To NCI designation through difficulty: How KU’s Roy Jensen made it happen

On a June day in 2002, Roy Jensen, a pathologist at Vanderbilt-Ingram Cancer Center, was back home in the Kansas City environs, taking his young sons to basketball camp in Lawrence.

Bill Self, KU’s just-recruited men’s basketball coach, happened to walk through the gym’s door and Jensen, a basketball fanatic, was talking with him.

“I’m like living the dream, baby. I’m talking to Bill Self. You know, his first day on the job, first day in Lawrence, and I am having a great time,“ Jensen said, reconstructing the day’s events.

Just then, Jensen’s cell phone rang.

“Boy, I really don’t want to take this phone call, because I’m having a lot of fun here, but my wife was out on an errand that day, and so, just in case something had happened, I didn’t want to miss a call. And it was from the (913) area code.”

Jensen took the call. It was Barbara Atkinson, executive dean and vice chancellor for clinical affairs of the KU School of Medicine.

“So, I excused myself from Bill Self and started talking to Barbara Atkinson about the possibility of taking a look at the KU Cancer Center job. And that conversation went well, and at the end of it, I said, ‘Oh, by the way, would you like me to come by this afternoon?’”

Atkinson’s objective was to find someone gutsy enough to take on the task of securing an NCI designation over five years. To accomplish this, KU was willing to commit around $29 million—not even remotely enough.

As negotiations ensued, Jensen was adamant about one aspect of his recruitment package: a “hunting license,” i.e. a commitment that he would be allowed to raise money without having to pay the “dean’s tax.”

“Because I had seen things happen at Vanderbilt, where the director had gone out and raised money, and by some miracle the cardiology division had a new clinic, things like that, I just said, ‘I want no dean’s tax, and every dollar that gets raised for cancer gets spent on cancer—no, if, and, or buts. And I got a solid yes, absolutely, no question about it.”

This proved to be a sound strategic move.

It’s doubtful that anyone could have attained an NCI designation in five years, especially with all the setbacks, political battles and an economic crisis, but Jensen did accomplish the task in eight years.

“I told folks when I arrived that it would be a five-year process. And I think I largely adhered to that, if you cut me two years of slack, because of the civil war [between the hospital CEO and the dean of the medical school] and one year of slack because of the Great Recession,” Jensen said.

Jensen spoke with Paul Goldberg, editor and publisher of The Cancer Letter and co-editor of the Cancer History Project.

Roy Jensen: So, the KU Cancer Center, if you go all the way back to the 1970s, the director at the time was a guy by the name of Barth Hoogstraten.

Barth Hoogstraten, my understanding is, started SWOG, along with some other folks. And in fact, SWOG used to be located at KU before it moved down to San Antonio. And I’ve never met Dr. Hoogstraten, although I believe he’s alive.

As far as I know, he moved down to Florida and retired on a boat. But he was quite a character, and KU submitted a grant for the original round after the National Cancer Act was passed, but it was a little bit under duress, because at the time Dr. Hoogstraten was on sabbatical in Egypt.

This was the mid-1970s. Fax machines were just coming into vogue at that point, and of course, there was a problem with phone lines. So, I think it was a cluster, in terms of trying to get the application in.

So, that did not go well.

And then, about 10, 15 years later, there was another pretty serious attempt to submit a P30 grant. And unfortunately, the cancer center director at the time, right as they were getting ready to submit, was diagnosed with pancreatic cancer.

And so, that all fell apart. And then, there was another attempt in the early 1990s, and they got a P30 award, but then they never actually submitted an application. So, there were at least three failed attempts prior to us getting started. And this was kind of all in the backdrop, kind of a tough time for KU Medical Center.

It was under financial duress, because the hospital was losing money and was not very good quality, frankly. And they had quite a few issues with the Kansas State Legislature at the time.

So, the medical center was having a really rough time, and in fact, that led to a bill being passed in 1998, where the hospital was separated from the university. That was modeled after something they had done in Colorado as well.

So, our hospital is actually a separate entity from the university, and that poses all kinds of challenges. But the end result of all of that is that it allowed the hospital to be run like a business. Refore that, if they wanted to buy a CT scanner, they had to pass a bill in the legislature. It was that crazy. You cannot run a modern healthcare system under such idiotic rules.

And so, that was really essential, because I think at some point, any endeavor in academic medicine has to be supported by a strong, profitable clinical program. So, that was a key milestone. In fact, lots of things at KU Medical Center are marked by that milestone.

RJ: That was 1997. The hospital started off on a really great trajectory, because they had a CEO by the name of Irene Cumming, who really knew how to run a hospital.

She was quite experienced, and so one of the first things that she actually did when she became the CEO of the hospital authority was she had to buy back the oncology outpatient practice from Salick.

RJ: Yes. It had been sold off in the 1990s, in a stunningly short-sighted move by the university. And so, that was one of the first things that had to happen once the hospital split out.

RJ: Salick.

RJ: Yes.

Then, the health system and the university kind of started going down parallel tracks, and the university still had a hard time getting its act together, frankly.

I’ve never gone back and checked the date on this, but I’ve been told that at one point we had been through 18 deans in 18 years. So, that gives you an indication of the stability of the institution and the ability to think big and do big things.

It was essentially nothing. So it was a tough time.

Now, that started to change with the appointment of Barbara Atkinson as dean. She initially came as the pathology chair, following her tenure as dean in Philadelphia at Hahnemann. And she was the dean who was left holding the bag. [The CEO, Sherif Abdelhak, ultimately pled no contest to dipping into charitable endowments to stave off collapse of Allegheny Health, Education and Research Foundation.]

And so, she had no clue any of this was going on until the feds rolled in and started seizing records. But to her credit, she helped right the ship there, but when she was done with that, I think she was worn out and a good friend of hers, who was dean here at the time, asked her to come be chair of pathology.

And so, she came to do that, and then, about a couple of years following that, our dean left, and Barbara Atkinson was the obvious internal candidate to take over, because she had been dean before. Just like 1997, that was a signature event in the medical center because Barbara knew how to run it.

She had done most of her training and spent most of her career at Penn. So, she knew really good places, how they are supposed to operate.

And she immediately started turning this place around in many, many different ways.

So, that started around 2000, 2001 or so. And that also happened to be about the time that the SPORE program from NCI started up. And I was a reviewer for the SPORE programs, and I sat next to a guy by the name of William Jewell.

So, his name being Jewell and my name being Jensen, we sit right next to each other, and we started talking, and he was asking me about where I was from, and I said, “Well, I’m at Vanderbilt, but I’m originally from Kansas.”

And he was very surprised by that, and immediately struck up a conversation, and he knew that Vanderbilt had become designated in the ‘90s, and I had been part of that effort, and so, he asked me to be on the EAB for KU, and I agreed to do that.

And so, we had an EAB meeting, and it was pretty clear that there was quite a bit of work left to be done in terms of getting the institution ready to submit an application. And Bill Jewell was basically at retirement age.

And so, KU called me up and asked me if I might be interested in the job. And that’s kind of an interesting story in itself, because as it turns out, when they called me, I was in Lawrence, Kansas.

This was June of 2002, and you’ll remember that Roy Williams had just left KU as basketball coach and gone to North Carolina. And some new guy by the name of Bill Self was coming in to take over as men’s basketball coach.

Before any of that happened, I had signed my sons up to be in the basketball camp. I had grown up in the Kansas City region, and every year we took a week of vacation, and brought my sons back to Lawrence, so that they could go to basketball camp, and 2002 was no different, except for the fact that this new guy, Bill Self, was there.

I used to follow my kids around to the different gyms in Lawrence, where they had basketball camp, and it just so happened that I was following my youngest son that day, and who should walk in the door first day on the job but Bill Self?  And so, I’m like living the dream, baby.

I’m talking to Bill Self. You know, his first day on the job, first day in Lawrence, and I am having a great time there, and my phone rang, and I thought for a second, it was like, “Boy, I really don’t want to take this phone call, because I’m having a lot of fun here, but I knew my wife was out on an errand that day, and so, just in case something had happened, I didn’t want to miss a call.

And it was from the (913) area code. So, I took the call and it turned out to be Barbara Atkinson.

So, I excused myself from Bill Self and started talking to Barbara Atkinson about the possibility of taking a look at the KU Cancer Center job. And that conversation went well, and at the end of it, I said, “Oh, by the way, would you like me to come by this afternoon?”

And you could tell she nearly fell off her chair. She had no idea that I was already in Kansas City. So, that’s what I did. I went back to my mother-in-law’s house, got cleaned up and went in and talked to Barbara that afternoon.

RJ: She lives near Lawrence.

RJ: I grew up in Gardner. I graduated from Gardner High School.

RJ: Well, I played junior college basketball, and then for a whole host of reasons, I went to Pittsburgh State and then from Pittsburgh State I went to Vanderbilt.

I have three credit hours from KU, but that was in an extension course, but I never went to KU for any of my training. It was all in Vanderbilt.

RJ: Michael Teitell, the guy at UCLA, and then Michelle LeBeau was also in pathology. And then I’m trying to think if there’s anyone else…

RJ: Cheryl Willman. So, there are three now.

RJ: I didn’t know any different, because the cancer center director at Vanderbilt was Harold Moses. Not a lot of people know this, but he’s actually a board-certified pathologist, but he spent most of his career doing basic science research.

So, growing up in a cancer center with a pathologist director, that was how it was done as far as I was concerned.

And this is a time when you could call Joe Simone and ask, “How much money do you have to have in order to go after a designation?” At that time I think he would have said a hundred million. Is that what was being pledged?

Well, no, not anywhere near that.

I think the fact that they would ask me to do this job was not a sign of how qualified I was. It was a sign of how desperate KU was. I think my recruitment package was like $29 million, most of which was very hard to nail down exactly.

Well, and not that those promises had been fulfilled or not, but we’ll get to that later. Essentially, the only thing I really asked for was a hunting license.

And because I had seen things happen at Vanderbilt where the director had gone out and raised money, and by some miracle the cardiology division had a new clinic, things like that. And so, I just said, “I want no dean’ s tax, and every dollar that gets raised for cancer gets spent on cancer—no, if, and, or buts. And I got a solid yes, absolutely, no question about it.

And so, that was really the only thing I asked for.

RJ: So, my negotiation was about a year before I finally took the job, and it was pretty evident that it was not going to be kind of a fill-out-some-forms-and-send-them-in-to-NCI, and we’ll be golden.

There were a lot of things that had to happen. Like you always have those moments when you take a new job and you find out something the first week you are there, and you think, “Oh my God, what have I gotten myself into?”

Well, that moment for me came when no one could produce a list of the active clinical trials in cancer that were going on at KU.

RJ: Couldn’t do it…

We couldn’t find out how many patients had been enrolled on clinical trials, because it was just sort of the Wild, Wild West. Everybody’s secretary was their research nurse, their CNC, their data coordinator. It was a totally small-d democratic, organic system with no central organization whatsoever.

And I think we had about $14 million of total cancer funding at the time. And so, it was clear that was going to be a heavy lift.

And so, I wanted an assurance that we could pioneer the idea of a multidisciplinary clinic in breast. And I got pushback from the chair of medicine at the time.

RJ: Absolutely totally opposed. You know, and basically this was an individual who did not want anybody moving their cheese.

“We’re doing just fine. You don’t need to be coming in here and filling these people full of all kinds of crazy ideas.”

And the biggest lift for the whole thing was trying to change the culture, because out of all the faculty at KU Medical Center, only three had ever been members of an NCI-designated cancer center.

And that was me, that was Barbara Atkinson, who is the dean, and a guy by the name of Matt Mayo, who was a bio-statistician at KU. He had been at UAB. So, you almost had to spell NCI, because it was just a foreign concept almost.

RJ: This is 2004. So, the other thing that had to be overcome was that this place was obsessed with competing against what they considered to be their competition, which was the local private practice hospitals.

Nobody even imagined that their competition was MD Anderson, or Mayo, or someplace like that. All they cared about, was having more patients than the private practice slicks down the road.

RJ: Yes.

RJ: Oh yeah. So, in 2004, 2005, we’re just really trying to get things ramped up and started. It turned out the $29 million was very ephemeral, let’s put it that way, and so, I really didn’t have a lot of resources that I could use to change behavior.

And then, kind of about that same time, we had, in essence, sort of a civil war break out between the hospital CEO and the dean of the medical school, and that’s what prompted the phone call to you, at least one of the reasons that prompted the phone call.

RJ: I was actually hired, and the institution made a conscious effort to go after NCI designation, because when Barbara Atkinson took over, she was shocked that Kansas City did not have an NCI-designated cancer center, because she’d been in Philadelphia her whole career.

And I think at the time they had four: Penn, Jefferson, and Fox Chase, and Wistar.

And Kansas City was the largest metropolitan area in the country that did not have an NCI-designated center, and she basically decided that cancer was the best vehicle to raise all boats, because it has such a broad impact across the clinical endeavors, and the basic sciences as well.

So, that was her idea, to raise the level of the medical center through a quest to get NCI designation.

And just to give you an illustration of why that was necessary, when I applied to medical school back in the late 1970s, I think KU was ranked 35th in the medical schools. And by the time that I came here, in 2004, I think we dropped to 83rd.

See, that’s what happens when you have 18 deans in 18 years. There’s no vision, you can’t articulate a plan, you’re obviously just in survival mode, and so that’s what had happened.

Barbara, to turn this around, said, “By God, we’re going to go after NCI designation, and I’m going to recruit a fool who’s dumb enough to come here and take this job offer.”

It’s a damn-near impossible task.

RJ: So, right away, we figured out, and I knew this from the beginning, that $29 million was not even close, and that point was emphasized pretty vigorously by a group, I think it was called the blue ribbon task force.

And this had been convened by some of the city fathers, because one of the things that had actually attracted me to taking the job was the fact that The Stowers Institute for Medical Research had been started about the same time that the hospital separated in the late nineties by Jim Stowers, and Jim Stowers endowed The Stowers Institute with $2 billion.

It has, I believe, the second largest endowment of any biomedical research organization in the country, second only to Howard Hughes.

And Kansas City had never been a region which had been known for a robust biomedical research community. We make cars, and we do transportation, and we have grain elevators, and that kind of thing, but we can never be confused with the biotech hub of planet earth.

And so, when Jim Stowers started the institute, the civic leadership of Kansas City said, “Hey, wait a second. What’s this biomedical research stuff? How can we leverage having the Stowers Institute here?” So, they brought in all of these folks from all over the country to look at the possibilities, and I was asked to go talk to those people, because it was convened shortly after I got here.

Quite a few heavy hitters from all around the country came in, and I made a presentation on why it was necessary to have an NCI-designated cancer center in Kansas City and the kind of the resources that I had available to me, and I was basically laughed out of the room, and was told, “One, you are woefully unqualified and naive. Two, you don’t have anywhere near the resources to pull this off, and if you actually think that this is even humanly possible, you’re even dumber than we think.”

RJ: It was pretty much that blunt, and this was not just an opinion expressed with just me and the room, this was all the city leaders in the room as well.

So, I was like, “Okay, clearly this is not going to be a picnic.”

But then, on the internal front, I was getting all kinds of pushback from the hospital, because it turns out that Irene Cumming really knows how to run a hospital, but she really knows how to run a private practice hospital, not an academic hospital.

And she could not be convinced of the value of investing in the cancer center, and in getting an NCI designation, so I was pretty much like a beached whale, and had no resources, had no real power in the institution.

I was kind of scratching my head about where this was all going to go. Like the community would just say, “They had a press conference, but they have no resources, they have no plan.”

This is a joke. Oh, and by the way, some of our private practice hospitals, we can get them NCI-designated. So, why bother with KU?” Which, of course, was total BS, but that was just par for the course.

So, at that point, I decided I needed some resources. And you remember the one thing that I was able to negotiate was a hunting license.

And I made sure that the hunting license covered the state legislature. And so, I was allowed to meet with, and work with, the KU lobbyist at the time, who was a woman by the name of Kathy Damron, and we were able to get a $5 million annual line item in the budget from the state legislature and the governor, because at the time the governor was Kathleen Sebelius, and the legislature was largely led by moderate Johnson County, Kansas, Republicans, who had controlled everything in the State of Kansas for decades and decades.

And it turned out a number of them and their family members had been affected by cancer, and so, my efforts really resonated with them, and we were able to get that passed into law in the summer of 2007.

And frankly, that was the absolutely critical piece that allowed things to move forward. Because at that point, I had $5 million that I could count on every single year to start changing people’s behaviors and providing incentives and doing things that needed to be done to go for NCI designation. So, that was one thing.

The other thing that we worked on, and this happened in 2008, was that we were able to get a bond issue passed in Johnson County for an eighth-of-a-cent sales tax, and a third of that would come to the cancer center to support a clinical research facility that would be located in Johnson County and that would support our clinical research infrastructure.

It turns out that back in 2004, that sales tax, even though we’re splitting it three different ways and we only got a third, raised $5 million for the cancer center every year. Now it’s up to about six and a half million. And so, between the $5 million from the legislature and the $5 million from the sales tax, we were in business.

I could get the basic science guys motivated with the line item and I could get the clinical folks motivated with a real infrastructure to conduct clinical trials and allow that to move forward with. And so, we pretty much have leveraged the heck out of those two things and then once the state legislature came through, then the philanthropy started coming through.

And on top of the philanthropy, or on top of the legislature, we raised well over $200 million in the community.

And in addition to that, [Governor] Kathleen Sebelius had passed something called the Kansas Bioscience Authority, which was in essence, an investment vehicle that was designed around building the biosciences in Kansas.

And that all got started, remember, basically because of Stowers. Got people all excited about the possibility of biomedical research and the biosciences.

Now, back to that blue ribbon panel…. Essentially, what they decided was, “Well, if Roy is successful, that’s fine, we’ll support that,” but they didn’t really do much about it. But what they did do a lot about was to support the animal health industry, and 20, 25% of the headquarters for the animal health industry is within 200 miles of Kansas City.

And so, that got people all excited about, “Well, we need an investment vehicle to help out with this,” and it was called the [Kansas] Bioscience Authority, and it got signed by Kathleen Sebelius, and through a very long and somewhat contentious process, we were finally able to convince them to spend $50 million to support the NCI designation effort.

RJ: So, all of a sudden, we go from literally being the pauper, selling pencils at the corner, to we have hundreds of millions dollars at our disposal. And that made all the difference.

RJ: Pretty much.

RJ: So, at that point, see, I had pretty much given up on doing things internally at KU, because there were no resources, and I couldn’t get any traction, but now I had money, and I could start influencing behavior, and I think the hospital, through civic pressure, decided that, “Okay, we need to get on board,” and so, then all of a sudden I started getting $3 million from the hospital every year.

So, we’re growing and growing, and they also started to see the impact.

In 2004, I think we had 1,700 index patients in our tumor registry, and now we have 6,500. So, they were starting to see the benefits of where this was heading, and so, they decided to turn loose with it. And there had been a change in the hospital CEO.

So, that was a couple of big events that I told you that kind of the hospital CEO and the dean had declared war on each other in the newspapers. And literally, I mean, there was a front page story about the ongoing civil war at KU Medical Center, both in the Kansas City [Star] and in the Lawrence Journal World.

RJ: And the Lawrence Journal World… You remember Dolph Simons?

RJ: He was on the side of the hospital, so he was ripping Barbara Atkinson up one side and down the other.

And then the Kansas City Star, I think, made a reasonable attempt at being fairly neutral, but they also had a lot of influence from the Missouri side. So, people from some of the private hospitals on the Missouri side, they were always stirring things up and causing problems, and kind of baiting the Star. What now?

RJ: And we thank you for that, Paul. So, that civil war erupted kind of about a-year-and-a-half or two years after I got here, which kind of shut down progress. That was another reason why I went external. And then, of course, when all of these things started getting aligned, then guess what happened? 2008.

RJ: So, that really took the wind out of a lot of the philanthropic sales and, obviously, the leadership of the university and the medical center became quite conservative in terms of what they wanted to do. So, it just totally changed the dynamic.

RJ: So, the other aha moment that I had the first week that I took this job was when I found out that there were less than 400 faculty at KU Medical Center, and that was despite having one of the largest medical schools in the country.

There’s still only one medical school in the State of Kansas. And I think at the time we had 225 or so students, and so we had less than 400 faculty, and I found that just absolutely astounding. Baylor, at the time, had 3,000 faculty. WashU had 2,500, something like that. Vanderbilt had close to 2,000.

And so I was just stunned at how you could operate a major academic medical center with less than 400 faculty.

This was everybody. This was clinicians, basic scientists, the whole ball of wax.

RJ: And so it was like, “Oh my God.” That was another… It was like, “I am in trouble,” but the people who were here were quite good. So, for instance, Carol Fabian, who you have extoled the virtues of in your publication the last week, she was a bastion of excellence, and she was a hard-charging woman.

She was the leader in breast medical oncology. She practically single-handedly started the whole breast cancer prevention field, and so there was really something to build on with that. But like I said, we only had $14 million of cancer-related funding, so there wasn’t a huge amount.

RJ: But that Kansas Bioscience Authority funding, one of the things that it did, was it was extraordinarily helpful with recruiting. And a lot of people, a lot of faculty were fairly disgruntled with their institutions after the Great Recession.

And we had money, we had legislature money, we had Bioscience Authority money, we had Johnson County money. And so, it turned out that once we got over the shock of all the things that were happening with the Great Recession, it turned out to be a huge boon to us, because it’s always great to have money when nobody else has money.

RJ: We recruited a ton of people in 2009, 2010.

That’s how we got Andy Godwin from Fox Chase, that’s how we got Danny Welch from UAB, that’s how we got Shrikant Anant from [Oklahoma Health Sciences Center].

And with those guys—obviously they’d been in NCI-designated cancer centers; Shri had been at WashU before he went to Oklahoma—we had a core nidus of senior people who’d been there, they’d done that, they knew exactly how to move things forward, and the flywheel started to turn.

RJ: One of the things that led me to leave Vanderbilt and come back here, I’ve said this to many people many times, the worst thing about not having a cancer center at the University of Kansas, is that we don’t have a cancer center.

The best thing about not having a cancer center at the University of Kansas is that we don’t have one, and we can build it the way we need to.

Once you establish something, nobody ever wants to change it. And that’s one of the biggest lesson I ever had from going through this process, is that no one likes change. And in not having something is a huge advantage when you’re trying to build something from the ground up, because you can essentially build it however you want, because there was nobody here who had ever been at a cancer center practically.

I could tell people, “No, this is how you have to do it.” And they say, “Oh, okay. I guess you know.”

Now, whether or not that was the case is a little dubious, but it passed muster at the time.

The biggest reason that I decided to come back here is because I felt we could build a cancer center that was focused on drug discovery and development.

And I felt like there were unique assets in this region that no other place had, that could be leveraged, one of which is we have had a top five, top 10 school of pharmacy for decades, and for decades KU School of Pharmacy held the formulation contract with the NCI. For instance, Taxol was turned into a drug in Malott Hall,  University of Kansas in the Pharmaceutical Chemistry Department.

And Velcade was turned into a drug in the same laboratory. So, we had world-class expertise in drug discovery and development that very few other places had. We also had a very strong pharmaceutical CRO industry in Kansas City, which very few people know about or appreciate.

Everybody knows about Research Triangle Park, everybody knows about New Jersey, but nobody knows about Kansas City. And the reason why that’s the case is because Marion Laboratories was here for many years, and eventually it got bought out, and in the mid ‘90’s, there were two North American headquarters for Sanofi.

One was in New Jersey. One was in Kansas City, and they essentially decided to close the Kansas City office and move as many people as possible to New Jersey.

Well, you’ve lived around here, and the thought of born and bred Kansas Citians moving to New Jersey was a total anathema. They were not going to do it.

So, what happened as a result of that is that all these folks who had worked for Marion Laboratories, decided to go out and start their own businesses. Because the guy who had started Marion Laboratories, Ewing Kauffman, he was all about entrepreneurship, and he taught them how to do it.

So, that’s where Beckloff Associates came from, that’s where XenoTech came from, Quintiles had a major operation here.

So, pretty much every single expertise that you needed to do drug discovery and development was within a hundred miles of Kansas City, and in contrast to many other major universities, who either didn’t even have a school of pharmacy or had allowed theirs to die on the vine, we still have world-class expertise in formulation, medicinal chemistry, and all these other things.

And so, I had been frustrated at Vanderbilt, because, there were basically two paths to developing a drug. You could make a discovery, file an invention disclosure, and then sell the license to Big Pharma, and then you’d never see it again, or you could quit your day job and start a company and try to push the thing through, neither of which I found were very satisfactory choices.

And I felt like what if you built a cancer center that incorporated drug discovery expertise in the very DNA of the place, and you could allow cancer center investigators to keep their day job, but to interface with a cadre of people that we had hired in from industry, that allowed them to pursue drug discovery efforts as a side pursuit.

And they had all the expertise that they needed, but they didn’t have to stop doing what they’re really good at, which was writing papers, writing grants and making discoveries.

Because they had scientists largely make absolutely terrible businesspeople, and so most likely your company is going to fail. And half the time when big pharma buys an idea, they’re just trying to put it on the shelf, so that they eliminate competition for the drugs that they do have the patent on.

So, it’s a very unsatisfying experience. So I felt that there was a way to have a completely new paradigm and have drug discovery and development take place within academia. So that’s what brought me to KU.

RJ: Yes.

RJ: That’s almost a story in itself. One of the Kansas City institutions that was always on our side in this, was the Kauffman Foundation. And the Kauffman Foundation was run by a bunch of people who had been at Marion Laboratories.

And in talking with them was one of the things that led me to this idea that we could build a drug discovery operation within academia. And they not only helped envision that, but they also supplied the names of people who could help out with, and the name that rose to the top was a guy by the name of Scott Weir.

And Scott Weir from Day One has been our associate director for translational science, and he had spent 20, 25 years in Marion Laboratories, and happened to be on this blue ribbon panel that I told you about earlier.

But he was a believer, he found something that could be done. And the Kauffman Foundation provided us with an $8 million grant, which was matched by $8 million from KU Endowment, to get something called the Institute for Advancing Medical Innovation off the ground. And that funded this cadre of former pharmaceutical industry people, that can help us move our drug discovery efforts forward.

RJ: Every success begets more success. And another strength that we had here from the day that I walked in the door, was our smoking cessation group, and they were very strong.

The guy who was the chair of preventive medicine at the time, Jasjit Ahluwalia, had built a very strong cadre of smoking cessation people that were focused on tobacco abuse among minority populations.

But we had folks that had major research interests in the African American community, in the Native American community, and the Hispanic community and in rural [community]. And they really were quite good, and so we had that built in from Day One.

RJ: All of Kansas plus about the western third of Missouri. So I think it’s 92,000 to 93,000 square miles, and 4.5 million people.

RJ: Well, from the beginning, we were very focused on trying to make sure that we were not just a cancer center for Johnson County soccer moms. And we had a number of allies in that effort, namely a guy by the name of Gary Doolitle.

I’ve known Gary longer than any other person at KU, because we were undergraduates together at Pittsburgh State University, and both pre-meds.

And we graduated together in 1980, he went to KU, and I went to Vanderbilt. But Gary had in large part, built his career on telemedicine. He had done a sabbatical in Australia, where telemedicine had gotten started, and brought that expertise back to Kansas, because it was a really desperately needed approach to be able to connect with all of these rural areas. And so he literally knew every single oncology physician in the entire state of Kansas.

And shortly after I got here, Gary and I reconnected, and I told him that my vision was for us to build a network of these practices all across Kansas, so that they could leverage having an NCI-designated cancer center for the benefit of their patients.

And he was the entre to all of that, because he knew he’d gone to school with many of them. And he had been involved in telehealth efforts all across the state. And so, one of the first things we did is we just started traveling around the state and listening to folks and asking them what they needed and what could KU Cancer Center do to assist them in their practice?

RJ: Absolutely. And that was about a two-year due diligence process, because typically what happened was that the first meeting, we’d walked in the room, they shut the door, we’d introduce ourselves, and they would vent their spleens on all the past grievances they had with the University of Kansas Medical Center about this, that, and the other thing. And essentially, all the stories revolved around how they had been wronged or how they had been ignored.

RJ: Well, I think your perception was correct. Let me just say that.

RJ: No, Wichita always feels under threat by Kansas City, for whatever reasons.

RJ: But to tell you the truth, Kansas City didn’t have its act together, so it wasn’t a threat to anybody, so it was what it was. But so anyway, Gary and I had got through all of that, and we built something that was initially called the Midwest Cancer Alliance. It’s varied over the years, I think it’s usually about 20 different institutions that we’ve signed up, that we offer what I like to call the dim sum menu, and it’s all kinds of things.

We can put clinical trials at your organization, if you’re willing to do everything that we asked you to do in that regard. We can do telemedicine consults, if that’s what you want, we can do CME for your docs, for your nurses, for your pharmacists.

We can do psychological counseling services for cancer patients via telemedicine, if you want.

We can come out and do screening clinics for prostate cancer, melanoma, skin cancer. And we don’t refer the patients back to KU, we refer them to the local entity. We have a clinical trials network where these folks sit on the disease working group, and they pick trials that are appropriate for their population.

But we really try to be a back office to support oncology docs, who were out in small practice settings who are on their own, and provide that expertise that they need to improve the care of their patients.

RJ: We were doing telemedicine for 25 years before COVID. It started in the mid- ‘90’s. At this place, the medical center as a whole and cancer centers specifically, we turned on a dime for moving to telemedicine.

Within a week, 80% of our clinics were up and running on telemedicine. It was a stunning transformation.

RJ: Yes.

RJ: That was quite a process. Thank God for all those recruits that we got in 2010, because they really helped make it happen. And it was a great esprit de corps.

RJ: 2012.

RJ: Eight years. I told folks when I arrived that it would be a five-year process. And I think I largely adhered to that if you cut me two years of slack, because of the civil war and one year of slack because of the Great Recession.

RJ: We’re almost on time.

RJ: I think we get so much public and philanthropic support that people deserve to understand what we’re about.

RJ: Yes, we did.

RJ: That whole process was interesting. I don’t regret a minute of it. At the time, you could apply for comprehensive status anytime you wanted to. That has since been changed, as you well know. You’re not eligible for comprehensive status until your second renewal, and they might as well just call that The Kansas Rule.

It has been discussed, or Henry [Ciolino, director of the NCI Office of Cancer Centers] has discussed this at the annual AACI meeting and basically told people flat out that at the Kansas site visit, that first renewal, it was decided that no cancer centers should be able to apply for comprehensive status until their second renewal.

RJ: I think that they felt like it takes years for a cancer center to mature and reach the status that they wanted to associate with comprehensive status.

I also think that the game has changed. When the concept was first put in place, you had the MD Andersons and the Memorial Sloan Ketterings applying, and the fact that some NIH bureaucrats is going to tell them that they can have the highest level of designation from the get-go would be deeply offensive. And I largely agree with that sentiment.

I think what you have now are emerging cancer centers that are relatively recently established. And frankly, it takes a while for them to build that culture and get to the point where they are on that level.

So, from that standpoint, I agree with what’s happened. The other thing that I don’t regret is that we busted our hiney trying to become a comprehensive center, and that made us better. And in some respects, there’s 1% of me, the other 99% disagrees with this 1%, but the 1% of me that is, frankly, pleased that we did not get comprehensive status is the fact that having a ten-year period of time to move towards that level is extraordinarily helpful.

And we’re a heck of a lot better off now than what we would have been. If we had gotten comprehensive on the first renewal, we wouldn’t be as good as we are. I’ll just tell you flat out. Because it is very motivating. Our folks, they are obsessed, and they’re working every single day to make this happen, and it makes a difference having that carrot out there. It makes a difference from a philanthropic standpoint.

If we’d have gotten comprehensive status, then I go to a donor and I say, “We need this because we need comprehensive,” that’s no longer there. What you need me for? You already got comprehensive. It’s an interesting two-edged sword.

RJ: Sept. 25. Actually, that’s on a Saturday. So, it’s going to be Sept. 27 of this year.

RJ: That’s when it’s due. So, then we’ll have the site visit probably in February of 2022, and then we’ll hear in late June of ‘22.

RJ: We’re a hell of a lot better. It’s not even … While at the time we were not, let’s just say we were not appreciative of our pink sheets, they laid out a roadmap for us to get to comprehensive, and we have followed it.

RJ: Yeah. I think the difference is they got started in the 1940s through sixties and we’re just getting started now.

RJ: It’s a fascinating question, because the NCI waxes and wanes in terms of their receptiveness to new cancer centers, and that depends a lot upon their budget and kind of the political mood and all of those things. So, you have to catch the NCI in the right place.

And I think we certainly caught the NCI in the right place in 2011 and 2012. It helped tremendously that we were the biggest metropolitan area in the country that did not have a cancer center. And we also had United States Senators, on both sides of the state line, who were incredibly supportive and set on key committees for Labor HHS.

So, Roy Blunt and Jerry Moran have been champions for us from the get-go, because while we’re The University of Kansas Cancer Center, 45% of our patients come from Missouri. We’re right on the state line.

RJ: Well, I’m just saying that it’s a constantly varying variable. And then the other thing, of course, is the price tag is, I’m not sure it’s another logarithm more than what we had, but it keeps going up every single day. I think what you’re going to see is relatively established healthcare systems pairing up with universities or pre-existing cancer centers, where they think they could add two and two and get five.

RJ: So, Cold Spring Harbor, I think is moving in that direction. I think maybe Cedar Sinai is moving in that direction.

And I am biased, because I’ve been president at AACI, I’ve been the chair of Subcommittee A, so I am somebody who is within the confines of the process. But I think the process, while enormously frustrating at times, and seemingly wasteful of certain aspects of people’s valuable time, sure has a good product at the end of the day.

And you look at the advances that have happened in cancer research since the passage of the National Cancer Act and the development of the centers program, and it’s pretty stunning.

RJ: I think cancer centers in general, after they got over the initial shock, were probably better prepared than they thought to deal with this.

I think that’s certainly the situation that in our case.

Again, we leveraged the heck out of our telemedicine expertise. We knew how to take care of patients and staff in situations like, say bone marrow transplantation, where you had to be super careful about PPE and all of that kind of stuff. And you could apply a lot of those lessons to COVID patients.

We were extraordinarily lucky in that a lot of the molecular biology, the vaccine technology, was happening at just the right time to be able to accelerate the development of the vaccines in a way which clearly is going to save hundreds of thousands of lives, but did so in a manner where I am completely confident of not only their efficacy, but their safety.

And what is not discussed nearly enough is that just about all of the major vaccines that are coming out are completely blocking death and serious hospitalization. That’s astounding.

RJ: I would say that being a cancer center director is absolutely the best job in biomedical research. As long as the people that you report to value and are supportive of what you do, it’s a privilege. You really get to make an impact with your patients.

You can help bring incredibly smart people from many different disciplines together that really change science, change medicine in ways that you almost couldn’t imagine a few decades ago. And I just think it’s so much better than a dean’s job, or a department chair, or something like that, which is becoming increasingly burdensome. You can make a huge difference.

RJ: I see two things as really driving things over the course of the next decade or two. One of which is genomics.

We have three billion base pairs. Any one of them can be mutated. We have an enormous task ahead of us to understand what all the combinations, permutations, and whatever, mean as far as this disease. And so, artificial intelligence and analysis of complex genomes, we’re really just kind of scratching the surface there.

And I think eventually, sequencing the human genome is going to have just such a massive impact on our ability to develop new therapies and to really assess people’s risk, that it will be transformation.

I think the second, kind of related, thing is immunology and really understanding at a core fundamental level on how the immune system works is already proving to be such an incredible game changer that I don’t think we can even imagine what it’s going to be like in 10, 15 years.

When we figure out how to do CAR T therapy or whatever comes after CAR T therapy, some cellular therapy on an industrial scale for solid tumors, we’re going to have cancer on the run. And I think at that point, then the next big technology that’s going to come is continuous monitoring or periodic monitoring to really surveil populations and catch cancers early, before they become significant clinical problems.

I think that’ll be the final step.

And at that point, we will pretty much kick cancer’s ass.