisoning, we figured out some of the biochemical intermediates of hemoglobin synthesis would be fluorescent. So we developed a screening approach looking at fluorescent red cells. It actually ended up being pretty interesting. I never published because I got married instead when I was graduating med school. But Yale was a great place to go to school. We have a classmate Henry Chessin who somehow when looking for a thesis, discovered this group of radiation oncologists, radiation therapist in those days. So he introduced me to Mort Kligerman. And what happened serendipitously, my freshman adviser, it was guy named Sam Hellman. Sam and I got to know each other as soon as I started med school so I’ve known him a very long time, interestingly. But after a couple of months of med school, I was getting ready to quit because I found it so boring and I went to talk to Sam. And he said, “It was amazing, it took you only two months to figure this out.” And he said, “Learn the scientific stuff. Don’t worry about memorizing the anatomy. You’ll learn all that.” So Sam had become a good friend and a big influence of my career really, really way back to my, probably, third month of med school.
Theodore Phillips: So this was before Sam went up to the Joint?
C. Norman Coleman: Yes. Right, my sophomore year, he left. You didn’t see your advisers very often. But we sort of got to know each other a little bit. And it was sort of interesting how I ended up following in his footsteps 15 years later.
Theodore Phillips: Joe Bertino, you mentioned him. Did you do work in his lab or have anything to do with pharmacology at that point?
C. Norman Coleman: No. I ended up sort of circling back to that with Bruce Chabner because I ended up working in Bruce Chabner’s lab later at NIH lab. So as a senior, I did a rotation in metabolism and endocrinology. And there were two guys fresh from the NCI who had just come back to finish their training at Yale. And that was Robert Young and Bruce Chabner. By just dumb luck and being on that rotation, I got to meet both of them. As it turned out, it used to be a really slow rotation. But when I was on, we were seeing two or three new consults a day. So I became really good friends with Bruce and with Bob Young. During the draft, I applied for NIH like a lot of people did. Because I knew Bruce, I think I got accepted to his laboratory. So I came into the pharmacology world of Yale. I loved the class but I came into it more formally through Bruce, having met Bruce and Bob Young when I was in med school. And I ended up working with them later when I was in the NCI Medicine Branch. It was interesting how that came around.
Theodore Phillips: I was interested, did you go through the Berry Plan and sign up for the yellow berets at that point or some time later?
C. Norman Coleman: No. No. I wasn’t in the Berry Plan. And so the only lottery I ever won was a draft lottery. I think I was number 59 in the draft lottery. And I was an internist. I was going into internal medicine, so I was given a one year deferment. And then I either get the one year deferment and go in as a general medical officer or be drafted right after internship. So I was ready to get that (the Berry Plan). And then I got this call from NIH saying that I matched with the pharmacology group. It was Adamson and Oliverio’s group in pharmacology. So I matched with them. Of course, I took that opportunity being in the Public Health Service.
Theodore Phillips: That was while you were residency?
C. Norman Coleman: I was just an intern. When you’re an intern, you had to sign up for the Berry Plan and I got the one-year.
Theodore Phillips: You got into the -- what do they call it now?
C. Norman Coleman: It is the Public Health Service (still is).
Theodore Phillips: But you got in through the Berry Plan.
C. Norman Coleman: In lieu of the Berry Plan. So you could accept a Berry Plan. You either went in right away or you got some deferment. I didn’t get a full deferment to finish my specialty training. I would have just had one year of internship, one year of residency. Before I had to send that in, I got matched to the NIH.
Theodore Phillips: So that’s an interesting historical standpoint. People don’t remember what the Berry Plan was. So I understand it. I did the Berry Plan and joined the Navy right out of med school. I deferred and went away to finish my training. So you were able to either choose the Berry Plan or if you were accepted, you would get a position in the NIH.
C. Norman Coleman: Yes. So the Public Health Service counted as my military service.
Theodore Phillips: You were actually on active duty with the Public Health Service.
C. Norman Coleman: Yes. My assignment was to the NIH. So I am retired PHS Officer. I left as an Officer 0-3 and I stayed on the Reserves a while. I’m a retired 0-4 Public Health Service officer.
Theodore Phillips: Okay. So let’s go back to your internship. You went to the University of California in San Francisco. Is that right?
C. Norman Coleman: Right. So I started in internal medicine. Again, sort of a mathematician’s approach to medicine was internal medicine. And as you know, those were super competitive years. I did well in med school. I was a junior AOA at Yale. And I was lucky to get into UCSF. Everybody wanted to work in San Francisco. So I did my internship there. And as you know, because of my interest from Yale Med School was radiation therapy I did an elective at UCSF. As an internist, I was a really compulsive internist and I realized that it would be hard to do all of internal medicine and be really good at it. So I was beginning to gravitate toward oncology even early on. And I think it was my internship or resident year when I met you. I think I was the only medical house officer to ever do a rotation in radiation oncology.
Theodore Phillips: I think that’s true. That’s true.
C. Norman Coleman: Yes. I met you and I met Buschke. And I still remember they were grilling this junior resident Bill Wara in one of the morning conferences. So you got into my life really early. And I was delighted to have met Buschke, what an incredibly charming and intelligent man. So I did my internal medicine. In those days, you could short track. I did internship and residency at UC. Again, in the old days, they didn’t have all these subspecialists. When I was a junior medical resident I was essentially the chief medical officer at nights in the San Francisco General Emergency Room or on the wards. So really, as Eli Glatstein says, “You were educated before you were trained in those days.” You really learned how to become a doctor. And UCSF was fabulous. Holly Smith’s programs are just some of the best of the best. So I did that and then I was lined up then to do oncology. I was a clinical associate at the National Cancer Institute. I fell in love with San Francisco as everybody did. And the idea of coming back to the Bay Area after to do specialty training was really quite attractive.
Theodore Phillips: Your two years at the NCI, did that also count as a residency in hematology oncology?
C. Norman Coleman: Yes. So that was a short track year. So you had to do three clinical years which I did. For my third clinical year, I was a clinical associate on the Medicine Branch. And that was the Medicine Branch with Vince DeVita, Bruce Chabner, George Canellos, Philip Schein, and Bob Young. They’re the big five. And I did some work on pediatric oncology with John Ziegler and that group. And then I went into Bruce’s lab. So I was Bruce Chabner’s second fellow after Snuffy Myers. And that’s when I began to do mechanistic research, whatever they call it now. But the same stuff we were doing then, how were drugs activated and metabolized. So I did some of the original work on activation and metabolism of Ara-C. Can one predict who was going to respond and not? That counted for my internal medicine and my medical oncology. So I passed my internal medicine boards when I was in NIH.
And later, I took my medical oncology boards when I was at Stanford. And I got really interested in the laboratory. So my wife and I - it’s an interesting story - that when we were at UCSF, we had a couple of vacations. And one day, we were hiking at Mount Tam and looking back across the bay at the UC campus. And I remember saying to my wife, “You know, you could barely see that little building. You could spend your entire life in that little building and not see the rest of the world.” So at that point, we decided we were going to take a year off after I finished the service and travel around the world, which I did after I finished NCI before I went to Stanford. So that perspective of having to see the world and seeing the Parnassus Heights UCSF campus from Mount Tamalpais is really a life changing day, one of these epiphanies. And that, again, really influenced our life a great deal.
Theodore Phillips: When you did this trip around the world. How did you do it? Did you go by boat, by plane?
C. Norman Coleman: We went by plane. My parents had been world travelers so we had some sense of what that was like. We took ten months off. One month driving across country- we had very little money - so we drove across Canada and camped. We got a round the world ticket, which in those days, it was about 25 flights. The whole thing was about $2800 for each of us. And we really saw a lot of the world. So we went by plane to different cities. We’d walk around or take public transportation. We did two major treks, one to Mount Everest basecamp in Nepal and the other in Africa. We got interested in trekking from Yosemite.
As residents, a colleague took as to Yosemite and we fell in love with hiking. When we got to NIH, we learned how to become rock climbers because to be a trekker, you had to be a rock climber. Everybody was reading stuff about the treks so one wanted to do the Mount Everest trek which took five weeks. And since you only had three weeks of vacation, as a math major, I did the math and said, well, to get five weeks off, you had to take the whole year. So the time at Mount Tam and wanting to go see Mount Everest, lead us take the whole year to travel around the world. And we saw Asia, Africa. We were in the Khyber Pass. We were in what’s now Waziristan. So we had an incredible education of what the world was like. And by being able to see each country in context and cultures in context of one another was just incredibly instructive. As you know, we’ve kept this love our whole life of global outreach and learning about cultures. So that was a great year.
And then I had been accepted at Stanford. But they let me defer it for one year. So we came back in 1975 to do my radiation therapy training at Stanford. Vince had obviously talked to Saul and Henry Kaplan. So as soon as I got there, Saul basically said, “You treated a lot of lymphoma. So even though you’re a resident, we’re going to give you your own chemotherapy (called MOPP) clinic.” So I was essentially the only radiation therapy resident who was almost dual medical oncology and radiation when I got there.
Theodore Phillips: Did they pay you extra?
C. Norman Coleman: Yeah right. No, they didn’t. But the idea of the combined modality clinic came from that as I was part of the medical oncology group. When I finally went into faculty, we set up - Charlotte Jacobs and I - the famous “Monday Clinic”, that we would take care of all the complex multi-modality diseases. And for Stanford, that was a change. Stanford was mostly lymphomas and a few of this and a few of that. So because of the dual training and a great colleague, we were able to set up a combined modality clinic and that led to the sensitizers. All these things began to fit together. So when I was in the faculty, I was a dual faculty. I had two jobs rather than one. They didn’t pay anymore.
Theodore Phillips: We didn’t get in to why you decided to do a residency in rad. You’re already board certified in medicine and hematology oncology. What made you want to go and get triple boarded?
C. Norman Coleman: It was from my mathematics background as I hated not understanding things. And I did a lot of general medicine and it was almost too much to really understand all of it well. And I gravitated towards cancer. I like hard problems, too. No one wanted to go into oncology those days. When I was at NCI, Vince and those guys were just taking boards. The board was just a new specialty. And I’ve been exposed to radiation in med school. And a little bit at NCI where they had Ralph Johnson who was sort of an odd guy. And I figured, gee, I could really be a great oncologist if I could learn both radiation and medical oncology. So I figured, let me just specialize in cancer.
And when I told Vince DeVita I said, well, I’m going to do a radiation oncology residency. They were trying to get me to stay on as a faculty there which was very flattering. And I said, well, I’m going to do this. They said, “Well, you can’t do this. It’s a big mistake. But if you do, you train with Henry Kaplan.” Because Vince had come back from a sabbatical with Stanford when I had gotten there, so they were actually happy to have me go off and learn radiation as well. It was really to understand cancer and to keep up doing cancer research. Because I’ve become a researcher then, interested in pharmacology and, again, I thought drug development in bringing combined modality to radiation would really be pretty interesting.
Theodore Phillips: At Stanford, do you remember who were your fellow residents and who was on the faculty then?
C. Norman Coleman: Yes. The big people were Mal Bagshaw who was world famous. Henry Kaplan world renowned and with whom I became close over the years. I became quite close to Eli Glatstein and Dave Pistenmaa. Fantastic folks including John Earle, Don Goffinet, Sarah Donaldson, Zvi Fuks really, really great luminaries were on the faculty. Let’s see, Carole Milligan, Peter Ree and Bill Saunders were my co-residents. And Bill, he went to work at Berkeley and worked with you. So we developed that sort of collaboration across the Bay. The residents in the years near me, Rich Hoppe was a year ahead, Rich Carmel was there, Stephen Weller, Steve Bush. It was a really terrific group of folks. And again, we had a lot of cross rotation so as you know, UCSF residents came down to do lymphoma rotations. So I met Allen Lichter. Todd Wasserman, I sort of knew a little bit. But I got to know Todd better over the years. So I think my affiliations with you UCSF guys became even closer. It would help with the sensitizers. Helen Stone was working in your group. I think California was great from the people I worked with but also the association with UCSF.
Theodore Phillips: So I assume they recruited you right on to the faculty after you finished residency there at Stanford?
C. Norman Coleman: Well, as it happened in those days, you start to get recruited to be a chief while you’re still a resident. So I got some offer. I went to Henry Kaplan. It was some offer in a small program in the Midwest. He said, “I think you’ll get other offers in your career.” So I looked at the job at University of Utah. I was considering that. And then, I ended up getting offered to do both medical and radiation oncology. So I was a dual faculty at Stanford and I continued there.
I was really happy to be able to do that. I had gotten to know Martin Brown a little bit. And again, I hadn’t done much lab work as a resident. So I began to pair up with Martin Brown. That’s how I got involved in the sensitizer field because he was a radiation biologist and I was a pharmacologist. And he was about to go on sabbatical to do something, I don’t recall what. And we started talking about pharmacology and drug development. And then he went off to UK and worked with some pharmacologists. So the idea of changing the structure of misonidazole into something that was non-lipid soluble (to decrease neurotoxicity), I think, it was all his idea but it came from discussions with me as a pharmacologist. So I ended up sort of pairing up with Martin and my research went back to drug development, mechanistic stuff, and the sensitizers.
Theodore Phillips: So you were involved with Martin and the Stanford Research Institute people in developing etanidazole. Is that correct?
C. Norman Coleman: Right. I remember Martin came back and said, “God, you’re right. We need to develop these drugs.” I mean he did all the thinking. Bill Lee, again, Helen Stone, a lot of people were involved in that. So yes, so I got involved in the sensitizers. Todd Wasserman was a tremendous help to me. He was a colleague from NCI but he was ahead of me in training because I took the internal medicine. So he got me involved with the desmethylmisonidazole. I picked that up. And then etanidazole and the work we’re doing on neurotoxicity. And then the hypoxic toxins. So it came from that era, yeah.
Theodore Phillips: The desmethyl was interesting. I remember we had Jim Schwade bringing a kilo of it back from the U.K. He smuggled it in so the research could start with it. It was made by Roche in England.
C. Norman Coleman: Right. I didn’t realize he had done that. But it was just a great group of people. As you know, it was really very exciting times. Again, that led to various steps in the work I’m still doing now, stress response and things like that. But getting to work with Martin was great. The whole radiobiology group in the whole Bay Area was really terrific. George Hahn was there and Bob Kallman and Kendrick Smith so people doing really fundamental science. You had a great group. The group at Berkley was doing particle work, you know, Joe Castro.
So through NCOG, Northern California Oncology Group, I think my second day on the faculty, NCOG was sort of struggling. You remember that, I’m sure. I got on the faculty and Steve Carter was the chief of NCOG. And I think they thought it wasn’t going to work. So they said, “Well, why don’t you become the PI of NCOG.” And much to their surprise along with Mike Friedman and a bunch of other people, Steve Carter mostly, that NCOG got salvaged and ended up being one of the more creative cooperative groups. So NCOG got me involved in that and then the RTOG with the sensitizers. But a lot of that came out from collaborations with you and Todd and Martin. So I was really lucky to be involved with you folks.
Theodore Phillips: Was Steve Carter at the NCI while you were at NCI?
C. Norman Coleman: He was but I barely knew him.
Theodore Phillips: He was in the Extramural Program.
C. Norman Coleman: He was extramural. Todd was there. I may have seen him once or twice. So I knew who Steve was. He’s encyclopedic; he knew everything. But I didn’t get to work with him much at NCI. And then he was, I guess, recruited by NCOG which I thought was really terrific. He was quite the organizer.
Theodore Phillips: The Northern California Cancer Center which was formed by Stanford, Davis and UCSF recruited him out to head the original group that became known as NCOG.
C. Norman Coleman: Yeah. And that was the whole idea of rather than these big groups to create some regional fast moving groups. I think NCOG was very successful. But then eventually, they went back to the bigger groups.
Theodore Phillips: They killed them all off but I think it was Vince DeVita’s idea to have the smaller academically based regional groups.
C. Norman Coleman: Yes. I think NCOG was one of them.
Theodore Phillips: It was interesting, but they had trouble accruing enough patients fast enough. That was the big problem.
C. Norman Coleman: Yes.
Theodore Phillips: Okay. Now, here you are at Stanford. You’re working on sensitizers. You’re in the lab. What was happening with your family at that time?
C. Norman Coleman: My kids are both born when we came back from our trip around the world. So we had a daughter, Gabrielle, and a son, Keith. And they were both born in California and are both there now. My wife, is an MSW. She’s a clinical psychotherapist social worker. She was raising the kids. She would do some group work with mothers and kids. but basically with the kids all the time. One night a week, she would do some other work and I would take care of the kids. That was dad’s night which the kids always knew you could get into trouble.
We always had a really great time. The kids and I, we still have a great relationship. They were growing up. I worked too hard. And I think they came to realize that that these are hard jobs. Time not at work was family time as the priority. In the old days, you can bring the kids into the labs and you have the mice run around. So I would be doing experiments and you had a few mice that were being in isolated cages and not going back into the mouse house. The kids would play with them while they’re running on the counter. So the kids enjoyed it. They would help label tubes and loved the color tape and looking at the complex equipment like the HPLC.
They started school in California. I think my wife and I became Californians when we came to UCSF. When I took the job at Stanford the only brilliant investment I ever made in my life was in 1978, we bought a house in Mountain View, California for $106,000. We never sold it, so we kept the foothold in the California. We just love California, all the things you could do there, the outdoor living. It’s a great place to raise our kids, very progressive thinking. And that’s impacted both my kids. They’re both very progressive thinkers. My daughter was an astrophysics major at Princeton. She’s close to the smartest person I know, my son being equally talented. While doing her junior thesis on interstellar dust, she decided this wasn’t the career for her, ended up with a degree in both astrophysics and art. And she works at NBC News in the Bay Area now.
And my son, went to school in Boston. After high school he went back to California and he’s working right now. He worked for Google for a while as one of the project manager for Gmail. And he has a startup company doing social networking apps, in Palo Alto. (He now is VP of Product Development at Twitter). The kids and the whole family, picked up the whole California motif of being creative and fast moving and to have bright ideas and pursue them. That was a lot different than back East where things are much more stodgy. So California was a great place to raise kids.
Theodore Phillips: What happened in 1985 to lure you away from Stanford?
C. Norman Coleman: A few things were happening. The hardest thing was that Henry Kaplan got sick. And it ended up sort of unbeknownst to me that I had become actually one of his closer friends. I used to go over there once or twice a year. He’d invite me over to go into his lab and we sit and just talk about stuff for an afternoon. So when he got sick, a lot of people took care of him. But I ended up sort of being his primary doctor. He died in 1984 and that was a big change. The program was still strong and I was thinking of what to do next. Actually I had a sabbatical coming up and I wanted to learn molecular biology. So I was planning to take a year off and learn molecular biology. I got a call from Harvard. Sam Hellman had left in 1983. They had all these famous names they were trying to recruit to be the chair, either they didn’t offer it to them or didn’t want to take it or whatever. So I got a call from Bill Silen who was running the search committee. He wanted to come out and meet me. He was to flying to California so he and I had a dinner at the airport. I guess he liked what I was saying and they invited me out and I interviewed there. I first went out just to look as it was just a famous place. But, I thought who the heck wants to go to Boston, given the ongoing problems without a permanent chief with many people having left. And then I went back there the second time. When I was offered the position, I said this is unbelievable opportunity. And it’s just something I couldn’t turn down. So I talked to Sam and I got a great phone call from Vince. I hear from Vince periodically. I was sitting in my office one day and the phone rang. He said, “Norm. This is Vince.” He said, “If you want to stay at Stanford for the rest of your life, turn this job down.” Click. So that was it.
Theodore Phillips: Who said that, Vince?
C. Norman Coleman: Vince.
Theodore Phillips: That was Vince DeVita?
C. Norman Coleman: Yes. I took care of Teddy. I was one of Teddy’s doctors (I helped Dave Poplack and Phil Pizzo). So Vince and I and his family became really close friends over the years. That was Vince and that was great advice. And I decided this would be a great challenge. Harvard is a wonderful, wonderful place. And I talked to the Kaplans and they said if you want to help build what Henry Kaplan built, this is a great opportunity. He had turned down a job at Harvard to stay in the Bay Area. He didn’t regret it. But they thought it would be a great opportunity to sort of spread the Kaplan legacy. And again, it was working with my former mentor, Sam Hellman. So it was really just a great connection of things. I was a pretty young guy and as you know you were a young chairman. You were 34 or 35 when you got a chair’s job. I was still in my 30s when I took this job and it was just a great opportunity.
Theodore Phillips: So what happened in Boston? You stayed there for four years, it looks like.
C. Norman Coleman: Fourteen.
Theodore Phillips: Fourteen?
C. Norman Coleman: Fourteen years, yes.
Theodore Phillips: Fourteen years, okay.
C. Norman Coleman: Harvard chair was a long and terrific job. It was just a great era. The ‘80s were great. A lot of people had left. When the chair leaves and there are interims, that’s always difficult. So a bunch of people had left and we started building a program. We were one of the first to go from a three to four-year program with mandatory lab research. We got a lot of people interested in scientific careers. We had a big interest also in serving the community, particularly those who were underserved. I developed some of that in California when I set up the outreach program in Fremont.
We thought that it would be really good to bring good cancer care to the community. To do so we had set up a whole outreach network in Fall River, New Bedford, Framingham, and Waltham where Harvard staff would staff their radiation oncology clinics. And that would be a full time academic job. They would spend four days a week out there and a day a week in the Harvard hospital. It was a really great outreach model, so we developed this. The department went from - I don’t know - 1,500 to 2,000 new patients a year to - system-wide - we were seeing 4,500 new patients a year. We recruited great people like Anthony D’Amico starting in the community. We had great recruitments. So it was a really good time there.
The Boston hospital wars in the mid- to late-1990s is when the hospital wars all started in the U.S. The networks were starting to form. And the Joint Center was in between what ended up being the BIDMC and the Partners. So that whole collaborative program fell apart into competitive business models. That wasn’t the kind of thing I really wanted to do. I had been on the NCI, Board of Scientific Counselors and a few other advisory roles. They hired Ed Liu to be the director of the intramural program at NCI (I was on that search committee). Then when I was on a site visit to the Radiation Oncology Branch when Paul Okunieff who was the head of the radiation oncology branch announced he was going to leave. It was sort of like the same thing I had when I first went to Boston. I said if you could put together all the talent that’s available in radiation oncology and biology at the National Cancer Institute, you could really have some robust talent and really help the field move forward. Eli Glatstein had been here and had a world renowned program. So as you know, the directors of the Radiation Research Program (extramural program) would come every few years and leave. That didn’t seem to be great for our field. So both the changes at Harvard and new opportunities in Bethesda came together. Fourteen years is a long time in a chair’s job. So the new opportunities came along accompanied by the change from collaboration to business competition in Boston. I decided to go NCI.
Theodore Phillips: So during the good days in Boston, there were two separate groups really, the group based at the Brigham and the Joint, and then there was the group at Mass General. Is that correct?
C. Norman Coleman: Right. The Mass General chief was Herman Suit. He and I lived not too far away from each other. Herman Suit and I became and still are very, very good friends. He’s terrific guy. They had the big department. And the Joint Center was composed of Beth Israel, the Deaconess, the Dana Farber, Children’s, and the Brigham. And we expanded it to include these regional hospitals. So we had 35 or 40 docs. And we got along reasonably well. They had their territory. We had our territory. But then all the wars started between the hospitals. Because we were one of the inter-hospital departments, both Dan Tostsen, HMS Dean and Neil Rudenstine, Harvard president, had me on a lot of committees because they saw what we were trying to was be diplomats among warriors. And I said and they liked, we were “the alternate path to fighting”. We were involved in a lot of Harvard-wide things. But the hospital wars just became really difficult. And that whole model has really persisted and dominates healthcare now.
Theodore Phillips: How did it end up?
C. Norman Coleman: The Partners, Brigham and the Mass General became part of the Partners. The Farber joined in. So it was Brigham, Farber and Mass General. Children’s Hospital refused to join the partners. So Mass General built a competitive pediatric program! The Beth Israel and the Deaconess joined in to form Care Group. So we had our five hospitals and we had the regional network which was our outreach group and there were 10 or 12 docs there. They all really worked well together. They got apportioned into different networks. So a lot of that all fell apart. They lost their full-time Harvard appointments. They went from everybody being part of this big team with the idea the enemy was cancer to all the kind of stuff that goes on healthcare these days. Wonderful people, smart people, but they were put in these funny situations.
Theodore Phillips: It was not possible to have the Joint Center as Sam originally set it up to work anymore. It’s clear.
C. Norman Coleman: Well, it could have been. And we sort of thought we kept it going but it just couldn’t. So Dan Tostesen worked really hard to save it. But it just they had to start competing and who gets more of this and who gets more of that. There’s so much business to go around with people not getting care. But that’s the model these days. I’d rather fight disease than fight each other.
Theodore Phillips: Yeah. That’s what’s happening out here in California, too. You then moved on. Can you tell us a little bit about how the program, the radiation program, was structured when it went from the Joint to NCI?
C. Norman Coleman: Yes. So at Harvard, I kept my lab up which I felt was really good. I was doing sensitizer work and got into stress biology. When I looked at the NCI, there was a small Radiation Oncology Branch. They had Paul Okunieff who came to NCI from Mass General. I think the world of Paul. He’s a very, very smart guy. But they had very limited resources. There was the Division of Clinical Sciences which Ed Liu was the head of it. And I became one of Ed Liu’s deputies.
There was an extramural program (Radiation Research Program) in the Division of Cancer Treatment and Diagnosis which took care of the radiation oncology grants and things. There were firewalls so people in intramural program wouldn’t steal ideas from extramural. It seemed sort of silly. Under Rick Klausner as head of NCI, Ed Liu of the Division of Clinical Sciences and Bob Wittes, DCTC we put together the Radiation Oncology Sciences Program which involved both extramural and intramural. And we also worked with Jim Mitchell who was chief of the intramural Radiation Biology Branch and one of my great friends for a very long time that Eli had recruited. So we tried to put together this critical mass of people. We developed an idea which we called ROMATC, Radiation Oncology Molecular Assessment and Technology Center, with the idea that if you studied a few people really, really well, you could get a lot of information out and move science and clinical care ahead. So we did pioneering things. When I was at the Brigham with Anthony D’Amico, we set up a MR-guided brachy program in an open magnet. And I thought about, well, “what if we could do brachytherapy procedures in a closed magnet where you can actually see biology and do molecular profiling.” Microarrays were just getting going. We had access to a microarray center.
So our goal was really to promote, which is my interest still, is the concept radiation therapy is really a molecular entity. Radiation sciences could really understand complex tumor biology, and really understand the molecular changes that are created with radiation. With this knowledge there could be novel ways of using radiation. There were, I think, seven or eight patients under treatment when I got to the NCI. So I did prostate cancer in those days and helped recruit to build a prostate program. We recruited Howard Fine from Harvard to set up a neuro-oncology program. We took all the kids to NCI because Children’s Hospital in Washington wasn’t so thrilled with the service they were getting. And they asked if we could you please treat our patients. So we set up a really good pediatric oncology service. And we began to build up the program with curative diseases, pediatrics, unique imaging, molecular studies (and proteomics with Lance Liotta).
The residency program at NCI included civilian residents and also trainees from the military hospitals (Walter Reed and National Naval Medical Center, now merged). So the trainees we have are terrific. They’re really smart people. The civilians are interested in research. The military people are really attentive and great docs. So we invigorated the radiation oncology program. Ed Liu and I tried to recruit more people into general medical oncology. But the NCI was suffering the same problem universities have as people don’t like to refer patients to anybody. So it was always a challenge to get patients referred to the Clinical Center at NIH. But we set up this program called Radiation Oncology Science Program (ROSP). The imaging program recruited Pete Choyke to run the Molecular Imaging Program. It’s basically built on the ROMAT idea that we helped develop.
In 9/11, what happened in 2001, after the attacks, in large part starting with phone calls with Paul Okunieff, who again I think the world of, we in NCI put together some workshops on what could our field do to help the United States in case of a nuclear attack. We put together a research plan that led to actually a fair amount of research in normal tissues and medical countermeasures. So that got the radiation research community into play to help the country prepare. And in 2004, I was asked by the Assistant Secretary of Health and Human Services (HHS) if I could come help set up a medical response in case there was a radiologic or nuclear incident for the Republican National Convention and Democratic National Convention. Once I got down to HHS, they said, we really need you to set up a plan for health and medical response for the United States. So in 2004, I started doing this. It was probably a third of my time then. So I had to give up my Intramural Branch chief job because I couldn’t do four jobs. So starting in 2004, I have the extramural job, my downtown job and my laboratory. So my time here has evolved. But the programs we set up are doing reasonably well still. Anyway, NCI still needs more patients. But we have a really good faculty. Kevin Camphausen is the branch chief now and he does good work.
Theodore Phillips: He’s the head of the Intramural RadOnc?
C. Norman Coleman: Right.
Theodore Phillips: So what happened? I was there on sabbatical in ‘83, ‘84 and they had a really great intramural program at that time with Eli and Vince and Young and all. And they were doing a lot of IORT, one of the reasons I went there. So that also had died down and then you came back and revived it. Is that true?
C. Norman Coleman: Yes. We tried to. I think a lot of it died down just because of the competition for business. People wouldn’t send patients. I think Paul tried to build up a program and did a little bit. I think we were going in the right direction. Some of that was NCI leadership. Ed Liu left. I don’t know if you know Ed Liu but he’s beyond brilliant. He went and helped develop the Human Genome in Singapore. And he helped Singapore and Asia really go from sort of rote based medicine to really thought based medicine. He is a really terrific guy. So he left NCI. And the Intramural Program became more and more basic research when they merged basic and clinical sciences. A lot of the clinicians felt one could do basic research anywhere but that the Clinical Center was the unique resource. But it was just hard to build clinical services. I think Kevin has done an able job but there have been changes in leadership in medical oncology such that it’s just been hard to build clinical services.
Theodore Phillips: When did Vince leave?
C. Norman Coleman: He left in the late 1980’s.
Theodore Phillips: It has to be he left after his son, Teddy, died? Is that correct?
C. Norman Coleman: Yes. It wasn’t timed with that but based on other opportunities. So I left in ‘75. He must have left in mid-80s. He was at Memorial after Sam.
Theodore Phillips: He went to Yale as head of the cancer center, I think.
C. Norman Coleman: But he went there from Memorial. I believe he worked with Paul Marks for a while. And then he went to Yale. That was a big change at NCI. That whole group, the Big 5, eventually left. Bob Young stayed on for a while. Bruce stayed for a while and went to Harvard in the mid 1990’s. George Canellos went to Harvard earlier- to the Dana-Farber. Phil Schein had gone to Georgetown and then to Philadelphia. Bob Young was the last of that group to go.
Theodore Phillips: Bob Young went to Philadelphia.
C. Norman Coleman: To Fox Chase, right.
Theodore Phillips: Fox Chase, yes.
C. Norman Coleman: So you were there sort of at the tail end.
Theodore Phillips: Eli was running radiation therapy after Ralph Johnson. Eli had gotten there in the ‘78, ’79, right. Yeah.
Theodore Phillips: In ’84 he had a great program.
C. Norman Coleman: Right.
Theodore Phillips: He had residents then from the Army, the Navy and NCI.
C. Norman Coleman: Yes. So he created all of that. And again, he was my other major mentor. When I was thinking of leaving Harvard I had asked him. I said, Eli, can I talk to you? I said this is my vision for NCI. He said, geez, that will be great. So I decided to go back to NCI when Eli listened to what I said and said that would really be great to put that together (the Radiation Oncology Sciences Program). When I talked to him about doing that, he thought that would be a good thing to do. So yeah, so you (Ted) were there during the best of the times. The recovery from Ralph Johnson, he was an early stage radiation oncologist.
Theodore Phillips: Zvi Fuks was there. No Zvi wasn’t there but his friend from Israel was there doing IORT. His name I forget at the moment.
C. Norman Coleman: It will come to me in a second. Yeah. Right. Zelig Tochner.
Arjun Sahgal: Can I just jump in for a minute, Ted, with the time and everything.
Theodore Phillips: Sure. Yeah, please, please.
Arjun Sahgal: And maybe ask just one or two questions because I’ve just been sitting here in awe of your career. I think it’s amazing how much you’ve done. And when I went through everything and having known your work and particularly on radiation sensitizers, I guess maybe just a little bit of perspective of what went wrong and how it can go better because there really hasn’t been a successful radio sensitizer.
C. Norman Coleman: Well, I mean, there sort of has been and I think the problem we have is no different in medical oncology. The drugs that work really well are cisplatin and things like that. I think understanding the molecular mechanisms is important. So how my research has evolved, I think the heterogeneity of cancer is always a big problem that what you think you’re treating, you’re not necessarily treating. So the work that we ended up doing in the lab has been what we call radiation induced molecular targets. And it’s actually pretty interesting. What we’re trying to figure out is -- I mean, to me, Gray is calorimetry. You have to understand when you radiate something, what are all the molecular processes that you’re creating in a tumor and in a normal tissue and take advantage of these molecular processes. And then you can turn targets on to give some synthetic lethality.
So I think we do drug development as well as anybody has. You look at clever targets. But once you start treating things, the targets all change. And the medical oncologists now begin to realize that you start with 40 clones. And once you start treating, you get another 400. So I think radiation needs to remember it’s a molecular specialty if you want to develop drugs. If you’re just worrying about how many Gray you can give, we do a really pretty good job at that. So I’m not sure what went wrong other than realizing how complicated cancer is, is really being appreciated. And we say, sometimes it’s amazing we cure anything.
Arjun Sahgal: Do you think that the future with immunotherapy and radiation, you think that radiation acting as an immunomodulatory kind of therapy is really a future or do you think it’s kind of just something that’s kind of in the buzz right now?
C. Norman Coleman: I think if we do it wrong, it will be like endovascular brachytherapy. I think you don’t give 18 Gray on Monday. I think you have to really understand what’s happening. And again, my lab is collaborating with Sylvia’s (Formenti) and Sandra (Demaria) group [now at Weill Cornell Med School]. So I think if you really understand what it is you’re trying to do with the radiation, changing surface markers, creating damage response, if you really understand that, we call it focused biology. You can really focus that molecular perturbation that you want. And again, to me, I think that’s a major part of the future of our whole field. The other part, I think, is a future of our field is global health. And I can talk another whole bunch of time on that but we’re running out of time.
Theodore Phillips: But Norman, you’re still in charge of the Extramural Program, right?
C. Norman Coleman: Yup.
Theodore Phillips: And if we look back into the 70s and 80s, there was a tremendous effort to stimulate research by having grants that were targeted to chemo-radiation and meeting on sensitizers and meetings on chemo-radiation. That seems to have died out. Has the sort of proactive role of the radiation oncology branch go on a way or been prohibited or something?
C. Norman Coleman: The answer is no. I think in general, under Dr. Varmus funds went to RO1 based work, I think the way we influence things is we do have request for proposals. We have one coming out. It’s coming out very soon for a cooperative agreement to do combined modality work. So we try to do some of those. I think the problem is the funding level. When you’re funding nine or ten percent of grants, it’s just very difficult to have sustained funding. I think we look at the percentages of grants we (radiation)get funded and we’re no better and no worse than anybody else in cancer research. I think it’s very difficult for everybody. I think as long as we do good science, we get things funded.
The problem is sustainable careers. Again, I’m writing an editorial now on how I think we can address that. But you can’t expect people to do global health or to do basic research and have a sustainable career without consistent funding. It’s just almost impossible these days. So it’s almost how departments will realize we have to subsidize people to enable them to have sustainable careers. We have to sort of go back to some of the old models of having people be able to do work in a way when there’s a down period, you can continue doing that. I always worry about radiotherapy. We keep falling back into our technology. We have to do that right. Maybe hypo-fractionation is going to cure everything but I don’t think so. I think we need to keep understanding the biology of what we create. I think we have a great future.
Arjun Sahgal: And with that, do you think carbon ions has a major role? Do you see that in the next 20 years becoming kind of like the protons of today?
C. Norman Coleman: I hope it’s not the protons of today. Protons of today, I always felt we needed four proton centers. I think protons are proliferating beyond our understanding of what the biology is and what some of the issues were. I think carbon would be more expensive, and it will be done better. I think you need a few really collaborative centers not trying to kill each other who could really understand the biology of carbon. Again, we do some work with NASA. We work with Brookhaven and DOE to try to enable that kind of laboratory research to be done, so carbon when it’s rolled out is done really carefully. So I think you have to understand the biology you’re creating. I think there’s so much more to radiation biology than we really appreciate. And that’s what we try to do in our lab. You know, we (Moly, Adeola and Iris) show now and we have a paper just submitted that you can induce an adaptation to multi-fraction radiotherapy that you can then target with a drug that was useless before you gave the radiation. So radiation could potentially turn on molecular stress responses that can then become the synthetically lethal target. And no one can target biology like we can.
Arjun Sahgal: I mean, I guess, Ted, it’s about 2:00. I’m not sure how far in the hour we can go. I guess, as a young radiation oncologist and kind of getting to my mid-career, we need advice from people like yourself and for a new generation coming in, what would you advice for somebody who’s eager to be academic and get into the field. Where would you kind of advise them to put their efforts into?
C. Norman Coleman: Well, you sort of got to hate cancer and you got to try to understand that as Henry Kaplan once said, “If you want to cure Hodgkin’s disease, you got to think like a Hodgkin’s cell.” So you have to have people who really want to truly understand every time you see a patient what their disease is in a molecular level and in every treatment you’re doing. What it is you’re actually doing when you’re turning on your treatment and how you can understand and utilize all that. I wrote this editorial, I’m going to send in to the Red Journal. I think we have a great role as doctors. And I think if we go back to our role as doctors, we know cancer better than anybody. I think our technology has to be done spectacularly well. I think our biology is really there if you want to understand the biology. I think one of the biggest gaps and all the young folks are pushing it, and you guys in Canada and the young kids are all leading this, is global health. I have an NGO we are starting now called the International Cancer Expert Core. And the idea is can we have sustainable real bona fide careers in global health? There’s a shortage of 5,000 linear accelerators globally.
It’s a 30-year solution. The people who should lead the solution should be people in radiation oncology. So I think it’s a great field if we realize what our opportunities are. And as always, as I learned, you listen to the young people and you try to encourage them to be optimistic. I think there’s a lot of pessimism in medicine these days. That’s sort of sad to see.
Theodore Phillips: Norman, could you comment a little bit. You’re a triple boarder. There are a number of others that have been influential on our specialty like Mack Roach that are triple boarders. Do you see that as happening in the future or is that sort of a dying breed, you triple boarder guys?
C. Norman Coleman: Well, in Europe, they call them clinical oncologist. And I really wish, as Eli used to say about me, “It was unfair, you were educated before you were trained.” And I think the Canadians probably do a little bit and the Europeans. We have to be doctors a little bit. We have to really understand the diseases. And I think when you try to understand the disease more than the radiation of the disease, then, you sort of have to try to understand the biology more. So I think broad training is really important particularly nowadays. I mean, cancer biology, if you don’t keep up in science, the Red Journal is great. But if you’re not really keeping up in the basic fundamental science, then you quickly become out of date. So I think it’s really important that we as a specialty figure out how we can make sure we integrate good medical care and good science and all the kinds of things we can do as part of our daily lives in radiation oncology.
The editorial I’m going to write and who knows if it will get accepted is the idea to go back into these collaborative programs, because the consortium agreements like the Joint Center or big departments have the ability to take on a range of problems from science to societal to technology to policy [ “Masters of our Destiny” in Red Journal, 2016]. So you work with the people in the practice. You work with the people in academics. You get critical masses of people who can bring all kinds of skills and environments to the table and really push the frontiers. I think global health is a great opportunity for us to completely transform the world to bring altruism back to healthcare. There’s no group that can do it better than radiation oncology. You can’t do it in infectious diseases. That comes and goes. You can do it in cancer. Again, that’s my next big thing, I hope is global health.
Theodore Phillips: Do you have any favorite sayings, Norm?
C. Norman Coleman: Let’s see my two-favorite saying, well, one of them, “If you don’t change your direction you’re likely to end up where you’re headed.” I don’t remember who said that, I think it is just an ancient Chinese proverb. The other one is from Nelson Mandela, “It always seems impossible until it is done.” Again, that’s how we look at our challenges for nuclear stuff and look at our challenges for everything. You take on the hard problems, get some good people and go out and have a good time and try to do that.
To go back to the earlier discussion on sports and activities, my family has remained dedicated to being active and physically fit and also to travel including remote trekking. A great saying from my wife Karolynn is “if you don’t spend time taking care of your health you spend the time taking care of your illness”. She is a runner having been a top 10 in her age group in the Boston marathon for a number of years. I am still able to do triathlons and actually made it to the Ironman World Championships in Kona in 2016 by winning my age group in Canada race. In the year of our 45th anniversary we both won the 70 year old age group in a major Thanksgiving race in San Jose. The work-life balance can include a lot of work but physical fitness and health are really important. So is international travel to different cultures as it keeps us grounded and appreciative of what we have.
Theodore Phillips: Oh, okay. Okay, Norman, I think this has been a great interview. It will get transcribed and sent to you for your editing and additions, whatever you want to do with it. And it will also come to me and to the staff at ASTRO. And eventually, when it’s approved by you, it will get put on the website.
C. Norman Coleman: Oh, great. It was fun having you do it because you sort of know me from day one when I went into this field. Again, how much I appreciate your friendship and mentorship over the years.
Theodore Phillips: Okay. Well, it’s been good. And I think we’ll let you go at this point.
C. Norman Coleman: Okay. Thanks very much. I appreciate ASTRO dong this. Okay. Bye.
Theodore Phillips: Okay. Bye.
