Cancer Stories: The Art of Oncology: Conversations with the Pioneers of Oncology: Dr Allen Lichter (2022)

May 17, 2021

Dr. Hayes interviews Dr. Allen Lichter for a second time onASCO.

Dr. Daniel F. Hayes is the Stuart B. Padnos Professor ofBreast Cancer Research at the University of Michigan Rogel CancerCenter. Dr. Hayes’ research interests are in the field ofexperimental therapeutics and cancer biomarkers, especially inbreast cancer. He has served as chair of the SWOG Breast CancerTranslational Medicine Committee, and he was an inaugural memberand chaired the American Society of Clinical Oncology (ASCO) TumorMarker Guidelines Committee. Dr. Hayes served on the ASCO Board ofDirectors, and served a 3 year term as President of ASCO from2016-2018.

TRANSCRIPT

SPEAKER: The purpose of this podcast is to educate and toinform. This is not a substitute for professional medical care andis not intended for use in the diagnosis or treatment of individualconditions. Guests on this podcast express their own opinions,experience, and conclusions. The mention of any product, service,organization, activity, or therapy should not be construed as anASCO endorsement.

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DANIEL F. HAYES: Welcome to JCO's Cancer Stories-- The Art ofOncology, brought to you by the ASCO Podcast Network, a collectionof nine programs covering a range of educational and scientificcontent and offering enriching insights into the world of cancercare. You can find all of the shows, including this one, at apodcast.asco.org.

Today, our guest is Dr. Allen Lichter, the former CEO of theAmerican Society of Clinical Oncology. Dr. Lichter has previouslybeen a guest on this program in regards to his role as a radiationoncologist back in the early days and the research he did. Buttoday, I'm going to ask him more about the history of ASCO. Tobegin with, Dr. Lichter has leadership roles with Cellworks andLifelike. He has a consulting or advisory role with Integra,Ascentage Pharma, L-Nutra, and TRG Healthcare. He's also receivedtravel accommodations and expenses from Cellworks. Dr. Lichter,welcome to our program again.

ALLEN LICHTER: Dan, it's great to be here.

DANIEL F. HAYES: Terrific to have you. As I said, the last timewe spoke, I really was focused on having you tell us about theevolution of radio psychology in this country, and was a terrificinterview. I hope our listeners have had a chance to listen to it.But since you've had so much to do with ASCO, you've been apresident of ASCO, you've been a CEO of ASCO, you're pretty muchdone it all, I thought we'd take an opportunity to pick your brainabout the history of ASCO.

So to start with, I think a lot of our listeners probably don'tknow much about how ASCO got started in the first place. You wantto give us a little background about that?

ALLEN LICHTER: I think to understand ASCO, you have to go back,really, to the very beginnings of medical oncology. In the 1940sand '50s, a few chemotherapy agents were invented and brought intopractice. Toxicity was high. The benefits weren't that great. Butthere was some hope that through scientific discovery and research,things could get better.

In 1954, the NCI created the first National Drug Discoveryprogram, which began to catalyze the discovery of more chemotherapyagents. And it's into that environment that a group of, who werethen internal medicine docs, started to use chemotherapy more andbegan creating some training programs in medical oncology.

That led in the early '60s to an organizing meeting that tookplace at AACR. And there were 50 attendees. It was on November 4,1964. So here were these physicians who were interested in cancer,who got together at the American Association of Cancer Research andformed an organization concerned with the management, the clinicalmanagement, of cancer. And you go back to that early meeting andread the following sentence, quote, "This society shall not be asociety of chemotherapeuticsts only. The society should considerthe total management of cancer."

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They established dues of $10 a year, and they agreed to meetagain at the following spring. And on April 10, 1965, at the nextAACR meeting-- or, actually, the original meeting was off cyclefrom AACR. And then, in '65, they met formally at AACR for thefirst time.

That sentence, that this is not a society ofchemotherapeuticsts, as they wrote it-- because there were nomedical oncologists-- but was a society for cancer physicians ofall persuasions, was a fundamental organizing principle of ASCO, aprinciple that holds true today. And it is one of the greatstrengths of ASCO, is that it welcomes and embraces and enjoys themembership of oncologists of all subspecialties.

And then, as you move ahead in the development of medicaloncology, you get to the American Board of Internal Medicine thathad pressure from outside agitators, people like PJ Kennedy andPaul Calabrese and Paul Carbone, and Jim Holland and Tom Frei andAl Owens, to form and create a subspecialty board in this nascentspecialty of medical oncology.

And that came into fruition in the early 1970s. And if you goback into the '70s, ASCO had a revenue of $25,000. That was theannual revenue of the organization. It's now probably close to $150million. And ASCO is number two in terms of the size of its revenueof all medical professional societies in the US behind only theAmerican Medical Association.

So that first idea of founding the society, creating it as amultidisciplinary society, and standing back and watching it growas the specialties in oncology grew, has really borne fruit overmany, many years. There were seven founders of the organization.Their names are in the ASCO office. People who come to the ASCOoffice can come into our big boardroom, which is called theFounder's Room, and see the bios of Fred Ansfield, Robert Talley,Harry Bissell, William Wilson, Herman Freckman, Edonis Goldsmith,and very specially, Jane Wright-- Dr. Wright being not the onlyfemale in this group at the time, one of the few African-Americanmedical oncologists in the nation. She had a distinguished careerand has had many awards and tributes given to her both by ASCO andby AACR.

So the society moved along. And I like to say to people, youknow, what is really startling is that the field of medicaloncology, the medical oncologists forgot to establish the AmericanSociety of Medical Oncology. They are, to this day, the onlymedical subspecialty in internal medicine that does not have itsown dedicated professional society. ASCO has filled that role fromits inception through the time that the specialty boards werecreated. And to this day, there is no ESMO, there is only ASCO.

And so ASCO has this dual organizational responsibility, one tothe entire field of oncology, and then a very special relationshipwith the field of medical oncology, as we represent that specialtyalmost exclusively.

DANIEL F. HAYES: Let me jump in. There, for example, is aSociety of Surgical Oncology and the American Society ofTherapeutic Radiation Oncology, which I believe you were presidentof as well. So I agree with you that the internal medicine part ofit is really unique in terms of ASCO serving as a society foreverybody, even though there are these other societies thatrepresent the individual modalities.

ALLEN LICHTER: Yes. There is nothing quite like it. It hasworked well. We have never, to my knowledge, had an uprising of themedical oncology specialty saying we need a different organization.The community oncologists form the Community Oncology Alliance,COA, which is a thriving organization that pays a lot of attentionto those special needs of community practice in oncology. But eventhen, virtually all the members of COA are members of ASCO aswell.

So as the society moved along and it grew beyond its $25,000revenue, we hired a professional management firm to run theadministration of the society, a firm called Bostrom. They werebased out of Chicago. And for many years, a guy named Al Van Hornwas the executive director of ASCO. He was an employee of Bostrom,but his salary was paid by ASCO.

And the society grew, but we retained this relationship withASCO until we got into the early 1990s. I was on the board at thattime, but I'll digress for a moment to talk about how I got on theboard. So at the annual meeting of ASCO, they always had a member'smeeting. And it was like at 4 o'clock in the afternoon. And it wasin one of the meeting rooms. And the dais was set with a longtable. And the board of directors sat at the table.

And the membership who, those that came, sat in the audience andheard from the leaders of the organization what was going on, etcetera, et cetera. And then, they had open mic that members couldcome forward and ask questions. So I arose from my seat and went tothe microphone. And I said, gentlemen-- because they were all men--you have extolled the multidisciplinary nature of this organizationthat existed from its founding up to the present day. But as I lookat the assembled board in front of me, they are 100% medicaloncologists. And you have radiation oncologists and surgicaloncologists and pediatric oncologists and gynecologic oncologistsand so forth in the organization. And we have no representation onthe board.

And they said, thank you, Dr. Lichter, for your question. Anddown I sat. But a little seed was planted, I guess. Because overthe next couple years, the board decided to enlarge its membershipand have dedicated seats for a radiation oncologist, a surgicaloncologist, and a pediatric oncologist, seats that exist today. AndI got a call, OK, big mouth. You raised this. You raised this.We're going to run you for the board. And I said OK. And I gotelected to the board as the first radiation-- sitting in the firstradiation oncology seat.

I watched as the society grew. And we recognized, we needed totake over our own management, to move away from the hired hands atBostrom and to have our own organization. And it was under thesteady hand of then President John Glick, who led us through thistransition. We interviewed candidates to be the then called theexecutive vice president and hired John Durant, who was then at theUniversity of Alabama.

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And John took us through that transition. We opened an office inAlexandria, Virginia, and began to hire staff. And John was anabsolutely sensational leader for the organization during thatimportant transition. And that was in kind of the mid '90s. JohnGlick was one of the truly terrific presidents of ASCO. And Icontributed to that because I ran against John. And John wanted anelection. And it was my doing that John became president of ASCO. Igraciously lost to him.

They decided, for some reason or another, that they would run meagain for president. And I did win that election. I ran againstCharles Balch, who was a surgeon. And Charles later succeeded JohnDurant as the CEO of ASCO as ASCO's second CEO. I was president'98-'99 was my year. And the organization continued to grow. Irotated off the board and was happily in my job at Ann Arbor.

And then, Dr. Balch was stepping down and they were looking fora CEO. And I threw my hat in the ring and became the CEO of theorganization in 2006. And that's a big, broad overview of theorganization. It now has 45,000 members, as I say, a wonderful andsteady revenue stream, although it's been a challenge over the last18 months with COVID and losing the physical annual meeting. Butthose are the broad brush strokes.

DANIEL F. HAYES: So my impression, and correct me if I'm wrong,I mean, the original seven founders, I've read the minutes of theoriginal meeting. And they were pretty interested in how do youdose reduce? How do you get this drug? How do you get that drug?And I think there was maybe one or two scientific presentations.But correct me if I'm wrong. By the time came on the board, ASCOwas principally a place to present your data and publish yourpapers in JCO. By that time, personally, I feel that it began toroll back into saying, look, 60% to 70% of our members arecommunity oncologists. And I've seen a huge increase in ASCO'sfocus on the community oncologist. Is that perception all true, oram I making it up?

ALLEN LICHTER: I think that that's true. If you look back at thefirst annual meeting in 1965, I think there were three or fourpapers presented. They were all clinical, and in some respects, asthey should be. Because people wanted to begin to share theirexperience with using these new highly toxic agents. There was justno precedent. Everything was done through trial and error andclinical research and experimentation. And so the results wereshared. And the society continued along in that vein not so much asa pure scientific society, and certainly, not so much as presentingbasic science research, but presenting clinical research.

I think at the time, it was felt that the more pure science wasAACR. And ASCO was going to present the clinical stuff. And as youknow, for the first many, many years of the society, the twosocieties met back-to-back. So a typical meeting in the 1980s wasMonday and Tuesday was AACR. Wednesday was an overlap day, and thenThursday and Friday was ASCO. And so that dichotomy of, there isthe science, especially the bed science, and there's the clinicalscience at the end of the week, existed for quite some time untilASCO grew its meeting enough, worked out an arrangement with AACR,and the two meetings divided, with AACR meeting in April and ASCOmeeting in June-- again, something that still exists to thisday.

DANIEL F. HAYES: When you were CEO, though, for example, youinitiated the Department of Clinical Affairs or something to thateffect. And also, how did the affiliates begin to grow up? I mean,it was all news to me when I became president. I knew nothing aboutthat.

ALLEN LICHTER: Over the years, not only did ASCO develop as anational organization, but within each state, either a medicaloncology or an oncology writ large society was formed. And justabout every state had them. It was not a revolutionary idea tobegin to try to tie the affiliates into ASCO. Not that werefloundering in any way, but they could use some support speakers tobe arranged for their own annual gatherings.

And we became much more interested in making sure there was adialogue between ASCO central and what was going on in the trenchesof physician practice in the community and around the states. Andso we began to bring the state affiliates closer to theorganization. A lot of this was done under the guidance of JoeBailes, who was president of ASCO after me and had a prominent rolein the government relations aspects of reimbursement aspects of thespecialty. And Joe was very close to the state affiliates.

That grew in importance and we ended up creating the stateaffiliate council and hearing from them at each board meeting andthen finally, to the point where we had the president of the stateaffiliate council who was invited to attend every board meeting,and to be part of the board deliberations.

So it's complex to knit the whole thing together. Medicaloncology really, in essence, grew up as an academic discipline. Itwas started at major medical centers like Sloan Kettering and MDAnderson and so forth. You might be too young to remember, butpatients used to be admitted to hospital to receive theirchemotherapy. And they certainly were admitted, often admitted tohospital to receive their radiation to some extent, becauseinsurance wouldn't pay for it if it was given-- and there was nosuch thing as outpatient cancer therapy.

But as the specialty then began to move out of these largeacademic hospitals and into the community, that began this wholeinfrastructure of state affiliate societies and our relationship upand down. We are not just an organization of academics, althoughwe've been led mostly by academic physicians throughout ourhistory. The community oncologists have a very important role toplay not only in ASCO, but in the delivery of cancer care in thiscountry.

DANIEL F. HAYES: Actually, I am old enough. I remember I toldmany fellows that when I was a fellow, we put people in thehospital. All we had was prochlorperazine, Compazine, which doesn'twork at all. And we would give them barbiturates not because itkept them from throwing up, but it kept them from remembering howmuch they threw up so they would come back and get their nexttreatment. So it was pretty barbaric. Now, all outpatient, which isfantastic.

Actually, you touched on this briefly, but how about theevolution of ASCO as an advocacy organization in politics, whichhas taken a major step lately?

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ALLEN LICHTER: Even while we were under the management ofBostrom, we did have a legislative government relations team inWashington. And the first couple of fulltime employees that ASCOhad were hired in the government relations side. And a lot of thiswas really, again, we had to represent medical oncology inimportant areas of billing and reimbursements and Medicare coverageand Medicaid coverage, and so on, and so forth.

And as I said earlier, there was no one else to do it. We were,by default, those specialty society that was going to representmedical oncology. So we had to do that. The surgeons had their own.The radiation oncologists had their own, and so on, and so forth.But ASCO did that relatively early on. And of course, as thecomplexity of Medicare and Medicaid and private insurance, and thecost of care and inpatients and outpatients, and who's going to payfor what, where, and so on, and so forth, we have become deeplyenmeshed in that. Because, again, it's our responsibility to do so.And I think the society over the years has done an excellent job ofrepresenting this field.

DANIEL F. HAYES: Even to the extent that recently, we've set upa separate business, I think it's called the Association of ASCO,or ASCO assoc-- I can't remember what it's called.

ALLEN LICHTER: Yeah, I think it's the Association for ClinicalOncology. Anyway, it's named so that it can also be called ASCO.But when ASCO was founded-- and this makes us different from a lotof our sister societies-- we were founded as a 501(c)(3). That'sthe tax code, educational organization. And as a 501(c)(3)educational organization, we could not engage very much in what isknown as lobbying.

We could advocate for legislation. We could do some gentleadvocation for legislation. We could interface with regulatoryagencies. So we were unlimited in our ability to talk to the FDA orthe CDC or the Centers for Medicare and Medicaid and that. But wecouldn't do very much on the legislative side.

And we thought for a long time about whether that needed to beremedied or not. In the end, it was decided it did need to beremedied. That is, we needed to have the ability to have a biggerfootprint inside Capitol Hill in the legislative process.Virtually, all our sister societies had that. And many of them werefounded as-- and I'm not a tax expert but-- a (c)(4) or (c)(6)organizations, which gave them that ability. And ASCO was a (c)(3).in the end, we formed a new (c)(6), which is this Association forClinical Oncology, that allows us to have a more visible presenceon the legislative side of the house and the ability to influencelegislation on behalf of cancer patients and cancer physicians.

DANIEL F. HAYES: Yeah, I think most of our membership, probablyespecially the academics, have always just thought, well, I don'thave to worry about this. ASCO has my back. And what I have seen inthe last 10 years is, first of all, an increasing presence of ASCOon Capitol Hill. Again, many of our listeners may not know this,but twice a year, there is a so-called day on the Hill. And evenwhen I got elected, I think there were 40 of us that did this. Ihad never done it before. It was a lot of fun, where we go out andmeet with the senators and representatives and their staff, andwith specific issues that we think are important for ourpatients.

We just did this virtually last week. And I think there were 130of us or something. That's increased quite a bit. And thosediscussions are now being led by what is essentially a PAC, apolitical action committee, this association but with a lot moreinfluence that has had in the past. And I know I sound like I'm ona soapbox, but I've become a true believer, maintaining what youand your predecessors continued to emphasize, which is that we arenot a trade union. We are there to improve patient care. And that'swhat we do.

The topics we choose to discuss are related to things we feelneed to be legislated for the purpose of improving patient care.I'm actually very proud of this, which is why I'm discussing it.I've had nothing to do with it except show up. I'm proud to ASCOwho's done this.

ALLEN LICHTER: Yes. And with the political action committee, itdoes give us the chance to have a presence at certain events thatbefore, we couldn't, we could not have a presence then. It allowsus to have influence as we can support those legislators that aresympathetic to the work that we're trying to get accomplished, andso on, and so forth. We resisted it for so long, it was time andthe appropriate thing to do. And I join you in being proud of theorganization to have just done it.

DANIEL F. HAYES: So that's an advertisement. If any of ourlisteners would like to become part of the day's on the Hill, ifyou go into the volunteer corps, you can sign up and ASCP staffwill then teach you what you need to do and how you need to do it,and how you need to say it. You can be part of this, and it'sactually a lot of fun to do. And this association has very realguardrails set up so that we continue to advocate and lobby, again,for what we think is best for our patients. And that's anotherreason I was very supportive of it when it came around.

ALLEN LICHTER: Your mentioning of volunteers makes me want tocomment. Many of our sister societies, when I was CEO, theorganizations that got together a couple of times a year weresaying how difficult it was to get members to participate in thework of the society. Everybody was so busy in their practiceenvironment, or their academic environment, or whatever.

ASCO has always had exactly the opposite problem. We have waymore of our dedicated members who want to participate in thesociety than we have places for them to participate. So it's awonderful problem to have. It has been that way for as long as Ican remember, and continues that way today. It's a real tribute, Ithink, to the specialty as to how dedicated our members are inbeing willing to volunteer and serve, and really devoting a hugeamount of time. You've been president. You've been on the board.That service is all volunteer and takes, over a career, hundredsand hundreds and hundreds of hours. But people do it actively andwillingly. And our only problem is I wish we had more spots forpeople to have positions inside the organization.

DANIEL F. HAYES: When I became president, I think I had 220slots, or something like that, to fill. And I had something like2,000 people volunteer. And I agree with you. Actually, was itunder your watch that the designated seats for communityoncologists for the board became a reality? Or was that beforeyou?

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ALLEN LICHTER: That existed before. That was added. And I can'tremember if it was added at the time the subspecialists were addedor whether it came a separate thing. But yes, and it goes to whatwe were talking about before, which is with community oncologists,we felt very important even as today, that they needed a seat atthe table for ASCO. So we have this dedicated seat for a communityoncologist, and even have brought community people into theundesignated seats.

We learn a lot from our community colleagues and need them andhave them close at hand.

DANIEL F. HAYES: I have said many, many times before I was onthe board and when I was president that the academics, includingmyself, will speak up to show you how smart they are. But thecommunity oncologists on the board were there for a very realreason. And I learned very quickly my first year on the board, keepmy mouth shut and listen to these folks because they had a lot totell us. They're there because they want to make things well. Ithink the academics are too. They want to make things better. Butthe community oncologists are giving money up out of their pocket.They could be seeing patients. And they're there on the boardbecause they feel that they have a real set of concerns.

And again, I'm proud of the fact that the board of directors ismade up of a fair number of them who have really been instrumentalin what we do and how we do it.

ALLEN LICHTER: Yeah. I have to be a little bit of a Homer andsay, that certainly, Dan, you're at the University of Michigan. AndI used to be at the University of Michigan, but we've had threepresidents of ASCO in modern times, my presidency and yourpresidency, and now Lori Pierce. And of course, two of those peopleare--

DANIEL F. HAYES: Actually, Doug Blayney, so four.

ALLEN LICHTER: Doug was president while he was at Michigan.Absolutely, don't want to forget Dr. Blayney. And of course, two ofthose presidents were radiation oncologists from the department Iused to lead. And we are very proud of the work that the Red Hawksfrom Michigan are doing inside ASCO.

DANIEL F. HAYES: Go blue. I think that pretty much uses up ouralotted time here. Is there anything else about the history of ASCOyou think that our listeners ought to know about that they mightnot?

ALLEN LICHTER: You know, we are regarded as really, a highlysuccessful and highly effective society. Many organizations inmedicine have come to look to ASCO for ideas, for policy positions,for ways of running the organization. We have a fabulous staff madeup of both of about five physicians in our senior staff and anumber of distinguished professionals who support our policy andmembership in meetings, and so many other parts of ourorganization.

We created the Journal of Clinical Oncology out of nothing andbuilt it into the most important clinical journal in oncologytoday. It's an ever-changing critically important piece of theoncology ecosphere. And it's an organization I'm very proud of.

DANIEL F. HAYES: Me too. So with that, I will say to you what Isaid to you last time, thanks for all you've done for the field.Thanks for all you've done for ASCO, and thanks for all you've donefor me personally as well. And appreciate the time you spent withus today

ALLEN LICHTER: Dan, it's been a pleasure.

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DANIEL F. HAYES: Until next time, thank you for listening tothis JCO's Cancer Stories-- The Art of Oncology podcast. If youenjoyed what you heard today, don't forget to give us a rating orreview on Apple Podcasts or wherever you listen. While you'rethere, be sure to subscribe so you never miss an episode. JCO'sCancer Stories: The Art of Oncology podcast is just one of ASCO'smany podcasts. You can find all the shows at podcast.asco.org.

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