Jay Harris, MD, FASTRO
By Theodore Phillips and Lior Braunstein
The following interview of Jay Harris, MD, FASTRO, was conducted on June 1, 2016, by Theodore Phillips, MD, FASTRO and Lior Braunstein, MD.
Lior Braunstein: Dr. Harris, tell us a little bit about where you grew up and where you’re from.
Jay Harris: I grew up in a working-class neighborhood in New Jersey. My father and his father were carpenters. I went to a really bad high school and the counselors there found a program at Cornell where they took young juvenile delinquents who showed a glimmer of promise and took them after their junior year of high school. So my wife has had to live with the fact that I’m a high school dropout. And after four years at Cornell, I decided that a change of pace would be good and went to medical school at Stanford.
Lior Braunstein: What do you think some of those influences were that sent you along the way to medical school?
Jay Harris: I don’t know in your school, but they had a course in my grammar school called shop. I got a D in it, and it looked like I wasn’t going to be able to get into the family business so we had to think about other things to do. I’ve always had an interest in helping people and being of service. It seemed like an exciting thing to do. I met my wife the first day of medical school at Stanford, my future wife, and it was kind of an interesting time (the late 60’s) to be there.
Theodore Phillips: I noticed that you had a strong interest in mathematics. You majored in math. You also got a master’s while you’re in med school, I guess, in statistics. Was that your main focus originally?
Jay Harris: Yes. That’s a good point, Ted. I don’t know how this happened, but the head of the department - his name is Rupert Miller – and I took some introductory courses for a master’s degree. Then to complete the degree, he would meet with me privately and gave me a series of tutorials. And I completed my degree learning from this master. When I think back at it, I think it really contributed to my wanting to be in academic medicine. When people show this amazing interest in your career, at least to me, it really created a desire to give back. I love taking care of patients, but I never really seriously thought about community practice. I knew that I really wanted to have an academic career.
Theodore Phillips: Well, Stanford allowed you to do a master’s while you were going through med school as well, I guess.
Jay Harris: Well, I don’t know if you remember Ted, but at that time it was a mandatory five-year program. So people either did research, or got a master’s degree or something. The first two years were stretched out over three, so it gave me plenty of time to do the coursework.
Lior Braunstein: Did you have an interest in statistics beforehand or was it that mentoship that sent you down the path?
Jay Harris: Well, it seemed like a natural fit. I remember my interview for Stanford Medical School, I even talked about the fact that I always wanted to get at a master’s in statistics and do clinical research. At that time I thought I was flowering it up or whatever, but it turned out to be exactly what I did. It seemed like an ideal way to develop an academic career in medicine.
Theodore Phillips: At Stanford, were you exposed to Kaplan? Did that get you an early interest in radiation oncology or did that come later?
Jay Harris: Lior, I don’t know if you know, but Henry Kaplan was this towering figure at Stanford in radiation oncology. He’s probably one of the earliest physician scientists in our field.
Theodore Phillips: He’s the smartest man I ever met.
Jay Harris: Yes, well there’s that.
Lior Braunstein: And I’ve certainly seen photos of him with the first linear accelerator.
Jay Harris: Yes. The actual story goes like this. My wife took the elective and she said to me, Jay, you would really love radiation oncology; to which I replied that’s like the stupidest thing I’ve ever heard. I actually applied and was accepted into a radiology residency at Duke, and then I got drafted. I was in the army for two years. I loved my internship; I loved taking care of patients. I realized during those two years that I wanted to do something that involved direct patient care and finally rethought her suggestion. Like two years later, I can tell you that the gap between when she suggests something and I do it has gotten progressively shorter. While I was in the army, I then applied for residencies. My wife is from Boston. So, we came up here and I talked to Sam Hellman and to Herman Suit. I liked the program here more and so we moved here after 2 years in the Army.
Theodore Phillips: How did you deal with this two-year gap between internship and fellowship? So that was in the army. Where did they station you?
Jay Harris: They stationed me during the Vietnam War in a health facility on the Washington DC mall. It’s called the Forrestal Building and it housed the senior army lawyers, doctors and engineers. I mostly did annual physicals and saw minor health issues.
Theodore Phillips: Your experience was quite different than Eli Glatstein.
Jay Harris: Very different than Eli’s. So the guy who does the assignments came down for his annual physical. After the physical, I said to him, I always wondered how I got assigned here. You fill out this little form that says -- they give you three choices. People would say I want to be in Hawaii or Bethesda. My first choice was continental U.S., second choice continental U.S. and third continental U.S. East Coast and my wife is pregnant - which was true.
Theodore Phillips: I wondered what Eli put on his, but we’ll never know.
Jay Harris: Yes. He probably put Tripler.
Lior Braunstein: That military service was about two years. Aside from physicals, any other interesting duties outside of your medical training?
Jay Harris: I was so fearful of being sent to Vietnam. It was a really big issue. It turned out we had our two children during those two years and we were able to spend a lot of time with them. I think in many ways was a wonderful two years. It wasn’t close to our families, but we made friends there. And we definitely had the luxury of spending all this time with our kids, which a lot of people don’t get.
Theodore Phillips: Let’s go on to your residency at the Joint. Tell us about what it was like. Who’s the faculty? Who were your co-residents?
Jay Harris: I’ll start by saying that when I came for the interview, Sam Hellman and I got in a huge fight because, as you know Ted, Sam took this very unpopular stance against clinical trials because he thought you could never have true equipoise. I was not aware of his strong feelings and I just talked about the importance of clinical trials to advance knowledge, and he just ripped into me.
When I showed up having been accepted, he said he got outvoted. Marty Levine was there, who was the rock-solid clinician for the program. Bob Goodman had abbreviated training there and came on the faculty quickly. Bob Cassidy was there. Jim Belli ran a basic research lab, pretty classic radiobiology. I had only one other person in my class in residency, somebody by the name of Leslie Botnick who wound up in community practice in Los Angeles. There was a resident two years behind us, Chris Rose, another Gold Medal winner who went with Les Botnick to this practice in Los Angeles.
Theodore Phillips: Stan Order was there too, wasn’t he, on the faculty?
Jay Harris: And Stan Order was there. Yes, I forgot that. So a lot of people became chairs there. Ralph Weichselbaum was there a year ahead of me in the residency. Sam was let’s say more of a feared chief than a loved chief, and the irony for Ralph was he went to the University of Chicago to get away from Sam and then Sam became his dean.
Theodore Phillips: I did a sabbatical there while you were a resident, I think.
Jay Harris: Yes, I remember that.
Theodore Phillips: I always admired how much fear the faculty had of Sam. They did what he told them. When I was a chair, I could never achieve that nirvana position. They never were afraid of me at all. So I don’t know how he did it, but he did it.
Jay Harris: He had that look. I actually never emulated that. I don’t think my faculty feared me. But it worked for Sam especially in those early days when the field was quite new in this country. We now have a very mature field, but back then it was really a developing field. Nowadays, especially at Harvard, as Lior knows, we’re getting the best and the brightest medical students. In the last two years, we’ve had nine Harvard students apply in radiation oncology. These are not just ordinary Harvard students. Many of them, like Lior, are really superlative.
Theodore Phillips: Now, as I remember the department then was a hotbed of breast therapy. Is that how you got so interested in it and started your big career in it?
Jay Harris: Yes. Sam and Marty Levine and one of the surgeons, Bill Silen, who was at the BI, were early advocates for breast-conserving surgery. It seemed like a great opportunity. I must have asked Sam, I don’t know, five times to get involved in the studies. Four times he told me no, and then eventually he said yes. It really caught my interest and it really allowed me to use my statistics. It was pretty heady times trying to convince people that this was a viable approach.
I took a very different approach than Sam did. I think Sam was charismatic and I was much more direct about talking about the problems we were having. I subsequently heard from the surgeons at the Brigham that it wasn’t Sam who convinced them, but it was me. What they saw was my honesty in dealing with the situations. Winning over the Brigham surgeons was no mean feat. I remember there was a talk I gave because Sam couldn’t be there. The head of breast surgery at Memorial was there and his wife came up to me after the break and said I’m so and so’s wife and I didn’t like your talk at all!
Theodore Phillips: Why did she say that?
Jay Harris: Because the surgeons initially really hated breast-conserving surgery. They thought it was the wrong way to go. And there were still people -- Cushman Haagensen at Columbia at that time was still advocating radical mastectomy.
Theodore Phillips: I’d forgotten that. Well, speak a little bit more about the battle with the surgeons. Now are so accepting in favor of breast conservation, but back then that wasn’t true.
Jay Harris: No. It was pretty antagonistic. Well, eventually the clinical trials and in this country it was mainly the NSABP BO6, which showed equivalent survival that I think really turned it. Ironically, despite Sam, it was the clinical trials that really helped us make progress and get this going.
Theodore Phillips: Did any of the Boston hospitals participate in B-06?
Jay Harris: I don’t think so, actually.
Lior Braunstein: Along those lines, one question I had was that we often hear about innovators who change the treatment paradigm and the difficulty with being a leader out in front of the field, dealing with entrenched resistance and opposition to a changing practice. What do you think it was about breast conservation or, perhaps the environment in your research sphere that gave you the motivation to overcome that resistance?
Jay Harris: Well, the resistance never bothered me. My wife complains that I don’t tend to take things personally, which is true. So, I was just trying to figure out how we could do breast-conserving therapy effectively and safely. In pursuing these studies, we were doing studies along the lines of looking at local recurrence, cosmetic results and toxicities and trying to find a path to better results. So, I think I was just having the opportunity to do interesting studies, and make contributions and create new knowledge. And Lior knows this, but it’s very heady to create new knowledge and be a leader in the field.
Theodore Phillips: You’ve written several famous books on breast cancer, how did you get started in that area?
Jay Harris: That was actually initially through Sam. We got together and thought that there wasn’t a good textbook. So we joined up with David Kinne, who was then head of breast surgery at Memorial, and Marc Lippman who was my classmate in college but was a leading biologist in breast cancer research. We sort of worked together. We’re effectively on our 6th edition, so that’s been very gratifying. It’s been amazing to see — it comes out every four or five years — how much things changed in the field over that interval of time.
Theodore Phillips: With the advent of instant accessibility in all the papers on the Internet, do you think that textbooks like that are going to have a role in the future?
Jay Harris: That’s a really good question. I’m a little surprised how little our wonderful residents use the book. I think this may turn out to be relics and I’m actually not looking forward to doing another edition. It’s an amazing amount of work. I was the senior first author/editor so I took the leadership in terms of steering the ship and doing the necessary work to get things done. But I think people just go to the Web these days to ‘up to date’.
Theodore Phillips: Well, Lior, do you want to go into another area of questioning?
Lior Braunstein: Sure. I was curious, along those lines of contributions to breast conservation therapy in changing the treatment paradigm -- was there a moment or a time period where you were looking around at the field and felt an inflection point where things had really changed and you could palpably notice your contributions or was it more gradual and ongoing today even?
Jay Harris: Yeah. I think more gradual, Lior. And as you suggest, it’s kind of an ongoing process.
Lior Braunstein: As with most things, I suppose. In terms of other contributions, so certainly you’re extensively published in breast cancer. With regard to particular studies or trials or modes of thinking, what do you think has been among your biggest contributions to the field academically?
Jay Harris: Well, as you know, we’ve had a long interest in finding a way to avoid radiation in some patients with invasive cancer and DCIS. We did this wide excision alone studies using clinical and pathological features to select people which, as you know, didn’t work out.
Ted, actually, Lior is heading up a trial that we’re doing now where we’re characterizing cancers more based on biological characteristics and teamed up with a company to do a 50-gene analysis which will reliably identify really good risk patients. That study just opened up here. Lior actually did the heavy lifting on it, but I’m technically the principal investigator. So I think that’s really an incredibly exciting study moving away from classical descriptors of tumors to personalize treatment based on the biology.
Theodore Phillips: Did the results in any way influence radiation, either the target volume or the dose?
Jay Harris: Not really. We know that older patients with ER-positive cancers do extremely well. In many of those patients we don’t do a boost even because the outcome is so favorable. We also did a study here, a trial many years ago in which we asked the question is it better to give chemotherapy first or radiation first after a lumpectomy. The nickname for the trial is Upfront-Outback. So patients were either randomized to get chemotherapy first or radiation first, and the patients getting chemotherapy first did better. This was published in the New England Journal of Medicine.
Theodore Phillips: I remember that paper was very important. Could we go now to your national activities? You had a big role in ASTRO. Could you tell us about your experiences in ASTRO? What changed while you were in charge of ASTRO?
Jay Harris: I think Sarah Donaldson probably was orchestrating a lot of things on my behalf. We were running for ASTRO presidency, and then later going on to the American Board of Radiology. But the one thing she did that I thought wasn’t really good is I ran against Allen Lichter who was my good friend, and he was so crushed to lose that he never did anything for ASTRO ever again. I don’t know if you know this, Lior, but he became the executive director of ASCO and served in that position for many years.
Theodore Phillips: That’s the problem with those head-on-head elections. I remember I beat Jim Belli in the rad residency presidency election once and he was always upset by that ever since. It may be better not to have that kind of thing held. When I was elected, really I was the only candidate back then. So there was no hostility for the ASTRO presidency. Did that impair your ability to run ASTRO after the election?
Jay Harris: No, not in the least. What impaired my ability was the fact that the executive director in the middle of my time or maybe in the first third of my ASTRO presidency got immediately fired for some malfeasance. I don’t know if it was behavior or financial. But one day I was called up by the leadership and said he’s not going to be around anymore. It was then that I set up a procedure that I think is still being used today which is we had weekly phone calls with the chairman of the board, the president and the president-elect and we jointly steered the ship together.
Theodore Phillips: Did the executive director sit on those too?
Jay Harris: We didn’t have one. So he was gone.
Theodore Phillips: Nowadays, what does he do?
Jay Harris: Nowadays, yes, definitely. Ted knows this. But back then there was this ambivalence about whether ASTRO should take over the socioeconomic aspects of the specialty. Traditionally the socioeconomic aspects were handled by another group.
Then Steve Leibel succeeded me in the presidency, and together we made the decision that ASTRO should take over the socioeconomic aspects of the field - which I think was the right decision, but it also came with a lot of changes. ASTRO went from being primarily educational and academic to needing to represent entirety of the specialty. There was a lot more talk about reimbursement and community practice, and much more often would have a president who was in community practice and not in an academic medical center. I think it was the right decision, but it had multiple downstream consequences. But making that happen took a fair amount of work.
Theodore Phillips: You had mentioned just previously you got involved in the board. Can you tell us a little bit about your experience on the ABR?
Jay Harris: Yeah. I was on the ABR for ten years. I can’t remember, Ted. Were you on the board?
Theodore Phillips: No. I was an examiner, but I never got on the board.
Jay Harris: I found that very helpful. And when I started at the Brigham, one of my first patients was the head of radiology, a wonderful man by the name of Len Holman. He’d just been diagnosed with metastatic cancer and had been invited to join the board in radiology. At the end of his treatment, he said he wanted to talk to me. He said do you think that I should accept this offer under the circumstances? And I said absolutely. I said we can work together to create a research pathway in our specialty. So he joined the board and we created what became known as the Holman Pathway.
I don’t think that diagnostic radiologists would have ever approved it because they were so conservative. They were the last group to do recertification. But Len was so beloved that they let it pass. I think the Holman Pathway’s been just a great thing for our field. And Lior knows this, many of our residents are physician scientists, MD-PhDs, and if they are deemed clinically expert, we let them spend 18 to 21 months doing research. They’re really much more primed to have an academic career. So we’ve really created a group of terrific physician scientists.
Theodore Phillips: Do you have any data on what percentage of radiation oncologist residents use the Holman Pathway?
Jay Harris: It’s a relatively small percent. We carefully select for those people. For us, you have to be a really good clinician, not somebody we want to hide in the lab. Our Holman Pathway people are just really terrific, terrific doctors. Lior’s been working with Kent Mouw who’s one of them, who is just fabulous in the lab but also really is a strong clinician. We allow up to two years out of our seven or eight residents, but there are a lot of programs that rarely, if ever, have Holman Pathway people. Interestingly, I would say 80 percent to 90 percent of the Holman Pathway people are in radiation oncology. Very few are in diagnostic radiology.
Lior Braunstein: The Holman Pathway certainly became a defining feature of our training program. I’m curious, at a time when there’s not a lot of upheaval in terms of the structures of the residency programs - it’s quite difficult to take a year or even half-a-year and change that from clinical training to research. Was there something in particular that prompted that idea or was there a gap that you felt in radiation oncology training that necessitated something like this?
Jay Harris: It started as a gap and I negotiated with the powers that be. It allows technically for nine months of research, but I sort of said how about if we stretch it out to a year and do 25 percent things like on-call or covering clinics so that our residents could for the first time have a full year and do some amount of clinical work amounting to a nominal 25 percent. And as you know, all of our residents greatly value that year even if they’re not a Holman Pathway person. It really gives them an opportunity to do some sizable research.
Theodore Phillips: So all your residents get one year of research time out of their four. Is that correct?
Jay Harris: That’s correct.
Theodore Phillips: That’s very nice.
Jay Harris: Yes . As I said, it’s greatly appreciated. It’s pretty amazing what many of our residents are able to accomplish in that time.
Theodore Phillips: Do you wait a little while before you choose a resident for the Holman Pathway?
Jay Harris: Yes, we do. We don’t let people make that decision in the first year. We sit down with residents and say, well, let’s see your clinical trajectory. We want and you want to have mastery when you graduate. But many of our residents through selection are just really great clinically. So that decision is made after the first year. Sometimes well into the third year, people weigh the concerns about abbreviated clinical training versus more research time.
Theodore Phillips: Are you still on the board now?
Jay Harris: No. I’m off the board. I gave the board ten times before coming on the board and then another ten times as a board member, so 20 times in Louisville to give the Oral Boards.
Theodore Phillips: Yes, that’s the service beyond the call of duty.
Jay Harris: As I think about being ASTRO president and being on the board, the opportunities for changing the field I think are actually more so being on the American Board of Radiology. The ability to create the Holman Pathway, that’s pretty big in our specialty.
Theodore Phillips: In my experience it never caught on at UCSF. Recently I worked at Arizona. They don’t have it there. So I think it hasn’t been as appreciated and developed as much as it should be.
Jay Harris: Yes, I think that’s true. It’s pretty well-developed here in our Harvard program, so we regularly have two or three people in the lab.
Theodore Phillips: Let’s go to your honors. You’ve gotten a lot of honors. Could you tell us which ones you think were the most important or which you were most gratified by receiving?
Jay Harris: Well, I was really touched by being recognized by the Brinker Foundation for my contributions in breast cancer. I think even to this day I’m the only radiation oncologist who has gotten that honor. I also was given the Gianni Bonadonna Award from ASCO for contributions in breast cancer, and again the only radiation oncologist to be so honored. So given my commitment to breast cancer, those two honors really are meaningful for me.
Of course being recognized by your colleagues in getting the ASTRO Gold Medal was very meaningful for me. I don’t know if you were there, Ted, but rather than accept the award and talk about my accomplishments, I had my two very talented sons have a video where they completely roasted me which people just loved. Somebody said to me nobody could ever do that again. Our oldest son, Dan, is with ABC News so he sort of hijacked the facilities of ABC News to put this video together. Lior, did you ever see this?
Lior Braunstein: I did not, but I’ve heard the legendary stories.
Theodore Phillips: How about let’s talk some more about your family. You had one wife the whole time, it sounds like.
Jay Harris: Yes.
Theodore Phillips: A wonderful outcome. Your wife is a physician, is that right?
Jay Harris: Right. She’s a world-famous hematopathologist. She for years has done those weekly case conferences in the New England Journal of Medicine. They’re called CPCs. So that’s taken up a lot of her time. We’d like to say that our two sons have thought about medicine four milliseconds. Dan co-anchors Good Morning America on the weekends and also Nightline. And currently he’s doing the fifth version of this game show called 500 Questions. The last episode is on tonight at ABC primetime where they pit these two geniuses against each other, and Dan kind of hosts it and nimbly steers it through. Dan married a lovely doctor, curiously the same height and hair color as my wife, who also curiously works in Memorial although she’s a pulmonologist. Our other son, Matt, went into finance and works for Bain Capital running their venture capital division in Manhattan. They live very close to each other, and I would say they’re best friends.
Theodore Phillips: I remember one time when I was on sabbatical at Memorial, Joan and I were at the opera and we found you there. I guess you must get to New York quite often.
Jay Harris: Yes, I remember seeing you there. Well, now we get there even more often. Somehow Matt miraculously got us tickets for this show called Hamilton, which is like the most impossible ticket to get. So we’re going to be down there next weekend to see everybody and go see Hamilton.
Theodore Phillips: What are your main hobbies? Is opera one of them or you just happened to be at the opera that night when I saw you?
Jay Harris: I would say I just happened to be there. My wife and I enjoy reading and being with our families. Now we have four grandchildren. Matt has three and Dan has one, so that’s a big hobby now. As you know, it’s a lot easier to have grandchildren than children.
Theodore Phillips: Do you have any sports that keep you occupied, like golf or fly fishing or anything like that?
Jay Harris: No. I actually enjoy watching sports, and we’ve done a lot of biking over the years. We toured through most sections of Europe by groups, but we’re not doing that currently. I would say I’m still pretty much of a workaholic. I still love what I do. I love our residents. I love seeing patients. I really love doing research with brilliant residents.
Theodore Phillips: You stepped down as chair and then you brought Daphne in then?
Jay Harris: Yes, Daphne great. She’s really great. You’d be really proud of her. My life is definitely easier. You know what it’s like being a chair, and you know what it’s like when you stop being a chair. So I get home a little bit earlier, less pressure, less angst.
Theodore Phillips: I stopped being a chair when I was 65, but you went longer.
Jay Harris: I did. How many years did you do it?
Theodore Phillips: 27.
Jay Harris: Well, you started pretty young.
Theodore Phillips: I started young. Did you ever do any sabbaticals? I know you’ve done thousands of visiting professorships. What about sabbaticals?
Jay Harris: I’ve never done a sabbatical. My good friends at Institut Curie in Paris keep bugging me about coming to their institute to do a sabbatical, so I’m definitely tempted to do it now. I think I have the time and the flexibility.
Theodore Phillips: Yeah, it’s a great thing to do. I did three long ones in my career and they were all extremely rewarding. The second one was at the Joint. The first one was at Stanford. It’s a wonderful institution if your school offers it.
Jay Harris: Yeah. Well, I’d have to negotiate something with Daphne because we haven’t officially offered it.
Theodore Phillips: Are you working full-time still now?
Jay Harris: Yes.
Theodore Phillips: Are you planning to do that for the next ten years? How long do you think it’s worth working?
Jay Harris: I think we’re taking it a year at a time. My wife and I both love what we do. As long as it’s fun and we’re contributing. We’re taking it year-by-year, but I would say we’re not slowing down. There’s too much good work to be done. Fortunately, I still love seeing patients, so that really helps a lot.
Theodore Phillips: Lior, do you have some more questions?
Lior Braunstein: Sure. Just building on that, as you think back to all those years of contribution and the changes in our field, does anything stand out as especially memorable or particular surprises that you wouldn’t have anticipated along the way, but you would advise a young trainee to either be on the lookout for, or to try to anticipate?
Jay Harris: Yes. I know I’ve been very fortunate in my career, but I think the opportunity to train residents is probably the most meaningful for me. I was program director here for over 30 years and probably trained more residents than anybody, and it’s probably the thing that’s most meaningful to me. So, guys, I need to go do some simulations, speaking of clinical work. Thank you for this opportunity. I’ll get that video to you.
Theodore Phillips: That would be wonderful. And as you leave, do you have any favorite sayings?
Jay Harris: I very frequently say starting when I was the chair it’s never boring.
