Michael Link on advances in pediatric oncology, his term as ASCO President—and concern for the future

To date, Michael P. Link has the unique honor of being the only pediatric oncologist to have served as president of the American Society of Clinical Oncology. 

Link, who is the Lydia J. Lee Professor in Pediatric Oncology at Stanford University, appeared on the Cancer History Project Podcast in conversation with Paul Goldberg, co-editor of the Cancer History Project and editor and publisher of The Cancer Letter.

In honor of Childhood Cancer Awareness Month, Link revisits what drew him to pediatric oncology, his auspicious mentors, his 2011-2012 ASCO Presidential term—and his concerns about what he’s seeing in oncology today.

Over the course of his career, Link has seen a childhood cancer cure rate increase from a mere 40% to closer to 90%. But he’s concerned about how the field of oncology is being impacted today.

In his 2012 Presidential address, Link said:

He expressed shock about how things have changed in 2025. 

“I’m a pediatrician, so here I am and they have measles? I mean really, measles in 2025? How is that possible?” Link said. “I never thought I’d be in a position where I have to talk to people about measles and polio and chickenpox as a threat… And measles, it’s a matter of how serious your illness is going to be, and if you’re immunocompromised it’s life threatening.”

Other concerns from his time as ASCO President have reemerged—or never really gone away.

In 2012, Link said, “But all this newfound insight into these diseases and their treatment is only as good as our ability to deliver what we know. The current chemotherapy shortage is emblematic of the precarious nature of the path between the discovery and the delivery of our most exciting new findings.”

Speaking on the podcast, Link called this an issue of “whack-a-mole”—where new drugs go into shortage on a regular basis. “Can you believe that here we are in whatever year it is, 20-whenever the next shortage is going to come and we don’t have access to this?”

This oral history interview is available on Spotify, Apple Podcasts, and YouTube.

Related articles

• Michael Link’s 2012 ASCO Presidential Address: “Collaborating to Conquer Cancer: Lessons from Our Children”, Sept. 22, 2025
• Michael Link Elected ASCO President, Jan. 15, 2010
• ASCO 2012: Michael Link’s Presidential Address, and the 2012 Award Winners, June 8, 2012

Episode Transcript

Katie Goldberg: The Cancer History Project is an online archive of the history of oncology, collaboratively curated by the institutions and people who shaped it.

We have over 60 partners, spanning academic cancer centers, government agencies, advocacy groups, and even the occasional podcast.

Visit us online at cancerhistoryproject.com to dig through our archives.

I’m your host, Katie Goldberg.

Michael Link: I dedicate this talk to patients and families I have cared for over the course of my career. As pediatric oncologists and parents know, there is nothing more motivating than a sick child, nothing to keep one honest and humble like the probing questions of an adolescent, and no greater pleasure than to have intervened in a child’s life—to have the gratification of seeing that child grow up, realize his or her dreams, and start a family. My patients have been my partners in a wonderful profession, and collaborators in my own efforts to advance the field. I am grateful for how much they have enhanced my career and my life.

Katie Goldberg: That was Michael Link, presenting his 2012 American Society of Clinical Oncology Presidential address. 

This September, for Pediatric Cancer Awareness Month, we sat down with Dr. Link to talk about his career, his mentors, the field of pediatric oncology, and what he’s seeing today.

When Dr. Link started his career as a pediatric oncologist, only 40% of kids with cancer were cured. Today, that number is closer to 90%. 

Dr. Link has the unique honor of being the only pediatric oncologist to have served as ASCO president. His presidential term, 2011-2012, was colored by some of the same issues we still see today—particularly drug shortages.

The drug shortages Dr. Link saw during his presidential term keep coming back—sometimes it’s cheap drugs that should be easy to manufacture, other times it’s essential items like IV bags, and saline. He says the choices of who gets the drugs that are in limited supply are heartbreaking, and the substitutions are insufficient. And the cause? As ASCO President, he told the Wall Street Journal it was a “consequence of unfettered capitalism.”

Dr. Link became a pediatric oncologist at a time when the biology of the diseases was first becoming understood—when oncologists could “know their enemy.” During his first pediatric rotations, he realized that he loved working with kids, and supporting them through one of the greatest challenges of their lives. Their resilience, he says, is unmatched.

This interview was conducted by Paul Goldberg, editor and publisher of The Cancer Letter, and co-editor of the Cancer History Project.

Dr. Link is the Lydia J. Lee Professor in Pediatric Oncology at Stanford University.

This episode is accompanied by an archive which includes Dr. Link’s full 2012 ASCO Presidential Address, along with his original slides. Visit the link in the description of this episode to learn more.

The Cancer History Project is sponsored by the American Society of Clinical Oncology and the University of Texas MD Anderson Cancer Center. 

Paul Goldberg: Welcome to the Cancer History Project podcast. With us today, we have Dr. Michael Link who is a pediatrician at Stanford, and he is also the only pediatrician I believe ever to have served as ASCO president. So, is that correct?

Michael Link: There’s two messages there. They didn’t repeat it, so that may have be a reflection of what they thought about my presidency, but I like not to think that, I like to think that they learned something from pediatricians, and I hope that there will be soon another pediatric president.

Paul Goldberg: Well, now it’s even easier. You were there when ASCO presidency was more of a popularity contest that was decided by… You know? If you were a breast cancer doc, you had a better shot than a pediatrician.

Michael Link: That’s true. Yeah, it’s a much better system now in terms of making sure that they get an appropriate person to be president instead of just voting for the next breast cancer doctor, I agree.

Paul Goldberg: Yeah. So we’ve known each other probably through most of our careers. And—

Michael Link: Yeah, I remember you sitting in the side at the Board of Scientific Advisor meetings. I think that’s where I probably saw you for the first time. Neither of us were as gray as we are, but that was a long time ago in my career. So yes, I think that we have, and certainly I have, I’ll put in a shameless plug here that I read The Cancer Letter regularly. It’s a terrific way of pointing out to what’s going on because you are pretty well connected and certainly have your finger on the pulse of what’s new, including some paper you should have read. So I think it’s important, and I definitely read it.

Paul Goldberg: Well, thank you.

Michael Link: And thank you for all you do as in your advocacy, reporting, and everything else that goes along with The Cancer Letter.

Paul Goldberg: Well, thank you so much. It’s actually an interesting boundary between advocacy and reporting. And I guess when you do one well or try to do one very well, then you kind of switch over into the other.

Michael Link: Well, no, I think you’ve done a great job in terms of you just call them as you see them. And the advocacy part is sort of like if you can’t figure out what’s here, you need a CT scan. But I think that those are the kinds of things, that there’s a take on the news, which is pretty helpful for us out here not in Washington and not connected all the time. And of course now, particularly these times are very challenging, let’s put it that way.

Paul Goldberg: Very. Well, it’s interesting because pediatricians in general and pediatric oncologists have a certain insight into how to be in the world.

Michael Link: How to survive when the world is stacked against you, yeah. No, I think that-

Paul Goldberg: But also how to do something that is so important and that is so heartbreaking.

Michael Link: Well, I think that part of what, and as I said in my ASCO address, it’s partly there’s a certain optimism about doing this because we have moved the needle so far, even in the time period of my career, not because of my career particularly, but in that time period, I mean, things have really changed to where we cure the overwhelming, or let’s say 80% of all kids with cancer and leukemia. When I was a fellow, it was 40% of the kids were cured, and now it’s more than 90%. And I remember in particular, Burkitt Lymphoma, when I was a resident, we would see these kids and every one of them, although they seemed to respond initially, every one of them would die of their disease.

And now we cure that disease with impunity. And it’s remarkable. And also remarkable is that the drugs that we use. They’re very few that weren’t available at the time I was a resident. So it’s really collaboration, incremental improvement in clinical trials, and having virtually every patient participate. So it’s been a good run for pediatricians, and I suspect that that incremental improvement every time you do something and knowing that you have a wide-ranging impact on all the kids with cancer, that’s the kind of thing that keeps us optimistic, even in our times.

Paul Goldberg: I hadn’t thought about this. So most of the cytotoxic drugs, those drugs that cost, you know…

Michael Link: A nickel.

Paul Goldberg: … $5.

Michael Link: Yeah.

Paul Goldberg: That’s all you have right now mostly? I thought you would have all kinds of—

Michael Link: Oh, no, no, we have more, but in that particular disease, and even in leukemia, of course, now we have new agents which really gave that extra boost for the refract—for patients who have a high-risk disease. But in many of these diseases, these drugs, we’re still using the same ones. Now we’ve added, we’ve now added in, let’s say Hodgkin disease, Brentuximab is now in the mix, and checkpoint inhibitors are in the mix and really have further changed the paradigm. If you look at Burkitt lymphoma, except for the introduction of Rituximab, those drugs were all available when I was a resident, the drugs that we use. So it’s quite remarkable and just shows that if you have people thinking about it and how to do things better, better supportive care, you can move the needle. So it’s been wonderful to watch this change.

Paul Goldberg: What got you into oncology and pediatric oncology? How did that happen?

Michael Link: Well, I’m a big believer in that there are influential people in your life that serve as role models in a way that you want to be like that person. And my brother was a major influence on my life, he’s five years ahead of me, I think there’s no question that both of us sort of thought that we were going to be physicians early on, but the fact that he did it and found it very rewarding sort of influenced me.

But when he was a resident, he did pediatrics and he sort of encouraged me to do a few rotations, and a couple of my rotations were quite remarkable in terms of I didn’t know that I would really like kids that much. I mean, I didn’t have children of my own at this time, and just the idea of taking kids through pretty serious illness and then coming out the other side, and something that’s still true today, if it weren’t for the parents, it would be a totally delightful experience taking care of these kids. But it’s just because they are incredibly resilient. So his influence really permeated.

I did a few rotations in Boston, I had been in medical school at Stanford, and he said that would be a good idea to check out some other places, and the idea that Boston was sort of a center of where you could network. And I met some people there that there’s no question that continued to influence my career, and then I did my residency there and my fellowship. And into my internship, for example, I met Harvey Cohen, who, he was a pediatric oncology fellow at the time, although he had also had a PhD in biochemistry. And just his style, how he took care of patients, had a lasting influence on me and really sort of sealed the deal. He and another one of my mentors, Howard Weinstein—still the smartest oncologist I know—these were people who were just so excited about what they did and committed to what they did and showed me how you relate to patients that I wanted to be part of that, part them, and never regretted that decision for sure.

Harvey ultimately became my department chairman at Stanford years later, but I learned a lot from mentors that I had in Boston during my residency and ultimately my fellowship. And then of course, you have some major players that have influenced my life. Sharon Murphy, she rest in peace. Very important figure in terms of how I continued what I wanted to be interested in. David Nathan, of course, is a major influence. And Joe Simone, these were people who I was flattered to be in their sphere of influence, and people who really took care of me, took me under their wing. And these were people that certainly influenced my career. So people who came along and you wanted to emulate their style, emulate how they took care of people, how they integrated basic knowledge of basic science into care, these were the things that influenced my choice of pediatric oncology, and it’s certainly a choice that I’ve never regretted.

Paul Goldberg: Yeah, what about your brother? Where is he now?

Michael Link: Well, my brother unfortunately died about four years ago of pancreatic cancer, but he was a pediatrician and pediatric nephrologist, and so no question, there were some decisions that I had to make that I might say were, having lived as his younger brother my whole life, and people in my teachers in school would call me by my brother’s name, and, you know—

Paul Goldberg: His name is?

Michael Link: So he was David. So they would call me David and I would say, “Oh, that’s my brother,” and so this went all through life this way. And ironically when I was at medical school at Stanford, far away from his reach, and I enjoyed the idea that I was my own person, and then I went back to Boston and one of the downsides of Boston was there I was in his territory, and he had been a resident at the Mass General, and I did some rotations there, but specifically, I had a wonderful rotation as a medical student at the Children’s Hospital, so I decided I was going to choose the Boston Children’s Hospital, and so partly to get away from his direct influence.

And so, I was ready to start, and found out that just a couple months before I started my internship, he had accepted a fellowship in nephrology at Children’s Hospital, so we were together again, and the page operators would confuse us all the time. So I was right back where I started, and I think that was one of the reasons I think that I didn’t take a job in Boston at Dana-Farber, I actually migrated to Stanford over the objections of David Nathan, no less a person. So that was… You know? I had to contend with that, but I had to get out from under, and I think it was a good decision for me.

Paul Goldberg: Where did you grow up?

Michael Link: I grew up in Cleveland, Ohio. Good place to grow up, a lot of people from Cleveland, but not a lot… You know? I mean, I realized that if LeBron James could change the entire economic outlook of a city just by leaving or coming, I realized that probably I needed something a little more than that. It was a good place to grow up, but I am glad to have left. And certainly when I went to medical school, I fell in love with California, and so that was one of my reasons for returning 40 years ago.

Paul Goldberg: Wow, wow. It’s been 40 years at Stanford.

Michael Link: Actually more. I joined the faculty in 1979.

Paul Goldberg: Just thinking back, when did you make the decision to go into pediatric oncology?

Michael Link: I think that when I was a resident finishing my internship and starting my residency, I sort of had to sit down with a couple of my mentors who were planning my career for me, as they can only do in Boston. And they basically told me the things that I couldn’t do and the fields where the science was really the most exciting, and they were really in genetics at that time and hematology oncology. And as I said, I had a couple people there who just made… You know? And during my rotation on the oncology service, I really fell in love with the clinical aspects of the field.

And of course, at that time, there was just the beginnings of the excitement surrounding the biology and understanding more of the biology of leukemia. So it was really sort of a slam dunk. And then David Nathan, of course, planned my career for me, just telling me what I should do. So initially I thought I was going to be a bone marrow transplanter, but ultimately sort of just was influenced by the oncologist and was happy to do pediatric oncology. So it was really that stay in Boston during my beginning of my junior residency where I was totally captivated by all aspects of it, and then that’s when I really decided to enter the field.

Paul Goldberg: But this is also the time of just incredible excitement in that field.

Michael Link: Yeah. And it’s even more exciting now obviously, but in there, this is when the biology of leukemia was being unraveled, and the idea that you could sort out risk groups of children with leukemia, and understanding that this disease which was look the same under the microscope, was really 15, 20, 25 different diseases on a molecular level. This was all emerging at that time, and how could you resist? I mean, you could really understand your enemy for the first time. So that was always one of the things that I’ve told residents too. I said, “Why did you be an oncologist?” Said, “You can actually see your enemy. You look at the microscope and there it is, it’s leukemia, it’s a Wilms tumor,” or whatever. I said. “Show me what a lupus looks like.” You know?

You can’t even grab your enemy and sort of visualize it. So this was another one of the attractions that you could… And I love the collaboration. I mean, the idea of this multidisciplinary care, of really working with surgeons and working with pathologists and working with radiation oncologists. I mean, it was such an attractive thing, and that was what was emerging at that time of how we took care of patients. And as I’m sure you know and I had some wonderful collaborators, of Sarah Donaldson, my radiotherapy collaborator, wonderful mentor and colleague, and Ron Levy who sort of introduced me to all the immunology of… I mean, these are people who were huge figures in my life, my professional life. And so it was an easy migration into pediatric oncology, for sure.

Paul Goldberg: Yeah, yeah. And I guess just having mentors like Joe Simone who was a total giant, and even in leukemia as well and childhood disease.

Michael Link: Yeah and he was just a wonderful mentor. I mean, you have to understand, in the addition of to these people, they’re pediatricians, which they are warm, welcoming, helpful, and it was an atmosphere of that, they’re your colleagues. I mean, they accepted you as a colleague. It was a wonderful feeling. And as I said, we’re a relatively small community of pediatric oncologists, but we all like each other, help each other, collaborate with each other, and that’s I think one of the wonderful nature of the field of pediatric oncology. And I think that’s been that way for a long time.

Paul Goldberg: And run studies together, which is—

Michael Link: Exactly, oh, that’s the whole thing, the idea that you know you… As I said, I reviewed my presidential address, and that was the whole point. You couldn’t do it by yourself. There was just no way you were going to have enough patients in one institution to run studies that are going to have statistical endpoints or the endpoints that statisticians are going to be able to hang their hat on. And so you had to collaborate, and so that was one of the wonderful things about the pediatric oncology group, the Children’s Cancer Group, and ultimately the children’s oncology group, and also some of the small collaborations, five or six institutions getting together. We have our own Hodgkin Consortium with St. Jude, Dana-Farber, and Stanford, and a couple other institutions, all collaborating to have enough patients to make a meaningful contribution to the field. So, yes. I-

Paul Goldberg: And also, yeah, this is an era when there were four cooperative groups in pediatrics, right?

Michael Link: Yeah, well, there was at the time with the Children’s Cancer Group, the pediatric oncology group, and then the Wilms Tumor was a separate little group, and the inner group rhabdomyosarcoma study group. And at the time we had this meeting that turned to be really transformational. We were meeting, I actually was the vice chairman of the pediatric oncology group and also of the Rhabdomyosarcoma study group. And we were sitting around and talking about studies where we have to collaborate, and Sharon Murphy just had this, she said, “Why are we doing this? Why don’t we just merge?” I mean, she said it in only way Sharon could say it, in a very compelling… The argument was essentially irrefutable. And from then on, we just sort of merged.

And there were some bumps in the road and some regrets and some unregrets, we always felt that the competition between groups was actually healthy in some ways because you had more than one idea going at the time, but ultimately, of course, the way things have gone, and because the cure rates are so high, and there’s not enough patients in the whole galaxy to do some of the studies that we’d like to do, so the unification of the groups as COG was an important and really transformational idea that she had. I think it’s changed the face of pediatric cancer.

Paul Goldberg: Yeah, totally. And then also paved the way for other groups to merge and become more—

Michael Link: Yeah, I mean, it just needed in this day and age. Where the patients are a resource, that is in short supply sometimes for some of the studies that you want to do. And especially, again, back to that theme, that’s the cancers that we thought are one cancer, are actually multiple, multiple different subtypes that have different prognosis, different driving mutations that we know now, so that the groups that you’re studying are getting smaller and smaller. And so international collaboration is the name of the game if you’re going to get anything done. So Sharon had foresight, there’s no question about it, and it was definitely needed, and I think it accelerated it, paved the way certainly in pediatric oncology and showed the way for our adult colleagues.

Paul Goldberg: Mm-hmm, mm-hmm, that’s fascinating to think about that era. And really covering it was very interesting.

Michael Link: Mm-hmm, yeah.

Paul Goldberg: How did you get involved in ASCO, and did you get to presidency? How did you—

Michael Link: Well, that’s a different story. We didn’t have to storm the capitol, but…

So I was a board member. I’m not sure really how, I suspect people like Joe Simone, and also Phil Pizzo at that time was a board member, and they were, I guess in a pediatrician on the board of ASCO. And so I am sure that behind the scenes, they must have pushed my thing along, because I was on the ballot and made it to the board of directors. And I had a couple of episodes where I really advocated for pediatrics. I said, here we are. You raise a lot of money on pediatric and little bald children, but you don’t do much for them. That was one of my… And they really went to bat and really did a number of things. So when I was on the board, we started the Alliance for Childhood Cancer, another one of Sharon’s brain children, where we really establish an organization of organizations, both professional, advocacy, with a theme that they all had a stake in children with cancer.

So the AACR example, ASCO, and these are the big organizations that are proud of the alliance. And this was a mechanism that was totally bankrolled and funded by ASCO for a long time, to help us with our advocacy work. And so that was sort of past tense. And then I guess somewhere along the line, somebody made a decision that maybe we should have a pediatric president. And that of course, still, those years as the president of ASCO is among the highlights of my career.

Of course, as you well know, it was actually an opportune moment because when I was the president-elect and the president was when the drug shortage that became a catastrophe, that was really the theme, the alternate theme of my presidency. And so getting to understand the inner workings of how this all happens, and the economics and then of course met Zeke Emanuel and sort of his understanding, really understanding the economics behind these drugs, and as you say, those drugs that are $5 a vial that are really curative that were unavailable.

And so mostly I was educated by the ASCO staff, obviously had a lot of interaction with some of my favorite people of ASCO when I was president. And of course they would tell me what I was supposed to say and would wind me up and put me in front of Paul Goldberg and the New York Times and others to say, and I would say something.

Occasionally, I have been known to make a faux pas. For example, I was interviewed by the Wall Street Journal, and I told them that the drug shortages were a consequence of unfettered capitalism. And so I was told later that that probably wasn’t the right audience for that particular comment, but it’s true.

Paul Goldberg: It’s true!

Michael Link: So that was the education that I had, and it got me very involved, I could go through sort of what I see as the stages of my own personal trajectory in my career. But that got me to understand how important advocacy was, and how important understanding how things really work and where the levers are that you could push on, to try to get things done. I mean, that was a really important part of my education as president of ASCO. So that was, as I said, a highlight of my career in many ways. But certainly dealing with the political issues at that time was part of my education.

Paul Goldberg: I’m just thinking about the unfettered capitalism point. Because I mean, I think it’s unfettered monopoly behavior by… or whatever it is. I think just capitalism proper would’ve probably produced the drugs.

Michael Link: So here’s what happened that really made me understand this, is that there was one of the drug production facilities in Bedford, Ohio, which is right near where I grew up. They had whatever it is, an FDA inspection, and they had whatever it was that they were shut down.

Paul Goldberg: Ben Venue, right?

Michael Link: Ben Venue, yeah. And so what happened was I began to understand it. So here you have a plant that you’re going to have to put in a few million dollars to sort of refurbish it or whatever, and then you can decide, “Do I want to make cytarabine and methotrexate at a nickel of vial where I’m losing money on every vial that I make? Or can I make Viagra?” whatever else they want to make at that time, which is obviously it’s a pill, not an injectable, but just sort of as a metaphor, “Or I’m going to make something where I can make a lot of money?” And understanding from the point of view of a corporation which, you know, owes to its stockholders. That’s an economics decision, which is understandable. There isn’t much incentive to make a drug that you lose money on in every vial, and there’s especially these injectables where it’s actually not so easy to put it into a vial the right way around.

So I learned a lot about that, I learned from my own colleagues who had gone into industry about what this manufacturing process is all about. I learned some of what goes on in the FDA and their efforts to try to import drugs and workarounds to try to solve the problem, but ultimately, it’s an economics proposition, and we’re in a situation where there’s no shortages of the very expensive drugs, but there’s certainly shortages of drugs that are pretty cheap. And it’s not only cancer drugs, of course, it’s anything like even IV bags, bicarbonate, things that you would think would never go out of production, but you can’t get them, you can’t take care of the patients.

Paul Goldberg: No, for you as a pediatric oncologist, this is a tragedy. This is not just, oh, like for me, I’m reporting it and I’m bored stiff reporting it. It’s like watching grass grow. It doesn’t go away. We all hate it. Yeah, okay, well, solve the damn problem, you know, raise the prices.

Michael Link: You would think—

Paul Goldberg: Do whatever. But for you, it’s hell!

Michael Link: Well, for us, it got to the point where it put us in an incredible ethical bind where we had a limited supply of a drug and you were actually making decisions which patients should get it, and which patients therefore would go to the back of the line. And those are the kinds of decisions you never want to have to make. And then there you had a recipe for how to cure a disease, and then you have to say, how do you modify this with the drugs that are available? So, oh, it was horrible times, and it was, as we talked about delivery, what’s the point of having done all this investigation, having a recipe or a protocol that would cure the overwhelming majority of kids with lymphoma or leukemia, and then finding out that you can’t deliver the goods because something as stupid as you don’t have this cheap drug available. It was terrible times, and unfortunately continues to rear it’s ugly head periodically. So, you know.

Paul Goldberg: Yeah, yeah.

Michael Link: We haven’t solved the problem.

Paul Goldberg: It’s not that it was, I would argue that it is a terrible time, and it just keeps coming back every year almost, now. Actually, one of your trainees is someone—

Michael Link: George?

Paul Goldberg: George. The first time actually I talked to him, George Tidmarsh, now chairman of Cedar, director of Cedar, first time I talked to him was when he was making Levoleucovorin, right?

Michael Link: Yeah. He taught me a lot. I mean, he was one of our trainees who went into industry, and he knew his way around the FDA for sure. And he was the one that explained to me about the manufacturing process and that these are as sort of low-level stuff as this is, you’d think that this is easy to solve, why it is so difficult to solve and why it was so difficult to import drugs. So he solved the, I think it was the Leucovorin and also the Doxil problem with importing. And he, remember at the time, had established citizens oncology. In other words, he would establish a licensed company that could produce the drugs, but he needed a lot of investment. And of course, the problem was, first of all, it was a whack-a-mole problem, this drug’s in shortage now, somebody comes into the market and makes it. And so you got to make sure that you have somebody buying the drugs.

It’s interesting, it’s a lot like the, in a different context, the vaccine problem. In other words, how do you know how much measles and mumps vaccine you should make? And the question is, how did they solve that? Well, they solved it at the CDC by sort of having a kind of contract relationship with the companies that they would say, “We will contract to make X number of vials of MMR for the state of Massachusetts, and we will guarantee that there’s a buyer for it.”

And of course, the way that was worked out is because you know exactly how many doses of MMR you need because all you have to do is take the number of birth certificates and multiply by three, so they knew exactly what the need was. In cancer, nobody seemed to know how much methotrexate do we need in a given year, and so it became a much more complicated problem to solve. But there was some interesting models that came up, and George, of course, I hope we have a friend and a friend at FDA now in him, a friend to pediatrics, but he educated me a lot on some of the complexities of why the problem is not so easy to solve, let me put it that way.

Paul Goldberg: Well, the problem that I know he solved and help solve was Levoleucovorin, which actually was a different drug with a different payment schedule, I mean, different price, and therefore you could charge for it. And if you needed more and you bought this other… You know?

Michael Link: Yeah, now you’re way above my pay grade. So this is where I sort of talk to these people and try to understand the problem, and I rely on… And this is where again, back to the ASCO presidency, where you’re working with people who really know their way around Capitol Hill, really know their way around legislation. And people like Deb Kamen, who they get it and they can look at the downstream effects of things that you might propose that you think would solve the problem. And it was actually a privilege to work with these people to really broaden my horizon of why these problems aren’t as easy to solve as I would’ve thought they would’ve been.

Paul Goldberg: I’m still kind of in that, even after many decades of covering this idiotic problem of drug shortages, I’m still kind of in the sense I’m so incensed that I believe they can actually solve it. If they wanted to solve this problem, they would solve this problem.

Michael Link: Yeah, well, you sound like me, which makes you sound like my father.

That was his approach to life. He’d say, “Look, this is an easy problem. Just put three people in the room together and you should have it solved, and don’t let them out until they’ve solved it.” I agree, I don don’t get it.

Paul Goldberg: And that’s right. What did he do?

Michael Link: He was a businessman, but he was very smart. And I have to say that I miss him a lot because he cut through the chaff very quickly on some of these… He wasn’t a physician, but he looked at me like some of the things I was doing… He was wonderful, I called him up once and I said—I was a fellow or whatever—I got my first paper published and I was really excited, in Blood, and he said, “How much did they pay you for it?” And I said, “Actually, I had to pay $50 to get the thing reviewed,” and he looked at me like I was a moron. So it gives you some—

Paul Goldberg: I mean, really, it sounds truly… It’s like, raise the price or raise—

Michael Link: Well, as Zeke pointed out, this isn’t a problem in other countries, in European countries, they don’t have shortages of methotrexate. This is a United States problem predominantly. And why is that? And partly his analysis of this, that the drugs are so cheap and the profit margins so thin, that it’s fine when everything’s running smooth. But when you have a problem, a glitch, and it’s going to cost you a lot of money to fix the glitch, is it really worth that investment to make a drug that you’re sort of barely making a profit on at all? So I get it.

Paul Goldberg: It’s a very taut system, and not—

Michael Link: Yeah. Not much room.

Paul Goldberg: Yeah. But then raise the price. I don’t know, that’s just me.

Michael Link: It’s been a while since I’ve really sort of focused on this in my career, I have to admit, but it was interesting listening to all the arguments of what the root cause of this, whether it was the manufacturers, whether it was the FDA, whether it was these consortia that supplied hospitals. I mean, there’s all kinds of theories. Some of them subscribable to, and some of them which are totally off the wall, conspiracy theories. But in general, it’s just tragic that, you know… That was the key point, that we have the cure in our hands, we have the recipe, and it’s unfathomable that the problem actually, or the limiting factor is that you can’t get these cheap drugs that are just unavailable.

Paul Goldberg: Yeah, I was covering most recently the platinum drugs, and the harrowing conversations and the rationing systems that have—

Michael Link: And the idea that you could substitute. I mean, we actually wrote a paper about that. Okay, you have to have a workaround, and so you sort of put in a workaround that should work. It should work—famous, “should work” in oncology. And it didn’t. I mean, in our situation, we thought when nitrogen mustard was in short supply, we thought, okay, we’ll just substitute cyclophosphamide. Same class, we could figure out the dose, and we demonstrated without any doubt that there was an increase in the relapse hazard with that drug substitution. So not everything that you think works works, unfortunately. And that was a very, how shall I say it? A difficult lesson. And the platinum thing is just another thing. “Well, I use carbo.” There’s plenty of studies that show that it’s not a one-to-one substitution.

Paul Goldberg: Yeah, it’s like Otis’s joke is, he asks, what does Otis Brawley and 5-FU have in common? And that is age. Otis was born in… You know?

Michael Link: That sounds like an Otis joke.

Paul Goldberg: Yeah, and nitrogen mustard? My God, it’s like Joe Simone was born—

Michael Link: Oh yeah, we were using it. It’s no longer available, but still, I mean the idea that here we had a regimen that was perfectly good and you’d think that, okay, so… Just as you did, this is a drug of historical interest only. All we have to do is substitute the most reasonable newcomer or a drug that has the same mechanism of action, if you will. And it was a failure. So sometimes these recipes, I’m sure Julia Child would sympathize. You can’t just willy-nilly substitute and expect to have it come out the same.

Paul Goldberg: Absolutely.

Michael Link: So, hard lesson to learn.

Paul Goldberg: And it must lead to just harrowing conversations. Can you remember anybody, any of those conversations? How do you do it?

Michael Link: He was horrible. I mean, actually, I’m trying to think of, it was a publication about the ethical considerations surrounding these drug shortages, which was sort of really, it was where the rubber met the road. How do you decide who gets the drug? And then we have to talk about the likelihood of being cured.

So in other words, you sort of put all your eggs in that basket of the patients that it really would make a difference in it to being cured. Whereas patients who were less likely to be cured, the unavailability of this drug would sort of in a very harsh way, have less of an impact. That’s not a kind of decision that I wanted to make, but there were some case stories about exactly those sorts of things that… It was terrible. Terrible.

Paul Goldberg: Yeah, if it ever comes up again, I really want to cover it from the point of view of the parents.

Michael Link: What do people do that are in the trenches and how do you actually say this? I mean, that’s how you started. Can you believe that here we are in whatever year it is, 20-whenever the next shortage is going to come and we don’t have access to this? And of course, there’s plenty of other things that are… Antibiotics have been in short supply, things as basic as bicarb, there’s a time you couldn’t get any IV bags or something like that. It’s just preposterous.

Paul Goldberg: Saline.

Michael Link: Saline, yeah.

Paul Goldberg: Yeah.

Michael Link: So here we are, this is the United States of America in the 21st century. Really?

Paul Goldberg: Speaking of which, you knew where the field was going, or at least you had a sense of how to orient your career to make the most impact. Did you ever imagine that the war on cancer, which is—

Michael Link: White flag. Yeah, it’s terrible. I mean, what’s going on now, of course, I can take it to even a different level. I mean, you have to understand, I’m a pediatrician, so here I am and they have measles? I mean really, measles in 2025? How is that possible? And I remember this brought back a funny story that when I was a medical student, we were rounding, some kid presented with acute paralysis, and we had all these consultants telling us what this could be, immunity, blah, blah, blah. And we had one of these cagey old community pediatricians who rounded with us, he was our community attending, and he said, “This is polio. What is wrong with you people?”

I mean, and it turned out to be polio, a case of polio. And this was way back when. I don’t know why the patient had not been immunized. But to think that these things which we haven’t thought of heard about, forgetting my role as measles in the community is terrible for immunocompromised hosts and all that, but just to think that there are people getting a disease that we wiped out, it’s unfathomable to me. And so this is basic pediatrics, it’s not even pediatric oncology, but if that’s the state, that’s the state of our country, it’s regrettable.

Paul Goldberg: Are you seeing it now?

Michael Link: Well, in Texas, they have cases of measles and we’ve had cases of measles in California. I haven’t seen a case personally, but I worry about it… You know? We used to be, when we would take care of our kids who were… You know? We would tell parents, kids can go to school unless there’s something going around the school, because most of the infections that these kids get are from germs that are already in their body, they’re not going to catch it from anybody.

Then came COVID where we had to have a totally different approach and say, gee, that if that kid in front of you in line in McDonald’s has COVID, it really is a danger, and so we had to sort of revamp what we tell people. But I never thought I’d be in a position where I have to talk to people about measles and polio and chickenpox as a threat, because… And measles, it’s a matter of how serious your illness is going to be, and if you’re immunocompromised it’s life threatening. And so, I don’t know, it’s—

Paul Goldberg: And polio?

Michael Link: Yeah.

Paul Goldberg: I haven’t seen polio yet.

Michael Link: No, I haven’t seen it yet. But yeah, I was going to say it’s the same thing. And there was a thing about diphtheria. There’s another one that this is part of my presidential address. It was so funny to look at this, of how successful we were in eradicating diphtheria, just with a vaccine. And I have the curves, and there happened to be a paper published of how prevention is so important, it’s part of my ASCO presidential address. And here we are, this is how many years, 15 years since I’ve been the president of ASCO and giving that address, and we’re talking about the same thing again, that we’re back where we started or back before we started. It’s hard to believe.

Paul Goldberg: Well, as a mentor, how do you keep young people that you mentor from…

Michael Link: Being discouraged?

Paul Goldberg: … going into driving Ubers or whatever?

Michael Link: Well, I hope that’s not the choice, but I think that the way I got into it was just the excitement and passion of the people that were my mentors. In other words, in every way, in caring for the patients and their caring and their advocating for them. That was part of it. And being really smart, that was one of the things that I wanted to be like Howard Weinstein, for example. And I think that now the science is so fascinating that if you can’t get excited by this stuff, if you can’t get excited by the molecular underpinnings and targeted agents and multiple ways of doing it, I mean, gosh.

So I mean, think there’s a generational difference, and I think one of the things that is most discouraging is if I were planning to go into the field and I wanted to be a translational scientist, and I wanted to see what the R01 pay line was this week, I mean, why would anybody go into academic anything for that matter? And then we are losing some of our best and brightest to industry. I mean, that’s for sure. But the idea that academics, and certainly in pediatric oncology, it’s really in the academic centers where a lot of it takes place, that it’s difficult to convince people to look at what’s going on at the NIH and to be willing to commit to a three-year fellowship and then whatever, it’s four or five years of junior faculty before they’re independent investigators. It’s kind of scary for the field.

Paul Goldberg: For the field. Yeah.

Michael Link: I’m sure this drew beyond pediatrics. I have a very narrow view because that’s what I do, but it’s got to be true everywhere in oncology for sure.

Paul Goldberg: But you want that, that’s the most important part of oncology, is the pipeline into pediatrics.

Michael Link: And the pipeline’s important for two things. Number one of course is because I’m going to retire, I should have retired maybe already, and need to be replaced. But more than that is these are the people that continue to stimulate us. In other words, having a journal club or having a meeting where you discuss something and having one of your fellows or very junior faculty members say, “Hey, I read this paper that,” or “We just did something in the lab, that this, that and the other, which was exciting,” boy, that’s what continues to make it interesting and exciting to do this. And so we need the next generation coming up to keep the field moving and keeping it exciting. And that’s what worries me a lot in terms of what the current state of affairs is. Besides the fact that, I don’t know how many of those people are going to resign their positions and all that experience and expertise is migrating out of Washington.

Paul Goldberg: Well, I was actually thinking about Stanford. I did forget to ask you about it. The draw of Stanford at the time. I mean, my God, there were just giants of the field working there every… What was it like?

Michael Link: Well, so I must say that part of the reason I went back to Stanford was to get away from my brother, number one, and number two, because I had fallen in love with California and I really wanted to go back. But I realized that my opportunity and what I wanted to do when I went back there is to treat lymphoma. And of course why that was was because there was Henry Kaplan, Saul Rosenberg. I mean sitting in lymphoma staging conference at that time, and then of course with Richard Hoppe sort of an up and coming, Sarah Donaldson is sort of the radiotherapist for kids, I mean the pediatric arm, and I wanted to be the oncology half of that dyad.

It was a privilege. I mean, when Henry Kaplan talked about something and when he looked at an x-ray or when he gave you… just a pearl would fall out there and you realized, my gosh, you just learned something incredible from years and years of experience.

And when they went through all this meticulous staging in the day when surgical staging was… and why it happened, and then you had one of the leaders in terms of lymphography, all this sort of expertise in one room, it really was a privilege. And I will say, just as an aside, one of the privileges of being the ASCO president was the same thing. You’re sitting at a table with the board members of ASCO, and it was a… You know? You had Larry Norton next to you, and I mean one individual after another with phenomenal expertise, phenomenal range of knowledge and a perspective in a variety of different areas. Some bringing legislative and those sorts of things, other people just plain science and how to do clinical trials, all that kind of stuff. For me, it was like, wow, I had a little bit of a feeling that I didn’t belong there, like somebody’s going to find me out kind of thing. But it was an amazing privilege, each of those things, to be surrounded by people like that.

Paul Goldberg: Yeah. It takes years to get over the imposter syndrome.

Michael Link: Well, I still have it sometimes, but yeah, it does. My wife would always encourage me. I would say, “God, I was around them with all these big boys.” And she said, “Maybe you are a big boy,” but that’s because she’s my wife, not because it’s true.

Paul Goldberg: Yeah, that’s fascinating. Looking at where we are right now, and I mean this is a field that needs leadership, as much leadership as it can get, because it’s getting a lot of beating from the outside. If you were to exercise leadership, what are your thoughts about where we are and how do we get out of where we are? How do we survive?

Michael Link: Yeah, that’s a difficult question because I look at it, so I see that the leaders of the leaders of ASCO, AACR, they’re doing their best to stand up to some of this as best they can. I certainly admire Alan Garber. So Alan, president of Harvard, former Stanford faculty member, and actually a friend. I admire the fact that he’s willing to take them to court, stand up for academics, stand up for the fact that you can’t take a $1 billion worth of grants away from Harvard. But I’m a little bit discouraged by the fact that so many other leaders have caved to this. I mean, it tells you something, that you’re willing to negotiate with these things and put up with. It’s very difficult. And what worries me more is that this is not necessarily only a reflection of the current administration. I mean, it’s a reflection of our country. Some of this anti-elitism and is obviously in there in the parts of the country that maybe we don’t visit enough or don’t cater to enough, but they don’t want to see what the experts have to say.

This came certainly during the COVID epidemic, a lot of anti leadership or anti people trying to tell you what to do. And people kind of forget sometimes that the bodies were being stacked up in refrigerated trucks in New York before we had any kind of guidelines and before we had a vaccine. They seem to have forgotten that. So it’s discouraging that this sentiment, that there’s not an uprising against this revolution against expertise and against people who know what they’re doing, because that’s the name of the game. I mean, the idea is that you want people who actually know what they’re doing to take care of you and to sort of run health policy.

You ask these people, would they take their Mercedes to a Mercedes dealership or would they take it to the local gas station? And they would probably tell you that they really want the experts doing the work. Well, that’s what we want at all these government institutions, and unfortunately they’re being attacked. So I’m kind of discouraged by what’s afoot in our country, but it’s mostly the idea that expertise and data are being replaced by narrative, and that’s a very frightening situation.

Paul Goldberg: Is there a way that we can compete on the narrative, like we just did, for example? I mean, you don’t really have to say evidence-based medicine.

Michael Link: Unfortunately people get their information, that data and science are not sort of the basis for how people understand the world. It’s narrative. And sometimes the most compelling narrative, which may not at all be based in any data or facts, is what sort of captures the imagination of many of our voters. And I don’t know where is the problem that we don’t teach science appropriately, that people are not based on what we can prove, that they’re unwilling to accept, things like that the sun rises in the east every day. So it’s things like that that are scary in terms of how do we reverse this trend. And I just don’t mean, the trouble is that I’m preaching to the choir. The people that understand this and are doing their best against it are already converted. The question is what we do about the majority of people out there who do the voting and who seem to be going along with this, data not withstanding? So it’s a discouraging time for me, for sure.

Paul Goldberg: Yeah. Yeah, I didn’t think we would ever get to this point where we are. It’s very scary, and I don’t know—

Michael Link: I mean, how can you deny the efficacy, and when we talk about vaccines and their danger? I mean, this is one of the great contributions of pediatrics to the world, and any number of studies that show that there’s no connection between the MMR vaccine and autism doesn’t seem to convince anybody. In other words, the out there sort of outrageous commentary seems to be more compelling than just plain, hard-nosed data, which is, as you might say, boring.

Paul Goldberg: Yeah, I wouldn’t. But yeah, I guess also looking at the mRNA, that when you ban that, you get…

Michael Link: Yeah, especially since it led to Trump’s greatest triumph of the mRNA vaccine, you would think that this would be something that would be extolled. And I mean, I don’t get it. I just do not get it, and I think there’s too much anti-science or ignorance of science in our country, which is—

Paul Goldberg: Yeah, that, but there’s also the cancer and mRNA.

Michael Link: Oh, yeah, oh, I’m just talking about that there’s been a withholding funding for mRNA vaccines, I’m talking about in general. I thought you were referring to—

Paul Goldberg: Yeah, but also both.

Michael Link: Yeah.

Paul Goldberg: Right? I mean, there’s idea of, well, tamping down the mRNA, ending of that. It’s really odd. But I don’t know, I’m going to be optimistic in spite of myself.

Michael Link: Our people are not usually optimists, but I guess you have to be. I mean, look, if you take the long view, I mean, people say that we’ve been in this kind of situation before, and I accept that, although never to this degree, I don’t think, where there’s been this much division and this much denial of facts. And so it’s discouraging.

I’m at an age where I’m very close to retirement, and so I can say that it doesn’t affect me, but I certainly worry about my children and their children, the world that they’re inheriting. I mean, I want my kids to have availability of vaccines against diseases, and I want science to continue to move forward and develop new cures. And it’s going to be difficult if you dismantle the NIH for one thing, and dismantle the regulatory agencies.

Paul Goldberg: Yeah, but actually I’m going to have to start getting optimistic here, which is that Congress didn’t allow that to happen.

Michael Link: Yeah. So I’m encouraged, it’s not done deal yet, but yeah.

Paul Goldberg: Oh, is it done deal enough. Oh yeah, there’s no way, that 40% cut not happening.

Michael Link: Oh, that, for sure. But the idea that this used to be, that, from way back when, that doubling the NIH budget used to be sort of everybody bought into it, it was nonpartisan or it was bi—whatever you’d call it, it was like some of the Republicans were the biggest defenders of this doubling of the budget. And for all the right reasons, that it improved science, it improved the healthcare of Americans. And it also created jobs for God’s sake, of all the things to use as an argument. But all the stuff that NIH funding had done and all the companies that have spun off from university grants and developing new technologies. This is obvious, this is sort of a slam dunk. To think it’s not a slam dunk is kind of discouraging.

Paul Goldberg: Yeah, let’s get your presidential address and publish it.

Michael Link: Okay, I’ll send it to you.

Paul Goldberg: Because that would be fun to have this conversation and your address.

Michael Link: Well, talk about some of the same issues, unfortunately, some of the same issues, but fortunately also, but I think that it reflects sort of where my career trajectory is as what I think is important. Basically still at the root of it is the pleasure of taking care of patients and taking them through an illness. That is still what makes this career for me and for anybody I think, who’s an oncologist, not just pediatric oncologist, that’s what makes it worthwhile. But you hope you can sort of do things that move the needle also, move the needle on a disease by running a study. And more for me, it’s now sort of moving the needle on advocacy so you can sort of do something for the greater good.

So my career has been sort of a, how shall I say, it’s migrating from the pleasure of taking care of an individual to sort of doing a study that benefits a lot of people, to understanding through advocacy. That was mostly through ASCO, that if you really want to move the needle and make sure that there are drugs available or whatever it is, that kids have insurance, then you really have to get involved in the advocacy business. So that’s where I’ve migrated, but I still love taking care of patients.

Paul Goldberg: That’s fascinating. That’s excellent. Thank you for doing all of this for all the 40 plus years.

Michael Link: No, I’m flattered to be part of this project, or that really is… You know? Pediatrics, we sort of are the tail end of things, but when you see my ASCO presidential address, you’ll see that we think that we’ve been leading the way and we’ve provided the model for how we should proceed.

Paul Goldberg: That is true, that is undeniably correct. So, thank you.

Michael Link: As some of my mentors, the Joe Simones, David Nathans, Phil Pizzos of the world, yes, they certainly would subscribe to that.

Paul Goldberg: Yeah, thank you.

Katie Goldberg: The Cancer History Project is an initiative of The Cancer Letter, the leading source for information on the issues that shape oncology since 1973. 

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