Weeks before death from sarcoma, Norm Coleman reflects on career in radiation oncology, addressing health disparities

Soon after he was diagnosed with a dedifferentiated liposarcoma, C. Norman Coleman reached out to The Cancer Letter and the Cancer History Project to initiate a series of interviews about his life and career.

“I don’t know how much time I have,” Norm said during the first interview.

The plan was to keep going for as long as possible. Alas, only one interview–about an hour’s worth–got done.

Coleman died March 1 at 79 (The Cancer Letter, March 8, 2024).

Colleagues say Coleman was working on a manuscript two days before he died. 

At NCI, Coleman was the associate director of the Radiation Research Program, senior investigator in the Radiation Oncology Branch in the Center for Cancer Research, and leader of a research laboratory at NIH.

He was also the founder of the International Cancer Expert Corps, a non-profit he created to provide mentorship to cancer professionals in low- and middle-income countries and in regions with indigenous populations in upper-income countries.

Coleman spoke with Otis Brawley and Paul Goldberg, co-editors of the Cancer History Project. Brawley is the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, and Goldberg is the editor and publisher of The Cancer Letter.

As a medical student at Yale School of Medicine in 1969, amid race riots in New Haven, Coleman volunteered to help Black families navigate the healthcare system.

When I was in med school, 1968-69, in New Haven, they had the Black Panther trials. Those were the days of, all the things were so bad, people would rather burn down the cities than live in it.

“I think having someone who actually cared about them was a big deal, that you learn about their personal lives, and their relationships, and you began to realize how much people trust you because you’re a doctor,” Coleman said.

Coleman recalls working with one family, which included six children. When someone was sick, or experienced another health problem, they weren’t sure where to turn. Coleman would point them to a doctor and help them navigate appointments.

“I would go over. They had dial up phones those days. You’d go up there once a week, [see] what they had issues with, how they were doing, visit some of the kids,” he said.  “You spent time there, you began to know them, you get the familiarity. I loved my visits there.”

Coleman began to understand their perspective.

“I really could understand from how they looked at the healthcare system and how they looked at Yale, why all the anger, all that sort of stuff,” he said. “They didn’t know who I was, but we quickly developed these levels of trust because of what you’re trying to do.”   

During a time of unrest, as members of the Black Panther party protested in New Haven, Coleman spent time with this family.

“I could see it from people on The Hill, how unfair things were. Most of them were not violent, but how unfair it was. And that just shouldn’t be,” he said. 

What began as an interest in helping people navigate health disparities as a medical student led to a lifelong career in the field.

“When I was a resident at Stanford, we took some rotations out in underserved places,” he said. “And for those of you who remember the Bay Area, the East Bay was actually underserved at one time.”

Coleman went out and conducted tumor boards in the local hospitals of underserved areas.

“So, the whole idea of bringing cancer care to the community seemed to make sense, and bringing cancer care to where people needed it makes sense,” he said.

Later, while at Harvard, where he served as professor and chairman of the Harvard Medical School Joint Center for Radiation Therapy, Coleman visited community hospitals. 

“We began setting up a very unique model, which we called an outreach program, not a satellite, which was the idea to bring expertise to the community in cancer care, or help develop expertise,” he said. “They would do the local investment, because they had the resources. With their local investment and our expertise, we would begin to set up cancer programs. The [Harvard] Joint Center had 2,500 new patients a year.”

At NCI, Coleman conceptualized the Cancer Disparities Research Partnership program, which helped build cancer research programs in underserved regions globally.

Coleman worked with Samir Khleif, who is a Biomedical Scholar Professor at Georgetown University, to build Al Aman Cancer Center, which later became King Hussein Cancer Center, in Jordan.

“When you want to do something, it takes the first two years for people realizing that you’re the real deal, and then all the doors open up,” he said. “So, Samir helped build that program that was Al Aman Cancer Center that became the King Hussein Cancer Center, with local investment, Samir being on site, bringing in resources of mentorship to help them do their own work, them building up their excellence. They’re the major cancer center in the Middle East.”

King Hussein Cancer Center is part of the International Cancer Expert Corps, which Coleman founded.

“The first thing you do when you go to communities, you listen, you listen, you listen,” he said. “You listen, you listen, you hear, and then you listen. We’d listen to the communities, give them what they asked for, give them what they should have asked for, and the same deal.

“We had a very successful approach, we think, to building cancer programs.” 

Coleman views the ICEC as a Peace Corps for oncology mentorship.

“So, the ICEC was really a cancer Peace Corps to develop mentorship cores where people who would be mentors to help remote places, low- and- middle-income countries who are willing to invest in themselves to then have investment,” he said. “What’s really needed in all these is expertise. So, the expertise with local people, and us mentoring the expertise. That’s been the ICEC model of how do you get expertise, and how do you get it in low and middle income countries, and how do you make these alliances or partnerships.”

Transcript

Norm Coleman: Well, I had something occur that I didn’t ever anticipate, which is, I think you’re aware of some of it, or not; I don’t know…

NC: I have an issue with cancer, unfortunately. Last September, I qualified for the Ironman 70.3 World Championship in New Zealand, coming up this year.

There probably are only 20 people in the world who can still do that. Doing fine. Had some symptoms, ended up with a malignancy that I’m doing battle with now. You live a good life, and you don’t expect things to happen, but they do when you get into these age groups.

So, it’s that challenge.

NC: Yes, I’ve been doing this. The half Ironman is a 1.2 mile swim, a 56 mile bike, running a half marathon. I can still do these. I can still beat a lot of people half my age, and we never expected cancer to be an issue, but it can be.

NC: Things are largely the same. Living in Somerset. I’m still working in the Radiation Research Program, which is always a challenge during difficult times. I still work at the Administration for Strategic Preparedness and Response, ASPR, and I’m involved in a lot of what’s going on in the world.

Anything nuclear, they bring me in. So, I’m involved in that. One of the more exciting things is we had a concept of, it was initially radiation-inducible molecular processes.

It’s something we discovered in our lab that when you treat tumors and tumor cells they adapt very quickly. We had our first in vivo paper showing that when you start treating tumors, they adapt very, very quickly, and that’s just been accepted in Molecular Cancer Therapeutics on Friday.

That’s a really big deal.

I’m a busy guy.

And the other aspect, I think you both know, we’re doing the International Cancer Expert Corps. It fits into both of your characters. For people who have nothing in intolerable situations, that’s not tolerable.

I think we’ve come a long way to doing that. So, I’ve got a lot of stuff going on. You know how it is, you keep it going when you have to take care of treatments and stuff.

NC: I really appreciate, more than you can imagine, the opportunity to be able to talk about things and ideas, and particularly with a friend. Geez, I’ve known both of you for 40 years, something like that.

You guys are very special.

NC: I hadn’t known that.

NC: So things you both relate to…You were probably almost part of that era. So, when I was in med school, 1968-69, in New Haven, they had the Black Panther trials.

Those were the days of, all the things were so bad, people would rather burn down the cities than live in it. I was involved a little bit in community work, and the price of inequality and the injustices struck me at that point in time.

It’s been a theme that’s in many ways driving me for almost my entire career since then, is that the idea of people having such inequality, essential things that people would take for granted aren’t available, seem to be not a good thing.

So, the theme of that really percolated through my whole life, when I was able to do something about it. When I was a resident at Stanford, we took some rotations out in underserved places.

And for those of you who remember the Bay Area, the East Bay was actually underserved at one time.

If I had bought 10 acres, I wouldn’t have to be doing any of this… No, it was under service. So I started going out.

I used to see patients from the bay. The surgeons liked me. I saw a lot of patients, and I would go out and do tumor boards out in their hospital. So, the whole idea of bringing cancer care to the community seemed to make sense, and bringing cancer care to where people needed it makes sense. 

I finished medicine at UC San Francisco. That was an interesting experience, with everything. I finished at NCI, the Public Health Service. So, that’s when I was at Stanford. When I got to the joint center, it was just an amazingly interesting program, and it was the same sort of thing.

This guy, Frank Govern and I were both attuned to the community. When we first got there, we called Howard, talked to the head of the cancer center there, said we’d like to come out and visit you. And they said you were the first people who ever called and came out to visit us.

There may have been some along the way, but it was really striking how our ability and our interests would translate into both meaningful relationships with people, but people also appreciated their situations.

When I was at Stanford we set up our first community program. The place in Fremont, we set up a satellite at those days, which was sort of a new approach, but our satellites, rather than trying to pull people in, was to put high-quality docs in the community, have the people stay in the community, and send the ones across to Stanford to do that.

So, in Boston we started visiting a lot of the community hospitals. There are the Boston hospitals, and you get 30 or 40 miles out, and there were nice people in nice hospitals. The quality of care was fair. And when you got farther out to the old mill towns like Fore River, New Bedford, there was almost no cancer care.

Frank Govern was a young guy, he had been a hospital president who joined me as my COO, and he was very attuned to how things worked in the community.

We began setting up a very unique model, which we called an outreach program, not a satellite, which was the idea to bring expertise to the community in cancer care, or help develop expertise.

They would do the local investment, because they had the resources. With their local investment and our expertise, we would begin to set up cancer programs. The [Harvard] Joint Center had 2,500 new patients a year.

When I finished, our outreach program had 2,500 new patients a year.

We were at some conference once, and someone from Switzerland said, your department sees more patients than my country.

It was a very robust model. And what was really unique is I thought there were groups of academics, and I still think it’s true, who don’t want to be in the mothership, they don’t want to be in private practice, but they would love to have an academic role in the community.

These folks in the community were full-time Harvard faculty. Harvard was loose enough that they let me do that. And by being in the community, they had the prestige of Harvard faculty, they were part of our big Joint Center faculty; everybody had a job that was the most important in the Joint Center.

So, everybody was valued. People had a little difference in salary for where they worked. And it was just a tremendously successful program, good quality care, setting up things in the community.

And we knew how to do this. Fore River went from eight patients in Fore River, New Bedford, to 180 patients when we left.

And heaven knows what happened to them, but we were able to deliver good care. The idea of bringing care to the underserved was terrific. We had a skill, and we were really good at it, and we knew how to bring these things forward.

The next step was when I was a chair at Harvard, my wife and I took a year off and traveled around the world in ‘74, ‘75. It was one of these times, it’ll be a nice anecdote when we get to that, of realizing we needed to educate ourselves.

We traveled around the whole world, from Asia, Africa. We took a bus across the Khyber Pass. We were hikers, so we went to a lot of the mountains. We were very, very comfortable with different cultures, and in fact, because of the experiences we had in foreign cultures, we took our kids to those.

In 1994, my kids and our family, and a few families spent seven weeks in Nepal. And for those who are familiar with the Asian cultures, it was around the Everest region, which is the Tibetan Buddhist culture.

And it’s not about religion, it’s about how these people live in harmony, how they look after one another, and how they approach a world with different kind of equanimity.

We had this wonderful trek out there, we have very close friends. I taught myself Nepali, enough to get around, and when we were coming back on the trek, we said, “These are wonderful people. We’d love to help them.”

The first thing you do when you go to communities, you listen, you listen, you listen. You listen, you listen, you hear, and then you listen. We’d listen to the communities, give them what they asked for, give them what they should have asked for, and the same deal.

And I said, “Well, what do I know that I can do that could be helpful?” And I said, “Well, I know how to set up cancer centers.”

At Harvard, we had what we called the Nepal Project, which has two ideas, and you’ll both appreciate that. Now, I looked at my faculty; they were wonderful. Most of them thought you had to get vaccinated to cross the Charles River.

And I figured that they would do really well by spending a month in this culture, but they wouldn’t go to travel.

I said, “Well, we’re going to go there to try to set this up as you being mentors, going out there to teach,” recognizing they would really be going out there to learn. The effort at the Nepal Cancer Center was a really solid one.

We had raised some money, we were ready to do it, and then it got caught in Harvard politics.

It was sort of getting towards the end of my term there. We had enough money in one of the foundations I had—that we could have helped them build and run a cancer center. That did not come to pass.

And again, on the anecdotal sort of stuff, I remember we worked at it really hard. I had some good friends in Nepal who were senior in the country, very great people. And I remember I came back and said, “I’m really sorry we just failed. We couldn’t get this done. All the politics got in the way,” and things like that.

And they said, “You didn’t fail. Do you realize what it meant to our country that someone like you was willing to put in so much to help us? You’ve changed the way we think about ourselves.”

It was that realization that what we do with our character, our intentions, our trying to do things, in some ways succeeding is important, but in some ways it’s really meaningful, and meaningful in just a simple humanitarian way that the cross-culturalism, which we loved when we love India, the craziness, caring about people, putting in the effort goes a really, really long way. We knew we had something we wanted to do.

And the sad thing about my outreach program was that part of the reason I left Boston was it was patients becoming customers.

All the hospital wars…

I understood why they were doing the wars, but it wasn’t a thing for me. The outreach program was a different hospital system.

The outreach group was like a whole separate division of the Joint Center. I think people did reasonably well. They kept their jobs, but the idea of this community entity really bringing good things out to the community sort of ended.

The next thing in that happened when we came back to NIH, and this fellow Frank Govern joined me at NIH, and again interested in global health, there’s a man named Samir Khleif, who I think you probably both know.

So, Samir was interested. Rick Klausner made some arrangements in Jordan, and Samir Khleif was going to go out and do something in Jordan, and he called Frank, and said, “Frank, what do I do?”

So, because of our experience, we helped guide Samir into how you go about building his program. He’s a very honorable, very trustworthy guy. How it takes time to build trust in all these community settings. When you want to do something, it takes the first two years for people realizing that you’re the real deal, and then all the doors open up.

So, Samir helped build that program that was Al Aman Cancer Center that became the King Hussein Cancer Center, with local investment, Samir being on site, bringing in resources of mentorship to help them do their own work, them building up their excellence. They’re the major cancer center in the Middle East.

They’re part of ICEC, with the idea of you empower people to solve problems. And another thing we would do, and we worked as communities. The first thing you do when you go to communities, you listen, you listen, you listen.

You listen, you listen, you hear, and then you listen. We’d listen to the communities, give them what they asked for, give them what they should have asked for, and the same deal.

We had a very successful approach, we think, to building cancer programs. So, we started to do that initially within the NCI.

And the NCI is funny, because it does global science and it’s not a healthcare institution. So we’re interested in it. We set up two programs. The first one was suitable with the NCI, which is the Cancer Disparities Research Partnership Program.

The CDRP was, again, Frank Govern’s idea.

And what cancer centers have to do, they look at their bar graphs and they have to have a certain mix of people to pass their reviews. They tried to do that. I mean there were, again, honorable efforts, but what often happened was it was the trickle down. The funds went from the big cancer center to the little cancer center. Frank Govern had this great idea, he said, “Let’s turn this around, why don’t we give the big grant to the little guys, the disparities place. Cancer centers would have to, they wanted their numbers for their center.”

Telemedicine was just being invented. The NCI had Telesynergy. So, we were setting up a program where there were grantees, who actually, centers in the community competed to be their mentors.

And then we ended up being successful in three out of six programs, all to some extent, the biggest one being Rapid City, South Dakota, where again the Native Americans were, sort of like a lot of these foreign countries.

Daniel Petereit, who ran that, the first two years he couldn’t get anybody on a study. He would go around to tribe after tribe after tribe telling him what they were trying to do.

After two years, they trusted him and the whole doors opened up to him. The building of trust was what really launched the Cancer Disparities Research Partnership, whatever DEI is worth, and I think it’s worth a lot.

We recognized DEI was present in the 1990s, and I think this is, again, an innovative program to that. So having experience, having success, knowing what we knew how to do, we went ahead to try to do global health, and we tried to do some kind of Cancer Peace Corps within NCI, and there really wasn’t quite a model for that.

So, the ICEC was really a cancer Peace Corps to develop mentorship cores where people who would be mentors to help remote places, low- and- middle-income countries who are willing to invest in themselves to then have investment.,

And what’s really needed in all these is expertise. So, the expertise with local people, and us mentoring the expertise. That’s been the ICEC model of how do you get expertise, and how do you get it in low and middle income countries, and how do you make these alliances or partnerships.

The bottom line in these things is all trusted partnerships, as I like to say.

The three of us are on the call, we know each other and trust each other. And so much of the world runs on very modest-sized groups of people who truly are trusted partnerships with the ethics, characteristics, integrity, we argue we have lab meetings and we haggle. But the idea that you’re in it for the right reason, and that’s sort of the basis of what the International Cancer Expert Corps is.

NC: It went outside with Harold [Varmus]. We had a discussion with Harold Varmus, and he looked at it and said, I’m not sure if this fits in there, but he said this is a good idea.

So he said, “Why don’t you do this as an NGO?”

And we felt, should we or should we not? It was in about 2012, 2013 when we tried to put this together. In 2014, we actually became incorporated as a 501(c)3. We were an official entity.

We’re in our second 10 years now, and we began putting together groups of people we thought would be interested in this, a lot of the people who were really interested in global health who we thought could potentially do this.

We had a lot of what we call, “normals,” people from the Peace Corps. We knew it was a great idea.

Ellen Stovall was a really close friend of mine, and I came back to work to Washington, in many ways, to work with Ellen.

And I told Ellen with doing that, “would you like to join us?” She was working with NCCS. And she said, “Absolutely, this is the next step in bringing care to the community.”

We’ve been building ever since on putting together a corps of people, putting together young investigators. We’ve got a lot of advice and it’s a fairly complicated story, but what you learn, you either depend on donations or you have to have some source of income.

We thought we would get much more buy-in from the accelerated companies. We thought they would love us to help out, put out new markets. For complicated reasons, I’ve learned they have their markets, and we were looking at a different part of the world.

We recognize we needed new technology, that if you have technology that could generate revenue and the technology could also improve cancer care, that was a win-win situation. We started working on getting potential investors. There’s a meeting, International Conference on Translational Research in Radiation Oncology and Physics for Health, in Europe.

Then I was supposed to give a talk at the physics part. I was going to give a talk on some usual topic.

I said, “I can give you this usual topic, but let me tell you about an idea I have about bringing cancer care to the underserved.”

These are physicists. I gave this talk. I walked out the door, expected to get fruit thrown at me. When I worked outside the door, there was Ugo Amaldi, who helped invent a linear accelerator, whose father was the first director general of CERN.

And he came up and told me, “We can build, for you, a better linear accelerator.”

And the physicists began to rally around that, and I didn’t progress that much. A couple of years later, when I came back to another meeting, he grabbed me by the shirt and said, “We have to do this project. It’s really important.”

So, we began getting collaborative programs with really, really smart physicists, some of which were in CERN, some of which were the Science and Technology Facilities Council in the UK.

They invested in us.

We were designing novel technology, smart technology. It was a technological leap at the level of linear accelerators. Anything you can do without having to take your grandfathered technology, you can really move.

Part of where ICEC is now is getting together some really, really, smart technology. We’re building a corps of people who want to become experts. We’re giving out grants now. We have a grant, the Coleman/Kaplan Grant, which is, again, another side story.

Paul Kaplan, who was Henry Kaplan’s son… (I was Henry Kaplan’s doctor at Stanford, and I became very close to the Kaplan family.) Paul passed away, but he gave us a $1 million endowment just for our mentorship programs.

We’re at the crux right now where we’ve developed a healthcare model system. It’s very smart policy. We publish all this stuff, it’s all peer-reviewed. We think the ICEC is at a point, with the right investment we could finally change the paradigm of local investment, because of mentorship, trusted relationships, all the knowledge bases that are now accessible, to really bring expert cancer care in an exponential way.

The shortage of linear accelerators is now at 5,000 around the world.

We wouldn’t tolerate that. The number I like to use, if we could commission one great well-staffed linear accelerator a week, it would take a hundred years to solve the current shortage.

I call it the century challenge.

How quickly can we, by using exponential models, solve this?

And again, we think we have the model, we think we have the technology, we think we have all this, we’re at the point we’re looking for investment. But we think it’s really a paradigm shift for the entire world, and also for the United States, and the Western world, to be active as a conglomerate working together for low- and middle-income countries.

We’re members of the IEA trusted partnership. We’re members of the UN Council of NGOs. We’re now advisory on the WHO NGOs. We’re really becoming a big entity. We’re known around the world. [The U.S.] Department of Energy comes to us for information.

This interview is interesting, because at a really major point in time now that if we can do this, it would be so much good, and the opportunity for altruism that is sometimes not so easy to come by in the world of this medicine we have now.

And with modern diagnostics, modern information shortage, you can do so much with less, like smart technology.

That’s what ICEC is now.

NC: It was a Cancer Peace Corps, like they did with the Peace Corps.

The government may give us some money, some companies would give us money. We would have a corps of mentors. We would end up trying to do guideline protocol-based cancer care, but as ways of mentoring people, teach them how to fish sort of thing.

You could support people with some money, so they could do this as part of a career, and not on Saturdays and Sundays. It’s basically a Cancer Peace Corps where people could spend part of their careers being mentors, building the kind of relationships of trust, educating the educators about things you can learn in culture.

And that’s how we started to do that. When we realized we were not going to get money for this easily, government was not going to do it, industry was not going to do it, and we had to try to figure a way of getting something that could help fund the corps, could have a source of some kind of income, and what we would hope we would have enough funds to be able to have people become the mentors.

It’s an expert corps, it’s getting expertise on the ground to build from the people on the ground where they can become the experts. And doing what we did in CDRP, and doing what we did in Jordan, these are the best cancer centers in the world, because they were mentored, they got confidence, and now they mentor their region.

We developed an exponential model. What took us a lot of time is we didn’t have the money to pay people. We know how NGOs are, and we had to develop a model, both a business model, and a science model, and a technology model that could potentially raise funds to sustain this.

The last five or six years is working with physicists, CERN policy people, to create models that are solving a healthcare model, and you treat cancer rather than you have a healthcare system buy experimental expensive stuff. We’ve really changed an entire paradigm.

It’s been those seven or eight years of putting this together to where we actually have something that someone may invest in. We spent a fair amount of money doing fundraising. People don’t invest in the underserved.

And we’re also showing it a way that, when you do this sort of thing, it’s really good for you. It makes people feel good, it’s good for the people you’re helping. It’s good for diplomacy, it’s good for world peace—and a lot of diplomacy, as we all know, shockingly happens through physicians and countries. A lot of ministers of this, the ministers of that are physicians.

Trusted networks, there is so much one can get out of that. So it went from, “Everybody would give us money,” it was so obvious that no one would give us money to “How to build something that would be interesting?”

And I think what we put together is really a fascinating model that addresses NCDs, infectious diseases, a model we call flex competence.

Some of the model of how to deal with these disasters comes from my work down at HHS, of how, when some disaster happens, you have to be able to deploy things, and you have to be ready.

It really pulls together a lot of things I know, and the people I’m working with are just absolutely brilliant people from all aspects of policy, government, healthcare, physics, technology. It’s sort of amazing.

And if someone gets us the money we’re looking for now—and I’m not allowed to ask for it—we could be a major force globally in three to five years.

NC: Yes. Just because you’re poor, it doesn’t mean you should have bad care, and it’s that it’s helping, but it’s also what I learned as a community worker and when I learned traveling. There’s so much richness. When you go out there to teach, you’re going out there to learn. So, to develop these ways of not just them getting care, but linking it to a greater network, so they’re part of something—not just a little group out there. They’re part of something that’s really trying to transform the way care is given and the way people interact.

NC: Well, a lot of this is working in places the competition doesn’t want to go. I’ve got a lot of these out of the way places people don’t care that much about. It’s very difficult, and you see it even with global health programs, the idea you need one linear accelerator a week, it’ll take you a hundred years.

There are a lot of wonderful programs out there that are trying to build a cancer program with one or two countries, and are developing wonderful programs. Maybe they get a linear accelerator every few years.

Can they somehow pull together to realize this problem is so big, there’s so much for all of us to do, and if we can get past this competition, that the competition is the need we’re trying to meet rather than competing with each other.

Someone once gave me a great piece of advice and was quite brilliant. He said, “If you can’t solve a problem, make it bigger.”

And this really applies to this to some extent. The problem is so big, there is so much opportunity, it takes such a great team. You develop the camaraderie you have during house officer training, or grad school, that we’re in this to try to solve a problem together.

We did this with the CDRP. And you tap into a natural aspect of people. And you don’t need a million. My only number is if I had two people from every state being volunteers for ICEC, giving me eight hours a week, that would be a lot. And you go to different countries, you don’t need millions, you need hundreds.

You need people dedicated to do this. So you create the right environment. And again, I think one thing I’d like to do, and I think I’m good at, is creating environments.

It was about that, but realizing there’s so much good out there that you can do, and there’s so much good you get in return, and altruism it is a rare thing, but when you do things just to do good for yourself, people feel generally good about themselves.

NC: It’s a healthcare systems problem. There are certainly plenty of them right now that are stable enough that you can do that.

The design of our accelerator, we had a meeting at CERN and the goal of this is exactly what you had in mind—is you need robust, stable equipment that doesn’t need a repairman to come in, that can work in the harsh environments, and can perform, and it doesn’t need to be at the level of the most expensive linear accelerator.

It’s got to be really, really good. So the first meeting at CERN, which was spurred on by the folks we met at CERN and someone named Manjit Dosanjh, who was the biologist working at CERN—the first meeting at CERN is how can we go about doing that? We brought people from companies, a lot of other things. Part of the radiation world is you get to see cool things.

I’m an advisor for NASA and I was involved on a NASA space flight. Before we had our first meeting, I contacted my friends at NASA and said, “Could you send us a NASA engineer who understands the Space Station?”

Because looking at these out of the way places like the Space Station, when something breaks, how do you modularize it? How do you use smart technologies to know it’s going to break? That was built into all of this smart technology, ease of repair, not needing a serviceman, robustness. Exactly what you said was built in.

There are solutions in some places.

A lot of places buy Linux from these companies, and they have no one to run them. The answer is there are enough places, easily, that do what we needed to do for years. But also the example of when you start doing things that succeed, other people want to join in.

So it’s pilots that succeed, it’s Jamal Khader, who shows what we can do working with them. We’re working in Bugando, we’re working in CDRP. I think people see, we know how to succeed.

NC: We haven’t put any, and we haven’t for a while, but the mentorship corps is agnostic. There’s a mentorship corps that’ll help anybody anywhere.

They need to do some local investment, and they need to put in enough to have some staffing, some equipment, and some education.

We’re going to mentor people already at some level of education, and there are a number of places for us to do that. Some countries order 10 variants, they get them delivered and they don’t have the capacity to take care of them. Machines are excellent. What we’re trying to do is trying to develop the expertise, mentorship that enables these folks.

And then when our own equipment is out, we think we’ll be able to have technology that can do what we’re trying to do because we’re addressing the technology for the situation that’s going to be working. It’s going to be in Uganda or Botswana, not in New York City.

And because we don’t have legacy issues—the creativity you can do. We want the iPhone, and there’s no reason you can’t have an iPhone with the right sort of people, but we’re agnostic to mentorship.

NC: Not directly enough, but we’re aware of that.

Again, we need money to be able to build up enough of a corps that people can actually commit 20% of their time.

We’re hoping academic departments would see this as valuable global health. People could have a research day, we can have the corps, we can work with folks around the world seeing what each center needs, and develop education and training.

Ukraine’s really good. I mean there’s a lot of stuff already there. Some of it, they’re running in short supply, because people aren’t there. Those are the kinds of situations where I’m not sure how much mentorship they need. I think they need some mentorship.

I think being part of a global partnership would really be rewarding for them.

I think the person-to-person connectivity keeps people working in situations because what they’re doing is valued and matters. It’s not—you’re in the hinterland. I think being part of something bigger, with a real mission, keeps people’s level of spirit of what they’re trying to do high, and Ukraine helps a lot of the neighbors. Ukraine is terrific. So, we are aware of Ukraine. Again, there’s only so much we can do, but that’s the kind of place we talk about.

And again, I see Ukraine from my nuclear side, so I’m fairly well aware of what’s going on, from ASPR and NATO and things.

It’s the caring. It’s trusted partnership and character, and that drives so much, and you build it up in a place, and it can really transform our places, to take care of themselves. We’ve done that. We know it works.

NC: So, people putting in a reasonable amount of work frequently is probably 20. We have two full-time employees. You know how that is. Two full-time employees, a lot of volunteers. We have a list of people who would look for things to do.

We just started giving grants, the Coleman/Kaplan grants, and these are research projects. People, residents going in rotation, going to a place. The answer is, “Don’t just sit there, take notes. What did you do that got you to where you decided to do that, to what you were able to do? Did you do anything that you’d thought you’d do? Write all this up, and when you’re finished you’ll have a nice paper, but you’re also going to have specific aims for a research grant. You can say, ‘Are there questions there I can ask?’”

We funded a number of small grants. They’ve gone very, very well, surprisingly. When we started giving out our first Ellen Stovall Grant a couple of years ago, we would give out a couple of thousand dollars to get letters for from deans. They were very appreciative that someone saw this work as valuable.

If we had $50 million, $100 million, which we’d like to get, we could rapidly begin to set up the expertise corps.

And then the issue would be, as you alluded to, Paul, how do you get people on the ground who are willing to match with that? But it’s like what I learned in Nepal, what is Norm Coleman doing out here in Kathmandu, and doing something?

And it’s funny, when I got on the call with Bugando…

So we tried to do the cancer center. I was out there, I could speak Nepali in a laughable way, and I gave this little talk in Nepal, at the groundbreaking ceremony.

When I got on the call with Bugando, they said, “I know you. You were the one in Kathmandu talking about the Nepal Cancer Center in 1996.”

Like, an immediate affinity. And I could use my seven Nepali phrases. It’s that sort of connectivity that is surprisingly available around the world.

I think, if we had money to begin these partnerships, if we could afford the mentorship—mentorship is not that expensive.

It’s buying people’s time, having that time valued.

I looked at my faculty; they were wonderful. Most of them thought you had to get vaccinated to cross the Charles River. And I figured that they would do really well by spending a month in this culture, but they wouldn’t go to travel. I said, ‘Well, we’re going to go there to try to set this up as you being mentors, going out there to teach,’ recognizing they would really be going out there to learn.

And I think with some medical schools realizing it’s important, getting enough money so the department says you’re not doing something for nothing. You’re bringing something in, bringing recognition to the department, it would go a long way.

The recognition to the department came with the NCCCP program, Donna O’Brien’s and the John Niederhuber’s program. And that was the similar idea that the patients were in the community. Why don’t we bring the cancer clinical trials to the community?

And we said, “We have to give them all this money.”

I said, “Look, we need to give them enough money so they could run their program, but the opportunity for them to participate in this would be so valuable to them, that they would give us a lot of things just for the opportunity to participate.”

It’s that side of the equation that people sort of miss.

That’s what I think came from my travel, my love of differences, love of being in the community. We get a boot out of things that go on there, and just the feeling of helping. I think that’s a key missing ingredient.

It needs money. People have to own their time to be able to do this.

And we’re depending on a lot of retirees, too.

So, we wrote a paper on the value of global health for aging, because you have people who are 65, 70, they don’t want more money anymore. They don’t want to work 80 hours a week, they want to work eight hours a week, 10 hours a week. They’ll give you the time, you need to just have it organized so they can mentor, and they love to mentor.

We can have a lot of senior mentors mentoring junior mentors, mentoring international mentors, having these circles of mentorship that these mentors then go forth, and you can see it being exponential.

We also addressed aging, which I think is a big issue. And we got really interesting buy-in in Singapore when we talked about this because a lot of these societies, people live forever, and they’re looking for things to do. So, there’s a lot of stuff there, but when you think about it, it’s actually quite workable. Just needs some money.

Everything does a little bit. And the technology, the things we’re doing with technology, is really fabulous.

NC: What we’ve done is we’ve done on the ground studies of Africa, the Balkans, and the former Soviet Union countries, and we’ve got to the places, we have surveys, we actually understand their needs.

They’re all in big need.

Africa is the most obvious, although a lot of places aren’t much better than that. And it is a great deal of interest in Africa, for a lot of reasons other than cancer. So, Africa is certainly one.

Again, we’re working now, and we have a group in Moldova today going out there to help them to getting a linear accelerator. How do we help them build the expertise they need for the lin-acc? So, I think there’s a lot of places, and I think what’s good is a lot of people. Americans come from various countries, so there’s a lot of affinities—they want to go back and help their countries.

They could do that. They could become the mentor for their own countries. People select places they want. We have a number of universities who are part of ICEC. We’re working with Duke and their program. We work a little bit with Indiana. We try to partner up with places that already have programs that we can build out our model, help build pilot programs. A lot of it is organic. Someone comes, “Can you help us here?” And the answer is, “Yeah, let’s see what we can do. Let’s see what your needs are.”

Do we have the resources? Can we muster the expertise to do that? And that just needs money at this point. Needs money to be able to have people be able to do it.

NC: I was a med student. I thought, “We lived in this underserved community. I should do something. I should try to help these folks.”

It just seemed like something worth doing. There was a thing called the community health visitor program. The visiting nurse said, “Yeah, we’d love to have people go out. As a med student, we’d give you a couple of families, and you would help them access the healthcare system.”

The second nice thing to do, and I was given this wonderful family, You spent time there, you began to know them, you get the familiarity. I loved my visits there. They were always nice visits that could help them with what they were doing.

We had this bit of an affinity, but you realize how wonderful these people were, the people, the invisibles—but they were substantial people. So, the city was cooking up, and I wasn’t a rabble-rouser. And so, when things were happening, they were talking to me, they were giving me some information, what was happening. I really could understand from how they looked at the healthcare system and how they looked at Yale, why all the anger, all that sort of stuff.

I happened to be there for a different reason at the right time. I wasn’t so much involved in what was going on in New Haven, but understanding, I think viscerally understanding and being out with the people who were getting nothing. You really appreciated how the world looked to them. It was compassion. It was just raw.

NC: They had six kids. Access to healthcare. They had a problem, they had no idea what to do. I would go over. They had dial up phones those days. You’d go up there once a week, [see] what they had issues with, how they were doing, visit some of the kids. Most of the kids were happy, healthy kids. I think they enjoyed getting to know me. I was 20-something.

I was a little older than some of their kids. It was just a nice relationship.

NC: I do remember all the kids.

NC: We lost touch when I left New Haven. That was like 60 years ago. When we left, hopefully someone else would’ve taken that over. It was a very individual program, and individual people in med school had to do that. And I don’t think there were a lot of people who did that.

NC: It was both. I was like their GP. I would go in periodically when things were OK just to see how they were doing and talk to them. You often didn’t even know what questions to ask. How are you doing? How are you feeling?

There was some vaginal bleeding, or some kid had some kind of thing, and you helped make the connection to help the kid get into the right clinic. We were med students, so we weren’t really being doctors.

We could explain things to them.

They understood the system. And so, it was mostly that. I think having someone who actually cared about them was a big deal, that you learn about their personal lives, and their relationships, and you began to realize how much people trust you because you’re a doctor.

They didn’t know who I was, but we quickly developed these levels of trust because of what you’re trying to do. And again, seeing, I had a bit of an insiders view of the Black Panther riots. I could see it from people on The Hill, how unfair things were. Most of them were not violent, but how unfair it was. And that just shouldn’t be.

NC: I don’t think we had that level of conversation. I think it was more how much more comfortable they got when they had medical problems after they got to know me. When something came up, they would bring up, “Oh, by the way, Carl has this, and what do you think of that?”

And other things may come up. It was just the level of trust that they would access what I could potentially help them with. And I think that was really touching.

And again, the idea that being out there for the right reason, and people sense that, you know that, Paul, you’re right as much as anybody. People understand that.

And I think that’s kind of a rewarding thing for me, too. When the tough things are happening, they would say, “We hear there’s rumors, and it’s supposed to come out in the next couple of days.”

We would communicate, or the nurse would say, “Look, I went to see the family and they said, be a little careful.” The sort of rumblings going on… So they warned me, “Don’t come out.”

NC: I think it was Doc. They knew I was a med student. It was the formality of a patient-physician. It was like being a GP.

NC: We needed a clinic, so I helped them get to the number, or they figured it out, I said, “call this number,” and they would do their visits.

NC: Two years and two months.

I stayed for two years, and then my wife and I decided to travel around—1974-75 was our year traveling around the world.

I finished up a few projects. I was on the Medicine Branch, Pediatric Oncology Branch.

Then I was Bruce Chabner’s second fellow, doing pharmacology. Then we decided to travel around the world.

I decided to go into radiotherapy after all that.

The NCI years were my double free space, on account of my internal medicine, and on account of my medical oncology. I was able to get double-boarded from that.

Those are the most wonderful years imaginable.

NC: At Stanford.

NC: When I was finishing NCI, to take the year off, my mother-in-law had an abdominal mass. We thought she had ovarian cancer. So, I went to Chabner and said, “Bruce, can I stay another year as a fellow here? I may have to stay around for my mother.”

And he came back the next day.

He said, “No, you can’t stay as a fellow. We want to put you on staff.”

Which I thought was very touching, but I was sort of gravitating towards radiation. And Vince [DeVita] had just been on sabbatical at Stanford when I got to the Medicine Branch.

So, he said, “You can’t go to radiotherapy, you stay with us,” sort of thing. “But if you go, train with Henry Kaplan,” and I’m sure he contacted Henry Kaplan.

So, when I got there, that’s a whole ‘nother story.

But I was a board certified medical oncologist starting a radiotherapy residency. And because I was at NCI, I treated as much Hodgkin’s as anybody.

When I was a radiotherapy resident, they used to have chemotherapy clinics called MOPP clinics.

So, I had a MOPP clinic as well in some of my years at Stanford, but it was with Henry Kaplan and everybody said, “If you go there, you’ve got to work with Eli Glatstein, Mark Green, all the folks there who were already at Stanford.”

John Glick said, “You work with Eli. So, I got hooked up with Kaplan who was enormous. And Eli.”

NC: And I developed a nice relationship with Dr. Kaplan.

NC: I can ask them if they have anything from that era, but I would doubt they would. It may well have been. He was very international.

NC: You read Charlotte Jacobs’s book on Henry Kaplan?

NC: It’s a great book.

NC: The daughter is the last one left, and the son-in-law, and the son-in-law is on our ICEC. The Kaplans are very tied into that. I’ll ask them if they have any photographs from those days. I’m happy to ask. I don’t know if they still have that archive. But that’s interesting.