Louis Harrison, MD, FASTRO
By Naomi Schechter, MD and Paul Wallner, DO, FASTRO
The following interview of Louis Harrison, MD, FASTRO, was conducted on November 14, 2018, by Naomi Schechter, MD and Paul Wallner, DO, FASTRO.
Naomi Schechter: Okay. So we'll start off. If you could let us know where you were born and where you grew up.
Louis Harrison: I was born and raised in Brooklyn, New York.
Naomi Schechter: Me too. So tell me where, what part of Brooklyn?
Louis Harrison: Sheepshead Bay.
Naomi Schechter: What did you like to do when you were young?
Louis Harrison: Play basketball, play paddle ball, ride my bicycle, play stickball and to go bowling with my friends.
Naomi Schechter: I did this question in there because, just working with you, I just think of you as such a creative person and always pushing at the forefront of our field. So I was wondering if you were a bit of an inventor as a child.
Louis Harrison: No. I can't say that I was an inventor, but I was very studious. I was a dedicated student. I liked school and I enjoyed the classes that I took. It was a good mix of school and athletics, but I can't claim to have invented anything.
Naomi Schechter: Well, what were your favorite subjects?
Louis Harrison: I invented ways to fool my parents sometimes, but that's about it.
Naomi Schechter: You don't want to share any of those?
Louis Harrison: No. I think I'll keep those to myself.
Naomi Schechter: So undergraduate education, high school, college?
Louis Harrison: Yes, I went to high school. I actually went to a private high school in Brooklyn called Poly Prep (Polytechnic Preparatory Country Day School). I went to that school from the 5th grade to the end of high school, and then I went to college at Duke University.
Naomi Schechter: How did you choose to go into medicine?
Louis Harrison: I always wanted to be a doctor since I was very young. I don't have a recollection of ever thinking about or considering anything else. I was one of these little kids that played doctor. I had a doctor’s stethoscope. My grandparents would sit in the waiting room and I would call them into the bedroom which was my examining room. It was funny. I had pictures, I don't know if I still have them, of me doing that. For whatever reason, I always was fascinated by medicine and never considered anything else from a very, very young age.
Naomi Schechter: Were there other people in medicine in your family?
Louis Harrison: No, no, no. Other than to the extent to which every Jewish grandmother has pseudo-medical degrees and I had two Jewish grandmothers who consider themselves very knowledgeable, I am the first official physician in my family.
Naomi Schechter: Why do you think you chose radiation oncology?
Louis Harrison: Well, I was originally in surgery. My initial aspiration was to become a surgeon and was to become a cancer surgeon. In fact, at my medical school graduation, there's a medicine award and a surgery award. I actually won the surgery award at my medical school graduation. I was very committed to surgery even throughout medical school.
And I was committed to cancer from a very early age also because one of the kids that I played with in Brooklyn down the street who was a good friend of mine developed osteogenic sarcoma. He got his leg amputated and died when I was very young. I didn't understand all the medical details except that all of a sudden lost his leg and all of a sudden died, and he was very sick.
That left a lasting impression on me and my mother. I lived in a multifamily house. My grandparents lived downstairs and we lived upstairs. So my mother, my grandmother, the mother of my friend - his name was Martin Elk - and a few other ladies on the block created a little fundraising organization. This organization was created in the 1960s. It exists still today. The purpose was to raise money and give it to Memorial Sloan Kettering for cancer research and to help the kids.
Even as a very, very young person, I would make trips every year with my mother and my grandmother to the toy store to spend the money that was raised to buy toys for the kids at MSKCC. I helped them pick the toys because I was a kid and I knew what the kids like to play with. I went with them and delivered toys to Memorial Sloan Kettering. So I actually started my relationship with Memorial Sloan Kettering when I was 8, 9, 10 years old, way before I ever had the privilege of working there as an attending. So, that's a nice little parallel in terms of my life.
Naomi Schechter: That's lovely. So women were very important to your future. Who else perhaps encouraged you along the way?
Louis Harrison: Both of my parents, and my grandmother and grandfather. We all lived in the same house. I had a few teachers in high school that were role models for me in terms of school. I did have a physician who in truth is like my fourth cousin but I thought of him more as a physician in the family. He was one of the first gastroenterologists in Brooklyn and he was a role model for me as well.
Paul Wallner: I'll interrupt occasionally. You were talking about surgery and I noticed your PGY1 was in surgery. So what sort of changed course?
Louis Harrison: Yes. In medical school I was very focused on surgery and cancer surgery and, in fact, matched into the five-year surgery program at Mount Sinai. But during my fourth year of medical school I took electives in medical oncology and in radiation oncology. At that point, I became persuaded that I thought the future was going to be more about saving organs than removing organs, and quality of life issues, plus organ and function preservation.
So, I actually evolved during my fourth year of medical school away from surgery even though I enjoyed the procedures and I evolved towards the concept of saving things rather than taking them out. I was more intrigued by that idea. So even though I was in the five-year program at Mount Sinai, I applied for a radiation oncology residency at that point. I was one of two or three people that left the surgical program for another field because of that evolution.
Naomi Schechter: So you started the surgical program?
Louis Harrison: Yes, I did. I started it. I completed the first year but I didn't go further because I elected to change to radiation oncology.
Naomi Schechter: So your residency, can you describe that?
Louis Harrison: Yes. I did my residency at Yale. I had a great time. I still maintain to this day a close relationship with that institution. I was visiting professor there just a few weeks ago. I hadn't been back there in a long time. But the Yale program was very strong in clinical radiation oncology, in radiation biology and physics. It was a fun yet hard-working program and led by Jim Fisher who was a brilliant man. Probably if you would ask me to make a list of some of the smartest people I've ever met in my life, Jim Fisher would be at or near the top of that list. I felt like I had a superb residency experience. I would also mention Dick Peschel who was the residency program director and a wonderful teacher.
Naomi Schechter: Who were your mentors in the program?
Louis Harrison: Dick Peschel and Yung Son. Dick Peschel was my main mentor and, of course Jim Fisher. I would say both of those people are my mentors.
Naomi Schechter: What was it about them that cemented the relationship?
Louis Harrison: Dick Peschel was the residency program director. He gave us a lot of the lectures. He taught us how to read a paper and taught us how to write a paper. He was a critical thinker to the extent to which you can, quote/unquote, teach someone to think analytically and be critical and understand what's important and what isn't and what's junk and what's good. Dick was very, very good at that. Jim, Dr. Fisher, I think he’s just sheer intellect. Paul, did you know Jim Fisher?
Paul Wallner: I did. I didn’t know him well.
Louis Harrison: Just his sheer intellect made you strive to push your own intellectual boundaries and think about things and contemplate things that you might not have thought of just because you'd say to yourself, well, how would Dr. Fisher think about this? So even without inspiring you or actively inspiring you to do that, being with him caused that. He had this unique way of being brilliant and insightful and asking questions that you would not think to ask and yet did it with such humanity and such matter-of-factness that his ability to stay close to humanity despite how smart he was was a gift.
Paul Wallner: Just to interject a small comment here. I'm sure Naomi will move on to this in a moment. Of all the programs in the country, the training programs in the country, I think Jim Fisher and the Yale program during his tenure probably serves as an incubator for more significant leadership than any other program in the country.
Naomi Schechter: Could I ask you to give one example of when you're talking about adding the humanity aspect which is so important? Is there one episode that perhaps stands out in your mind?
Louis Harrison: I'm trying to figure out the best way to -- because this is not something that I would necessarily want you to write about. When you hear what I'm going to say, you'll understand why.
Naomi Schechter: We can leave it out, but I want to hear.
Paul Wallner: We can either go off the record or you can just slash it. You can just cut it when you’re --
Louis Harrison: I'm Jewish. I'm not an Orthodox Jew by any stretch of the imagination, but I am Jewish and I'm proud to be Jewish. I was on a particular day seeing a patient, a new patient at Yale that was Dr. Fisher's patient. It was Dr. Fisher who was the attending. I was in scrubs that day because I did a lot of brachytherapy as a resident. I was wearing a Chai necklace representing the Jewish symbol of life. It was around my neck and it was obvious. The patient turned out to be a Nazi. It was a German patient and it was a patient who clearly was anti-Semitic. He had seen the Chai around my neck and did not want me involved in his care. It was a patient that had some standing in the community. Dr. Fisher, I guess from his point of view, was in the dilemma of honoring a patient's wish on the one hand and respecting my heritage on the other. Dr. Fisher told the patient that if he wanted Dr. Fisher, then he got me too. If he didn't want me to be involved, then he wasn't going to be involved. And all that was his choice. I never forgot that.
Naomi Schechter: That is really a special memory. Thank you for sharing it. Who were your fellow residents?
Louis Harrison: My fellow residents, well, in my year my most significant fellow resident was Bruce Haffty. Bruce was a couple years younger than me. Another fellow resident that was in my vintage was Tim Mate I don't know if you know that name, Naomi, but Tim is at the Swedish in Seattle. Tom Fogel, who is in practice in Santa Barbara now. Joseph Cardinale, who is still in the Yale community, was my other co-resident. Joe was actually the Chief Resident. There was another one named Barry Kazynski who was an MD PhD who tragically died way too young. That was the group that I remember the best. There were some others that were not as consequential. Bruce and I were good friends. I was his chief resident and he and I instantly became friends when he started and have remained close friends ever since. Lynn Wilson, who trained after I was there, another fellow Yale alum, has also remained a very close friend.
Naomi Schechter: What was your research focus at the time?
Louis Harrison: I was very interested in brachytherapy and head and neck cancer. I was all over the operating room. There was an attending at Yale named Yung Son. He did most of the brachy there so I was just all over the brachytherapy cases. I had a lot of interest in interstitial brachytherapy, and in learning and doing brachytherapy, and trying to bring some rigor and even some protocols to that practice which in that era - as Paul will tell you - was the cowboy territory.
And head and neck. I was always interested in head and neck cancer so I got involved with the head and neck group and did things in head and neck cancer. That was one of the things that really started me officially on my quest to preserve organs, to think about organ and function preservation, larynx preservation, tongue preservation, eye preservation, head and neck skin cancers. You know, cosmesis. All of that started when I was at Yale.
Naomi Schechter: How did it change during that time you were there as an attending?
Louis Harrison: Well, I was never an attending at Yale. After my residency, I left Yale. I wanted to stay at Yale as an attending as it turns out. Dr. Fisher, another one of the things that he did is -- he wanted me to stay at Yale. I wanted to stay at Yale but I wanted to do a fellowship in brachytherapy. Jim's idea was to go to Memorial Sloan Kettering, do a fellowship in brachytherapy, and then come back to Yale and really take charge of the brachy program.
Now I'm a New Yorker, as you know, and my wife's a New Yorker. My wife, Ilene, is also from Sheepshead Bay. There was a lot of gravitational pull for us to return to New York, Zvi Fuks and Sam Hellman were just coming there at around that time and they were working towards creating a great program at MSKCC. I decided to become a part of that endeavor. Anyway, I went down to Memorial for an interview for the brachy fellowship. It went through the day. I was going to do what Dr. Fisher wanted, do the fellowship and then come back to Yale and I hit it off with Zvi Fuks. I'll never forget this. I started my day with Dr. Fuks and I ended my day with Dr. Fuks. As my day was ending, I was in his office and we really, really hit it off. To this day I consider him one of my lifelong mentors. I love Zvi. You'll appreciate this, Naomi, from your days at Memorial, but in his own inimitable way - - he said, “Louis, you are not going to get the fellowship.”
Naomi Schechter: Oh. But you did pretty good.
Louis Harrison: There I was at the end of this interview day and he was like, “Louis, you are not going to get the fellowship.” I was crushed. Then he said the reason is “you're going to be an attending instead.”
Naomi Schechter: Oh, my gosh.
Louis Harrison: So he left me. He always did. He’d leave you that 30 seconds thinking that you're dead only to resurrect you in a way that you never expected, right? You know what I'm talking about. Vintage Zvi!!
Naomi Schechter: Yes.
Louis Harrison: But that was the first day I met him so I didn't know that that's what was happening. So then I went home to my wife and I said I didn’t get the fellowship. She said, oh no. Then I told her what happened and she really wanted to move back to New York. Then I had the task of going to tell Dr. Fisher what --
Naomi Schechter: But he never gave you a choice. He just told you you're going to be an attending.
Louis Harrison: But now I had to explain this to Dr. Fisher, which I did, and he understood completely. Family first. That's how much of a gentleman he was to me when I told him that at the end of the day this is what my wife really wants to do and I concur. Although I have to tell you that Ilene was the driver of this because she is in most of our decisions. And that's what happened.
Naomi Schechter: Wow. That's amazing story.
Naomi Schechter: I got the impression when I was at Sloan Kettering that each of the individual attendings had really worked to build the program to the stature it was. At the time I went, it was the number one cancer center in the country. So how would you say you all did that as a group, the team? There were so many stars by the time I came, but I know that you all had built it individually.
Louis Harrison: Well, Sam Hellman was the hospital physician-in-chief and Zvi was the department chairman. I think all of us shared a tremendous loyalty and devotion to Zvi. Sam was there for a much shorter time but it was nice to have a radiation oncologist there as physician-in-chief. But even after he left, Zvi was the driving force. I think he inspired us and he loved us. He helped make us successful with that inspiration and that focus. Zvi listened carefully and remembered everything you told him.
You know Zvi. Paul, you know Zvi. Zvi is a special person and he lights up a spark. If he takes a special interest in you, it feels great. I think of him all the time because how he mentors people, his own unique style of mentorship is a style that I've tried to emulate in some ways. Nobody can be Zvi, but he inspired us all and he picked good people.
You know, the most important job of a chair is picking people. If you choose the right people and give them the resources and get out of their way, that's a very good formula for success. And Zvi did that. He chose good people. He helped us and he got out of our way. If we were screwing up, he would tell us.
But Zvi also had a tremendous humanity and he would never forget things that were meaningful. I can tell you that I told him once when I interviewed, the first day I was there I told him that one of my inspirations growing up in terms of communication skills was a man named Abba Eban. Do you know that name? Do any of you know that name?
Paul Wallner: He was the foreign minister of Israel. The first foreign minister.
Louis Harrison: That's right, the foreign minister of Israel. He was the Israeli ambassador to the United Nations and he just had a gift of speaking beautifully and was recognized for this skill. I mentioned this to Zvi when I interviewed. This never ever came up again. Years later, and I mean several years later, I was in clinic and I got paged to 5868 which was Zvi's extension, “Louis, come to my office now.” Not knowing what to expect, and assuming that I must be in trouble, I went down to his office. Abba Eban was sitting in his office.Zvi wanted me to meet him. He remembered that story from years ago.
Naomi Schechter: No way.
Louis Harrison: He wanted to introduce me to Abba Eban because he remembered, God knows how he remembered what I told him so many years ago. That's Zvi Fuks.
Naomi Schechter: Wow. That's amazing. I can see why you say that. All the attendings really had their unique path. You're all different but all leaders. So what would you consider to be your main clinical and research focus areas and contributions to the field, for the record?
Louis Harrison: My contributions in head and neck cancer that have led to organ and function preservation, mainly for oropharynx cancer. Part of that was we were one of the first to use radiation and chemotherapy together in head and neck cancer, one of the first to use delayed concomitant boost as part of the treatment, and one of the early ones to use modern brachytherapy techniques.
In that context, I would have to include two specific contributions. One was our randomized trial in soft tissue sarcoma where we published our data comparing surgery versus surgery plus brachytherapy and showed the advantage to radiation specifically to brachytherapy in the local management of soft tissue sarcoma. That was the first time in my career that I got a plenary session presentation at ASTRO, it was that paper and that presentation. So that's something that I think was important.
Naomi Schechter: And meaningful with your childhood influence.
Louis Harrison: Absolutely. That's true. That's a very good point. Thank you. Then I would say the contributions about developing intraoperative radiation therapy. I think those were the things. All of that started at Memorial. The head and neck were continued afterwards as to the IORT work. But I think those are the main areas I would focus on.
Paul Wallner: Lou, can you talk a little bit about the evolution of the brachytherapy service during the years that you were there?
Louis Harrison: Yes. When I got there, the way it was done is that each of us were assigned a day. My day was Wednesday. The surgeons at Memorial Sloan Kettering saw all the patients and made all the decisions. That's the way it was. If you were on your OR day, you were on-call to go to the operating room when they needed your attention for a potential procedure. So you'd show up on Wednesday, and your pager would go off that they are ready for you in a certain OR. You'd go into the OR and they would be doing a thoracotomy and there would be a close margin along the aorta. Then your job would be to assess the situation and decide whether to do brachytherapy, and potentially do the procedure. Then, as you're finishing your pager would go off that another team was ready for you in another OR. You go into the other OR and they would have another situation for you to review and decide. You went from room to room to room throughout the day and handled whatever came up.
I did not like this way of doing things, and neither did Zvi. But about three years into my tenure at Memorial Sloan Kettering, they made me the chief of the brachytherapy service because Dr. Hilaris (had left. When Zvi asked me to do this, I said, “Zvi, I'll do it under one condition: I'm going to change this whole process, and insist on a process whereby the radiation oncologists sees all the patients in consultation up front, and the OR cases are then jointly booked with the surgeon and the radiation oncologists; the surgeons may not like this and I will need your support. The case will be booked for the brachytherapy under the name of the radiation oncologist. We'll get informed consent and that whole thing. If you will support me on that, then I'll do this in addition to building an IORT suite.” And to Zvi's credit, he supported me and we did it.
There were many surgeons who did not like this and did not want to make this process change. They felt it would be inefficient and cumbersome. But we knew it was the right thing to do, so we did it. You have to remember that I was three years out of training. So I was junior when we did this. Zvi had my back.
This allowed us to make better clinical decisions and take control of the work. That allowed us to start to develop clinical trials. That allowed us to start to do work that combined external beam and brachytherapy. It allowed us to start to bring purpose, integrity, all of the right things to this area of practice which didn't exist before when it was more like a service than an academic endeavor. This was a complete sea change. I believe that this move, as uncomfortable as it was, was a very important step in radiation oncology. Radiation oncologists are getting the respect we deserved and having the standing we deserved at Memorial because before that we were technicians for the surgeons.
Naomi Schechter: Well, thank you for doing that. That was one of the lessons that I actually took away from spending time with you, is that we are oncologists and that we need to be making the decisions and weighing in equally. So I really appreciate that you did that for us.
Louis Harrison: Thank you.
Naomi Schechter: What were some of the controversies in your career? So that was one of the main ones. Do you have any others? You have many hats on with the head and neck, and the sarcoma and the lung. Were you on all those services, or do you feel like it was because you were the brachytherapy lead that had brought it all together? Or did you have a favorite path?
Louis Harrison: Head and neck was always my passion, but the brachytherapy aspect of it got me involved in all of these other programs. For Sarcoma, I was fortunate to work with Dr. Murray Brennan. So it was through brachytherapy that I got to do a lot of these other things. Then when we started the IORT program, one of the first areas that we explored IORT was in rectal cancer. Dr. Warren Enker, who was one of the senior colorectal surgeons there, who was a good friend to this day, I worked together with him on that.
So while my anatomical site that I was always and still am most passionate about is head and neck, these procedures and exploring and expanding these procedures did get me involved in these other sites. Quite frankly, I really enjoyed that. I think that nowadays, as we all know, in radiation oncology everybody is very, very site-specific. But doing brachy allowed me to be a little bit more versatile which I appreciated and still appreciate.
Naomi Schechter: You've had leadership roles with so many organizations. We thought of ASTRO, RTOG, ABR, ACR, PTCOG, ASCO, ABS. Which ones would you say that you were majorly involved with and want to speak about?
Louis Harrison: Well, ASTRO is first and foremost obviously. Over the years, I spent about eight or nine years as the vice chair for the refresher courses and helped organize the educational program for the ASTRO meeting. I did that for many years. Obviously, I was elected president of ASTRO. So I did the rotation of president-elect, president, chairman, et cetera. Over the years, with the Radiation Oncology Institute and with any number of taskforce and projects, my relationship with ASTRO has been first and foremost.
I was similarly very active in the American Brachytherapy Society. I did serve as President and Chairman of the Board of that society. I did a lot of work with people in that society. Those are the two that I would say are the most significant to me. Some of those societies that you listed there I've been involved with, but I've led ASTRO and ABS so those are the key ones for me.
Naomi Schechter: What do you consider transformative developments in radiation oncology and oncology in general during your career?
Louis Harrison: There's a lot of different ways to answer that. I think that the caliber of people that have been attracted to this field and that are in this field and that are leading this field now are the highest quality that exists in medicine. So I think that's been a very, very important transformation because as we become better leaders as radiation oncologist, we have the ability to influence treatments and influence research. Although we have a long, long way to go, don't get me wrong, we've come a long way. So I think that that's important.
I think the growing role of radiation therapy in so many diseases. We can go disease by disease by disease. There had been legitimate innovations that had put radiation in such a key role in brain tumors, head and neck, breast, lung - you name it - and with new opportunities arising all the time. Now, of course, with treating metastatic disease and using genomics and radiomics and modeling and things that are bringing more biology to the field, the opportunities will grow even further.
I think, at least in my view, radiation oncology for a bulk of what would be the timing of my career and maybe Paul's career, all of the efforts were made in physics and treatment planning and how to get those into organs more precisely and how to protect normal organs. Another couple of millimeters better as you move to 3-D and IMRT. Et cetera, et cetera, et cetera. I think the boom now and certainly what we're focused on here at Moffitt is the biology and bringing genomics, bringing mathematical modeling, bringing radiomics and adaptive therapies, using other kinds of biological modifiers and predictive biomarkers to the table to personalize and individually factor these into a personalized treatment plan.
So the next era of evolution and I think a very important era of evolution for our field is not just thinking about those distributions and conformality but thinking about completely individualizing therapy using all of these new opportunities in biology and genomics and personalization.
Paul Wallner: Louis, you're listed in your CV as being a member of the Department of Integrated Mathematical Oncology. That's a new one for me. Can you explain that a little bit?
Louis Harrison: Yes. So at Moffitt we have a Department of Integrated Mathematical Oncology. This department is filled with mathematicians who are totally devoted to the arena of predictive modeling. So just like if you imagine a hurricane coming towards the United States, and you watch the weather report and you see the path of the hurricane. It can go this way, or it can go that way. But as it gets closer and closer to land, the ability to predict where it's going to hit, how it's going to hit, what the winds are going to be gets more and more precise.
A lot of the principles of predicting the weather and predicting something like a hurricane, they've brought to predicting what's going to happen to a cancer - how it's going to grow, how it's going to develop, the kinetics of it, the biology of it, where it's going to spread, how it's going to spread - and bring that kind of thinking to understanding how to treat a particular cancer by understanding its individual response characteristics. So there's a whole science that has been built around this kind of response modeling that is predicated on mathematics. I am lucky to be working with an incedible at Moffitt who have taught me a lot about this approach.
So what we have done in our department is build some systems that allow us to look at tumor growth and apply the predicates of mathematical modeling to tumor growth so that we can apply radiation to individual tumors in a manner that respects that growth pattern, and that potentially, most optimally interferes with that growth pattern and then adapts the treatment during the treatment to take response into mind so that the treatment can adapt and respond to these evolving growth and modeling characteristics.
This team that's well-funded and that has become very well-known is strongly integrated into our department's research program and into our adaptive therapy program. That is my secondary appointment here at Moffitt and a lot of those people that are primary scientists have their secondary clinical appointment in radiation oncology. So this involves radiomics also. It involves other kinds of modeling, like modeling immune response, but this is a very dynamic relationship.
Paul Wallner: Do you think the next step in that is artificial intelligence?
Louis Harrison: Yes. Oh, yes. And Machine Learning and Deep learning.
Paul Wallner: You and I can retire then?
Louis Harrison: Oh, yes. Absolutely. And when we retire, treatments will be cheaper and more effective.
Paul Wallner: Good.
Naomi Schechter: Do you want to talk about your move to Moffitt? We skipped something in there too. So do you want to talk about your other position in New York?
Louis Harrison: Oh, I loved that job. I did it for 15, 16 years. I went to Beth Israel. Beth Israel linked up and created this incredible health system called Continuum. I had the privilege of creating and leading the radiation oncology program across that entire health system, and then became the physician-in-chief for all of cancer programs for the entire Continuum health system.
Continuum at its prime was seven hospitals in New York, 3,300 beds. Outside of Sloan Kettering, the largest cancer program in New York. The Manhattan campus for Albert Einstein, that was the main medical school that we were involved with.
We built a citywide, multi-institutional, multi-disciplinary cancer program. The crowning achievement was to get gold-level accreditation by the American College of Surgeons Commission on Cancer. One of the very, very few health systems in the United States to be accredited as an entire network, which meant that we achieved a single standard of care throughout a large hospital system and research program and in all eight categories got gold-level accreditation. So that was just an incredible experience.
Naomi Schechter: It’s amazing. So how could you leave there?
Louis Harrison: Well, a couple of things happened. I was there for 17 years. It was time for something new and different. Our younger daughter was moving to Tampa to go to Graduate School and Moffitt was recruiting me to lead their Radiation Oncology Department and Program. So, we decided to take a family adventure and move to Tampa..
Naomi Schechter: Can you elaborate?
Louis Harrison: As it turns out, at that time, Moffitt was recruiting me to come to Moffitt to be the chair. At the same time, our younger daughter was looking to go to graduate school to get her masters in speech and language pathology. Just by this really, really great sort of juxtaposition, the program that she focused on was the University of South Florida in Tampa and just as I was being recruited to Moffitt. So we had a family meeting and we decided maybe we should all have an experience and come to Tampa.
Now, I knew she'd be here at least three or four years if she was going to be in that program and I was ready for a change. So, off to Moffitt and Tampa. It has turned out to be a wonderful experience, and I have had the chance to work with outstanding people.
Naomi Schechter: Do you want to talk a bit more about your family? Your significant other when you met. It sounds like you met from Brooklyn or Sheepshead Bay.
Louis Harrison: Yes. Ilene and I met when I was a third-year medical student and she was a first year nursing student at Downstate. We grew up in the same neighborhood. We didn't know each other but we lived about ten blocks from each other. We had a lot of common people we knew although we didn't know each other. We got married in 1983. So we've been married for 35 years. We have two children. Barbara who's 33 is married with a two-year-old and is pregnant with their second child. They live in Raleigh, North Carolina. And Michelle, our younger daughter, lives here in Tampa and works as a speech pathologist as I mentioned earlier.
Naomi Schechter: Do you have any hobbies. I think you like golf. Is that right?
Louis Harrison: I love golf. I like to ride my bike and play tennis. I also like to read biographies and read American history.
Naomi Schechter: Which biography are you reading now?
Louis Harrison: Well, right now I'm reading a book about Abraham Lincoln.
Naomi Schechter: No kidding. And what has been your favorite book that you've read? Like a biography or history.
Louis Harrison: I would say if there's such thing as a favorite book, along those lines I would say a book called A Magnificent Catastrophe comes to mind. That is a great book about the election of 1800 which was the first contested presidential election in American history. It just brings you down to earth about if you think it was dirty today, look at it back then.
But I would say another book that I thought is wonderful is the Team of Rivals, the Doris Kearns Goodwin book on Abraham Lincoln. I'm actually re-reading that book now, which was what I mentioned. One of the things I like about Abraham Lincoln and one of the things I like about looking back at American history is reading about the people that were charged with resolving important conflicts and how they did it. There's no better example than that, than Abraham Lincoln and the Civil War. The Team of Rivals, if you know the book, is basically he took all the people that ran against him and put them in his cabinet. That's how he created the government. Boy, do we have a lot to learn from Abraham Lincoln.
Naomi Schechter: You have created so many wonderful programs. What words of wisdom, maybe conflict resolution or just leading -- words of wisdom would you give to future leaders in our field?
Louis Harrison: It's funny you should ask that question. At the recent ASTRO meeting, Sarah Hoffe led a program on leadership in radiation oncology and I was on the panel. I think the words of wisdom that I would give is to learn about influence and emotional intelligence and to work on developing your skills in the arena of emotional intelligence. Part of that allows you to influence the world around you in a way that's positive and in a way that's agreeable to other people. I think that those skills, which are ingredients of leadership, have been lacking in medicine although it's getting much better. So that would be my advice.
Naomi Schechter: I appreciate you giving this interview and we would all welcome a biography from you. I would like to ask just before we go, because our time is coming close, who are you most grateful for?
Louis Harrison: I'm most grateful for my parents and my family that I was born into. I was raised by two great parents. I had four great, wonderful grandparents. We’re very close knit, living all together. That kind of environment shaped me. If I wasn't in that environment with those people, Lord knows what would've happened. So I'm grateful for my parents and my family.
Naomi Schechter: Thank you. I think that's a wonderful way to close the interview. Anything we forgot?
Louis Harrison: Gosh, I don't know. Thank you for being so interested.
Paul Wallner: Thank you for the time and for your contributions.
Louis Harrison: My pleasure, guys. Thank you very much. Take care. Bye.
The following interview of Louis Harrison, MD, FASTRO, was conducted on November 14, 2018, by Naomi Schechter, MD and Paul Wallner, DO, FASTRO.
Naomi Schechter: Okay. So we'll start off. If you could let us know where you were born and where you grew up.
Louis Harrison: I was born and raised in Brooklyn, New York.
Naomi Schechter: Me too. So tell me where, what part of Brooklyn?
Louis Harrison: Sheepshead Bay.
Naomi Schechter: What did you like to do when you were young?
Louis Harrison: Play basketball, play paddle ball, ride my bicycle, play stickball and to go bowling with my friends.
Naomi Schechter: I did this question in there because, just working with you, I just think of you as such a creative person and always pushing at the forefront of our field. So I was wondering if you were a bit of an inventor as a child.
Louis Harrison: No. I can't say that I was an inventor, but I was very studious. I was a dedicated student. I liked school and I enjoyed the classes that I took. It was a good mix of school and athletics, but I can't claim to have invented anything.
Naomi Schechter: Well, what were your favorite subjects?
Louis Harrison: I invented ways to fool my parents sometimes, but that's about it.
Naomi Schechter: You don't want to share any of those?
Louis Harrison: No. I think I'll keep those to myself.
Naomi Schechter: So undergraduate education, high school, college?
Louis Harrison: Yes, I went to high school. I actually went to a private high school in Brooklyn called Poly Prep (Polytechnic Preparatory Country Day School). I went to that school from the 5th grade to the end of high school, and then I went to college at Duke University.
Naomi Schechter: How did you choose to go into medicine?
Louis Harrison: I always wanted to be a doctor since I was very young. I don't have a recollection of ever thinking about or considering anything else. I was one of these little kids that played doctor. I had a doctor’s stethoscope. My grandparents would sit in the waiting room and I would call them into the bedroom which was my examining room. It was funny. I had pictures, I don't know if I still have them, of me doing that. For whatever reason, I always was fascinated by medicine and never considered anything else from a very, very young age.
Naomi Schechter: Were there other people in medicine in your family?
Louis Harrison: No, no, no. Other than to the extent to which every Jewish grandmother has pseudo-medical degrees and I had two Jewish grandmothers who consider themselves very knowledgeable, I am the first official physician in my family.
Naomi Schechter: Why do you think you chose radiation oncology?
Louis Harrison: Well, I was originally in surgery. My initial aspiration was to become a surgeon and was to become a cancer surgeon. In fact, at my medical school graduation, there's a medicine award and a surgery award. I actually won the surgery award at my medical school graduation. I was very committed to surgery even throughout medical school.
And I was committed to cancer from a very early age also because one of the kids that I played with in Brooklyn down the street who was a good friend of mine developed osteogenic sarcoma. He got his leg amputated and died when I was very young. I didn't understand all the medical details except that all of a sudden lost his leg and all of a sudden died, and he was very sick.
That left a lasting impression on me and my mother. I lived in a multifamily house. My grandparents lived downstairs and we lived upstairs. So my mother, my grandmother, the mother of my friend - his name was Martin Elk - and a few other ladies on the block created a little fundraising organization. This organization was created in the 1960s. It exists still today. The purpose was to raise money and give it to Memorial Sloan Kettering for cancer research and to help the kids.
Even as a very, very young person, I would make trips every year with my mother and my grandmother to the toy store to spend the money that was raised to buy toys for the kids at MSKCC. I helped them pick the toys because I was a kid and I knew what the kids like to play with. I went with them and delivered toys to Memorial Sloan Kettering. So I actually started my relationship with Memorial Sloan Kettering when I was 8, 9, 10 years old, way before I ever had the privilege of working there as an attending. So, that's a nice little parallel in terms of my life.
Naomi Schechter: That's lovely. So women were very important to your future. Who else perhaps encouraged you along the way?
Louis Harrison: Both of my parents, and my grandmother and grandfather. We all lived in the same house. I had a few teachers in high school that were role models for me in terms of school. I did have a physician who in truth is like my fourth cousin but I thought of him more as a physician in the family. He was one of the first gastroenterologists in Brooklyn and he was a role model for me as well.
Paul Wallner: I'll interrupt occasionally. You were talking about surgery and I noticed your PGY1 was in surgery. So what sort of changed course?
Louis Harrison: Yes. In medical school I was very focused on surgery and cancer surgery and, in fact, matched into the five-year surgery program at Mount Sinai. But during my fourth year of medical school I took electives in medical oncology and in radiation oncology. At that point, I became persuaded that I thought the future was going to be more about saving organs than removing organs, and quality of life issues, plus organ and function preservation.
So, I actually evolved during my fourth year of medical school away from surgery even though I enjoyed the procedures and I evolved towards the concept of saving things rather than taking them out. I was more intrigued by that idea. So even though I was in the five-year program at Mount Sinai, I applied for a radiation oncology residency at that point. I was one of two or three people that left the surgical program for another field because of that evolution.
Naomi Schechter: So you started the surgical program?
Louis Harrison: Yes, I did. I started it. I completed the first year but I didn't go further because I elected to change to radiation oncology.
Naomi Schechter: So your residency, can you describe that?
Louis Harrison: Yes. I did my residency at Yale. I had a great time. I still maintain to this day a close relationship with that institution. I was visiting professor there just a few weeks ago. I hadn't been back there in a long time. But the Yale program was very strong in clinical radiation oncology, in radiation biology and physics. It was a fun yet hard-working program and led by Jim Fisher who was a brilliant man. Probably if you would ask me to make a list of some of the smartest people I've ever met in my life, Jim Fisher would be at or near the top of that list. I felt like I had a superb residency experience. I would also mention Dick Peschel who was the residency program director and a wonderful teacher.
Naomi Schechter: Who were your mentors in the program?
Louis Harrison: Dick Peschel and Yung Son. Dick Peschel was my main mentor and, of course Jim Fisher. I would say both of those people are my mentors.
Naomi Schechter: What was it about them that cemented the relationship?
Louis Harrison: Dick Peschel was the residency program director. He gave us a lot of the lectures. He taught us how to read a paper and taught us how to write a paper. He was a critical thinker to the extent to which you can, quote/unquote, teach someone to think analytically and be critical and understand what's important and what isn't and what's junk and what's good. Dick was very, very good at that. Jim, Dr. Fisher, I think he’s just sheer intellect. Paul, did you know Jim Fisher?
Paul Wallner: I did. I didn’t know him well.
Louis Harrison: Just his sheer intellect made you strive to push your own intellectual boundaries and think about things and contemplate things that you might not have thought of just because you'd say to yourself, well, how would Dr. Fisher think about this? So even without inspiring you or actively inspiring you to do that, being with him caused that. He had this unique way of being brilliant and insightful and asking questions that you would not think to ask and yet did it with such humanity and such matter-of-factness that his ability to stay close to humanity despite how smart he was was a gift.
Paul Wallner: Just to interject a small comment here. I'm sure Naomi will move on to this in a moment. Of all the programs in the country, the training programs in the country, I think Jim Fisher and the Yale program during his tenure probably serves as an incubator for more significant leadership than any other program in the country.
Naomi Schechter: Could I ask you to give one example of when you're talking about adding the humanity aspect which is so important? Is there one episode that perhaps stands out in your mind?
Louis Harrison: I'm trying to figure out the best way to -- because this is not something that I would necessarily want you to write about. When you hear what I'm going to say, you'll understand why.
Naomi Schechter: We can leave it out, but I want to hear.
Paul Wallner: We can either go off the record or you can just slash it. You can just cut it when you’re --
Louis Harrison: I'm Jewish. I'm not an Orthodox Jew by any stretch of the imagination, but I am Jewish and I'm proud to be Jewish. I was on a particular day seeing a patient, a new patient at Yale that was Dr. Fisher's patient. It was Dr. Fisher who was the attending. I was in scrubs that day because I did a lot of brachytherapy as a resident. I was wearing a Chai necklace representing the Jewish symbol of life. It was around my neck and it was obvious. The patient turned out to be a Nazi. It was a German patient and it was a patient who clearly was anti-Semitic. He had seen the Chai around my neck and did not want me involved in his care. It was a patient that had some standing in the community. Dr. Fisher, I guess from his point of view, was in the dilemma of honoring a patient's wish on the one hand and respecting my heritage on the other. Dr. Fisher told the patient that if he wanted Dr. Fisher, then he got me too. If he didn't want me to be involved, then he wasn't going to be involved. And all that was his choice. I never forgot that.
Naomi Schechter: That is really a special memory. Thank you for sharing it. Who were your fellow residents?
Louis Harrison: My fellow residents, well, in my year my most significant fellow resident was Bruce Haffty. Bruce was a couple years younger than me. Another fellow resident that was in my vintage was Tim Mate I don't know if you know that name, Naomi, but Tim is at the Swedish in Seattle. Tom Fogel, who is in practice in Santa Barbara now. Joseph Cardinale, who is still in the Yale community, was my other co-resident. Joe was actually the Chief Resident. There was another one named Barry Kazynski who was an MD PhD who tragically died way too young. That was the group that I remember the best. There were some others that were not as consequential. Bruce and I were good friends. I was his chief resident and he and I instantly became friends when he started and have remained close friends ever since. Lynn Wilson, who trained after I was there, another fellow Yale alum, has also remained a very close friend.
Naomi Schechter: What was your research focus at the time?
Louis Harrison: I was very interested in brachytherapy and head and neck cancer. I was all over the operating room. There was an attending at Yale named Yung Son. He did most of the brachy there so I was just all over the brachytherapy cases. I had a lot of interest in interstitial brachytherapy, and in learning and doing brachytherapy, and trying to bring some rigor and even some protocols to that practice which in that era - as Paul will tell you - was the cowboy territory.
And head and neck. I was always interested in head and neck cancer so I got involved with the head and neck group and did things in head and neck cancer. That was one of the things that really started me officially on my quest to preserve organs, to think about organ and function preservation, larynx preservation, tongue preservation, eye preservation, head and neck skin cancers. You know, cosmesis. All of that started when I was at Yale.
Naomi Schechter: How did it change during that time you were there as an attending?
Louis Harrison: Well, I was never an attending at Yale. After my residency, I left Yale. I wanted to stay at Yale as an attending as it turns out. Dr. Fisher, another one of the things that he did is -- he wanted me to stay at Yale. I wanted to stay at Yale but I wanted to do a fellowship in brachytherapy. Jim's idea was to go to Memorial Sloan Kettering, do a fellowship in brachytherapy, and then come back to Yale and really take charge of the brachy program.
Now I'm a New Yorker, as you know, and my wife's a New Yorker. My wife, Ilene, is also from Sheepshead Bay. There was a lot of gravitational pull for us to return to New York, Zvi Fuks and Sam Hellman were just coming there at around that time and they were working towards creating a great program at MSKCC. I decided to become a part of that endeavor. Anyway, I went down to Memorial for an interview for the brachy fellowship. It went through the day. I was going to do what Dr. Fisher wanted, do the fellowship and then come back to Yale and I hit it off with Zvi Fuks. I'll never forget this. I started my day with Dr. Fuks and I ended my day with Dr. Fuks. As my day was ending, I was in his office and we really, really hit it off. To this day I consider him one of my lifelong mentors. I love Zvi. You'll appreciate this, Naomi, from your days at Memorial, but in his own inimitable way - - he said, “Louis, you are not going to get the fellowship.”
Naomi Schechter: Oh. But you did pretty good.
Louis Harrison: There I was at the end of this interview day and he was like, “Louis, you are not going to get the fellowship.” I was crushed. Then he said the reason is “you're going to be an attending instead.”
Naomi Schechter: Oh, my gosh.
Louis Harrison: So he left me. He always did. He’d leave you that 30 seconds thinking that you're dead only to resurrect you in a way that you never expected, right? You know what I'm talking about. Vintage Zvi!!
Naomi Schechter: Yes.
Louis Harrison: But that was the first day I met him so I didn't know that that's what was happening. So then I went home to my wife and I said I didn’t get the fellowship. She said, oh no. Then I told her what happened and she really wanted to move back to New York. Then I had the task of going to tell Dr. Fisher what --
Naomi Schechter: But he never gave you a choice. He just told you you're going to be an attending.
Louis Harrison: But now I had to explain this to Dr. Fisher, which I did, and he understood completely. Family first. That's how much of a gentleman he was to me when I told him that at the end of the day this is what my wife really wants to do and I concur. Although I have to tell you that Ilene was the driver of this because she is in most of our decisions. And that's what happened.
Naomi Schechter: Wow. That's amazing story.
Naomi Schechter: I got the impression when I was at Sloan Kettering that each of the individual attendings had really worked to build the program to the stature it was. At the time I went, it was the number one cancer center in the country. So how would you say you all did that as a group, the team? There were so many stars by the time I came, but I know that you all had built it individually.
Louis Harrison: Well, Sam Hellman was the hospital physician-in-chief and Zvi was the department chairman. I think all of us shared a tremendous loyalty and devotion to Zvi. Sam was there for a much shorter time but it was nice to have a radiation oncologist there as physician-in-chief. But even after he left, Zvi was the driving force. I think he inspired us and he loved us. He helped make us successful with that inspiration and that focus. Zvi listened carefully and remembered everything you told him.
You know Zvi. Paul, you know Zvi. Zvi is a special person and he lights up a spark. If he takes a special interest in you, it feels great. I think of him all the time because how he mentors people, his own unique style of mentorship is a style that I've tried to emulate in some ways. Nobody can be Zvi, but he inspired us all and he picked good people.
You know, the most important job of a chair is picking people. If you choose the right people and give them the resources and get out of their way, that's a very good formula for success. And Zvi did that. He chose good people. He helped us and he got out of our way. If we were screwing up, he would tell us.
But Zvi also had a tremendous humanity and he would never forget things that were meaningful. I can tell you that I told him once when I interviewed, the first day I was there I told him that one of my inspirations growing up in terms of communication skills was a man named Abba Eban. Do you know that name? Do any of you know that name?
Paul Wallner: He was the foreign minister of Israel. The first foreign minister.
Louis Harrison: That's right, the foreign minister of Israel. He was the Israeli ambassador to the United Nations and he just had a gift of speaking beautifully and was recognized for this skill. I mentioned this to Zvi when I interviewed. This never ever came up again. Years later, and I mean several years later, I was in clinic and I got paged to 5868 which was Zvi's extension, “Louis, come to my office now.” Not knowing what to expect, and assuming that I must be in trouble, I went down to his office. Abba Eban was sitting in his office.Zvi wanted me to meet him. He remembered that story from years ago.
Naomi Schechter: No way.
Louis Harrison: He wanted to introduce me to Abba Eban because he remembered, God knows how he remembered what I told him so many years ago. That's Zvi Fuks.
Naomi Schechter: Wow. That's amazing. I can see why you say that. All the attendings really had their unique path. You're all different but all leaders. So what would you consider to be your main clinical and research focus areas and contributions to the field, for the record?
Louis Harrison: My contributions in head and neck cancer that have led to organ and function preservation, mainly for oropharynx cancer. Part of that was we were one of the first to use radiation and chemotherapy together in head and neck cancer, one of the first to use delayed concomitant boost as part of the treatment, and one of the early ones to use modern brachytherapy techniques.
In that context, I would have to include two specific contributions. One was our randomized trial in soft tissue sarcoma where we published our data comparing surgery versus surgery plus brachytherapy and showed the advantage to radiation specifically to brachytherapy in the local management of soft tissue sarcoma. That was the first time in my career that I got a plenary session presentation at ASTRO, it was that paper and that presentation. So that's something that I think was important.
Naomi Schechter: And meaningful with your childhood influence.
Louis Harrison: Absolutely. That's true. That's a very good point. Thank you. Then I would say the contributions about developing intraoperative radiation therapy. I think those were the things. All of that started at Memorial. The head and neck were continued afterwards as to the IORT work. But I think those are the main areas I would focus on.
Paul Wallner: Lou, can you talk a little bit about the evolution of the brachytherapy service during the years that you were there?
Louis Harrison: Yes. When I got there, the way it was done is that each of us were assigned a day. My day was Wednesday. The surgeons at Memorial Sloan Kettering saw all the patients and made all the decisions. That's the way it was. If you were on your OR day, you were on-call to go to the operating room when they needed your attention for a potential procedure. So you'd show up on Wednesday, and your pager would go off that they are ready for you in a certain OR. You'd go into the OR and they would be doing a thoracotomy and there would be a close margin along the aorta. Then your job would be to assess the situation and decide whether to do brachytherapy, and potentially do the procedure. Then, as you're finishing your pager would go off that another team was ready for you in another OR. You go into the other OR and they would have another situation for you to review and decide. You went from room to room to room throughout the day and handled whatever came up.
I did not like this way of doing things, and neither did Zvi. But about three years into my tenure at Memorial Sloan Kettering, they made me the chief of the brachytherapy service because Dr. Hilaris (had left. When Zvi asked me to do this, I said, “Zvi, I'll do it under one condition: I'm going to change this whole process, and insist on a process whereby the radiation oncologists sees all the patients in consultation up front, and the OR cases are then jointly booked with the surgeon and the radiation oncologists; the surgeons may not like this and I will need your support. The case will be booked for the brachytherapy under the name of the radiation oncologist. We'll get informed consent and that whole thing. If you will support me on that, then I'll do this in addition to building an IORT suite.” And to Zvi's credit, he supported me and we did it.
There were many surgeons who did not like this and did not want to make this process change. They felt it would be inefficient and cumbersome. But we knew it was the right thing to do, so we did it. You have to remember that I was three years out of training. So I was junior when we did this. Zvi had my back.
This allowed us to make better clinical decisions and take control of the work. That allowed us to start to develop clinical trials. That allowed us to start to do work that combined external beam and brachytherapy. It allowed us to start to bring purpose, integrity, all of the right things to this area of practice which didn't exist before when it was more like a service than an academic endeavor. This was a complete sea change. I believe that this move, as uncomfortable as it was, was a very important step in radiation oncology. Radiation oncologists are getting the respect we deserved and having the standing we deserved at Memorial because before that we were technicians for the surgeons.
Naomi Schechter: Well, thank you for doing that. That was one of the lessons that I actually took away from spending time with you, is that we are oncologists and that we need to be making the decisions and weighing in equally. So I really appreciate that you did that for us.
Louis Harrison: Thank you.
Naomi Schechter: What were some of the controversies in your career? So that was one of the main ones. Do you have any others? You have many hats on with the head and neck, and the sarcoma and the lung. Were you on all those services, or do you feel like it was because you were the brachytherapy lead that had brought it all together? Or did you have a favorite path?
Louis Harrison: Head and neck was always my passion, but the brachytherapy aspect of it got me involved in all of these other programs. For Sarcoma, I was fortunate to work with Dr. Murray Brennan. So it was through brachytherapy that I got to do a lot of these other things. Then when we started the IORT program, one of the first areas that we explored IORT was in rectal cancer. Dr. Warren Enker, who was one of the senior colorectal surgeons there, who was a good friend to this day, I worked together with him on that.
So while my anatomical site that I was always and still am most passionate about is head and neck, these procedures and exploring and expanding these procedures did get me involved in these other sites. Quite frankly, I really enjoyed that. I think that nowadays, as we all know, in radiation oncology everybody is very, very site-specific. But doing brachy allowed me to be a little bit more versatile which I appreciated and still appreciate.
Naomi Schechter: You've had leadership roles with so many organizations. We thought of ASTRO, RTOG, ABR, ACR, PTCOG, ASCO, ABS. Which ones would you say that you were majorly involved with and want to speak about?
Louis Harrison: Well, ASTRO is first and foremost obviously. Over the years, I spent about eight or nine years as the vice chair for the refresher courses and helped organize the educational program for the ASTRO meeting. I did that for many years. Obviously, I was elected president of ASTRO. So I did the rotation of president-elect, president, chairman, et cetera. Over the years, with the Radiation Oncology Institute and with any number of taskforce and projects, my relationship with ASTRO has been first and foremost.
I was similarly very active in the American Brachytherapy Society. I did serve as President and Chairman of the Board of that society. I did a lot of work with people in that society. Those are the two that I would say are the most significant to me. Some of those societies that you listed there I've been involved with, but I've led ASTRO and ABS so those are the key ones for me.
Naomi Schechter: What do you consider transformative developments in radiation oncology and oncology in general during your career?
Louis Harrison: There's a lot of different ways to answer that. I think that the caliber of people that have been attracted to this field and that are in this field and that are leading this field now are the highest quality that exists in medicine. So I think that's been a very, very important transformation because as we become better leaders as radiation oncologist, we have the ability to influence treatments and influence research. Although we have a long, long way to go, don't get me wrong, we've come a long way. So I think that that's important.
I think the growing role of radiation therapy in so many diseases. We can go disease by disease by disease. There had been legitimate innovations that had put radiation in such a key role in brain tumors, head and neck, breast, lung - you name it - and with new opportunities arising all the time. Now, of course, with treating metastatic disease and using genomics and radiomics and modeling and things that are bringing more biology to the field, the opportunities will grow even further.
I think, at least in my view, radiation oncology for a bulk of what would be the timing of my career and maybe Paul's career, all of the efforts were made in physics and treatment planning and how to get those into organs more precisely and how to protect normal organs. Another couple of millimeters better as you move to 3-D and IMRT. Et cetera, et cetera, et cetera. I think the boom now and certainly what we're focused on here at Moffitt is the biology and bringing genomics, bringing mathematical modeling, bringing radiomics and adaptive therapies, using other kinds of biological modifiers and predictive biomarkers to the table to personalize and individually factor these into a personalized treatment plan.
So the next era of evolution and I think a very important era of evolution for our field is not just thinking about those distributions and conformality but thinking about completely individualizing therapy using all of these new opportunities in biology and genomics and personalization.
Paul Wallner: Louis, you're listed in your CV as being a member of the Department of Integrated Mathematical Oncology. That's a new one for me. Can you explain that a little bit?
Louis Harrison: Yes. So at Moffitt we have a Department of Integrated Mathematical Oncology. This department is filled with mathematicians who are totally devoted to the arena of predictive modeling. So just like if you imagine a hurricane coming towards the United States, and you watch the weather report and you see the path of the hurricane. It can go this way, or it can go that way. But as it gets closer and closer to land, the ability to predict where it's going to hit, how it's going to hit, what the winds are going to be gets more and more precise.
A lot of the principles of predicting the weather and predicting something like a hurricane, they've brought to predicting what's going to happen to a cancer - how it's going to grow, how it's going to develop, the kinetics of it, the biology of it, where it's going to spread, how it's going to spread - and bring that kind of thinking to understanding how to treat a particular cancer by understanding its individual response characteristics. So there's a whole science that has been built around this kind of response modeling that is predicated on mathematics. I am lucky to be working with an incedible at Moffitt who have taught me a lot about this approach.
So what we have done in our department is build some systems that allow us to look at tumor growth and apply the predicates of mathematical modeling to tumor growth so that we can apply radiation to individual tumors in a manner that respects that growth pattern, and that potentially, most optimally interferes with that growth pattern and then adapts the treatment during the treatment to take response into mind so that the treatment can adapt and respond to these evolving growth and modeling characteristics.
This team that's well-funded and that has become very well-known is strongly integrated into our department's research program and into our adaptive therapy program. That is my secondary appointment here at Moffitt and a lot of those people that are primary scientists have their secondary clinical appointment in radiation oncology. So this involves radiomics also. It involves other kinds of modeling, like modeling immune response, but this is a very dynamic relationship.
Paul Wallner: Do you think the next step in that is artificial intelligence?
Louis Harrison: Yes. Oh, yes. And Machine Learning and Deep learning.
Paul Wallner: You and I can retire then?
Louis Harrison: Oh, yes. Absolutely. And when we retire, treatments will be cheaper and more effective.
Paul Wallner: Good.
Naomi Schechter: Do you want to talk about your move to Moffitt? We skipped something in there too. So do you want to talk about your other position in New York?
Louis Harrison: Oh, I loved that job. I did it for 15, 16 years. I went to Beth Israel. Beth Israel linked up and created this incredible health system called Continuum. I had the privilege of creating and leading the radiation oncology program across that entire health system, and then became the physician-in-chief for all of cancer programs for the entire Continuum health system.
Continuum at its prime was seven hospitals in New York, 3,300 beds. Outside of Sloan Kettering, the largest cancer program in New York. The Manhattan campus for Albert Einstein, that was the main medical school that we were involved with.
We built a citywide, multi-institutional, multi-disciplinary cancer program. The crowning achievement was to get gold-level accreditation by the American College of Surgeons Commission on Cancer. One of the very, very few health systems in the United States to be accredited as an entire network, which meant that we achieved a single standard of care throughout a large hospital system and research program and in all eight categories got gold-level accreditation. So that was just an incredible experience.
Naomi Schechter: It’s amazing. So how could you leave there?
Louis Harrison: Well, a couple of things happened. I was there for 17 years. It was time for something new and different. Our younger daughter was moving to Tampa to go to Graduate School and Moffitt was recruiting me to lead their Radiation Oncology Department and Program. So, we decided to take a family adventure and move to Tampa..
Naomi Schechter: Can you elaborate?
Louis Harrison: As it turns out, at that time, Moffitt was recruiting me to come to Moffitt to be the chair. At the same time, our younger daughter was looking to go to graduate school to get her masters in speech and language pathology. Just by this really, really great sort of juxtaposition, the program that she focused on was the University of South Florida in Tampa and just as I was being recruited to Moffitt. So we had a family meeting and we decided maybe we should all have an experience and come to Tampa.
Now, I knew she'd be here at least three or four years if she was going to be in that program and I was ready for a change. So, off to Moffitt and Tampa. It has turned out to be a wonderful experience, and I have had the chance to work with outstanding people.
Naomi Schechter: Do you want to talk a bit more about your family? Your significant other when you met. It sounds like you met from Brooklyn or Sheepshead Bay.
Louis Harrison: Yes. Ilene and I met when I was a third-year medical student and she was a first year nursing student at Downstate. We grew up in the same neighborhood. We didn't know each other but we lived about ten blocks from each other. We had a lot of common people we knew although we didn't know each other. We got married in 1983. So we've been married for 35 years. We have two children. Barbara who's 33 is married with a two-year-old and is pregnant with their second child. They live in Raleigh, North Carolina. And Michelle, our younger daughter, lives here in Tampa and works as a speech pathologist as I mentioned earlier.
Naomi Schechter: Do you have any hobbies. I think you like golf. Is that right?
Louis Harrison: I love golf. I like to ride my bike and play tennis. I also like to read biographies and read American history.
Naomi Schechter: Which biography are you reading now?
Louis Harrison: Well, right now I'm reading a book about Abraham Lincoln.
Naomi Schechter: No kidding. And what has been your favorite book that you've read? Like a biography or history.
Louis Harrison: I would say if there's such thing as a favorite book, along those lines I would say a book called A Magnificent Catastrophe comes to mind. That is a great book about the election of 1800 which was the first contested presidential election in American history. It just brings you down to earth about if you think it was dirty today, look at it back then.
But I would say another book that I thought is wonderful is the Team of Rivals, the Doris Kearns Goodwin book on Abraham Lincoln. I'm actually re-reading that book now, which was what I mentioned. One of the things I like about Abraham Lincoln and one of the things I like about looking back at American history is reading about the people that were charged with resolving important conflicts and how they did it. There's no better example than that, than Abraham Lincoln and the Civil War. The Team of Rivals, if you know the book, is basically he took all the people that ran against him and put them in his cabinet. That's how he created the government. Boy, do we have a lot to learn from Abraham Lincoln.
Naomi Schechter: You have created so many wonderful programs. What words of wisdom, maybe conflict resolution or just leading -- words of wisdom would you give to future leaders in our field?
Louis Harrison: It's funny you should ask that question. At the recent ASTRO meeting, Sarah Hoffe led a program on leadership in radiation oncology and I was on the panel. I think the words of wisdom that I would give is to learn about influence and emotional intelligence and to work on developing your skills in the arena of emotional intelligence. Part of that allows you to influence the world around you in a way that's positive and in a way that's agreeable to other people. I think that those skills, which are ingredients of leadership, have been lacking in medicine although it's getting much better. So that would be my advice.
Naomi Schechter: I appreciate you giving this interview and we would all welcome a biography from you. I would like to ask just before we go, because our time is coming close, who are you most grateful for?
Louis Harrison: I'm most grateful for my parents and my family that I was born into. I was raised by two great parents. I had four great, wonderful grandparents. We’re very close knit, living all together. That kind of environment shaped me. If I wasn't in that environment with those people, Lord knows what would've happened. So I'm grateful for my parents and my family.
Naomi Schechter: Thank you. I think that's a wonderful way to close the interview. Anything we forgot?
Louis Harrison: Gosh, I don't know. Thank you for being so interested.
Paul Wallner: Thank you for the time and for your contributions.
Louis Harrison: My pleasure, guys. Thank you very much. Take care. Bye.
